TRAUMA RECOVERY: THE ROLE OF STRESS INOCULATION AND VALUES CLARIFICATION MATT E. JAREMKO, PH.D. STEVE CRUMP, M.A.

Transcription

1 TRAUMA RECOVERY: THE ROLE OF STRESS INOCULATION AND VALUES CLARIFICATION MATT E. JAREMKO, PH.D. STEVE CRUMP, M.A. Facebook: Matt E. Jaremko Website: drmattbook.com Blog: Hope for Post-Traumatic Growth

2 BASIS OF THIS PRESENTATION: FORTHCOMING SELF HELP BOOK

3 TRAUMA: THE BLACK PLAGUE OF MODERN TIMES 87%: FOLKS WHO REPORT HAVING EXPEREINCED TRAUMA! (Kilpatrick, et al, 2013) Physical or sexual assault (53.1%) Death of family/close friend to violence/accident/disaster (51.8%) Natural Disaster (50.5%) Accident/Fire (48.3%) Witnessed physical/sexual assault (33.2%) Threat or injury to family/close friend due to violence/accident/disaster (32.4%) Witnessed dead bodies/parts unexpectedly (22.6%) Exposure to hazardous chemicals (16.7%) Work exposure (11.5%) Combat or warzone exposure (7.8%) RELATED SUBJECTIVE TRAUMA-CHIDLREN OF ACOHOLICS, DIVORCE, JOB LOSS, TRAUMAS INSIDE THE HOME, etc (Meg Jay, 2017)

4 TRAUMA RECOVERY: SESSIONS WITH DR. MATT MAJOR PREMISES THE IMPORTANCE OF NARRATIVES IN RECOVERY FROM TRAUMA THE STORY ONE IS CLOSEST TO IS ONE S OWN CREATIVE NON-FICTION: USING FICTIONAL NARRATIVES TO DESCRIBE, INFORM AND MOTIVATE RECOVERY FROM TRAUMA TRUE-TO-LIFE STORIES OF SEVEN FICTIONAL TRAUMA VICTIMS ARE DESCRIBED COMPELLINGLY-WRITTEN SCENES OF GROUP, INDIVIDUAL AND FAMILY THERAPY EXPLAIN THE COGNITIVE-BEHAVIORAL SCIENCE OF PTSD AND IT S TREATMENT PTSD AS A DISORDER OF BEING STUCK IN USING ALL ENERGY TO AVOID AND ESCAPE FROM THE CONSTANT UNPLEASANT SYMPTOMS WITHOUT APPROACH TO VALUES AND MEANINGFUL PURSUITS. ABSENCE OF BELIEF (SELF EFFICACY) THAT ANYTHING CAN BE DONE TO CHANGE LIFE BEHAVIORAL SCIENCE SHOWS A TECHNOLOGY OF BEHAVIOR CHANGE THROUGH SOCIAL INTERACTION-THE POWER OF THE GROUP GRADUAL PROGRESSION TOWARD IMPROVED COPING AND AUTHENTICITY IS OUTLINED AND ILLUSTRATED

5 OBVIOUS SYMPTOMS OF PTSD RELIVING THE TRAUMA AVOIDING SITUATIONS THAT REMIND THE VICTIM OF THE TRAUMA FEELING NUMB FEELING KEYED UP PHYSICAL COMPLAINTS OF A POORLY DEFINED NATURE SHAME, DISPAIR, HOPELESSNESS POOR CONTROL OF EMOTIONS AND BEHAVIOR INTERPERSONAL/COMMUNICATION DIFFICULTIES IMPULSIVE/DESTRUCTIVE BEHAVIOR

6 LINGERING SYMPTOMS BEING STUCK IN BELIEFS AND BEHAVIOR THAT NOTHING CAN BE DONE (Resick, Monson and Chard, 2017) IMBALANCE BETWEEN AVOIDING UNPLEASANTRY OF SYMPTOMS AND APPROACH TO MEANINGFUL AND VALUED ACTIVITY (PURPOSE) (Jaremko and Fehlbaum, 2018) VALUES VACUUM (Meichenbaum, 2012) ABSENCE OF POST-TRAUMATIC GROWTH (Young, 2007) CONNECTION OF PAST TRAUMA ( UNPROCESSED ), SUBSTANCE ABUSE AND LEGAL ISSUES. E.G., MEMPHIS 1981.

