Trauma of Victimization: Critical Symptoms, Response, and Recovery. Kasia Wereszczynska, MA, LCPC, RYT Matt Glowiak, PhD, LCPC, CAADC, NCC

counseling speaks Trauma of Victimization: Critical Symptoms, Response, and Recovery Kasia Wereszczynska, MA, LCPC, RYT Matt Glowiak, PhD, LCPC, CAADC, NCC Chicago Deerfield Park Ridge Glenview 2015,, All Rights Reserved www.counselingspeaks.com 1

Presenter Biography Kasia Wereszczynska, MA, LCPC, RYT, is a clinical director, speaker, and yoga instructor. She is a co-founder of counseling speaks, a multicultural group counseling practice serving the Chicago metropolitan where she integrates mindfulness within crisis situations. Kasia has spent the last 9 years providing crisis interventions to culturally diverse populations serving the South Side of Chicago and the North Shore area.

Presenter Biography Dr. Matt Glowiak, LCPC, CAADC, NCC, is a clinical director, speaker, and educator. He is a co-founder of counseling speaks, a multicultural group counseling practice serving the Chicago metropolitan. Having managed a large caseload of individuals diagnosed primarily with opioid use disorder (heroin addiction), Matt has extensive experience intervening in substanceinduced crises and working with dually diagnosed clients and their families.

Learning Objectives 1. Define trauma 2. Assess symptomology associated with trauma 3. Determine the impact of dysfunction resulting from symptoms 4. Considerations for developing an effective treatment plan 5. Thoughtful strategies and approaches for empowerment

Trauma of Victimization Trauma may manifest itself in many forms and occur through one or more mediums. Victims may be impacted along any one or a combination of the biopsychosocial dimensions Because every victim's experience is different, the recovery process may vary significantly. 2015,, All Rights Reserved

Trauma of Victimization Although it is commonplace to rate some traumatic experiences as more severe than others, the reality is that the subjective experience of the event outweighs the objective reality. Consequently, multiple people experiencing the exact same event will present with varied critical symptoms, responses, and rates of recovery.

Trauma of Victimization To a great extent these differences are the product of one's culture--the behaviors, beliefs, values and symbols they accept. These differences compound further through the process of acculturation whereby individuals adopt the cultural traits of other groups. As such, one individual may experience trauma upon witnessing a shooting while another regards it as a part of everyday life.

Foreshortened Future Trauma can affect one s beliefs about the future via loss of hope, limited expectations about life, fear that life will end abruptly or early, or anticipation that normal life events won t occur (e.g., access to education, ability to have a significant and committed relationship, good opportunities for work). (National Center for Biotechnology Information, 2017) 2015,, All Rights Reserved

Shock and Numbness Shock and numbness are usually considered a part of the initial stage of the crisis reaction. Victims are faced with a situation beyond their control, and some may almost immediately go into shock and become disoriented for a while. (The National Center for Victims of Crimes, 2012)

Immediate and Delayed Reactions to Trauma (National Center for Biotechnology Information, 2017) Immediate Emotional Reactions Numbness and detachment Anxiety or severe fear Guilt (including survivor guilt) Exhilaration as a result of surviving Anger Sadness Helplessness Feeling unreal; depersonalization (e.g., feeling as if you are watching yourself) Disorientation Feeling out of control Denial Constriction of feelings Feeling overwhelmed Delayed Emotional Reactions Irritability and/or hostility Depression Mood swings, instability Anxiety (e.g., phobia, generalized anxiety) Fear of trauma recurrence Grief reactions Shame Feelings of fragility and/or vulnerability Emotional detachment from anything that requires emotional reactions (e.g., significant and/or family relationships, conversations about self, discussion of traumatic events or reactions to them)

Immediate and Delayed Reactions to Trauma (National Center for Biotechnology Information, 2017) Immediate Physical Reactions Nausea and/or gastrointestinal distress Sweating or shivering Faintness Muscle tremors or uncontrollable shaking Elevated heartbeat, respiration, and blood pressure Extreme fatigue or exhaustion Greater startle responses Depersonalization Delayed Physical Reactions Sleep disturbances, nightmares Somatization (e.g., increased focus on and worry about body aches and pains) Appetite and digestive changes Lowered resistance to colds and infection Persistent fatigue Elevated cortisol levels Hyperarousal Long-term health effects including heart, liver, autoimmune, and chronic obstructive pulmonary disease

Immediate and Delayed Reactions to Trauma (National Center for Biotechnology Information, 2017) Immediate Cognitive Reactions Difficulty concentrating Rumination or racing thoughts (e.g., replaying the traumatic event over and over again) Distortion of time and space (e.g., traumatic event may be perceived as if it was happening in slow motion, or a few seconds can be perceived as minutes) Memory problems (e.g., not being able to recall important aspects of the trauma) Strong identification with victims Delayed Cognitive Reactions Intrusive memories or flashbacks Reactivation of previous traumatic events Self-blame Preoccupation with event Difficulty making decisions Magical thinking: belief that certain behaviors, including avoidant behavior, will protect against future trauma Belief that feelings or memories are dangerous Generalization of triggers (e.g., a person who experiences a home invasion during the daytime may avoid being alone during the day) Suicidal thinking

