Reactions to Trauma Jason Mitchell, B.S. University of Colorado at Colorado Springs University Counseling Center

Prevalence 1245 American Adolescents 23% physical/sexual assault occurrence rate 1/5 develop PTSD Around 1.07 million teens Elliott & Briere, 1995 - 76% of American adults reported having been exposed to extreme stress Breslau & Davis, 1992 - 9% of an urban population suffered from PTSD Kulka et al., 1990 - 15.2% of U.S. Vietnam vets continue to suffer from PTSD Saxe et al., 1993 - 15 % of psychiatric inpatients meet the diagnosis for PTSD and many more have been found to have sever trauma histories ***All cited in van der Kolk & McFarlane (1996). In van der Kolk, McFarlane, & Weisaeth (Eds.) Truamatic Stress Kilpatrick, Saunders, Resnick, & Smith, 1995

Contrasted Effect “Normal” coping Abnormal coping Overly preoccupied with the event Involuntary intrusive thought Abnormal coping Failure to integrate Avoidance and hyperarousal Normal - Intrusive memories may allow us to become tolerant to the context (Horowitz, 1978) Abnormal - Start to organize life around trauma van der Kolk & McFarlane, 1996

Immediate and Short-Term Responses Observable Behaviors or Symptoms Conversion, agitation, stupor Emotions and Cognitions Anxiety, panic, numbing, confusion Mental Processes or Functions Defenses These symptoms can be confounded - Dissociation: observable behavior, an experience, and a form of defense against pain, distress, or humiliation Marmar et al., 1994

Psychopathology Acute Stress Response Chronic Response Adaptations in dealing with chronic response McFarland & Yehuda, 1996 Acute Stress Response - Intrusive symptoms - Variable levels of discomfort, arousal, dissociation, and memories - Significant self judgment of actions - May create negative beliefs about oneself and others - In normal responses these feeling/sensations/behaviors subside in time

Development of PTSD Unpredictable and uncontrollable Vulnerability vs. Resilience Psycho/Bio/Environmental influences Social Networks Coping Self-efficacy McFarland & Yehuda, 1996 Barlow 1988 - if individuals do not possess adequate coping skills or social support, they will become fearful about the repetition of the stress - This preoccupation with and anticipation of future stress that is the core of the disorder **Cited in Brett (1996) In van der Kolk, McFarlane, & Weisaeth (Eds.) Traumatic Stress Vulnerability - Psychological/Environmental/Biological individual differences that make an individual more susceptible to developing PTSD symptoms - Family history of psychological illness - Individuals of increased risk of reoccurring trauma (firefighters/auto accidents/domestic violence/drug user) - Neurobiology of an individual’s stress response, the capacity for self-modulation, the ability to tolerate the fear and threat that trauma involves, and the ability to cope with losses Resilience - factors may minimize individuals level of acute distress or allow more rapid modulation - Ability to cope with intrusive memory, ability to tolerate suffering - successful mobilization of social networks - coping self-efficacy

Impact Beliefs and Attitudes Physical Health Behavioral and Interpersonal Functioning Disordered Affect and Arousal Beliefs and Attitudes - modify vulnerability to subsequent traumatic events - hypervigiience and erratic driving/ self-medication and drug use - shift in an individual’s internal perceptual sensitivities - can be a powerful source of motivation (art and literature), shape culture Physical Health - Increased report of physical symptoms but the association can be unclear - physical symptoms can be the focus of the distress - physical symptoms can be directly caused by the stressor - physical symptoms can be a nonspecific response to exposure to a traumatic experience Behavioral and Interpersonal Functioning - (Concentration Camp) more frequent change in jobs, housing, and occupation - less qualified and well-paid work (Eitinger & Strom, 1973) - (Australian Female Prisoners) - PTSD and history of abuse was ubiquitous - factors contributed significantly to their criminal histories - Dysfunctional social groups (drug users) higher rate of PTSD - High levels of depression, suicide attempts and gestures, and alcohol abuse Disordered Affect and Arousal - significant psychological and neurobiological changes - increase vulnerability to other psychiatric disorders McFarland & Yehuda, 1996

Treatment Cognitive Behavior Therapy Eye Movement Desensitization and Reprocessing Psychopharmacology Individuals with PTSD become “stuck” on the trauma - relive the trauma in thoughts, feelings, actions, and images - Organize lives around the trauma - Avoidance: - isolation (situations, people, emotions) - drug and alcohol use - dissociation to keep thoughts out of conscious awareness - Changes in self-concept and world view Aim of therapy: help move away from the past and move away from interpreting arousal as a return of the trauma - become fully engaged in the present - regain control of emotional responses - take charge of life as a preemptive attempt to avoid future trauma van der Kolk, McFarlane, & Hart, 1996

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