Dissociation, PTSD & Healing Richard F. Stoltz, Ph. D Dissociation, PTSD & Healing Richard F. Stoltz, Ph.D., ABPP Deputy Director, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury

Objectives Clarify and explore the concept of dissociation Identify how dissociation is related to the development and sustainment of PTSD Examine multiple ways one can successfully recover and heal from traumas and PTSD

Disclosures The presenter has no financial relationships to disclose. This continuing education activity is managed and accredited by Professional Education Services Group in cooperation with AMSUS. Neither PESG,AMSUS, nor any accrediting organization support or endorse any product or service mentioned in this activity. PESG and AMSUS staff has no financial interest to disclose. Commercial support was not received for this activity.

Dissociation Normal Everyone dissociates, children more than adults Examples There but not fully there Mild, moderate, and severe Definition BASK Model – Dr. Bennett Braum

More Dissociation Case example – Woman who lost her life Voluntary ……….Involuntary continuum Meditation Hypnosis Case example – Marlboro Man Working Through & Letting Go

Involuntary Dissociation May assist the development and sustainment of PTSD (depending on one’s response) May assist with the development and sustainment of addictive behaviors Addictive behaviors are sometimes attempts to escape from involuntary dissociations (flashbacks) or to explore what might be behind or underneath their symptoms

Fundamental Question Fundamental Question Fundamental Choice To block or not to block Fundamental Choice Choose ways to welcome what’s troubling inside or keep attempting to avoid what’s troubling inside

Responding to Traumas/PTSD The right psychological strategy to use to survive a trauma is the wrong psychological strategy to use to recover from a trauma Need to clarify the difference Case Example – Vietnam Vet

Variability of PTSD Degree of dissociation Severity of trauma(s) Severity of symptoms Prior history of Traumas in childhood or adolescence (resolved or not) Likelihood of similar traumas happening again Degree of psychological health before the trauma(s) History of self-destructive/suicidal behavior

More Variability Any dual diagnoses e.g. TBI, substance abuse, depression Degree of guilt or moral injury Degree of social support Economic status/living situation Spiritual/existential view of life Degree of psychological insight Genetic/biological/neurological differences

Treatable Disorder PTSD is a highly treatable disorder, does not have to go on for decades Complicated cases often take time to resolve If one continues to fight against what’s troubling inside, some battles will be won, but one will not be at peace If what’s troubling inside stays inside, it will tend to unexpectedly haunt What’s troubling inside, wants/needs to come out What comes out begins to dissolve

Many Ways to Heal Better understand and control dissociation Get the person’s attention, form a positive connection, instill hope No single treatment works best for all Control and fear are often huge issues Encourage pt involvement in tx plan Often go from head–head to heart-heart Address cognitive and emotional components Exposure therapies/Cognitive therapies

More Ways to Heal Self-talk, core beliefs, unrealistic expectations Breathing, Relaxation, Hypnosis Dynamic techniques – empty chair, role playing Behavioral techniques – enjoyable activities, hobbies, sleep, nutrition, complementary therapies e.g. yoga Medication/medical procedures

Fundamental Goal Help the person face and express the truth about what is disturbing inside, instead of pushing it away Case example – The man who could not eat

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