This episode was pre-recorded as part of
a live continuing education webinar. On demand CEUs are still available for this
presentation through ALLCEUs. Register at ALLCEUs.com/CounselorToolbox. I'd like to welcome everybody to today's
presentation on trauma-informed care the impact of trauma. So we started out
talking about the socio-cultural affect of trauma and impact in kind of a
general way how it impacts cultures communities etc.
We also talked about you
know defining what is trauma but we've talked sort of vaguely about the impact
of trauma we've talked about those symptoms that are in the DSM as you know
occurring with PTSD hyper vigilance hyper arousal emotional detachment
yada-yada those more clinical things but we're going to look at the breadth of
symptoms that trauma may cause and sort of how they may progress the immediate
symptoms as as well as the delayed reactions that you may still be seeing a
year two three four years later and we're also going to finish up by talking
about the impact of trauma on the family we're going to learn about the sequence
of trauma reactions explore the comment immediate and delayed experiences and
explore impact of trauma on family I already covered that so delayed your
traumatic response now one of the things that we may not realize is that there
can be a delay of months or even years before the symptom appears so if the
person goes through a trauma and you know doesn't develop acute stress
disorder doesn't seem to develop PTSD and then you know eight nine ten months
later a couple years later all of a sudden there's a trigger it can happen
it's we're not saying it that it won't happen and you know what I've seen in
people who have experienced something like this a lot of times they're the
type of people who compartmentalize and they take whatever it was and they put
it in a tidy little box and I put it in the back of their mind and they just
refuse to think about it again until something triggers it childbirth for
example can trigger the memory of childhood sexual abuse for some people
that they may have completely dissociated put that in another box and
then when they have a child all of a sudden their abuse memories start
flooding back and they start having problems so you know we want to be
sensitive to the fact that it's not necessarily something that just recently
happened and it can catch people unawares you know they think they dealt
with it already or they didn't think it was traumatic so we want to be aware of
that trauma symptoms can appear suddenly even without conscious memory of the
original trauma or without overt provocation so for example somebody who
was abused as a child may not have a memory of that especially if they were
abused as a very young child and then something happens in their adult life
that triggers that memory it could be watching a movie it could be seeing
another parent strike their child you know it could be a variety of things it
doesn't have to be necessarily them getting abused again themselves clients
who are experiencing a delayed reaction to trauma can
fit if you help them create an environment that allows them to
acknowledge the trauma sometimes they start having flashbacks and nightmares
and they're like I don't know where these are coming from and you know we
don't want to get too far because there's that whole concept of false
memory so we don't want to get too far into having them detail necessarily
everything you want to be careful but we do want to talk to them about what are
you remembering and you know is there do you think this really happened discuss
their initial recall or first suspicions that they were having a traumatic
response and what I tell clients a lot of times is sometimes our brains they
want to help us survive so they block stuff that we're just not able to handle
at that particular point in time when people write their autobiographies for
me you know they'll write their autobiographies and they may have gaps
of you know a month or a couple of years where they really don't remember
anything and they find it very frustrating and my response to them is
you know for whatever reason your brain is not allowing you access to that when
you have the coping skills when you have the resources when there's a need for it
your brain will let you know and generally that does happen you know as
we go through treatment some of those gaps start to fill in not necessarily
all of them sometimes people just keep holes in their memory and there are ways
to address it if they want to explore hypnosis or or something like that but
most people you know in trauma-informed care we're going to look at you know is
how important is it to remember that gap there versus how important is it and
what do you need to do right now to help you recover sometimes that memory is
crucially important and we kind of talked about this yesterday sometimes
not so much we want to draw a connection between the trauma and presenting trauma
related symptoms so if the person has been showing some trauma related
symptoms but they haven't remembered the trauma and then all of a sudden they
start remembering the trauma most a time we can be pretty common pretty
confident that there was a trauma that they had just pushed away they weren't
able to look at or willing to look at and now it's starting to come out
explore their support systems and fortify them as as people start to
recognize a trauma and experience trauma related symptoms whether it's delayed or
immediate they need social support you know there are going to be nights when
they wake up in a terror there are going to be nights where they can't go to
sleep because they're afraid there are going to be times when they just need a
friendly voice on the other end of the line so it's important to make sure
they've got people they can reach out to and it may be people that are already in
their support network it may be people in support groups that they connect with
and it can be people in you know crisis hotlines last-ditch effort you want to