Immediate and Delayed Reactions to Trauma (National Center for Biotechnology Information, 2017) Immediate Behavioral Reactions Startled reaction Restlessness Sleep and appetite disturbances Difficulty expressing oneself Argumentative behavior Increased use of alcohol, drugs, and tobacco Withdrawal and apathy Avoidant behaviors Delayed Behavioral Reactions Avoidance of event reminders Social relationship disturbances Decreased activity level Engagement in high-risk behaviors Increased use of alcohol and drugs Withdrawal

Immediate and Delayed Reactions to Trauma (National Center for Biotechnology Information, 2017) Immediate Existential Reactions Intense use of prayer Restoration of faith in the goodness of others (e.g., receiving help from others) Loss of self-efficacy Despair about humanity, particularly if the event was intentional Immediate disruption of life assumptions (e.g., fairness, safety, goodness, predictability of life) Delayed Existential Reactions Questioning (e.g., Why me? ) Increased cynicism, disillusionment Increased self-confidence (e.g., If I can survive this, I can survive anything ) Loss of purpose Renewed faith Hopelessness Reestablishing priorities Redefining meaning and importance of life Reworking life s assumptions to accommodate the trauma (e.g., taking a self-defense class to reestablish a sense of safety)

Stress Related Disorders Acute stress disorder is characterized by the development of severe anxiety, dissociative, and other symptoms that occurs within 1 month after exposure to an extreme traumatic stressor. As a response to the traumatic event, the individual develops dissociative symptoms. For one to be diagnosed with post-traumatic stress disorder (PTSD), the individual must experience symptoms for at least 1 month following exposure to a traumatic event. In some cases people may experience delayed onset PTSD.

Secondary Injuries Beyond immediate injuries experienced, victims must also battle with secondary injuries. Secondary injuries are those that occur when there is a lack of appropriate support. For example, a female is sexually assaulted but is blamed because she wore promiscuous clothing to the party.

For victims to recover from a traumatic event, it is crucial that they receive proper support from the point of initial impact stage throughout the recovery process. Recovery Road

Thinking as a First Responder Inquire about the victim's welfare by determining whether that individual is safe Assesses whether the victim is in need of medical attention. Assure the victim that he or she was not at fault. Assist the victim with undertaking the task of rebuilding equilibrium.

Self-Help Tips for Coping Seek support and share what you are going through with others. Also make a point to take time to yourself. Allow yourself to feel and fully process the pain. Take care of your mind and body (i.e., eat healthy meals, relax) Re-engage in your normal routine soon but as appropriate Take control of your daily decisions but seek guidance as appropriate. Undertake daily tasks with care. Accidents are more likely to happen after severe stress. Utilize coping mechanisms that have worked in the past. (The National Center for Victims of Crimes, 2012) 2015,, All Rights Reserved

Advice to Counselors: Using Information About Biology and Trauma (National Center for Biotechnology Information, 2017) Educate your clients: Frame re-experiencing the event(s), hyperarousal, sleep disturbances, and other physical symptoms as physiological reactions to extreme stress Communicate that treatment and other wellness activities can improve both psychological and physiological symptoms (e.g., therapy meditation, exercise, yoga). You may need to refer certain clients to a psychiatrist who can evaluate them and, if warranted, prescribe psycho-tropic medication to address severe symptoms. Discuss traumatic stress symptoms and their physiological components. Explain links between traumatic stress symptoms and their physiological components. Explain links between traumatic stress symptoms and substance use disorders, if appropriate. Normalize trauma symptoms. For example, explain to clients that their symptoms are not a sign of weakness, a character flaw, being damaged, or going crazy. Support your clients and provide a message of hope that they are not alone, they are not at fault, and recovery is possible and anticipated 2015,, All Rights Reserved

The 5 Stages of Healing from Trauma Victim Feeling paralyzed, lifeless, and lacking energy Survivor The individual now has enough fight to start to live again Thriver The fight to heal gains momentum and becomes naturally reinforcing Server Offers lessons learned and guidance to others who have suffered trauma Empowered Server Has completed enough recovery to no longer be impacted by stimuli that might trigger past memories of the trauma (Berry, 2015) 2015,, All Rights Reserved

The 5 R's of Stress/Anxiety Reduction There are 5 core concepts which are used in the reduction of anxiety or stress. Recognition of the causes and sources of the threat or distress; education and consciousness raising. Relationships identified for support, help, reassurance Removal from (or of) the threat or stressor; managing the stimulus. Relaxation through techniques such as meditation, massage, breathing exercises, or imagery. Re-engagement through managed re-exposure and desensitization. (Benson, 1974) 2015,, All Rights Reserved

A Lesson from Mr. Rogers Anything that s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone.

References Benson, H. (1974). The relaxation response. Psychiatry, 37, p. 37-46. Berry, L. (2015). The 5 stages of healing from trauma. Retrieved from http://www.survivormanual.com/the-5-stages-of-healing-from-trauma/ National Center for Biotechnology Information. (2017). Understanding the Impact of Trauma. Retrieved from https://www.ncbi.nlm.nih.gov/books/nbk207191/ The National Center for Victims of Crimes (2012). The trauma of victimization. Retrieved from https://www.victimsofcrime.org/help-for-crimevictims/get-help-bulletins-for-crime-victims/trauma-of-victimization. U.S. Department of Veteran Affairs. (2016). What is PTSD? Retrieved from http://www.ptsd.va.gov/public/ptsd-overview/basics/what-is-ptsd.asp 2015,, All Rights Reserved