7 NECESSARY AND SUFFICIENT CONDITIONS FOR TRAUMA RECOVERY FINDING A GUIDE CRITICAL MASS OF BEING TRUTHFUL/AUTHENTIC ABOUT THE TRAUMA (MANY WITH PTSD HIDE SHAME ASSOCIATED WITH THE TRAUMA BUT IT MUST BE PROCESSED MORE DIRECTLY) LEARNING NEW INSTRUMENTAL AND COPING SKILLS GROUP INVOLVEMENT AND SUPPORT FINDING PASSION AND MEANING (VALUES CLARIFICATION)

8 THE ROLE OF FOLLOWING FALSE RULES IN PTSD HOW RULE FOLLOWING IS FORMED (Malott, 1989) HOW FOLLOWING RULES BECOMES GENERALIZED AND INFLEXIBLE COMMON FALSE RULES FOLLOWED BY FOLKS WITH PTSD SEXUAL ABUSE AND ASSUALT MILITARY/ WAR-RELATED TRAUMA NATURAL DISASTERS PARENTAL/SIBLING ABUSE ACTS OF TERROR MOTOR VEHCILE ACCIDENTS

9 THE ROLE OF SELF EFFICACY IN OVERCOMING TRAUMA DEFINITION OF SELF-EFFICACY (Bandura, 1994) ORIGINS OF SELF EFFICACY PERFORMANCE ACCOMPLISHMENTS VICARIOUS EXPERIENCES VERBAL PERSUASION PHYSIOLOGICAL AROUSAL WITHOUT THE ABOVE HISTORY, VICTIMS DON T TRY TO MAKE CHANGES SINCE THERE IS SO FAR TO GO AND EFFORT IS SEEN AS USELESS LITTLE AND OFTEN MAKE MUCH-SET SMALL TASKS TO ACCOMPLISH AND ARRANGE INCENTIVES (PAYOFFS) FOR ANY PROGRESS TOWARD COMPLETION. E.G., PREMACK CONTINGENCY.

10 VALUES CLARIFICATION AND TRAINING VALUES DEFINED USING A TECHNOLOGY OS SOCIAL CONSCIOUSNESS TO DISCOVER WHAT IS IMPORTANT AND MEANINGFUL ARRANGING ONE S ENVIRONMENT TO ENCOURAGE AND DEVELOP PASSION ABOUT BEHAVIOR IN WHICH INTEREST IS HIGH THE USE OF PERSONAL SCIENCE TO IDENTIFY AND INCREASE THE RATE OF DESIRABLE BEHAVIOR (DEFICITS) AND REDUCE THE RATE OF UNDESIRABLE BEHAVIOR (EXCESSES) THE ROLE OF ADJUNCT TREATMENT IN TREATMENT (SUBSTANCE ABUSE, FAMILY THERAPY, MARITAL THERAPY, ETC.) EXAMPLES OF VICTIMS FINDING A MISSION IN LIFE

11 STRESS INOCULATION TRAINING (Meichenbaum and Jaremko, 1983) THREE PHASES: EDUCATION SKILLS TRAINING APPLICATION

12 EDUCATION PHASE: WHAT IS THE STRESSFUL EVENT?

13 EDUCATION PHASE: STRESSFUL EVENT WHEN THE CYCLE GOES TOO FAST, ABILITY TO COPE IS LESSENED BECAUSE ALL EFFORT AND ENERGY IS USED DEALING WITH THE NEGATIVE EXPERIENCES WHAT PHYSICL REACTIONS WERE CAUSED BY THIS STRESSOR? EXAMPLES: HEART POUNDING, MUSCLE TENSION, HOLDING BREATHE, BUTTERFLIES, DRY MOUTH, HOT OR COLD FLASHES, PANIC ATTACKS, TREMBLING SHAKING GOAL OF COPING IS TO KEEP THE CYCLE FROM GOING TOO FAST SO THAT COPING METHODS CAN SOLVE THE PROBLESM CAUSING THE STRESSOR. FIND THE BRAKES! WHAT FEELINGS OR EMOTIONS DID YOU HAVE AS A RESULT OF THIS EVENT AND YOUR THOUGHTS ABOUT IT? Examples: Anxiety, Anger, Doubt, Worry, Shame, Agitation WHAT THOUGHTS OR APPRAISALS OF THIS SITUATION OCCUR TO YOU? Examples: I can t handle this, This is caused by others who don t like me, My negative feelings will never go away, I m a failure, I have to deal with this perfectly, etc.