make sure that if they wake up at 2:00 in the morning they can connect to a
live person somewhere so crisis hotlines can be you know sort of a last resource
and I say a last resource because most people you know it's kind of like
starting with a new therapist they got to rehash the whole thing when it when
they called a crisis hotline so it's not the ideal situation but it is a
compassionate person we want to identify their triggers what do you think may
have triggered this and if they're starting to remember what may have have
happened what their memory is what their experience was then you can start kind
of guessing about some of the triggers but we can ask them when did you start
noticing these symptoms and what was going on you know you weren't
experiencing them then what changed that made you start you know experiencing
them are feeling kind of wonky develop strategies to navigate and manage
symptoms and triggers so here we're going to talk about what your symptoms
are how they should represent a normal adaptation to help you survive until now
and we're going to talk about triggers and then we're going to talk about how
to deal with triggers minimize as many as possible
and you know deal with the ones that you can't minimize as well as managing
symptoms what are some alternate things you can do when you have when you feel
like you're constantly scanning and constantly on guard how can you help
yourself feel safer so we're going to talk real briefly about the biology of
trauma and it's a fascinating field to go to look into and to learn about but
there are changes during a trauma for some people especially an extended
trauma or an extreme trauma and it can be you know it's more problematic in
adolescents and youth whose brains are still developing but people who are have
fully developed brains like soldiers and cops they're not immune to it so when
there is a trauma your HPA axis your threat response system is activated and
so it says there's a threat you need to prepare to fight or flee so a bunch of
things happen and it releases cortisol cortisol is your stress hormone cortisol
causes you to have a release of blood glucose so you you know you've got that
immediate energy for fight or flee but it also causes the suppression of sex
hormones and serotonin sex hormones you know it's a threat this is not the time
to procreate so those go down and serotonin goes down serotonin is our
calming chemical we don't want to be calm right now we want to be prepared to
survive and to fight or flee so this is what happens but in a trauma situation
when the person never feels safe afterwards
they are in this persistent state of hyper vigilance if you will this
persistent state of alert in order to prevent themselves from being taken
unawares again and the brain like I explained I think two sessions ago if
you stay hyper-vigilant long enough the brain eventually will say you know what
I can't keep devoting resources to this I need to conserve some energy for when
they're actually is something to fight or flee from so
the person starts to have lower cortisol levels which is called hypo cortisol ISM
and they start to feel more depressed they start to feel more apathetic things
that used to make them happy don't make them happy anymore things that used to
bother them don't seem to bother them anymore they feel more numb you know
there's that numbing thing that we talked about and hypercortisolism has a
lot of other symptoms that go along with it when cortisol levels are high when
you're on high alert think about a soldier in a foxhole he's probably gonna
sleep at some point but is he gonna get good sleep no and people who've been
through a trauma may not be able to relax enough to get good sleep and as
sleep quality and quantity diminish depressive symptoms increase so we start
to see a lot of problems from this persistent activation of the threat
response system so think about sailors on a boat you know they have their
drills every once in a while but if the if the captain is calling a drill every
single hour every single day for three months or four months or heaven forbid
two years or something the sailors are going to start to get really worn down
and they're not gonna really even pay attention much anymore they're going to
drag their happy self up to where they're supposed to be but not with the
enthusiasm as before and this is kind of what happens when cortisol levels start
to go low and and this is regardless of what kind of trauma it is if it is
traumatic then the person felt a sense of loss of control for something going
on so it will cause them to be hyper-vigilant it will cause them
potential emot– potentially to emotionally disregulated symptoms will
come back you know when something when there's hypo cortisol ism the
interesting thing is when something does trigger the reaction when something does
trigger that symptom to go off again the stress response is significantly higher
than it normally would be for that particular stressor so it's zero to 120
which is what we think of as emotional dysregulation so as you start
understanding what's going on here you can start understanding how the brain
and chemicals in the brain and changes in the brain might be causing this and
if we can help not dampen the response but help turn off that HPA axis so it's
not constantly firing on alert let the person get some rest let the person get
some sleep and some relaxation and get those serotonin levels back up and the
estrogen levels back up or testosterone then they will start feeling a little
bit better so it is definitely a biopsychosocial approach to treating
trauma immediate reactions to trauma numbing a detachment anger fear
helplessness guilt including survivor guilt exhilaration as a result of
surviving so that's one we don't usually talk about we think about you know anger
fear guilt a all those things but exhilaration you're like where does that
come from and it's just that you survived and you know you're thankful
