1. 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

2. 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

3. 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

4. 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.

5. 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.

6. 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.

7. 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

8. What is PTSD?
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.

9. 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

10. 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

11. 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

12. 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.

13. Exercise – table discussion
Disease ranking

14. 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?

15. Impacts of trauma
- affects on the brain
- affects on child development
- affects on memory

16. 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.

17. 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%).

18. 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

19. 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

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

21. How healing happens?
Why do I feel so crazy -
How healing happens -

22. Effective treatments and supports
Trauma-focused cognitive behavioural therapy
Prolonged Exposure Therapy
Cognitive Processing Therapy
Eye Movement Desensitisation and Reprocessing (EDMR)
Medication

23. 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

24. Where to get help GP – Better Access
A Psychologist (The Australian Psychological Society has a referral service: Ph )
A psychiatrist (see RANZCP website)
Local community mental health centre

25. 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  

26. 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  

27. 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

28. How to help - exercise
Fact sheets

29. Helpful resources
Promoting recovery after trauma -
Factsheets and booklets -
Online treatment programs
Mindspot -
eCentreClinic -
Mental Health Online -
PTSD Coach Australia app -