Professional Documents
Culture Documents
Julian D. Ford, Ph.D. Department of Psychiatry University of Connecticut Health Center Center for Trauma Response, Recovery and Preparedness (CTRP) www.CTRP.org
Recurrent Unwanted Memories Awake/Asleep or Biopsychological Distress 2 Reminders Avoidance of Internal/External Reminders, Emotional Numbing, Social Detachment, Amnesia Hyperarousal (Anxious, Irritable, Insomnia, Poor Concentration, Hypervigilance, Reactive) Significant psychosocial/healthcare impairment Duration 30+ days (may be delayed or chronic)
What is PTSD?
Post =
After
or
Stress = Disorder =
Temporal
Traumatic Shock + Acute Stress Symptomatology = first month Traumatic Grief = 3-6 months Extent and Nature of Exposure or Loss Females > Males Old Age = Risk & Reslience Children: Caregiver Contagion, not age Socioeconomic or Ethnocultural Adversity
Individual
Sociocultural
Facts about PTSD Regardless of whether your life is in danger or you are directly physically harmed, the closer you are to death or danger (including as a witness or as a bereaved friend or loved one) the more likely (but not definitely) you will experience traumatic stress
Facts about PTSD The natural tendency is to avoid thinking about or getting help for traumatic stress reactions But the best way to prevent or recover from PTSD is to recognize and deal with stress reactions before or as soon as possible after they are a disorder
External stimuli
THALAMUS
Novelty & Threat Detection
AMYGDALA
Alarm
HIPPOCAMPUS
Cognitive Map/Categories Working Memory
Locus Coeruleus
Memory Encoding Activation
If you keep reacting to daily stressors as if you wont survive, the body assumes youre still in danger and wont turn off the brains alarm! If you deal with daily stressors by using your brains organizing system, youre showing your body that youre safe--& the alarm turns down
Emotion Self-Check
Evaluate Thoughts Define Personal Needs/Goals Open New Options for Achieving Goals Make a Contribution (Live Your Values)
Emotionally Contained Yet Compassionately Present Modeling Modulated Concern and Sadness Observe and Educate re: Stress/Grief Reactions Amelioration of Immediate Physical Impairment Facilitation of Personal Control/Choice Recognition of Role Concerns re:Significant Others Confident referral to mental health if indicated
Step 3: Self Check (How much distress? How much control? The worst ever?)
Phase I: Critical Incident Stress Management (CISM) Four Essential Steps, No Panacea
FACTS Non-intrusive inquiry into specifics THOUGHTS Encourage linkage of facts FEELINGS Support and encourage CLOSURE Normalization, education, reassurance
Phase I: Critical Incident Stress Management (CISM) Scientific Evidence: Not a Panacea
Potentially Effective (e.g., EMS Team post9/11) 1. For intact work teams or groups 2. To reconstruct a shared narrative Potentially Harmful (e.g., MVA survivors) 1. Single-session individual debriefing 2. To heighten distress or force recall of trauma
Conclusion: PTSD Can be Prevented and Treated Successfully Health Care Providers Role
1.
Educate patients about stress and survival reactions, and ASD and PTSD 2. Teach Focusing Skills by Own Example 3. Identify Early Signs of PTSD and Refer to Qualified Trauma Treatment Specialists 4. Reinforce the FREEDOM Skills even in brief health care encounters