The art and science of treating trauma survivors Tovah Means, MS, LMFT Watch Hill Therapy Chicago, IL

Art & Science of Treating Trauma Survivors Dilemma - What little we know, what we still don’t know, and the limits of current research & EBT’s Core Elements of Traumatic Response Top Down vs Bottom Up Processing Trauma Spectrum & Unique Factors

Current Research Evidence Based Treatments (EBT or EVT) Polyvagal Syndrome (Dr. Stephen Porges, Ph.D) PTSD vs. Stress Disorder (Rachel Yehuda, Ph.D) EMDR vs. Prozac (van der Kolk et al)

Current Research Brain Regions Impacted & Sensitive Periods (Martin Teicher, MD) Trauma Sensitive Yoga (Bessel Van der Kolk, MD) Impacts on Play: Rhesus Monkeys (Stephen Suomi, Ph.D) and Rats with Cat Hair (JP Panksepp)

Core Elements of Traumatic Response Traumatic Memory - Time

Core Elements of Traumatic Response Somatization - Bodily Response

Core Elements of Traumatic Response Cognition - Thinking

Core Elements of Traumatic Response Neuroscience - The way we’re wired

Core Elements of Traumatic Response Ego States - We are Multiple

Core Elements of Traumatic Response Affective States - Emotional Distress

Core Elements of Traumatic Response Defense Mechanisms - Fight, Flight, & Freeze

Core Elements of Traumatic Response Relationships & Attachment

Top Down vs. Bottom Up

Models & Interventions Sensorimotor Psychotherapy (Pat Ogden) SMART: Sensory Motor Arousal Regulation Treatment (Elizabeth Warner, Psy.D) Somatic Experiencing (Peter Levine) The Body Remembers (Babette Rothschild) EMDR (Francine Shapiro)

Models & Interventions Integrative Treatment of Complex Trauma for Children (Cheryl Lanktree, Ph.D. and John Briere, Ph.D.) Trauma Sensitive Yoga & The Body Keeps Score (Bessel Van der Kolk) Interpersonal Neurobiology, Mindsight (Dr. Dan Siegel) Neurosequential Model (Dr. Bruce Perry) DBT, FAP, ACT (Marsha Linehan, Steven Hayes)

TRAUMA SPECTRUM One Event (R) Multiple Event (R) - Late Onset Multiple Event (R) - Early Onset R=Relational

Trauma Spectrum The farther down the spectrum you get the more drastic the effects of the traumatic experience. More influence the trauma has in shaping what you know about the world and relationships. Greater impact on the brain and development. What your brain and body have to do to survive becomes more damaging in the long run. Ex. dissociation. Less ability to use language to process the experience.

One Event TRAUMA SPECTRUM Examples: - Car accident - Loss of stability ex. house fire, job loss, bankruptcy - Being diagnosed with a life threatening illness - Public shame or humiliation

One Event (R) TRAUMA SPECTRUM Examples: - Physical or sexual assault - Witnessing violence - Sudden or tragic death - Natural disaster - Highly conflictual divorce

“Big T” trauma

Multiple Event (R) - Late Onset (Age 3 and up) TRAUMA SPECTRUM Examples: - On-going physical or sexual abuse - On-going neglect or emotional abuse - On-going abuse (above) by a loved one - On-going witnessing of violence - Torture, war - Chronic homelessness or community violence

Multiple Event (R) - Early Onset (Before age 3) TRAUMA SPECTRUM

“Small t” trauma “The traumatic stress field has adopted the term “complex trauma” to describe the experience of multiple, chronic, and prolonged, developmentally adverse traumatic events, most often of an interpersonal nature (eg, sexual or physical abuse, war, community violence) and early-life onset.” - Bessel Van Der Kolk

Biology

Early Relational Experience

Age

Duration

Severity

Response of Others

Cultural Beliefs & Practices

Meaning Making

Inventories and Assessment Measures Posttraumatic Cognitions Inventory (Foa, E. B., A. Ehlers, et al) Trauma Symptoms Check List & Trauma Symptom Inventory (John Briere) Aces Study (Center for Disease Control & Kaiser Permanente) Beck Depression Inventory (Aaron T. Beck) Multidimensional Inventory of Dissociation (Paul Dell, PhD) Dissociative Experiences Scale (Eve Bernstein Carlson, Ph.D. and Frank W. Putnam, M.D)

Other Resources Other Resources: Assessment and Screening Tools for Trauma in Children and Adolescents: A Review (Virginia C. Strand, Teresa L. Sarmiento, Lina E. Pasquale, Trauma Violence Abuse, January : 55-78)Virginia C. StrandTeresa L. SarmientoLina E. Pasquale National Child Traumatic Stress Network (NCTSN) Consultation -