that you survived so we don't want to say well somebody is you know seeming to
deal with it really well they're in a good mood they're downright giddy so
they have any problems in the future you can look at it as you know they have
this sense of exhilaration and wow what a rush maybe even a sense of being
reborn or life anew but then as that adrenaline wears off there can be a
opposite sort of reaction where it's like what the heck
happened and they start thinking about things even more there can also be
sadness a feeling of depersonalization for a lot of people in that you know if
you think of the grief process denial anger bargaining depression and
acceptance the first one is denial when something like this happens it's a loss
it's a loss of your personal control a loss of the way you conceptualize the
world there are a lot of you know sort of esoteric losses that happen in
addition to potentially tangible ones so there may be a feeling of
depersonalization because your brain does not know how to make sense of this
this does not fit into any schema that you have in there and your brains like
ah this isn't supposed to happen maybe it was a dream maybe it was a television
show maybe you know and you keep trying to think and bargain and maybe it wasn't
real and that can go on for extended periods of time you know even you know
after a trauma when the person is working with the cops or you know trying
to put things together they may have moments where they think maybe it was
just a dream disorientation that's pretty common if something unexpected
happens you're going to be disoriented feeling out of control
denial constriction of feelings you know just kind of shutting down and I've seen
it before not everybody gets super emotive not everybody shuts down
everybody deals with trauma in their own way so we don't want to again assume
that just because somebody's not overly emotive that they're dealing with it
quite well they may just not be feeling anything right now and feeling
overwhelmed just kind of looking around going I have no idea where to begin to
fix this so those are just the immediate reactions and that's the immediate
emotional reactions there's a whole bunch of other stuff we're gonna go to
but as time passes and it can be three or four days or it can be you know three
or four months after the immediate reaction or the immediate sensations the
person may start having irritability and/or hostility you know
their world was turned upside down what happened to them was likely not fair
irritability and hostility are also power moves they keep people away so I'm
going to push people away to stay safer depression as the cortisol levels go
down as serotonin levels go down as estrogen and testosterone levels go down
people are going to start experiencing depressive symptoms but not always you
know there there may be some mood swings because you know they're not feeling a
lot but when they do feel something it's zero to 150 because that HPA axis is
holding on and then when it's finally triggered it just kind of opens the
floodgates there's no trickle to it at all it's like turning the water on or
off there's no moderate stream there can be anxiety and fear of the trauma
recurrence that's totally natural and it can go on for years if someone was
victimized when they were younger when they were a child when their children
get to be that age they may start having flashbacks they may have start having a
recurrence of some of those trauma symptoms and fearing that trauma is
going to recur to their child they may fear the trauma after it happens it's
going to recur to them so you know we don't want to negate what might be going on with any
of our any of our clients grief reactions as I said there are a lot of
losses oh my gosh when a trauma happens so we want to be open so how did this
change the way you view life how does this change the way you think how does
this change what makes you happy what's makes you sad what makes you scared and
all of those can be potential losses for them so we want to help them frame it in
terms of a change or a loss and help them adjust and move to that stage of
acceptance shame can perpetuate you know for for many many years after something
happens a feeling of being fragile or vulnerable can perpetuate and emotional
detachment you know just not even being able to connect emotions with what
happened then but sometimes not even being able to connect emotions with
what's going on now it's just I can't feel and we see emotional detachment a
lot in law enforcement and military who see a lot of really traumatic things and
you know they start they shut this down and then they shut that down and
eventually they just it's too dangerous in in some ways to feel so so um they
start becoming detached and just kind of emotionally flat now somebody asked me
to say more about shame depending on what happened you may have a shame that
you didn't do something shame that you did do something you dressed a certain
way or you said a certain thing or you somehow you brought it you feel like you
brought it on yourself or some you may have shamed because you feel like you
didn't protect somebody else you can have shame about
how things turned out you know after going through for example a rape exam
you know that's pretty humiliating and you've already been humiliated once
after a rape then you have to go through a rape exam which is humiliating again
and you just keep being humiliated so their shame associated with or can be
associated with the whole process and then having to tell the detectives and
the lawyers and the court you know exactly what happened and kind of bare
your soul to everybody can be humiliating and and people can be
shameful and people can look in retrospect like you said and say you
know what I should have done this and I would have gotten away I should have
done that and I would have gotten away and other people may say that too and it
can be very very triggering I'll share with you when I was younger I was the
