Chie MaekoyaTokiwa International Victimology Institute

1The 11th Asian Post Graduate Course on Victimology and Victim Assistance

What is a traumatic experience? Possible reactions to a traumatic situation Effects of victimization Ecological view of psychological trauma Recovery Treatment Resilience Posttraumatic growth

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Traumatic eventTraumatic eventExperience that causes physical, emotional, psychological distress, or harm. It is an event that is perceived and experienced as a threat to one's safety or to the stability of one's world.

The person’s response involves intense fear, helplessness or horror

e.g.) natural disaster, war, terrorism, physical assault, sexual assault, spousal abuse, child abuse, traffic accident

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An event is likely to be traumatic if: It happened unexpectedly. It was unprepared. Victim felt powerless to prevent it. It happened repeatedly. Someone was intentionally cruel. It happened in childhood.

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Emotional Effects shock terror irritability blame anger guilt grief or sadness emotional numbing helplessness loss of pleasure derived from familiar activities difficulty feeling happy difficulty experiencing loving feelings

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Cognitive Effects impaired concentration impaired decision making ability memory impairment disbelief confusion nightmares decreased self-esteem decreased self-efficacy self-blame intrusive thoughts/memories worry dissociation (e.g., tunnel vision, dreamlike or "spacey"

feeling)

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Physical Effects fatigue, exhaustion insomnia cardiovascular strain startle response hyper-arousal increased physical pain reduced immune response headaches gastrointestinal upset decreased appetite decreased libido vulnerability to illness

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Interpersonal Effects increased relational conflict social withdrawal reduced relational intimacy alienation impaired work performance impaired school performance decreased satisfaction distrust externalization of blame externalization of vulnerability feeling abandoned/rejected overprotectiveness

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• Belief in personal invulnerability• Perception of the world as meaningful• Perception of oneself as positive

Traumatic eventTraumatic event Threat Danger

Insecurityself-questioning

Basic assumptions victims hold about themselves and their world

change assumption

Negative emotion brings questions that sometimes damagewhat one believes about oneself, others, and the world

Individuals are not equally vulnerable to, nor similarly affected by, traumatic events.

Persons, events, environments factors may influence an individual post-traumatic response and recovery.

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Traumatic Traumatic EventEvent

Reaction to the traumatic event Recovery

Person Event Environment

Person◦ Age ◦ Developmental stage◦ Initial distress level ◦ Intelligence ◦ Personality ◦ Affects ◦ Cognition ◦ Coping styles ◦ Role ◦ Relationship between victim and offender

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Event◦ Frequency◦ severity and duration of the event experienced◦ degree of physical violence and bodily violation

involved◦ the extent of the terror and humiliation

endured◦ whether trauma was experienced alone or in

the company of others

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Environment◦ context within which the traumatic event was

experienced (home, school, work place or other context) ◦ victim’s natural support system◦ the ability of that system to foster adaptive rather than

maladaptive coping◦ the degree of safety and control afforded the victim

post-trauma◦ attitudes and behaviors of first respondents ◦ action and understanding of family, friends, caregivers,

significant individual/ group◦ community attitude and values◦ political and economic factors attending victimization◦ the quality, quantity, accessibility and cultural relevance

of victims care and advocacy resources

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Normal response to loss, particularly to the loss of someone or something to which a bond was formed.

Five Stages of Grief and Loss (Kubler-Ross, 1969) Denial “This can’t be happening to me. ” Anger “Why me?” “How can this happen to

me?” Bargaining “Make this not happen, and in return

I will __.” Depression “I’m so sad.” Acceptance “It’s going to be okay.”

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Post Traumatic Stress Disorder (PTSD)◦ Re-experiencing the traumatic event◦ Avoidance and emotional numbing◦ Increased arousal

Acute Stress Disorder (ASD) Anxiety disorders Mood disorders Substance abuse Eating disorders Sexual dysfunction Self medicating Suicide

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A personal and unique process that reflects a change in one’s attitudes, values, feelings, goals, skills, and roles, and it involves the development of new meaning and purpose in one’s life. It moves a person from the state of pain, confusion, and anger to a state of normativeness.

Psycho/social coping theory (Dussich, 2006) focusing on the presence and strength or the absence and weakness of individual coping resources.

Three psychosocial recovery conditions: Absence of major symptomsPositive identity of self Resumption of a functional daily life

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Establishment of Establishment of safetysafety

Reconnection Reconnection with ordinary lifewith ordinary life

Remembrance Remembrance and mourningand mourning

Herman, 1992

A guiding principle of achieving recovery is to help a person regain power and control.

Establishing safety begins by focusing on control of the body and gradually moves outward toward control of the environment.

