PTSD Exploring the Functional

Nature of Symptoms

Instructor: Dr. Dawn-Elise Snipes LPC-MHSP, LMHC, CCDRC

Executive Director: AllCEUs

Host: Counselor Toolbox and Happiness Isn’t Brain Surgery Podcasts

Objectives

Review PTSD Symptoms and explore their

functional nature

Purpose

By understanding the function of symptoms we

can

Normalize the behavior

Identify alternate ways to meet that same need or

address the issue

Re-Experiencing

Trying to replay it to figure out how to integrate into

your schema (like fitting a puzzle piece)

Reminding the person of similar situations to “protect”

them

Purpose

Avoidance

The system is already over taxed. Avoiding upsetting stimuli

by blocking out most stimuli, memories of the event.

Avoiding unnecessary use of energy by not getting “excited.”

Changes in Beliefs

Protects against future “surprises”

Tries to assimilate the experience into schema

Increased Arousal

Protects the individual

Re-Experiencing

You re-experience things every day

Access schema that guide your actions

When you go to work

When you encounter a particularly volatile client

When you approach a stop light

Re-Experiencing in PTSD

The context is often overgeneralized

The precipitating factors are often unknown

In many cases the resolution was not one of empowerment, resulting in trying to continually figure out how to not be disempowered

Re-Experiencing: Assimilation or Accommodation

Intrusive distressing memories of the traumatic events

In children repetitive play may occur in which themes or aspects of the traumatic events are expressed.

Recurrent distressing dreams in which the content or feeling of the dream is related to the events

In children there may be frightening dreams without recognizable content.

Flashbacks or other dissociative reactions in which the individual feels or acts as if the traumatic events are recurring

In children trauma-specific reenactment may occur in play.

Re-Experiencing

Intense or prolonged psychological or

physiological distress at exposure to internal or

external cues that symbolize or resemble an

aspect of the traumatic events

The event represents a time in which the person

experienced or witnessed something horrifying

The brain is trying to help the client

Avoid future similar situations

Learn how to protect during future similar situations

Avoidance

Purpose: Avoidance of Recurrence of Pain or Arousal of Stress Response System

Emotional numbness and avoidance of places, people, and activities that are reminders of the trauma.

Inability to remember an important aspect of the traumatic events (not due to head injury, alcohol, or drugs)

Purpose: An exhausted system conserves energy in case there is another threat

Markedly diminished interest or participation in significant activities

Feelings of detachment or estrangement from others

Persistent inability to experience positive emotions

Hypocortisolism

Cortisol is the stress chemical

After extreme stress and/or under chronic stress

the brain may reduce the responsiveness of the

stress response system by reducing the cortisol

This is protective, it keeps the organism from

using precious resources by getting “excited”

about anything (including pleasure)

Due to fear conditioning, when a stressor is

detected, the stress response is exaggerated.

Changes in Beliefs

Purpose: The need for order and meaning

(Regaining control, Ability to predict)

Persistent and exaggerated negative beliefs or

expectations about oneself, others, or the world

“I am bad”

“No one can be trusted”

"The world is completely dangerous"

Persistent, distorted blame of self or others about the

cause or consequences of the traumatic events

Changes in Beliefs

Persistent

Fear, horror

Anger

Guilt, shame

Trauma taps in to nearly every basic fear

Loss of Control

The Unknown

Death (Am I going to die? I could have died. I was unable to prevent someone from dying)

Isolation

Failure

Child abuse,

Car accident

Drowning

Bank robbery

Rape

War

Beliefs Interventions

After a trauma people’s lives are changed forever.

It is often necessary to grieve the loss not only of

tangible things like property, but also existential

things like belief in a just world and the goodness

of people.

Identifying the threats and associated thoughts

the person had/is having

Addressing cognitive distortions using Cognitive

Processing Therapy

CPT Challenging Questions

What is the evidence for and against this belief?