victim of a home invasion robbery and I was 11 you know I was home by myself I
was home sick from school that day and you know home invasion robbery and I
was paralyzed I remember not being able to make a sound not being able to move
and we'll be watching TV now and we'll be watching law and order or one of
those shows or something and my husband who's a cop and has been trained to act
in you know stressful situations is always like well why doesn't that person
just run or scream or do this and every time it just you know I just want to go
maybe they can't you don't understand that not everybody reacts the way that
you do to a trauma and you know I quit saying that a long time ago but it's
important to understand that sometimes well-meaning people even you know 20 30
years later will say things that trigger that shame reaction again and they go
well why didn't I they may not have been able to they did what they did and they
survived and let's get through that cognitive reactions to trauma difficulty
concentrating ruminating or racing thoughts distortion of time and space
memory problems and strong identification with victims so let's
kind of go through those real quick obviously after a trauma of any sort or
a stressor of any sort we're not going to concentrate so well the brain devotes
those resources to fight or flee not learn and concentrate so the the energy
and the neuro chemicals we need aren't aren't there for concentration so
writing things down can help encouraging people to be kind to themselves because
they're not going to concentrate as well ruminating or racing thoughts obviously
you can ruminate overs with survivor guilt
you can ruminate over what you should have done you can ruminate over how bad
the world is or unsafe it is there are a lot of things that you can do well on a
lot of times rumination serves the purpose of trying to help the person
sort through things and figure out how to regain control but sometimes they can
get stuck in it racing thoughts are just kind of the opposite I mean they're just
going all over the place because they don't want to sit still they don't want
to think about it so they're thinking about this and that and the other thing
over here distortion of time and space after something happens you know
sometimes it'll feel like you can't remember when it happened was it
yesterday or was it a week ago you know cuz so much is happening your schedule
gets turned upside down you know whether you're a victim of a crime and you know
you had to have physical exams and talked to a cops and all that kind of
stuff or whether your house burned down and you had to go stay at a hotel and
are involved with the Red Cross after a trauma for 99.9% of people their life is
disrupted in some way and and so they may have a distortion of time and space
because they don't have those normal anchors of going to work and coming home
think about when you're on vacation if you have like a two week vacation oh my
gosh wouldn't that be nice it's sometimes it's hard to remember is it
Saturday or is it garbage day because you're not doing your normal things
memory problems when we're traumatized our ability to
consolidate memories you know there's a lot of chemical reactions that happen
that keeps you from consolidating some of those memories which is cool in a way
because your brain is going you know what we really don't need to remember
that that was pretty horrid so it keeps those memories from consolidating well
that may continue to go on because you're having difficulty concentrating
but sometimes those memory problems the person can't remember what happened
during the trauma when you're being interviewed by the cop right after it
happens you're like you know what I can't remember and people look at you
quizzically or and and accuse the victims I guess of either lying or not
paying attention or not wanting to help or whatever but we need to remember that
even right after the trauma if all of those neuro chemicals were going and the
person wasn't able to consolidate those memories they weren't able to do it you
know we we can't squeeze blood out of a turnip and they may identify strongly
with other victims of similar crimes if they were the victim themselves or if
they're observing a crime if they're a second if they're a bystander and they
see the crime happen they may have a super strong identification with the
victims and sort of an over empathetic response delayed cognitively you know we
don't just suddenly turn a switch and all of a sudden or we're back to
thinking in our happy hunky-dory way they may have intrusive memories or
flashbacks so we talked to people about what's the purpose of this and how is it
protective reactivation of previous traumatic events so things can happen in
the future like I said when women have started having children or even men it
can I would assume it can happen with them too when they bring home their
first child if they were abused as a child they may start having flashbacks
to what that was like and wondering if there going to be an abusive parent or
wondering if they're going to be able to protect their child and
starts bringing back floods of feelings and memories there self-blame you know
still that's emotional and physical our emotional and cognitive so thinking
about your cognitive distortions and a lot of times cognitive distortions are
all or nothing and you know I should have been able to get away there's no
way this should have happened so we want to look at self blames through the lens
of two things emotional versus factual reasoning well
three things emotional versus factual reasoning because if they are reasoning
using emotions not facts it's probably faulty reasoning right now when they're
doing this reasoning they're calm so they can see all these opportunities
when you're not calm you're not seeing all those opportunities so you need to
remember what kind of state you were in when this was happening so emotional