Indicators of the establishment of safetyVictims: No longer feel completely vulnerable or isolated Able to control most disturbing symptoms Able to rely on self and others for support Sense of deserving support and care

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Reconstruction of the trauma involves the victims telling the details of the trauma so that memory can be integrated into the survivor’s life story.

Process involves intense grief. Ultimately they are able to put the story,

including the imagery, into words. The victim achieves the ability to construct not only what happened but also what he felt.

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The survivor faces the task of creating a future

They develop ◦ New sense of self◦ New relationships◦ A meaning for life “faith”

Empowerment and reconnection are the core experiences of recovery.

A sense of power and control will be increased in this last stage.

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Authority over the remembering processIntegration of memory and affectAffect toleranceSymptom masterySelf-esteem and self-cohesionSafe attachmentMeaning making

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Authority over the Authority over the remembering processremembering process

Integration of memory Integration of memory and affectand affect

An individual has a new or renewed authority over the remembering process. She can choose to recall the event or not.

The balance of power between the individual and her memories is reversed.

Memory and affect are joined.

The past is remembered with feeling.

An individual is able to identify contemporary feelings about the past.

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Affect toleranceAffect tolerance Symptom masterySymptom mastery

Affects associated with traumatic events no longer overwhelm or threaten.

Feelings can be felt and named and endured without dissociation.

Persistent symptoms have decreased and become more manageable. Stimulus for trigger of flashback are known and can be avoided.

An individual might continuously experience symptomatic arousal, but she has mastered and practices healthy coping routines to reduce arousal and manage stress.

An individual gains the ability to predict and manage symptoms.

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Self esteem & Self CohesionSelf esteem & Self Cohesion

An individual feels sense of self and self worse

Feeling of guilt, shame and self-blame are decreased and new or newly restored sense of self-worth is given.

Self-critical review is replaced by more realistic appraisal, reflecting a more positive new view of self.

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Safe AttachmentSafe Attachment Meaning MakingMeaning Making

An individual entails the development or the repair and restoration of a survivor’s relational capacities. The pull to isolation is replaced by a new or renewed capacity for trust and attachment.

An individual is able to negotiate and maintain physical and emotional safety in relationship and views the possibility of intimate connectedness with some degree of optimism.

An individual assigns new meaning to the trauma, to the self as a trauma survivor and to the world in which traumatic events occur.

He might embrace the belief that misfortune endured has yielded new found strength and compassion.

He names and mourns the traumatic past and imbues it somehow with meaning that is both life affirming and self-affirming.

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Incidence of dysfunction= stress + risk factorsocial supports + coping skills + self-esteem

(Swift, 1986)

Personal resources ◦ Physical assets◦ Psychic assets◦ Socio assetsAdequate resources result in resiliency, safety,

and an enhanced ability to recoverRecovery is best facilitated by the tailoring of

resources that are person-specific, culture-sensitive & situation-realistic (Dussich, 2008).

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traumtraumaa

victim

citizensurvivor

Their world view reduced to a narrow focus on their physical health and basic needs

Beginning to find their place in their worldmake adjustment to accommodate their new situation reestablishing connection with their friend and community

Fulfillment of the individual’s rights social integration and access to all aspects of society

Ferguson, Richie and Gomez (2004)

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The process of recovery is highly individualistic.

Victim servicesThe purpose is to reduce victims suffering and to

facilitate victim recovery (Dussich, 2006). Victim service providers need to gather appropriate

resources.Services which facilitate victim’s recovery

health and psychological care Advocacy Personal social support Justice system services Financial reparation

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Treatment is necessary if survivors have.. Experienced of difficulty in social/ personal life Long persistence of symptoms Risk for suicide and self harming behaviorPossible treatment methods Psychotherapy Psycho education

◦ Normalization, self blame, give information to help understanding Cognitive Behavioral Therapy (CBT)

working cognitions to change emotion, thoughts and behaviors Eye Movement Desensitization and Reprocessing (EMDR)

accelerated information-processing model to account for resolution of traumatic memories Group therapy Play therapy (children) Pharmacotherapy (medication)

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Factors in resilience ◦ Caring and supportive relationship within and

outside the family◦ Capacity to make realistic plan and take steps

to carry them out◦ A positive view of yourself and confidence in

your strength and abilities◦ Skills in communication and problem solving◦ Capacity to manage strong feelings and

impulses

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Make connections Avoid seeing crises as insurmountable

problems Accepting that change is a part of living Move toward the goal Take decisive actions Look for opportunities for self-discovery Nurture a positive view of yourself Keep things in perspective Maintain a hopeful outlook Take care of yourself

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Positive changes which occur as a result of coping with a traumatic event.

PTG includes: Improvement of relationships with others Openness to new possibilities Greater appreciation of life Enhancement of personal strength Spiritual development

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