PTSD & TBI: The Perfect Storm

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Godfrey Carr
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1 PTSD & TBI: The Perfect Storm Part 2 Paul Greenwell MS, LIMHP Lutheran Family Services Inc. At Ease Program Supervisor Purpose The purpose of this activity is to inform the audience of evidence-based treatment techniques which can be used in the treatment of PTSD. 1

2 Learning Objective Describe two evidence-based treatment techniques for Post Traumatic Stress Disorder. Notice of Requirements for Successful Completion: In order to receive contact hour credit for this activity, you must: Sign in Be present for the entire day of the conference Complete and submit the evaluation form 2

3 Conflict of Interest Conflict of Interest: A conflict of interest occurs when an individual has an opportunity to affect educational content about health care products or services of a commercial interest with which he/she has a financial relationship. There are no relevant financial relationships with any commercial interests pertaining to this activity. General Considerations Trauma informed approach Evidence based treatment needs to be utilized within a positive therapeutic relationship. It is not a substitute. Safety and Trust - The client needs to trust that you will help them to stay safe as they go along this journey with you. 3

4 Emerged from traditional exposure therapy Confront safe but anxiety-provoking situations Emotional Processing Theory a program for escaping danger Fear Structure The fear structure includes... Representations of the feared stimuli The fear response Meaning associated with the stimuli 4

5 Pathological Fear Structure Does not accurately represent the world Escape/Avoidance responses are evoked by harmless stimuli Responses interfere with adaptive behavior Erroneous associations Treatment Conditions Fear structure must be activated New information must be incorporated into the fear structure 5

6 Treatment Framework weekly/bi-weekly 90 min. Trauma Interview Avoidance Hierarchy In-Vivo Exposure Imaginal Exposure Session Recording and Homework Treatment Framework Avoidance maintains PTSD Pushing away thoughts Avoiding people, places, things Avoidance prevents new/adaptive information from being incorporated into the fear structure 6

7 Treatment Framework Imaginal Exposure Revisit the traumatic experience in your imagination and recount the trauma aloud. 5 Point Rationale Beginning - Middle - End Repeat exercise for minutes Homework Treatment Framework In-Vivo Exposure 4 Point rationale Avoidance Hierarchy: Situations SUDS: Scale - Anchor Points Stay until anxiety has decreased significantly 7

8 Considerations Sufficient memory of the traumatic event Exclusion Criteria Suicidal/Homicidal Self-Injurious Behavior Psychosis Current environment is not safe Approach to Psychotherapy Adaptive Information Processing Model Memory Networks Node/Target 8-Phases of Treatment 8

9 8-Phases of Treatment History - Experiential contributors, Target sequence Preparation - Rapport, Education, Affect management skill Assessment - Access the target, Baseline measurements Desensitization - Reprocessing the target memory network Installation - Linkages to positive memory networks Body Scan - Residual physical/somatic manifestations Closure - Stabilize, Close down, Plan Re-evaluation - Check treatment effect, Continue targeting sequence Phase 1: History Targeting Sequence Plan Starts with the presenting complaint Image, Negative Cog., Positive Cog. Past Experience: Float Back Tech. Present Triggers Future Template Selection of Target - Touchstone, Worst, Other past experience 9

10 Assessment Assessment: Target = Incident chosen for reprocessing Image Negative Cog. and Positive Cog. Validity of Cognition: 1-7 Subjective Units of Disturbance: 0-10 Location of Body Sensation Reprocessing Reprocessing takes place as the targeted memory links to more adaptive networks Image, Negative Cog., Sensation Eye Movements vs. Bilateral Stimulation There is no should or have to or supposed to Therapist Role: Guide, Coach, Support 10

11 Installation Linking the desired positive cognition to the original memory/incident. Does the positive cognition still fit Think about the incident and those words. From 1-7, how true do they feel? Treatment effectiveness Improvement depends on amount and severity of trauma. Multiple traumas require more extensive treatment. Sessions are intensive and require a lot of work from the client. Clients do not recount their trauma Limited Homework - Self-monitoring, Basic journaling, Self care 11

12 Considerations is effective with individuals who have limited memory of the traumatic event. Treatment has been initiated with nothing more than a body-sensation to start with. Exclusion Criteria Suicidal/Homicidal, Self-injurious, Psychosis, Unsafe environment, Unstable environment has been used to treat individuals with dissociative disorders (experience is key) Resource List Foa, Edna, Therapy for PTSD: Emotional Processing of Traumatic Experiences Shapiro, Francine, - The Breakthrough Eye Movement Therapy for Overcoming Anxiety, Stress, and Trauma PTSD: National Center for PTSD, U.S. Department of Veterans Affairs 12

13 Questions??? Thank You for considering how you can support our Military Members, Veterans, and their Loved Ones 13

9/3/2014. Which impairs the ability to integrate these experiences in an adaptive manner.

9/3/2014. Which impairs the ability to integrate these experiences in an adaptive manner. Presented by DaLene Forester Thacker, PhD Licensed Marriage and Family Therapist Licensed Professional Clinical Counselor Director and Trainer with AEI daleneforester@yahoo.com I was not able to use EMDR