PTSD
Exploring the Functional Nature of Symptoms
Instructor: Dr. Dawn-Elise Snipes LPC-MHSP, LMHC, CCDRC
Executive Director: AllCEUs
Host: Counselor Toolbox and Happiness Isn’t Brain Surgery Podcasts
Continuing education Credits for this podcast are available at https://allceus.com/member/cart/index/product/id/59/c/
Objectives
~ Review PTSD Symptoms and explore their functional nature
Purpose
~ By understanding the function of symptoms we can
~ Normalize the behavior
~ Identify alternate ways to meet that same need or address the issue
~ Re-Experiencing
~ Trying to replay it to figure out how to integrate into your schema (like fitting a puzzle piece)
~ Reminding the person of similar situations to “protect” them
Purpose
~ Avoidance
~ The system is already over taxed. Avoiding upsetting stimuli by blocking out most stimuli, memories of the event.
~ Avoiding unnecessary use of energy by not getting “excited.”
~ Changes in Beliefs
~ Protects against future “surprises”
~ Tries to assimilate the experience into schema
~ Increased Arousal
~ Protects the individual
Re-Experiencing
~ You re-experience things every day
~ Access schema that guide your actions
~ When you go to work
~ When you encounter a particularly volatile client
~ When you approach a stop light
~ Re-Experiencing in PTSD
~ The context is often overgeneralized
~ The precipitating factors are often unknown
~ In many cases the resolution was not one of empowerment, resulting in trying to continually figure out how to not be disempowered
Re-Experiencing: Assimilation or Accommodation
~ Intrusive distressing memories of the traumatic events
~ In children repetitive play may occur in which themes or aspects of the traumatic events are expressed.
~ Recurrent distressing dreams in which the content or feeling of the dream is related to the events
~ In children there may be frightening dreams without recognizable content.
~ Flashbacks or other dissociative reactions in which the individual feels or acts as if the traumatic events are recurring
~ In children trauma-specific reenactment may occur in play.
Re-Experiencing
~ Intense or prolonged psychological or physiological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic events
~ The event represents a time in which the person experienced or witnessed something horrifying
~ The brain is trying to help the client
~ Avoid future similar situations
~ Learn how to protect during future similar situations
Avoidance
~ Purpose: Avoidance of Recurrence of Pain or Arousal of Stress Response System
~ Emotional numbness and avoidance of places, people, and activities that are reminders of the trauma.
~ Inability to remember an important aspect of the traumatic events (not due to head injury, alcohol, or drugs)
~ Purpose: An exhausted system conserves energy in case there is another threat
~ Markedly diminished interest or participation in significant activities
~ Feelings of detachment or estrangement from others
~ Persistent inability to experience positive emotions
Hypocortisolism
~ Cortisol is the stress chemical
~ After extreme stress and/or under chronic stress the brain may reduce the responsiveness of the stress response system by reducing the cortisol
~ This is protective, it keeps the organism from using precious resources by getting “excited” about anything (including pleasure)
~ Due to fear conditioning, when a stressor is detected, the stress response is exaggerated.
Changes in Beliefs
~ Purpose: The need for order and meaning (Regaining control, Ability to predict)
~ Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world
~ “I am bad”
~ “No one can be trusted”
~ “The world is completely dangerous”
~ Persistent, distorted blame of self or others about the cause or consequences of the traumatic events
Changes in Beliefs
~ Persistent
~ Fear, horror
~ Anger
~ Guilt, shame
~ Trauma taps in to nearly every basic fear
~ Loss of Control
~ The Unknown
~ Death (Am I going to die? I could have died. I was unable to prevent someone from dying)
~ Isolation
~ Failure
Beliefs Interventions
~ After a trauma people’s lives are changed forever.
~ It is often necessary to grieve the loss not only of tangible things like property, but also existential things like belief in a just world and the goodness of people.
~ Identifying the threats and associated thoughts the person had/is having
~ Addressing cognitive distortions using Cognitive Processing Therapy
CPT Challenging Questions
~ What is the evidence for and against this belief?
~ Are the sources of this evidence reliable?
