The story of PTSD is the tale of the indomitable and

indefatigable human spirit to survive and adapt.

Dr. Donald Meichenbaum

Psychological Constructs After Trauma

Fear stucture Trauma memory Early trauma stucture Early PTSD symptoms Recovery processes

A fear structure is a program for escaping danger

It includes information about:

The feared stimuli

The fear responses

The meaning of stimuli and responses

Trauma Memory

Is a specific fear structure that includes representations of: Stimuli present during the trauma Physiological and behavioral responses

that occurred during the trauma Meanings associated with these stimuli

and responses Associations among stimulus, response,

and meaning representations may be realistic or unrealistic

Schematic Model of a Memory Shortly After the Rape

Scream

Confused Incompetent

Afraid

I - Me

Uncontrollable

Rape Man

Shoot

GunBald

Tall

Freeze

Say“I love you”

Alone Suburbs

Home

PTSDSymptoms

Dangerous

Source: Edna Foa, PE for PTSD

Characteristics Of Early Trauma Structure

Large number of stimuli Excessive responses (PTSD

symptoms) Erroneous associations between

stimuli and “danger” Erroneous associations between

responses and “incompetent” Fragmented and poorly organized

relationships among representations

Early PTSD Symptoms

Trauma reminders in daily life activate the trauma memory and the associated perception of “danger” and “ self incompetence”.

Activation of the trauma memory is reflected in re-experiencing symptoms and arousal

Re-experiencing and arousal motivate avoidance behavior.

Recovery Processes

Repeated activation of the trauma memory (emotional engagement)

Incorporation of corrective information about “world” and “self”

Activation and disconfirmation occur via confronting trauma reminders (e.g., thinking about, and contact with trauma reminders)

Corrective information consists of the absence of the anticipated harm

Schematic Model of a Recovered Rape Memory

Scream

Confused Incompetent

Afraid

I - Me

Uncontrollable

Rape Man

Shoot

GunBald

Tall

Freeze

Say“I love you”

Alone Suburbs

Home

Dangerous

Source: Edna Foa, PE for PTSD

Emotional Processes After Trauma

Schematic Model of Emotional Processing

Recovery Pathology

Schemas

SelfSchema

World Schema

TraumaticEvent

TraumaRecords

Post-TraumaEvents

Post-TraumaRecords

Pre-TraumaRecords

Source: Edna Foa, PE for PTSD

Schematic Model of Recovery Following Trauma

Recovery

Schemas

SelfSchema “I am mostly competent.”

World Schema “The world is mostly safe.”

TraumaticEvent

TraumaRecords “It was not my

fault; I handled it as well as could be expected.”

Post-TraumaEvents

Post-Trauma

Records “Some but not all people can

be trusted; PTSD

symptoms are normal and temporary.”

Pre-Trauma RecordsBalanced, flexible

premises about “self” and “world”

Source: Edna Foa, PE for PTSD

Schematic Model of Developing Pathology Following Trauma

Pathology

Schemas

SelfSchema

“I am entirely incompetent.”

World Schema “The world is

entirely dangerous.”

TraumaticEvent

TraumaRecords

“It is my fault.”

Post-TraumaEvents

Post-Trauma

Records “People are

untrustworthy; PTSD

symptoms are dangerous.”

Pre-Trauma RecordsRigid premises about

“self” and “world”

1038Source: Edna Foa, PE for PTSD

Vulnerabilities to PTSD

Pre-Trauma Factors

A history of prior traumatization Underdeveloped protective skills Personality negative thought

patterns Biology/hereditery factor Family characteristics Recent life stressors Initial distress at the time of trauma

Post-Trauma Factors

Recovery environment lack of support from family, friends and community

Secondary victimization Conspiracy of silence Ineffective coping Lack of treatment or ineffective

treatment

CBT Treatments for PTSD

• Promote safe confrontations (via exposure, discussions) with trauma reminders (memories, situations)

• Aim at modifying the dysfunctional cognitions underlying PTSD

• Exposure Procedures

• Anxiety Management Procedures

• Cognitive therapy

Cognitive-Behavioral Treatment

A set of techniques designed to

help patients confront their feared

objects, situations, memories, and

images (e.g., systematic

desensitization, flooding).

Anxiety Management Treatment

Relaxation Training Controlled Breathing Positive Self-talk and Imagery Social Skills Training Distraction Techniques

(e.g., thought stopping)

Cognitive Therapy

Identifying dysfunctional, erroneous thoughts and beliefs (cognitions)

Challenging these cognitions Replacing these cognitions with

functional, realistic cognitions

When circumstances don’t fit our ideas, they become our difficulties

-Benjamin Franklin-

I don’t want to remember but I can’t seem to forget

-PTSD Sufferer-

The Basic Principles of Cognitive Restructuring

Major PTSD treatment goal is to integrate dissociated trauma material with associated memories, so the fabric of our memory becomes like one continuous memory.

Integration is facilitated by restructuring unproductive ideas that maintain emotional arousal and interfere with processing.

Unproductive ideas can relate to the present, the past, or the future. Each can keep arousal dysfunctionally high.

Cognitive therapy asserts that thoughts significantly influence our reactions to events.

Cognitive therapy enables us to stop, identify unproductive thoughts, and replace them with more functional thoughts.

We stop running from arousing thoughts or only partially confronting them, and begin to persistently confront and challenge them

We shift from the helpless victim mode to the action mode, gaining mastery over the one thing we can consistently control our thoughts

ABC Model of Cognitive Therapy

A B C A = stand for the Activating (or

upsetting) event B = is the Belief (or automatic

thoughts) that we tell ourselves about A C = is the emotional and physical

Consequences (or arousal)Most people think that A causes C. In reality, it is B, our self talk, that has greater influence.

Automatic Thoughts and Distortions

When upsetting event occurs, automatic thoughts (ATs) run through our minds. Although we’re all capable of thinking reasonably about upsetting events, sometimes our automatic thoughts are distorted or unreasonably negative.

Distorted ATs occur so rapidly that we hardly notice them, let alone stop to question them. Yet these ATs profoundly affect our mood, our body’s arousal, and our ability to process clearly.

The Distortions Thoughts on PTSD

1. Flaw Fixation fear focus ATs2. Dismissing the Positive3. Assuming ; - mind reading

- jumping to conclusions

- fortune telling4. Catastrophizing horrible or awful5. All-or-none thinking think in extremes6. Should (must/ought) rigid demands

7. Making feelings facts 8. Over generalizing9. Abusive labeling10. Personalizing11. Blaming12. Unfavorable comparisons13. Regrets

Analyzing & Processing

Step 1 : The FactsAt the top briefly describe an upsetting event from the past, present, or future and the resulting feeling. Rate the intensity of these feelings (from 1 to 10). Remember, getting in touch with disturbing feelings is a way to stop them from controlling us.

Step 2 : Analysis of thoughts- List of Automatic thoughts (ATs)- Identify the distortions- Try to respond, or talk back, to each distorted AT

Step 3 : ResultWith this process, upsetting events will still probably be upsetting, though not as disturbing

The Seven Principles of Healing

1. Healing starts by applying skill to manage PTSD symptoms

2. Healing occurs when traumatic memory is processed or integrated

3. Healing occurs when confronting replaces avoidance

4. Healing occurs in a climate of safety and pacing5. Healing occurs when boundaries are intact6. Kind awareness and acceptance of feeling aid

the healing journey7. Balance in our lives is necessary to heal

The life you have led doesn’t need to be the only life you have

-Anna Quindlen-

thank you