Are the sources of this evidence reliable?

Is my reasoning based on facts or feelings?

Is this belief based on habit or facts?

Habits can be persistent negative interpretations or old “tapes” that have never been checked.

Am I basing my belief on the whole picture, or a small aspect of it?

Does my belief contain all-or-none terms?

In what ways is this belief confusing high probability and low probability events?

Increased Arousal

Irritable or aggressive behavior

Anger/threat reaction to continue to self-protect

Interventions:

Help the person identify and address triggers

Develop skills to address emotional and behavioral dysregulation (STOP Stop Think Observe Participate)

Reckless or self-destructive behavior

Stop the pain (I don’t care if I die, because…)

Distract (Numb through thrill)

Regain control (Lightening doesn’t strike twice)

Increased Arousal

Exaggerated startle response (Hypocortisolism)

Think how exhausting it would be to go from 0 to 100

each time you were startled.

Because of hypervigilance, people with PTSD are aware of

more things that may startle

Interventions

Help client understand brain changes that resulted from the

brains “decision” that continuing to use energy to fight was

futile

Develop tools to reduce vulnerabilities and increase energy

reserves

Increased Arousal

Hypervigilance

Purpose: Protective because the world seems dangerous

and unpredictable

Other Symptoms

Problems with concentration

Hypervigilance prevents filtering out extraneous stimuli

Intervention: Create places that are “peaceful and safe”

Difficulty falling or staying asleep or restless sleep

You are vulnerable when you are asleep

Create a safe sleeping space and ability to easily re-ground

Emotional support dogs can be helpful here

Final Thoughts

Tormenting thoughts and feelings and attempts to

stop or avoid those thoughts and feelings are

central to PTSD

In the song “Wrong Side of Heaven” by Five Finger

Death Punch the artist speaks of this torment.

Imagine you have been in a situation in which you

Had to kill to protect others

Had to let someone die to protect yourself and be

there for your kids/family

Wrong Side of Heaven

I spoke to God today and she said that she's ashamed. What have I become. What have I done

I did some awful things in the spirit of what was right

I spoke to the devil today and he swears he's not to blame, and I understood 'cause I feel the same.

I accept that the devil did not make me do it. I chose it, but at what cost.

Arms wide open, I stand alone. I'm no hero and I'm not made of stone.

I feel totally isolated. I don’t believe people could understand. I did not do it to be a hero. I am tormented by what I felt I had to do for what I felt was right.

Wrong Side of Heaven Right or wrong, I can hardly tell. I'm on the wrong side of

heaven and the righteous side of hell.

I know what I did, I did for the right reasons, but I don’t feel deserving of forgiveness, but I also don’t believe I should be damned because I was trying to do what was right.

I heard from God today and she sounded just like me. What have I done and who have I become.

Like God, I talk, believe, pray about doing things for the right reasons

I saw the devil today and he looked a lot like meI looked away, I turned away

Like the devil, I have done a lot of things I don’t know if I can forgive myself for, and am not sure if I deserve forgiveness. I can’t stand to see the potential for evil in myself.

Summary

Increased Arousal

The traumatic threat was unpredictable, ergo future events are unpredictable.

Increased arousal keeps people alert to potential threats.

Using CPT Challenging Questions help the client examine his/her beliefs about the event and his/her current safety

Avoidance and numbing helps the person survive since nobody can be “alert” and agonizing for that long

Helping the person understand that during a traumatic event, certain chemicals in the body prevent effective memory formation. This is protective.

Numbing helps preserve precious energy.

Summary

Changes in beliefs

Keeps the person from being vulnerable again

Helps the person try to make sense of it.

Re-Experiencing

Like trying to fit a puzzle piece, the brain is trying to

make sense of how this fits into current schema

The brain may have to develop new schema based on

likely faulty memories from the trauma, so many

stimuli are overgeneralized and cause “triggers” for

anxiety to be everywhere.