The Fundamentals and Treatment of Trauma - Georgia … · The Fundamentals and Treatment of Trauma Shannon K. Nix, M.S., ... Trauma-Focused CBT (TF-CBT) TF-CBT: a ... The National

The Fundamentals and Treatment of Trauma Shannon K. Nix, M.S., LPC, NCC

Associate Director, Sexual Assault and Violence Intervention & Prevention (SAVIP) at the University of South Carolina

Objectives

As a result of this workshop you will be able to:

Demonstrate knowledge of trauma to include post-traumatic stress disorder as defined in the DSM-5 and the neurobiology of trauma.

Apply evidence-based therapeutic techniques when working with trauma survivors.

Shannon K. Nix, M.S., LPC, NCC, January 2016

What is trauma?

Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being (SAMHSA, 2014)


What is trauma: DSM-5

Exposure to actual or threatened death, serious injury or sexual violation

Causes clinically significant distress or impairment in the individual’s social interactions, capacity to work or other important areas of functioning

4 symptom clusters 1. Re-experiencing 2. Avoidance 3. Negative thoughts/mood 4. Arousal


Neurobiology of Trauma

HPA Axis

Fight Flight Freeze

Normal, involuntary, automatic, and biological response to trauma


Effects of Stress Hormones

Impairment in rational thought Irritability Emotional numbing Tonic immobility or “rape paralysis syndrome” Unexpected reactions (laughing, positive mood)

Disorganized/fragmented memory of event

A word on alcohol and memory


Evidence-based Interventions


Trauma Treatment

Evidence-based interventions include but are not limited to Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), Trauma-Focused CBT (TF-CBT)

TF-CBT: a structured, short-term treatment model (8-25 sessions) for children/adolescents and their caregiver

PE: exposure therapy (in vivo and imaginal) combined with breathing/relaxation exercises; also structured and short-term (8-15 sessions)


Cognitive Processing Therapy (CPT)

Developed by Patricia Resick, PhD, Kate Chard, PhD, and Candice Monson, PhD

Endorsed by the U.S. Department of Veterans Affairs and Defense and the International Society of Traumatic Stress Studies as a best practice treatment for PTSD

Consists of 12 sessions, manualized, assignment-heavy Main goals: clients feel their feelings about the

trauma/s and balance their beliefs


CPT: A timeline

Intake: Client reports a trauma hx Assess for PTSD and other disorders Educate client on PTSD and CPT Sessions 2-3: Determine the client’s willingness/ability to participate in CPT CPT contract Begin therapy (12+ sessions) Ongoing Consult, consult, consult & debrief, debrief, debrief Aftercare


CPT: Important Concepts

Just world belief

Assimilation

Accommodation

Over-accommodation

Stuck points Shannon K. Nix, M.S., LPC, NCC, January 2016

CPT: Important Concepts

1. Safety 2. Trust 3. Power/control 4. Esteem 5. Intimacy


CPT: Sessions 1-2

Session 1: Introduction & Education Therapist does most of the talking Client is overwhelmed at the end – be prepared for this First HW assignment: Impact Statement, begin Stuck Point log

Session 2: Meaning of the Event (Impact Statement) Client reads Impact Statement while therapist listens for

additional stuck points ABC sheet education Second HW assignment: Complete ABC sheets daily + one on

the most traumatic incident Shannon K. Nix, M.S., LPC, NCC, January 2016

Session 2a: Optional session for Traumatic Bereavement Introduced at end of session 2 in lieu of ABC

worksheets When to use:

Ct. witnessed death of a loved one Ct. experienced unexpected & traumatic death of a

loved one Ct. experiencing survivor guilt Ct. may have killed others (combat)


CPT: Session 3

Session 3: Identification of Thoughts & Feelings (ABC sheet) Review ABC sheets to ensure client has the hang of it Review ABC sheet on traumatic incident Assign written Trauma Account Third HW assignment: write trauma account with as many

details as possible and ct’s thoughts/feelings during event


CPT: Sessions 4-5 (Trauma Accounts)

Session 4: Remembering Traumatic Events (account/s) Client reads Trauma Account aloud in session Client and therapist identify additional stuck points Fourth HW assignment: Second Trauma Account

Session 5: Remembering Traumatic Events Client reads second account aloud in session Identify differences between first and second account, focusing

on thoughts/feelings Introduce Challenging Questions worksheet Fifth HW assignment: complete CQ worksheet on one SP daily


CPT: Sessions 6-7

Session 6: Challenging Questions Shift in therapist bx: Ct. now begins to ask & answer Socratic questions

for themselves

Focus also shifts to over-accommodation

Introduction to Patterns of Problematic Thinking

Sixth HW assignment: Patterns of Problematic Thinking worksheet

Session 7: Patterns of Problematic Thinking Introduce the Challenging Beliefs worksheet

Introduce first of five themes: Safety

Seventh HW assignment: Challenging Belief worksheet daily, read Safety module and complete a CB worksheet as necessary


Session 8: Safety Issues Session 9: Trust Issues Session 10: Power/Control Issues Session 11: Esteem Issues Session 12: Intimacy Issues & Meaning of the Event

Client reads aloud a new Impact Statement focusing on what the event means to them now and on their current beliefs in the five topic areas above.

