Chie Maekoya
What is a traumatic experience?
Possible reactions to a traumatic situation
Effects of victimization
Ecological view of psychological trauma
Recovery
Treatment
Resilience
Traumatic eventTraumatic event
Experience that causes physical, emotional, psychological distress, or harm. It is an
event that is perceived and experienced as a threat to one's safety or to the stability of one's world.
The person’s response involves intense fear, helplessness or horror
An event is likely to be traumatic if:
It happened unexpectedly.
It was unprepared.
Victim felt powerless to prevent it.
It happened repeatedly.
Someone was intentionally cruel.
Emotional Effects shock
terror
irritability blame
anger guilt
grief or sadness
emotional numbing helplessness
loss of pleasure derived from familiar activities difficulty feeling happy
Cognitive Effects
impaired concentration
impaired decision making ability memory impairment
disbelief confusion nightmares
decreased self-esteem decreased self-efficacy self-blame
intrusive thoughts/memories worry
dissociation (e.g., tunnel vision, dreamlike or "spacey"
Physical Effects
fatigue, exhaustion insomnia
cardiovascular strain startle response
hyper-arousal
increased physical pain
reduced immune response headaches
gastrointestinal upset decreased appetite decreased libido
Interpersonal Effects
increased relational conflict social withdrawal
reduced relational intimacy alienation
impaired work performance impaired school performance decreased satisfaction
distrust
externalization of blame
• Belief in personal invulnerability
• Perception of the world as meaningful • Perception of oneself as positive
Traumatic event
Traumatic event Threat
Danger Insecurity self-questioning Basic assumptions victims hold
about themselves and their world
change assumption
Individuals are not equally vulnerable to, nor
similarly affected by, traumatic events.
Persons, events, environments factors may
influence an individual post-traumatic
response and recovery.
Traumatic
Traumatic
Event
Person
◦ Age
◦ Developmental stage
◦ Initial distress level
◦ Intelligence
◦ Personality
◦ Affects
◦ Cognition
◦ Coping styles
◦ Role
Event
◦ Frequency
◦ severity and duration of the event experienced
◦ degree of physical violence and bodily violation involved
◦ the extent of the terror and humiliation endured
Environment
◦ context within which the traumatic event was
experienced (home, school, work place or other context)
◦ victim’s natural support system
◦ the ability of that system to foster adaptive rather than maladaptive coping
◦ the degree of safety and control afforded the victim post-trauma
◦ attitudes and behaviors of first respondents
◦ action and understanding of family, friends, caregivers, significant individual/ group
◦ community attitude and values
◦ political and economic factors attending victimization
Normal response to loss, particularly to the loss
of someone or something to which a bond was formed.
Five Stages of Grief and Loss (Kubler-Ross, 1969)
Denial “This can’t be happening to me. ”
Anger “Why me?” “How can this happen to
me?”
Bargaining “Make this not happen, and in return
I will __.”
Depression “I’m so sad.”
Post Traumatic Stress Disorder (PTSD)
◦ Re-experiencing the traumatic event
◦ Avoidance and emotional numbing
◦ Increased arousal
Acute Stress Disorder (ASD)
Anxiety disorders
Mood disorders
Substance abuse
Eating disorders
Sexual dysfunction
Self medicating
A personal and unique process that reflects a change in one’s attitudes, values, feelings, goals, skills, and roles, and it involves the development of new meaning and
purpose in one’s life. It moves a person from the state of pain, confusion, and anger to a state of normativeness.
Psycho/social coping theory (Dussich, 2006)
focusing on the presence and strength or the absence and weakness of individual coping resources.
Three psychosocial recovery conditions:
Absence of major symptoms Positive identity of self
Establishment of
Establishment of
safety
safety
Reconnection
Reconnection
with ordinary life
with ordinary life
Remembrance
Remembrance
and mourning
A guiding principle of achieving recovery is to
help a person regain power and control.
Establishing safety begins by focusing on control
of the body and gradually moves outward toward control of the environment.
Indicators of the establishment of safety
Victims:
No longer feel completely vulnerable or isolated Able to control most disturbing symptoms
Reconstruction of the trauma involves the victims
telling the details of the trauma so that memory can be integrated into the survivor’s life story.
