1. Healing and Modalities of Therapy Bob Campbell, Psy.D., M.Div. MKSN Conference April 20, 2013

2. Adult Survivors of Childhood Trauma Every case is unique Not every person will develop a disorder The type or severity of trauma does not determine the probability of developing a disorder Diathesis/Stress Model Any extreme stressor Physical, sexual, psychological abuse

3. Symptoms of Traumatic Stress Stuck between fight and flight and freeze Flashbacks Re-experiencing Avoidance Hyperarousal Irritability Restricted range of affect

4. PTSD – Posttraumatic Stress Disorder PTSD Usually related to a specific event or series of discrete events Car accident, natural disaster, war Complex PTSD - DESNOS Disorder of Extreme Stress, NOS Prolonged, repeated trauma Additional symptoms Developmental Trauma Disorder – DESNOS in children

5. Disorders of Extreme Stress, NOS Long-term trauma Person held in a state of captivity, physically or emotionally Unable to get away from the danger Examples: Concentration camps Prisoner of War camps Prostitution brothels Long-term domestic violence Long-term child physical abuse Long-term child sexual abuse

6. DESNOS – Additional Symptoms Emotional dysregulation persistent sadness, suicidal thoughts, anger Dissociation Helplessness, shame, guilt, stigma, feelings of isolation Distorted Perceptions of the Perpetrator attributing total power, becoming preoccupied with relationship or revenge Difficulty forming relationships Loss of meaning loss of faith or a sense of despair

7. DESNOS in Trafficked Females SymptomSevere rating Recurrent thoughts/memories75% Feeling the event is reoccuring52% Recurrent nightmares54% Feeling detached/withdrawn60% Unable to feel emotion44% Jumpy, easily startled67% Difficulty concentrating52% Trouble sleeping67% Feeling as if you don’t have a future65% Williamson, Dutch, and Clawson, 2010.

8. Other DESNOS issues Misdiagnosis as PD Poor assertiveness due to avoidance of topic Self-medication Self-mutilation Lack of understanding from others

9. Neurobiological Etiology of PTSD Memory Hippocampus Amygdala Anterior Cingulate Cortex

10. Evidence-Based Treatments for PTSD What is “evidence-based”? Many are based on exposure and response prevention Exposure Scary movies Response prevention Stay present These treatments focus on symptom reduction

11. Types of Treatment CBT – Cognitive Behavioral Therapy CPT – Cognitive Processing Therapy Prolonged Exposure EMDR – Eye Movement Desensitization and Reprocessing EFT (Tapping) – Emotional Freedom Techniques ACT – Acceptance and Commitment Therapy

12. CBT Cognitive Exposure Relaxation Education ThoughtsBehaviorsFeelings

13. CPT Cognitive Therapy Written accounts Exposure elements

14. Prolonged Exposure Classical conditioning antecedents Operant conditioning consequences

15. EMDR Alternating side stimuli Exposure elements Potential neurological change

16. EFT Tapping points Exposure elements Acupressure elements Relaxation elements

17. ACT Meditation Acceptance Willingness Values Defusion Self as context Increases flexibility

18. Non-Evidence-Based Therapies (that work) Existential Psychodynamic Self-Psychology (Not Do-it-yourself Psychology) Humanistic Family therapy Hypnotherapy Solution-focused therapy

19. Medications Anti-depressants SSRIs - paroxetine (Paxil) and sertaline (Zoloft) SNRIs - venlafaxine Atypicals – Wellbutrin, mirtazapine, bupropion Anti-psychotics Risperidone Quetiapine Avoid benzodiazepines Not effective for PTSD Serious side effects

20. Additional DESNOS Treatment Address interpersonal difficulties Restoration of control and power Develop healing relationships which create safety Remembrance and mourning Promote reconnection with everyday life

21. Some things to begin today Self-care Exercise Eating right Enjoying life Meditation Finding meaning Telling your story Finding the help you need

22. Dr. Bob Campbell rcampbell@willowwellness.com www.willowwellness.com