1. Understanding Trauma 101 Tracy Harvey, MSW, RSW Clinical Traumatologist Community Addiction Service Administrator Alberta Health Services Addiction and Mental Health tracy.harvey@albertahealthservices.ca

2. Although the world is full Of suffering, it is also full of the overcoming of it. Helen Keller

3. Objectives Increase awareness of trauma Understanding the impacts of trauma Exploration of resources

4. Non-diagnostic Definition of Trauma Trauma is considered to be any experience(s) that cause intense physical and psychological stress reactions. It can be one or many events, repeated experiences and/ or a set of life circumstances that threaten or harm an individual and have lasting effect on their physical, emotional, social and spiritual wellbeing. (SAMHSHA, 2012, p. 2, cited in SAMHSA 2013, p. xix).

5. Type 1 and Type 2 Trauma Type 1 One-time event Likelihood of good outcome (recovery) Type 2 On-going trauma Unavoidable Recovery more challenging

7. Common diagnosis Personality disorders Obsessive-compulsive disorder Somatization disorder Learning disabilities ADD/ ADHD Bipolar Substance abuse Attachment disorders

8. Trauma diagnosis Reactive Attachment Disorder (youth) Disinhibited Social Engagement Disorder (youth) PTSD (post-traumatic stress disorder) ASD (acute stress disorder) Adjustment Disorders DTD (developmental trauma disorder)

9. Developmental Trauma Disorder A. Exposure. The child or adolescent has experienced or witnessed multiple or prolonged adverse events over a period of at least one year beginning in childhood or early adolescence B. Affective and Physiological Dysregulation. The child exhibits impaired normative developmental competencies related to arousal regulation C. Attentional and Behavioral Dysregulation: The child exhibits impaired normative developmental competencies related to sustained attention, learning, or coping with stress D. Self and Relational Dysregulation. The child exhibits impaired normative developmental competencies in their sense of personal identity and involvement in relationships E. Posttraumatic Spectrum Symptoms. The child exhibits at least one symptom in at least two of the three PTSD symptom clusters B, C, & D. F. Duration of disturbance (symptoms in DTD Criteria B, C, D, and E) at least 6 months. G. Functional Impairment. The disturbance causes clinically significant distress or impairment in at least two of the following areas of functioning: Scholastic Familial Peer group Legal Health vocational

10. The most violent place in America Perry, 1995

11. Challenges in Assessments Misunderstanding or intentional misrepresentation of symptoms Age of trauma Age of client Halo effect Emotional destabilization Ability and confidence of therapist Dissociation Complexity

12. Affect Disregulation – key characteristics Chronic preoccupation with suicide Self injury Overreaction to minor stress Become emotionally and cognitively overwhelmed Inability to calm or soothe oneself Alcohol and other drug use Problems with eating Compulsive sexual actives Trauma Bond Haskell, L. (2003) First stage trauma treatment: A guide for mental health professionals working with women. Toronto: Centre for Addictions and Mental Health (CAMH)

13. Issues for Clients in Dual Recovery Symptoms are often masked by either the trauma or addiction Both trauma and addiction are prone to minimization Tendency to become overwhelmed or disorganized Reliance on substances to contain trauma symptoms

14. Issues for Clients in Dual Recovery Lack of ability to create healthy boundaries Tendency to engage in self-destructive behaviors Typical treatments for addictions may not be appropriate (12 step) Difficulty in distinguishing ‘am safe’ vs ‘feel safe’

15. Repeated trauma in the adult life erodes the structure of the personality already formed, but repeated trauma in childhood forms and deforms the personality. (Herman, p. 96)

16. Neocortex Subcortex Limbic Brainstem

17. Dissociation A psychophysiological process with psychodynamic triggers which produces an alteration in ongoing consciousness Putman, 1985 Fragmented consciousness Occurs on a continuum

18. Hyperarousal a state of increased psychological and physiological tension marked by such effects as reduced pain tolerance, anxiety, exaggeration of startle responses, insomnia, fatigue, and accentuation of personality traits

19. States of Arousal CalmAlertAlarmFearTerror NormalRestVigilanceFreezeFlightFight Hyper-arousedRestVigilanceResistanceDefiantAggression DissociatedRestAvoidanceComplianceDissociation (partial) Full Dissociation Sphere of Concern WorldCommunityFamilySelfBody Integrity

20. Relationships and healing The core experiences of psychological trauma are the disempowerment and disconnection from others. Recovery therefore, is based upon the empowerment of the survivor and the creation of new connections. (Herman, p. 133)

21. A study in 2009 on the use of Seeking Safety with incarcerated looked at the difference between addiction focused treatment and treatment focused on dual recovery. (Zlotnick, Johnson, Najavits; Behavior Therapy, 2009, 40, p. 325-336.

22. Tri-Phasic Model for treatment Safety Mourning and Rememberance Reconnection

23. Resources AHS newsletter Trauma COP AHS trauma modules AHS Trauma Conference Peter Levine Bruce Perry John Briere First Stage Trauma Treatment - Haskell

24. Resources cont www.ptsd.va.gov www.sanctuaryweb.com www.camh.net www.childtrauma.org www.search-institute.org