Understanding and Treating Trauma in Adolescents. What is PTSD?

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1 Understanding and Treating Trauma in Adolescents Patrick L. DeChello Ph.D., LCSW, RPH Copyright 2013 D & S Associates 1 PTSD 1. What is PTSD??? 2. Who is at risk for PTSD??? 3. When does PTSD start???& How long does it last??? 4. Symptoms 5. Consequences Physiological outcomes Psychological outcomes Self-destructive behaviors 6. Treatment Psychotherapy Pharmacotherapy Copyright 2013 D & S Associates 2 What is PTSD? PTSD is an anxiety disorder that develops in response to a stressful event or situation of exceptionally threatening or catastrophic nature Copyright 2013 D & S Associates 3

2 Traumatic events Traumatic events that may trigger PTSD include: violent personal assaults Sexual assault Physical attack Abuse Stabbing natural disasters Accidents Military combat. Copyright 2013 D & S Associates 4 WHO IS AT RISK? Every One!!! Copyright 2013 D & S Associates 5 Who is at risk for PTSD?? People with military combat experience or civilians who have been harmed by war People who have been raped, sexually abused, or physically abused People who have been involved in or who have witnessed a life-threatening event People who have been involved in a natural disaster, such as a tornado or an earthquake Copyright 2013 D & S Associates 6

3 When does PTSD start?? & How long does it last??? The symptoms of PTSD can start after a delay of weeks, or even months. They usually appear within 3 months after the traumatic event. Some people get better within 6 months. Others may have the illness for much longer. Copyright 2013 D & S Associates 7 Symptoms Re-experiencing the event through flashbacks or nightmares Avoiding people, places or thoughts that bring back memories of the trauma Feeling angry & unable to trust people Social withdrawal Numbness Insomnia Lack of concentration Copyright 2013 D & S Associates 8 CONSEQUENCES 1)Physiological outcomes 2)Psychological outcomes 3)Self-destructive behaviors Copyright 2013 D & S Associates 9

4 1)Physiological outcomes Neurobiological changes (alterations in brainwave activity and in functioning of processes such as memory and fe Psychophysiological changes Hyper-arousal of the sympathetic nervous system, Sleep disturbances Increased neurohormonal changes that result in increased stress & depression Headache Stomach or digestive problems Dizziness Copyright 2013 D & S Associates 10 2)Psychological outcomes Depression Other anxiety disorders (such as phobias, panic, and social anxiety) Splitting off from the present Eating disorders Copyright 2013 D & S Associates 11 3)Self-destructive behaviors Low self esteem Alcohol and drug abuse Suicidal attempts Self-injury Risky sexual behaviors leading to unplanned pregnancy or STDs, including HIV Copyright 2013 D & S Associates 12

5 What are the difficulties (Dangers )? Depersonalization loss of contact with our bodies. (No-Self) Psychosis- Inability to tell inner reality from outer reality. (All-Self) In psychosis we mistake our subjectivity, what is going on inside ourselves, for objectivity, that which is going on outside ourselves. Flashbacks Copyright 2013 D & S Associates 13 What are the difficulties (Dangers )? Self Injury Suicide Cutting Accidents Premature death-e.g., cancer, heart attack, etc. Copyright 2013 D & S Associates 14 Treatment PTSD is treated by a variety of forms of psychotherapy (talk therapy) and pharmacotherapy (medication). There is no single best treatment, but some treatments are quite promising, especially cognitive behavioral therapy (CBT). Copyright 2013 D & S Associates 15

6 Exposure Therapy Imaginal Exposure In vivo Exposure patient is told to remain in anxiety provoking situation till the anxiety declines. 1. First it decreases the trauma. 2. Second doing it with an empathetic therapist they see it as not as dangerous at all the think about the trauma. 3. Third, repeatedly reliving the trauma decreases generalization so the client learns that the trauma is specific to an event and not the world in general. Copyright 2013 D & S Associates Fourth exposure creates a sense of competence and mastery. STRESS INNOCULATION TRAINING (SIT) deep breathing muscle relaxation assertiveness training role playing thought stopping Copyright 2013 D & S Associates 17 Trauma Focused Cognitive Behavioral Therapy Uses many techniques PSYCHOEDUCATION is key from the first Contact Therapist Normalizes the response to the trauma. comforting for the ADULT, parent and child to know that their reaction is not unusual Provide General Information on trauma to the adult or the parent. e.g. sexual abuse-give informational sheets and facts, types, why etc. Provide info on strategies to deal with trauma THOUGHT INTERRUPTION AND POSITIVE DISTRACTION Tell the client to think and worry for a finite period about the trauma and then force themselves through Thought Interruption to force themselves to stop the thoughts Positive Self-Talk Things will be ok My child will only be ok if I Copyright 2013 D & S Associates 18 am

7 EMDR Eye Movement Desensitization Reprocessing As the patient focuses on distressing images and thoughts the therapist elicits rapid lateral eye movements by asking the client to track their finger as it is moved back and forth in from of the patient s face. Lateral eye movements are essential to processing traumatic memories by reversing the neural blockages induced by the traumatic event(s) Dialectical Behavioral Training (DBT) Emotional Regulation Using activities, exercises, music, songs, readings to refocus and distract the emotions away from Trauma Reactions. Copyright 2013 D & S Associates 19 TRAUMA NARRATIVE- GRADUAL EXPOSURE Goal is to prevent intrusive thoughts/reminders from overwhelming the client. Done over several sessions: Child is encouraged to describe more and more detail of the traumatic event. Before, During & After Therapist urges the child to Put yourself back there in your mind as if it were happening now Then write about it. Copyright 2013 D & S Associates 20 Repeated writing, reading and recalling it desensitizes the child to the trauma reminders and decreases avoidance and hyperarousal. Therapist first introduces the concept and the therapeutic value of it. Do facts first, then thoughts and then recall the feelings. Disrupting the child while telling the story can hinder the process and promote avoidance. It may be tough to get the child started so you can read a book. Copyright 2013 D & S Associates 21

8 Helpful Books to Get the Child Started With the Narrative Please Tell (Jessie 1991-sexual abuse) A Place for Starr (Schor 2002 D.V.) All Kinds of Separation (Cunningham 1992) FILL IN THE BLANK BOOKS A Terrible Thing Happened (Alexander 1993 Violence) Molly s Mom Died/Sam s Dad Died (Holmes 1999) Barr Speaks Out (Goldman 1998 Suicide) Once the therapist has read the book they suggest the child write their own. Share the narrative with parents and compare recollections. Copyright 2013 D & S Associates 22 SYMPTOM Drug Type Transient psychosis, derealization low dose antipsychotics Depression antidepressants Panic attacks antidepressants, MAO inhibitors, High potency Benzodiazepines Chlonadine/Inderol beta blockers Copyright 2013 D & S Associates 23 Termination the 3 P s Predict- there will be rough times & triggers Plan how to cope when this happens. teach parent techniques relaxation visit a memorial site or do something that brings comfort. Permit allow the child to have these points in their life & allow family to express their feelings without seeing it as pathology. Copyright 2013 D & S Associates 24

9 Exercise Be Proactive! Get a calendar and go through it and mark all the reminder dates that might be difficult and write an activity plan for each of those dates as to something special you will do to cope or acknowledge the date and why it is special. Eg. Birthdays, Holidays, date of the traumatic event etc. Copyright 2013 D & S Associates 25 For Further Information Contact: Patrick DeChello Ph.D. D & S Associates P.O. Box 178 Middlefield, CT Copyright 2013 D & S Associates 26