Working with people affected by complex trauma and/or PTSD MHBiz 9 December 2015 Working with people affected by complex trauma and/or PTSD Dr. Leanne Craze, Sydney, Australia

What we will cover today What is trauma? Normal reactions to trauma When to worry What is PTSD? What is complex trauma? Affects of trauma Facts & stats

What we will cover today How healing happens Effective treatment and support Where to get help Trauma informed care Relevance to working with Hume customers How to help Helpful resources

What is trauma? Understanding trauma - https://vimeo.com/132773892\ Traumatic experiences that involve death, serious injury or sexual violence (actual or threatened) can potentially cause PTSD. Everyone responds to trauma differently and although people may experience extreme distress, most eventually recover on their own. Only a minority of people develop PTSD after a traumatic event.

Normal reaction to trauma Fear is a natural and healthy response to a life- threatening event. When people experience or witness danger, the body prepares to take action with the “fight-or- flight” response. The heart rate speeds up, breathing quickens and we feel anxious and ‘pumped’, enabling us to run or combat danger. These feelings of fear normally fade away after the traumatic event.

Acute stress reaction following trauma Signs and symptoms occurring during or shortly after trauma: a sense of detachment poor memory of the specific events generalized anxiety & hyperarousal avoidance of situations or stimuli that elicit memories of the trauma persistent, intrusive recollections of the event via flashbacks, dreams, or recurrent thoughts or visual images.

When to worry If symptoms of acute stress reaction persists for over a month - particularly Still being fearful and very upset Unable to escape intense & distressing feelings Jumpy & pervasive uneasiness Persistence of nightmares Can’t stop thinking about what happened Can’t get on with everyday activities Still feeling detached Feeling guilty and to blame

What is PTSD? https://www.youtube.com/watch?v=YMC2jt_QVEE When someone develops post-traumatic stress disorder (PTSD), fear, anxiety and memories of trauma persist for a long period of time and interfere with daily life. PTSD is a treatable anxiety disorder affecting around one million Australians each year.

Signs and symptoms of PTSD Three main sets Intrusive memories & images – daytime memories, dreams/nightmares & flashback experiences Avoidance of reminders – activities, places, people & feelings Arousal – resulting in difficulty sleeping, irritability or outbursts of anger, difficulty concentrating, hypervigilance, exaggerated startle response

Signs and symptoms of PTSD Additionally - emotional numbing e.g. restricted emotions feeling detached loss of interest difficulty seeing a long term future Frequently occurs with depression, other anxiety disorders and alcohol and drug misuse

What is complex trauma? Complex PTSD can be caused by any type of severe and long-term trauma Usually involves situations where the victim is held (perceived or actual) captive and unable to escape

What is complex trauma? The types of traumatic situations which can cause this disorder include: long-term childhood physical or sexual abuse long-term domestic violence concentration camps or prisoner of war camps prostitution brothels or sex trafficking organised child exploitation rings.

Exercise – table discussion Disease ranking

Exercise – table discussion Why do you think severe PTSD ranks so high? What do you think are the most difficult symptoms or affects of PTSD?

Impacts of trauma https://www.youtube.com/watch?v=LKWUmwxi1ZI - affects on the brain https://www.youtube.com/watch?v=Uzlt-LFr8-o - affects on child development https://www.youtube.com/watch?v=X4o-EXLkA7Y - affects on memory

How trauma affects development The Adverse Childhood Experiences (ACE) Study, a longitudinal study of the long-lasting impact of childhood trauma into adulthood 17,000 participants aged 19 to 90 nearly 64% experienced at least one exposure, and of those, 69% reported two plus incidents connection between childhood trauma exposure, high-risk behaviors (e.g., smoking, unprotected sex), chronic illness eg heart disease, mental illness, cancer, and early death.

Facts and stats About 5% to 10% of Australians experience PTSD at some point in their lives In a 12 month period, more women (8.3%) than men (4.6%) experience PTSD
The rate of PTSD differs according to the trauma experienced. As a general rule, higher rates of PTSD (up to 50%) for survivors of intentional acts of violence or prolonged/repeated events than in survivors of non-intentional trauma e.g. natural disasters or accidents (around 10%).

Facts and stats Following a trauma 20% of women & 8% of men will develop PTSD Between 5-20% of Australian veterans experience PTSD PTSD is high in front line emergency services and health and community services

Facts and stats Following a trauma 20% of women & 8% of men will develop PTSD Between 5-20% of Australian veterans experience PTSD PTSD is high in front line emergency services and health and community services

Exercise – how good can you google? In which population groups in Australia is PTSD high? In which professional groupings or workplaces is PTSD high?

How healing happens? Why do I feel so crazy - https://www.youtube.com/watch?v=4lnVcL51Ocs How healing happens - https://www.youtube.com/watch?v=cUlKIHVDxYw

Effective treatments and supports Trauma-focused cognitive behavioural therapy Prolonged Exposure Therapy Cognitive Processing Therapy Eye Movement Desensitisation and Reprocessing (EDMR) Medication https://www.youtube.com/watch?v=FeLLt39DI8A https://www.youtube.com/watch?v=Jqj5zDbkPxY https://www.youtube.com/watch?v=rHg_SlEqJGc https://www.youtube.com/watch?v=bnjEr7GVhLo

Other treatments Education about PTSD Training in controlling hyperventilation Relaxation training Distraction techniques Learning to alter unhelpful thinking patterns and beliefs Stress inoculation training Treatment of other conditions such as depression

Where to get help GP – Better Access A Psychologist (The Australian Psychological Society has a referral service: Ph. 1800 333 497) http://www.psychology.org.au/FindaPsychologist A psychiatrist (see RANZCP website) Local community mental health centre

Trauma informed care & Hume applied understanding the neurological, biological, psychological and social effects of trauma views the individual as having been harmed by something or someone recognition and acknowledgement of trauma and its prevalence awareness and sensitivity to trauma’s dynamics  

Trauma informed care & Hume strengths-based responsive to the impact of trauma emphasises physical, psychological, and emotional safety for both staff and clients creates opportunities for clients to rebuild a sense of control and empowerment  

Relevance to working with customers Many customers have experienced complex trauma Many customers will have PTSD Do no harm – what do we do that may trigger trauma or traumatise? Vicarious trauma Importance of self care and professional boundaries

How to help - exercise Fact sheets

Helpful resources Promoting recovery after trauma - http://phoenixaustralia.org/wp-content/uploads/2015/03/Phoenix-Adults-Guide.pdf Factsheets and booklets - http://phoenixaustralia.org/recovery/fact-sheets-and-booklets/ Online treatment programs Mindspot - https://mindspot.org.au/ptsd-course eCentreClinic - https://www.ecentreclinic.org/?q=PTSDCourse Mental Health Online - https://www.mentalhealthonline.org.au/ PTSD Coach Australia app - https://www.youtube.com/watch?v=2sUmqItlQvE