Dr Elspeth Traynor Clinical Psychologist

Transcription

1 Dr Elspeth Traynor Clinical Psychologist

2 Simple Trauma Dangerous, upsetting or life threatening event experienced or observed One-off Examples: car accident, house fire, assault, rape

3 Complex trauma Complex trauma is interpersonal Repeated and chronic Has a significant impact on functioning Examples: hostage, combat experience, torture or child abuse physical, emotional, sexual abuse or physical or emotional neglect

4 Adverse Childhood Experiences Abuse in childhood Parental mental health problem Parental substance abuse Domestic abuse Parent in prison Parental separation or divorce hildhood_trauma_affects_health_across_a_lifetime

5 Social Deprivation Scottish Index of Multiple Deprivation Tool to identify areas of poverty and inequality Income, employment, education, health, access to services, crime, housing

6 Attachment What we know about how to relate is LEARNED/ DEVELOPED over our lifetime Earliest experiences of care Other relationships since Learn what to expect from others Learn how to get what we need

7 Attachment Theory Strange situations experiment Still face experiment:

8 Trauma and the body A natural response to frightening situations Shared by all animals Prepares body for fright, flight, freeze Increases breathing, heart rate, adrenal system, cortisol, tenses muscles Because children s brains are not fully developed and because they often suffer repeated abuse, the process that turns off their fear response becomes short circuited damaging areas of the brain, especially the prefrontal cortex and hippocampus memory, language, judgement

9 PTSD diagnosis 1. Intrusive remembering 2. Avoidance, numbing 3. Increased arousal and some or all of: irritability, depression and weepiness, loss of interest, sleep disturbance.

10 Complex PTSD Symptoms of PTSD plus Emotion regulation difficulties Relationship difficulties Pervasive negative self concept

11 1. Emotion Regulation Difficulties Chronic depression, anxiety, anger Difficulty managing, labelling or controlling emotions Extreme emotional suppression or expression Impulsive and self-destructive behaviour: Alcohol or drug use, self harm, risk taking think_you_know_about_addiction_is_wrong

12 Ace Study - Summary Vincent Fellitti Principal Co-Investigator We found that the compulsive use of nicotine, alcohol, injected street drugs increases proportionally in a strong, graded, doseresponse manner that closely parallels the intensity of adverse life experience during childhood. This, of course, supports old psychoanalytic views and is at odds with current concepts of biological psychiatry and drug treatment programs. Our findings are disturbing to some as they imply that the basic causes of addiction lie within us and the way we treat each other, not in drug dealers or drug chemicals. This suggests that billions of dollars have been spent everywhere except where the answer is to be found.

13 Trauma and Addiction Links Self medication Managing emotional distress Self harm Risk taking Poor impulse control Impact on brain function high distress + poor planning

14 2. Relationship Difficulties Isolation and withdrawal from others Disruption and difficulty in intimate relationships Repeated search for rescuer Persistent distrust of others Repeated failures of self protection

15 2. Relationship Difficulties Abusive relationships are secret, coercive and powerful People may not recognise that they have been abused May speak positively about the perpetrator Impact of emotional neglect on ability to relate to others and seek help still face experiment May behave in ways that are confusing, inconsistent and difficult May be labelled as manipulative or self-destructive

16 3. Negative View of Self Shame Guilt Self blame Feeling damaged Feeling helpless Sense of hopelessness and despair

17 3. Negative View of Self Ideas about self are pervasive, hidden Accepted as fact and therefore unquestioned Destructive to relationships Impede ability to seek help or to prioritise health and wellbeing

18 Trauma and Health ACE studies Chronic pain, Fibromyalgia Chronic fatigue, ME Long term medical conditions

19 Trauma-Informed Practice Complex trauma causes a wide range physical and psychological damage Trauma can trap people into a pattern of social deprivation, poor health and relationship difficulties Survivors of chronic trauma are often misunderstood and their difficulties mis-represented Surviving trauma requires strength resilience which should be recognised and acknowledged A stage-based approach can build on these strengths and promote recovery

20 Treatment of Simple PTSD Establish safety Training in coping skills e.g. breathing and relaxation Trauma re-processing

21 Treatment of Complex PTSD Stage based approach Stage 1 safety and stabilisation Stage 2 trauma re-processing Stage 3 re-integration

22 Stage 2 Trauma re-processing Different from re-processing for simple PTSD Less focussed on detail of trauma Work centres on understanding the meaning and impact of the trauma Highly specialist - trained counsellors and therapists Not helpful or necessary for all clients experiencing trauma-related difficulty

23 Stage 1 Safety and Stabilisation Essential part of recovery May be neglected due to wish to move on to Stage 2

24

25 Safety Areas to Consider Environment Health Substance misuse Relationships Emotions

26 Building Relationship Safety with Clients The CORE EXPERIENCES of psychological trauma are disempowerment and disconnection from others. Recovery, therefore, is based upon the empowerment of the survivor and the creation of new connections (Herman 1992)

27 Consistent relationships are healing Can reverse brain effects Help to address CPTSD effects: emotion regulation, self concept, relationships with others, finding meaning

28 Applying Attachment Theory Building a well-functioning relationship is a core aim with clients affected by trauma Be consistent Be clear Do not make promises Establish clear boundaries with the client personal, time, purpose of contact, be explicit Seek supervision and support

29 Safety and Stabilisation Psycho-education information about normal responses to trauma. Problems arise from environment and experience not flaws in the person Coping skills for managing distress Working on building positive sense of self Building on strengths and coping strategies

30 Stage 3 Reconnection and Moving Forwards Continued work on developing positive sense of self Focus on quality of life meaning, purpose, enjoyment, fulfilment Reconnecting with people and activities

31 5 principles of Trauma-Informed Practice Safety Trustworthiness Choice Collaboration Empowerment

32 Glasgow Psychological Trauma Service The Anchor Who we are What we do therapy, advice, consultancy, training Remit criteria Referrals form, process Links to other services

33 Glasgow Psychological Trauma Service Redesign GG&C Trauma Service: Tertiary Mental Health Service. Lead Dr Lisa Reynolds Trauma & Homelessness Team Compass Sexual Assault & Abuse Service In-Care Survivors Major Incident Mental Health Response Female Offenders Glasgow Leaving Care Post TARA Traffickin g Post ICSSF The Scottish Child Abuse Enquiry

34 Glasgow Psychological Trauma Service Service re-design Psychology-led MDT Assessment, Treatment, Consultation, Resources, Training Trauma Phased model

35 The Anchor Staff

36 Model of care Joint working in partnership with services to build client-centred support/care/treatment plans Proactive approach to engage individuals Social Work and Leaving Care services Community Addiction Teams Statutory homelessness services Third Sector Aim to further develop skills of workers in responding to impact of trauma

37 Glasgow Psychological Trauma Service Who do we work with? Aged 16+ Current difficulties related to history of complex trauma Greater Glasgow and Clyde area Additional level of complexity e.g. homelessness, care history, torture, trafficking Happy to discuss potential referrals by phone

38 Trauma Pathway