~ Is my reasoning based on facts or feelings?
~ Is this belief based on habit or facts?
~ Habits can be persistent negative interpretations or old “tapes” that have never been checked.
~ Am I basing my belief on the whole picture, or a small aspect of it?
~ Does my belief contain all-or-none terms?
~ In what ways is this belief confusing high probability and low probability events?
Increased Arousal
~ Irritable or aggressive behavior
~ Anger/threat reaction to continue to self-protect
~ Interventions:
~ Help the person identify and address triggers
~ Develop skills to address emotional and behavioral dysregulation (STOP Stop Think Observe Participate)
~ Reckless or self-destructive behavior
~ Stop the pain (I don’t care if I die, because…)
~ Distract (Numb through thrill)
~ Regain control (Lightening doesn’t strike twice)
Increased Arousal
~ Exaggerated startle response (Hypocortisolism)
~ Think how exhausting it would be to go from 0 to 100 each time you were startled.
~ Because of hypervigilance, people with PTSD are aware of more things that may startle
~ Interventions
~ Help client understand brain changes that resulted from the brains “decision” that continuing to use energy to fight was futile
~ Develop tools to reduce vulnerabilities and increase energy reserves
Increased Arousal
~ Hypervigilance
~ Purpose: Protective because the world seems dangerous and unpredictable
~ Other Symptoms
~ Problems with concentration
~ Hypervigilance prevents filtering out extraneous stimuli
~ Intervention: Create places that are “peaceful and safe”
~ Difficulty falling or staying asleep or restless sleep
~ You are vulnerable when you are asleep
~ Create a safe sleeping space and ability to easily re-ground
~ Emotional support dogs can be helpful here
Final Thoughts
~ Tormenting thoughts and feelings and attempts to stop or avoid those thoughts and feelings are central to PTSD
~ In the song “Wrong Side of Heaven” by Five Finger Death Punch the artist speaks of this torment.
~ Imagine you have been in a situation in which you
~ Had to kill to protect others
~ Had to let someone die to protect yourself and be there for your kids/family
Wrong Side of Heaven
~ I spoke to God today and she said that she's ashamed. What have I become. What have I done
~ I did some awful things in the spirit of what was right
~ I spoke to the devil today and he swears he's not to blame, and I understood 'cause I feel the same.
~ I accept that the devil did not make me do it. I chose it, but at what cost.
~ Arms wide open, I stand alone. I'm no hero and I'm not made of stone.
~ I feel totally isolated. I don’t believe people could understand. I did not do it to be a hero. I am tormented by what I felt I had to do for what I felt was right.
Wrong Side of Heaven
~ Right or wrong, I can hardly tell. I'm on the wrong side of heaven and the righteous side of hell.
~ I know what I did, I did for the right reasons, but I don’t feel deserving of forgiveness, but I also don’t believe I should be damned because I was trying to do what was right.
~ I heard from God today and she sounded just like me. What have I done and who have I become.
~ Like God, I talk, believe, pray about doing things for the right reasons
~ I saw the devil today and he looked a lot like me
I looked away, I turned away
~ Like the devil, I have done a lot of things I don’t know if I can forgive myself for, and am not sure if I deserve forgiveness. I can’t stand to see the potential for evil in myself.
Summary
~ Increased Arousal
~ The traumatic threat was unpredictable, ergo future events are unpredictable.
~ Increased arousal keeps people alert to potential threats.
~ Using CPT Challenging Questions help the client examine his/her beliefs about the event and his/her current safety
~ Avoidance and numbing helps the person survive since nobody can be “alert” and agonizing for that long
~ Helping the person understand that during a traumatic event, certain chemicals in the body prevent effective memory formation. This is protective.
~ Numbing helps preserve precious energy.
Summary
~ Changes in beliefs
~ Keeps the person from being vulnerable again
~ Helps the person try to make sense of it.
~ Re-Experiencing
~ Like trying to fit a puzzle piece, the brain is trying to make sense of how this fits into current schema
~ The brain may have to develop new schema based on likely faulty memories from the trauma, so many stimuli are overgeneralized and cause “triggers” for anxiety to be everywhere.