14 EDUCATION PHASE: STRESSFUL EVENT FEELINGS AND EMOTIONS PHYSICAL REACTIONS AUTOMATIC NEGATIVE THOUGHTS MOST AVOIDANCE BEHAVIOR FAILS TO SOLVES THE CAUSES OF THE STRESSOR WHICH BEGINS THE CYCLE AGAN PRODUCTIVE ACTION UNPRODUCTIVE ACTION Avoidance RESOLVES PROBLEM REDUCES OR ENDS STRESS

15 POINT B COGNITIVE CONTESTING SKILLS RECOGNIZE AND SLOW DOWN NEGATIVITY, POSITIVE SELF EXAMINATION/TALK, CHALLENGING NEGATIVE SKILLS TRAINING: STRESSFUL EVENT WAYS TO KEEPING THE CYCLE FROM GOING TOO FAST: USE SKILLS IN REAL TIME TO ADDRESS EACH TYPE OF REACTION POINT C EMOTIONAL, SOCIAL & INSTRUMENTAL SKILLS ASSERTIVENESS, PROBLEM SOLVING, LISTENING, FOGGING, CONFLICT RESOLUTION, META-RULES PHYSICAL REACTIONS POINT A PHYSICAL COPING SKILLS SIGHS AND CLEANSING BREATHS, MUSCLE RELAXATION, REGULAR EXERCISE WHAT FEELINGS OR EMOTIONS DID YOU HAVE AS A RESULT OF THIS EVENT AND YOUR THOUGHTS ABOUT IT? Examples: Anxiety, Anger, Doubt, Worry, Shame, Agitation AUTOMATIC NEGATIVE THOUGHTS (AKA: FOLLOWING FALSE RULES) (STINKIN THINKIN )

16 SKILLS TRAINING: COGNITIVE PROCESSING THERAPY RESICK, ET AL, 2017 cptforptsd.com Descriptors of the 12 Sessions of Cognitive Processing Therapy (CPT) 1. Introduction and Education 2. Meaning of the Event (impact statement) 3. Identification of Thoughts and Feelings (ABC) 4. Remembering Traumatic Events (accounts) 5. Remembering Traumatic Events 6. Challenging Questions 7. Patterns of Problematic Thinking 8. Challenging Beliefs Worksheet (CBW) & Safety Issues 9. Trust Issues 10. Power/Control Issues 11. Esteem Issues 12. Intimacy Issues and the Meaning of the Event This point seems to repeat no. 4 is it correct? Yes, two sessions devoted to this task

17 APPLICATION: APPLICATION OF NEWLY FORMED SKILLS TO THERAPEUTIC TASKS Using group interaction to be more authentic Identifying false rules that keep one stuck in avoidance Self efficacy enhancement form success with small therapeutic tasks Realizing important life values and purpose through group involvement Getting outside of one s own self-preoccupied state by listening, giving and helping others Establishing and rehearsing coping sequences that deal. Creating a new (and more healthy) narrative of one s life; not as victim alone, but as victim AND survivor. TR-SWDM as a stimulator of such narrative rewrites.

18 REFERENCES Bandura, Albert (1994). Self-efficacy. In Encyclopedia of Human Behavior, vol. 4, pp New York, NY: Academic Press. Jaremko, M.E. and Fehlbaum, B. Trauma Recovery: Sessions with Dr. Matt. Washignton, DC: Anyi Publishing, 2018 Jay, M. Supernormal. New York: Twelve Books, 2017 Kilpatrick, D., et al., National Estimates of Exposure to Traumatic Events and PTSD Prevalence Using DSM-IV and DSM-5 Criteria. J Trauma Stress Oct; 26(5): Malott, R. W. (1989). The Achievement of Evasive Goals. In S. Hayes (Ed.), Rule-governed behavior. New York, NY: Plenum Press, pp Meichenbaum, D. and Jaremko, M. E. (1983). Stress reduction and prevention. United States: Plenum Publishing Corporation. Meichenbaum, D. (2012). Roadmap to resilience: a guide for military, trauma victims and their families. Belleair, FL: Institute Press. Resick, P., Monson, C., and Chard, K. (2017). Cognitive processing therapy for PTSD: a comprehensive manual. New York, NY: The Guilford Press, Tedeschi, R. G., & Calhoun, L. G. (1996). The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, vol. 9, pp Young, M. (2007). Finding Meaning in the Aftermath of Trauma: Resilience and Posttraumatic Growth in Female Survivors of Intimate Partner Violence. Theses, Dissertations, Professional Papers. Paper 449.