Trauma Recovery Treatment Interventions for Individuals with Substance Use Disorders (SUDs): An Eclectic Approach
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1 Trauma Recovery Treatment Interventions for Individuals with Substance Use Disorders (SUDs): An Eclectic Approach Tyanne Miskov MA, LLP,CAADC Easter Seals, MI
2 Alphabet Soup Post-Traumatic Stress Disorder= PTSD Substance Use Disorder/Disorders= SUD Stages of Change=SOC Evidence-Based Practice=EBP Cognitive Behavior Therapy=CBT Rational Emotive Behavior Therapy=REBT Dialectical Behavior Therapy=DBT Cognitive Processing Therapy=CPT Motivational Interviewing=MI
3 Self-Care Secondary Trauma Compassion Fatigue Vicarious Trauma Burnout ry-traumatic-stress Acute Vs Chonic?
4 Self-Care
5 Self-Care Burn- Out Prevention -Exercise, Healthy Eating, Sleep (what s that?) -Supervision, Colleague/Team -Small Caseloads (what s that?) -BOUNDARIES
6 Self-Care Burn Out Intervention : Consider a Self-Care Plan -EAP -Transfer a client (or 2)? -Vacation Time -Chocolate -FMLA -Win the lottery
7 Self-Care Tool for self-assessment/awareness AND tool for use with a client: ACE Adverse Childhood Experiences (Study of 17,000 participants)
8 Self-Care Calculate your ACE score:
9 Why consider Eclectic? Obstacles to fidelity in EBP in outpatient CMH Settings: 1. Client-based obstacles: Appointment compliance: Transportation, medical issues, memory/symptoms Other: SOC, homework aversion, bi-weekly 2. Provider-based obstacles: Caseload, appointment availability, training, staffing
10 EBP Buffet Before Beck, Ellis, Linehan, there was Buddha: "All That We Are Is the Result of What We Have Thought. The Mind Is Everything. What We Think, We Shall Become."
11 EBP + PTSD+SUD=? 1.CBT/REBT: Dr. Beck, Dr. Ellis CPT- Cognitive Processing Therapy: Dr. Resick, Dr. Chard, Dr. Monson 2.DBT: Dr. Linehan 3. MI:Dr. Miller, Dr. Rollnick 4. Seeking Safety: Dr. Najavits 5. Misc.
12 Clinical Issues/ Themes Related to - ANGER Individuals with PTSD-SUD A) Anger at the perpetrator, anger at the one(s) who failed to protect, anger at self B) Real Vs Perceived Threat, Respect C) Powerlessness v. Power Problem? Inappropriate and/or rage
13 Clinical Issues/ Themes Related to Individuals with PTSD-SUD Validation versus anti-validation Control versus powerlessness Second layer trauma- victim blaming Self-blame: perpetual self-punishment and self-sabotage Trust Physical health issues
14 Clinical Issues/ Themes Related to Individuals with PTSD-SUD All or Nothing/Black &White Thinking -Victim OR Perpetrator -Trust no one OR Trust everybody all the way and way too soon -Good OR Bad -Just world belief : Good things happen to good people, bad things happen to bad people
15 Interventions 7M
16 Clinical Issues/ Themes Related to Individuals with PTSD-SUD Core Belief & Stuck Points (CPT): The meaning people attach to a traumatic event: -AVOIDANCE -Assimilation: Traumatic event is given meaning to preserve original beliefs. I am worthless because I couldn t control what happened. Can t change my beliefs, alter the event. -Over-accommodated beliefs: Overall beliefs about self and the world change too much and are no longer accurate. If I let other people get close to me, I ll get hurt again. No one can be trusted, the world is completely dangerous. -Accommodation: Integrating the experience in a balanced way. Manage beliefs to accept what happened (but you don t have to like it).
17 Clinical Issues/ Themes Related to Individuals with PTSD-SUD ABSOLUTES (Ellis) I have always been abused by men: all men are abusive. Shoulds Always Never Everybody Nobody
18 Interventions Confrontation is tricky VALIDATION WITH BOUNDARIES The B words: Boundaries and Balance = Better ( normal ) Biology of Trauma- Fight or Flight, Mind-Body, PFC- Pre-Frontal Cortex
19 Interventions Do not dwell in the past, do not dream of the future, concentrate the mind on the present moment. -Buddha
20 Interventions Mindfulness (Wise Mind in DBT) Deep Breathing Grounding (Session Topic in Seeking Safety) Here and Now Observing Body Scan Self Soothe Progressive Muscle Relaxations Guided imagery/visualization
21 Interventions The Drama Triangle Stephen Karpman, in his 1968 article "Fairy Tales and Script Drama Analysis
22 Interventions Assertiveness Training (Interpersonal Effectiveness-DBT) 4 Communication styles: 1.Aggressive 2.Passive 3.Passive-Aggressive 4. Assertive- The Healthy/More Effective Style
23 Interventions The Anger Scale No anger Mildly Annoyed Angry Really Angry Rage Violence What was your response to the event? Did your response match-up?
24 Interventions Substance Use Relapse Prevention Plan: Include at minimum: 1. Triggers 2. Supports/Resources/Phone numbers 3. Strategies (Solution-Focused)
25 Interventions -Victim v. Survivor: List characteristics and behavior of Victim compared to Survivor -Trust Ladder Trust is not all or nothing: range
26 Interventions Radical Acceptance -Buddha -Marsha Linehan -Tara Brach Online Article: Pieces of Mind, Psychology Today July 8, 2012 by Karyn Hall, Ph.D.
27 Interventions Event-Thought-Feeling-Behavior: THE CHAIN Let s talk about the last time you had an overwhelming feeling When was the last time you did something that was self-destructive?
28 Resources -The Substance Abuse and Mental Health Services Administration: -National Institute Of Mental Health: -Special Populations & Co-Occurring Disorders -Center for Deployment Psychology: - Dr. Switzer : Tej0297wk Featuring Bob Newhart and Mo Collins
29 References Davis, M. Eshelman, E.R. McKay, M. Fanning, P. Relaxation and Stress Management Workbook. New Harbinger Publishing Inc, Follette, V, Ruzek, J. Cognitive Behavioral Therapies for Trauma, 2nd Ed. New York: The Guilford Press, Lewis, Judith H. Trauma and Recovery. New York:HarperCollins, Linehan, M. Cognitive-Behavioral Therapy of Borderline Personality Disorder. New York: The Guilford Press, Miller, W; Rollnick, S. Motivational Interviewing: Helping People Change. New York: The Guilford Press, 2012 Najavits, L. Seeking Safety, A Treatment Manual for PTSD and Substance Abuse. New York: The Guilford Press, Najavits, L; Gotthardt, Silke; Weiss, Roger D & Epstein, Marina. Cognitive Distortions in the Dual Diagnosis of PTSD and Substance Use Disorder. Cognitive Therapy and Research, Vol 28, No.2, April 2004, pp Ross, C. The Trauma Model. Richardson:Manitou Communications, Inc, 2000.
30 Contact Info. Tyanne Miskov MA, LLP, CAADC Behavioral Health Clinician: Easter Seals, MI (248)
31 Questions?
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