victims counselling kieran mundy

(1)

(2)

PSYCHOLOGICAL INTERVENTION

& TREATMENT

(3)

OVERVIEW

Exposure to a traumatic event is common

Post Traumatic Stress Disorder (PTSD)

Acute Stress Disorder (ASD)

Awareness of Presence of ASD/PTSD

Acute stress reaction

Treating Psychological Disorders

Topic 1

Topic 2

Topic 5

Topic 3

(4)

(5)

Most people have some kind of psychological

reaction to trauma—feelings of fear, sadness,

guilt and anger are common. But there is

also pain, a sense of loss, a loss of trust and

security, and often a total loss of community

as in the East Japan Great Earthquake.

Exposure to a traumatic event is

common

(6)

(7)

THE SURVIVORS

( ≅ 60-80%)( ≅ 60-80%)

POPULATION

Total Impact

= SURVIVORS

Resilient

+ SURVIVORS

(8)

(9)

Resilient Survivors

Most

(≅ 80%)

people exposed to intense stressors,

especially children, have no apparent disruption in close

relationships, at work, or in their daily lives. They

maintain relatively healthy levels of psychological

functioning.

Non-resilient Survivors

A minority (< 20%) have moderate to severe initial

elevations in bio-psycho-psychological symptoms that

significantly disrupt normal functioning and that decline

gradually over weeks, months, or years before returning

to pre-trauma levels.

(10)

SURVIVORS (RESILIENT)

The overwhelming majority who, most

probably, want to be left alone once basic

needs are met.

Able to identify the risk early enough.

Are aware that environmental assaults (like

tsunamis) are deadly.

Have the options available to avoid death or

injury.

(11)

TARGET THE HIDDEN VICTIMS (HIGAI

SHA)

A small minority of high-risk (vulnerable)

people.

Women, children or the elderly, but not

necessarily so.

Those unable to identify the threat.

Those people unaware of its victimizing force.

Those who not have the personal and other

resources to co

(12)

(13)

Despite the low risk, some people

develop Posttraumatic Stress Disorder

(PTSD) & Acute Stress Disorder (ASD).

The psychological reactions in the

aftermath of a SEA, MVA, or terrorist

attack, are

TRAUMA-IDENTIFIED

(cf.

Trauma-specific):i.e., the victim

identifies with the critical event cf. the

type of trauma is not specific to the

(14)

The reactions include any threat, real

or perceived, to the life or physical

safety of a person, their loved ones or

those around them and lead to

feelings of intense fear, helplessness

or horror.

More than a quarter of a million

(15)

(16)

(17)

Posttraumatic Stress

Disorder

Before a diagnosis of PTSD can be made, a number of symptoms in each of three categories (re-experiencing, avoidance &

emotional numbing, and hyperarousal) must be present for at least a month and lead to significant distress or impairment in important areas of functioning.

While symptoms often develop in the days and weeks following exposure to trauma, the onset of PTSD can be delayed for years for a significant number of people.

(18)

(19)

(20)

Acute Stress Disorder (ASD)

ASD is diagnosed between two days and one month following a

traumatic event.

There is significant overlap in the diagnostic criteria of ASD and PTSD.

The diagnosis of ASD requires the experience of several dissociative

symptoms not included in PTSD (e.g., detachment, reduced

awareness of surroundings, depersonalization, and dissociative

amnesia).

PTSD places greater emphasis on avoidance symptoms.

(21)

(22)

(23)

(24)

Awareness of PTSD/Acute

stress reaction/ASD

Most people experience some level of stress after a traumatic event and recover using their own resources.

Professional help is only necessary when a person’s distress is persistent or severe enough to cause significant impairment.

A thorough clinical assessment includes physical,

psychological, and social functioning.

(25)

(26)

Look for signs in specific

trauma populations

Some sub-populations are more at risk of victimization

than others.

For example, IDPs (the overwhelming majority),

refugees and asylum seekers, military and emergency

personnel, survivors of motor vehicle accidents, crime,

sexual assault,

(27)

Family members

should be included

in the assessment

process, education

and treatment

planning

The needs for care

of family members

should also be met.

Everything should

be done with the

person’s consent.

Refer to PHC for a thorough

clinical

(28)

(29)

Transforming the suffering of

PTSD: Is Recovery Possible?

Effective treatments for PTSD include psychological and medical interventions.

The cornerstone of treatment involves confronting the traumatic memory and addressing thoughts and beliefs associated with the experience.