Therapist reads original Impact Statement to client.

CPT: Sessions 8-12


CPT: Aftercare

At last session, schedule an appointment 1-2 months in the future.

Client is to continue using CPT skills (worksheets included) At follow up, therapist and client can decide how long

before next appointment. Some programs have monthly, drop-in aftercare groups


For More Information: CPT

Official website: http://cptforptsd.com/ CPT training package order form:

https://www.newpaltz.edu/media/idmh/idmh_cpt_training.pdf Center for Deployment Psychology:

http://deploymentpsych.org/treatments/cognitive-processing-therapy-cpt http://deploymentpsych.org/online-courses/cpt

MUSC online course (free): https://cpt.musc.edu/ National Center for PTSD:

http://www.ptsd.va.gov/ http://www.ptsd.va.gov/public/treatment/therapy-

med/cognitive_processing_therapy.asp Sign up for their newsletter from the main site


http://cptforptsd.com/

https://www.newpaltz.edu/media/idmh/idmh_cpt_training.pdf

http://deploymentpsych.org/online-courses/cpt

http://deploymentpsych.org/online-courses/cpt

https://cpt.musc.edu/

http://www.ptsd.va.gov/

http://www.ptsd.va.gov/public/treatment/therapy-med/cognitive_processing_therapy.asp

http://www.ptsd.va.gov/public/treatment/therapy-med/cognitive_processing_therapy.asp

For More Information: PE

Center for Deployment Psychology: http://deploymentpsych.org/treatments/prolonged-exposure-therapy-ptsd-pe

National Center for PTSD: http://www.ptsd.va.gov/public/treatment/therapy-med/prolonged-exposure-therapy.asp


http://deploymentpsych.org/treatments/prolonged-exposure-therapy-ptsd-pe

http://deploymentpsych.org/treatments/prolonged-exposure-therapy-ptsd-pe

http://www.ptsd.va.gov/public/treatment/therapy-med/prolonged-exposure-therapy.asp

http://www.ptsd.va.gov/public/treatment/therapy-med/prolonged-exposure-therapy.asp

For More Information: TF-CBT

TF-CBT Therapist Certification Program: https://tfcbt.org/ MUSC online course (free): https://tfcbt.musc.edu/ The National Child Traumatic Stress Network manual:

http://www.nctsnet.org/nctsn_assets/pdfs/TF-CBT_Implementation_Manual.pdf


https://tfcbt.org/

https://tfcbt.musc.edu/

https://tfcbt.musc.edu/




RESOURCES Alvarez, J., McLean, C., Harris, A. H. S., Rosen, C. S., Ruzek, J. I., Kimerling, R. (2011). The comparative

effectiveness of cognitive processing therapy for male veterans treated in a VHA posttraumatic stress disorder residential rehabilitation program. Journal of Consulting and Clinical Psychology, 79(5), 590-599.

American Psychiatric Association. (2013). Posttraumatic Stress Disorder. Retrieved from http://www.dsm5.org/Documents/PTSD%20Fact%20Sheet.pdf Campbell, R. (The United States Department of Justice, National Institute of Justice). (2012, December 3). The Neurobiology of Sexual Assault. Retrieved from http://nij.gov/multimedia/presenter/presenter-campbell/Pages/welcome.aspx Lilly, M. M., & Valdez, C. E. (2012). Interpersonal trauma and PTSD: The roles of gender and a lifespan perspective in predicting risk. Psychological Trauma: Theory, Research, Practice, and Policy, 4, 140-144. Resick, P. A., Monson, C. M., & Chard, K. M. (2008a). Cognitive processing therapy: Veteran/military version. Washington, DC: Department of Veterans’ Affairs. Resick, P. A., Galovski, T. E., Uhlmansiek, M. O., Scher, C. D., Clum, G. A., & Young-Xu, Y. (2008b). A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. Journal of Consulting and Clinical Psychology, 76(2), 243-258. Resick, P. A. (n.d.). Research on cognitive processing therapy: Beyond the basics [PDF document]. Retrieved from http://uwf.edu/cap/HCWMS/materials/Resick%20-%20Research%20on%20Cognitive%20Processing%20Therapy.pdf. Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.


http://www.dsm5.org/Documents/PTSD Fact Sheet.pdf

http://nij.gov/multimedia/presenter/presenter-campbell/Pages/welcome.aspx

http://uwf.edu/cap/HCWMS/materials/Resick - Research on Cognitive Processing Therapy.pdf