Process involves intense grief.
Ultimately they are able to put the story,
The survivor faces the task of creating a
future
They develop
◦ New sense of self
◦ New relationships
◦ A meaning for life “faith”
Empowerment and reconnection are the
core experiences of recovery.
Authority over the remembering process
Integration of memory and affect
Affect tolerance
Symptom mastery
Self-esteem and self-cohesion
Safe attachment
Authority over the
Authority over the
remembering process
remembering process Integration of memory and affectIntegration of memory and affect
An individual has a
new or renewed authority over the
remembering process. She can choose to
recall the event or not.
The balance of power
between the individual and her memories is reversed.
Memory and affect are
joined.
The past is
remembered with feeling.
An individual is able to
identify contemporary feelings about the
Affect tolerance
Affect tolerance Symptom masterySymptom mastery
Affects associated
with traumatic events no longer overwhelm or threaten.
Feelings can be felt
and named and endured without dissociation.
Persistent symptoms have
decreased and become more
manageable. Stimulus for trigger of flashback are known and can be avoided.
An individual might continuously
experience symptomatic arousal, but she has mastered and
practices healthy coping routines to reduce arousal and manage stress.
An individual gains the ability to
Self esteem & Self Cohesion
Self esteem & Self Cohesion
An individual feels sense of self and self
worse
Feeling of guilt, shame and self-blame are
decreased and new or newly restored sense of self-worth is given.
Self-critical review is replaced by more
Safe Attachment
Safe Attachment Meaning MakingMeaning Making
An individual entails the
development or the repair and restoration of a
survivor’s relational capacities. The pull to isolation is replaced by a
new or renewed capacity for trust and attachment.
An individual is able to
negotiate and maintain physical and emotional safety in relationship and views the possibility of
intimate connectedness with some degree of optimism.
An individual assigns new
meaning to the trauma, to the self as a trauma survivor and to the world in which
traumatic events occur.
He might embrace the belief
that misfortune endured has yielded new found strength and compassion.
He names and mourns the
Incidence of dysfunction= stress + risk factor
social supports + coping skills + self-esteem
(Swift, 1986)
Personal resources
◦ Physical assets
◦ Psychic assets
◦ Socio assets
Adequate resources result in resiliency, safety,
and an enhanced ability to recover
Recovery is best facilitated by the tailoring of
culture-traum
traum
a
a
victi
m survivor citizen
Their world
view reduced to a narrow focus on their physical
health and basic needs
Beginning to find
their place in their world
make adjustment
to accommodate their new situation
reestablishing
connection with their friend and
community
Fulfillment of
the individual’s rights
social
The process of recovery is highly
individualistic.
Victim services
The purpose is to reduce victims suffering and to
facilitate victim recovery (Dussich, 2006).
Victim service providers need to gather appropriate
resources.
Services which facilitate victim’s recovery
health and psychological care
Advocacy
Personal social support
Justice system services
Treatment is necessary if survivors have..
Experienced of difficulty in social/ personal life Long persistence of symptoms
Risk for suicide and self harming behavior
Possible treatment methods
Psychotherapy Psycho education
◦ Normalization, self blame, give information to help understanding
Cognitive Behavioral Therapy (CBT)
working cognitions to change emotion, thoughts and behaviors
Eye Movement Desensitization and Reprocessing (EMDR)
accelerated information-processing model to account for resolution of traumatic memories
Group therapy
Play therapy (children)
Factors in resilience
◦ Caring and supportive relationship within and outside the family
◦ Capacity to make realistic plan and take steps to carry them out
◦ A positive view of yourself and confidence in your strength and abilities
◦ Skills in communication and problem solving
◦ Capacity to manage strong feelings and
Make connections
Avoid seeing crises as insurmountable
problems
Accepting that change is a part of living Move toward the goal
Take decisive actions
Look for opportunities for self-discovery Nurture a positive view of yourself
Positive changes which occur as a result
of coping with a traumatic event.
PTG includes:
Improvement of relationships with others
Openness to new possibilities
Greater appreciation of life