Trauma-focused psychological interventions can reduce PTSD

symptoms, lessen anxiety and depression, and improve quality of life. They are also effective with people who have experienced prolonged or repeated traumatic events.

(30)

(31)

Awareness of Comorbid

Conditions

For people with comorbid conditions, the sequencing of treatment needs to be

(32)

(33)

(34)

For person presenting with non-specific health problems:

1.Ask if person has

experienced a traumatic event

2.Ask that person to

describe some examples of the traumatic event.

Initial Screening

1

2

Summary

Comprehensiven ess of Assessment

2

A detailed assessment of:

1.Of PTSD & related diagnoses.

2.Quality of life &

psychosocial functioning 3.Trauma history 4.General psychiatric status (including comorbidity). 5.Physical health 6.Substance use 7.Marital & Family situation

8.Vocational & social status

9.Assessment of

strengths & weaknesses

Assessment & Intervention

3

Should be considered in context of time elapsed since the traumatic

event:

(35)

Summary

[continued]

Should be undertaken throughout treatment. When progress is slow:

1.revisit case formulation 2.re-assess potential treatment obstacles 3.implement appropriate strategies. Service Planning

Screen individuals at high risk after major disasters and critical events.

1.Culturally &

linguistically appropriate screening for refugees and asylum seekers at high risk of developing PTSD.

2.There should be

adequate services in the context of the service delivery system for all those who require care.

5

Assessment & Monitoring

4

Psychological intervention

with adults with PTSD

6

Trauma-focused interventions:

1.Cognitive behavioral therapy or eye movement desensitization &

reprocessing.

2.Most gains with EMDR are due to engagement with traumatic memory,

cognitive processing, & rehearsal of coping and mastery responses.

3.Supportive counseling & relaxation SHOULD NOT be provided to adults cf.

(36)

Summary

[continued]

Where symptoms have not responded: 1.Use non-trauma-focused intervention (e.g., stress management, or psychopharmacology. Psychological intervention with adults with PTSD

[Continued]

Other issues for consideration:

1.Imaginal imaging

sessions require at least 90 minutes to ensure adequate therapy. 2.For people with problems due to multiple traumatic events, traumatic

bereavement, or if PTSD is chronic and

associated with disability and

comorbidity, specific sessions should be used to meet these needs.

7

Psychological intervention with adults with PTSD

[Continued]

6

Psychological intervention

with adults with PTSD

[Continued]

8

4. If adults have developed PTSD

following exposure to prolonged/repeated traumatic events, take time to

(37)

Summary

[continued]

There should be focus on vocational, family, and social rehabilitation interventions from the outset:

1.Where symptoms of PTSD have been present for three months or

longer, psychosocial intervention should be considered to prevent or reduce disability

associated with the disorder..

Psychosocial Rehabilitation [Continued]

2. If person does not respond to evidence based treatment, psychosocial intervention may reduce disability, improve functioning and community tenure.

(38)

(39)

(40)

And……finally

Are PTSD, ASD, Major Depression Disorder (MDD), and Substance Use Disorder (SUD) separate entities, or comorbid, and a universal cross culturally valid psychopathological response to traumatic stress?

Can these victimizations be cured or ameliorated with Western oriented clinical and psychosocial therapeutic interventions?

A relativist approach would suggest that psychological and/or physical trauma is embedded in the social and cultural framework of any society.

(41)

Differential victimization in

aftermath of SEA

V



_lh

(learned helplessness) is when the

victim learns to behave helplessly even

when the opportunity is restored for that

person to help him/herself by avoiding an

unpleasant or harmful circumstance to

which they have been exposed.

V



_guilt

is the degree to which a person

believes his/her victimization has violated

a moral standard and he/she bears

significant responsibility for that

violation.

(42)

aftermath of SEA

V



fear

is heightened in victimizing habitus and

can lead to aberrant changes in behavior when

the cause of the victimization is unknown (e.g.,

in a nuclear accident, climate change, or when

an assailant is unidentified), and is less when

the cause is known (e.g., in a crime in which

the perpetrator is identified, CO

2

emissions are

responsible, and so on).

V



_hope

is the level of anxiety associated with an

anticipated loss of hope. Hope is important to

both well-being and educational performance;

people low in hope are more likely to be

(43)

aftermath of SEA

1.

The magnitude of an acute

environmental event (e.g., a 9.1

magnitude earthquake) is

independent of its victimizing force

(

V



).

2.

The impact of the victimizing force is

dependent on awareness of the

victimizing potential of the SEA (e.g.,

a tsunami).