versus factual you want to look at the big picture is the person focusing on
one aspect of the situation or the whole thing who else was there what else was
going on what else was going through your mind at that particular point in
time and what cognitive distortions are you using you know are you using
all-or-none thinking or personalization when it's not helpful there can be a
preoccupation with the event you know wanting to get their power back
difficulty making decisions magical thinking or a belief that certain
behaviors including avoidant behavior will protect against future trauma so
you know this is especially true for example for parents whose children who
were abused as children especially if they were abused by you know somebody
outside of the family they may be way over protective of their children
because they don't want their children to be exposed at all so they're avoiding
even the slightest risk that this could happen again and you can see changes in
the person's own behavior how they may be avoiding situations that put them in
similar positions now the other caveat that you see with
magical thinking sometimes is people thinking lightning won't strike twice or
I'm gonna master this so there is a subset of people who survive traumas who
kind of put themselves in that situation again to try to get it right this time
try to master the trauma instead of feeling victimized so we want to talk
about that if someone who is date-raped continues to put themselves in risky
situations you know we want to talk about you know how they can stay safe
when they're when they're dating believe that feelings or memories are dangerous
yeah it can be really overwhelming so it can feel dangerous to the person because
they don't know what to do with these feelings and emotions and they can
generalise triggers so if you know one of my clients watched his best friend
commit suicide in front of him with a gun the sound was a very loud bang
well that very loud bang became generalized to just about anything that
was a very loud bang if it's a car backfiring if it's a door slamming and
that can trigger a very strong emotional reaction in him so we want to kind of
look at those things magical thinking could lead to OCD like behaviors yes
because if they believe that they do if they do this that and the other thing
then they'll be safe I would tend to look at it more as superstitious
behaviors than wanting to label it as OCD because it's generally not going to
progress to obsessive compulsive disorder but they will have a certain
ritual that they do which is you know somewhat superstitious in order to try
to stay safe behaviorally immediately people may have an exaggerated startle
reaction and even later they can have an exaggerated startle reaction so it's
important to help them understand it you can work with that you can start
learning to be okay with loud noises but it takes time
it doesn't happen overnight they may be Restless you know when your world's
turned upside down you want to get back to some sense of normalcy and if you're
hyper vigilant if you're worried that you know you got to stay on guard all
the time you've got norepinephrine and and cortisol in your system and it's
keeping you kind of awake and agitated so it makes sense that they may be
restless sleep and appetite disturbances well that's that's that old HPA axis
again we're not going to be able to rest enough to get good quality deep
restorative sleep so people are going to start getting a little more tired it
also means that hormones like gralen and Repton which are responsible for telling
you when you're hungry and when you're satiated they're gonna get out of whack
too so this is when we start to see physiological reactions so sleep just so
important difficulty expressing oneself how do you express yourself when you
can't even make sense of what happened so they may feel challenged in
expressing how they're feeling what they're needing they may feel numb so
they don't know and it's frustrating to them that they don't know what they need
but they don't know how to kind of articulate that we can help by
paraphrasing that if we ask them what they need and they're like I don't know
we can talk with them about how frustrating that must be to deal with
they can be argumentative you know this is the way it's going to be they're
trying to take control of their situation again I'm not going to testify
or I am going to testify or I'm not going to go to that shelter or I am and
and they can start getting very rigid in their opinions and remembering that most
of the time this is the way they're trying to get their world back into
control try to get that box back together again increased use of alcohol
drugs and tobacco for calming kind of purposes or just to help them forget for
just a minute to make those flashbacks go away to just numb it
doesn't mean they're gonna become an alcoholic or a drug addict no but we may
see an increased use of these drugs withdrawal and apathy cortisol levels go
down serotonin levels go down the person just starts feeling depressed hopeless
helpless makes sense and we can see avoidant behaviors not wanting to be
around other people well after you've been traumatized there's a lot of
reasons like we've already talked about you either can't trust them or you can't
take the input or you don't think they can handle your emotional stuff right
now so a lot of times people start avoiding other people and they may start
avoiding places that remind them of the trauma all of this you know works its
way through but people may continue to avoid event reminders you know my
stepfather they don't ever put up a Christmas tree because the Christmas
lights are triggering for him now you know he has learned to deal with the
Christmas lights at his daughter's house and everything but he doesn't want to be
surrounded by it at his house there may be social relationship disturbances just
still lingering distrust or frustration with other people or just irritability
you know not wanting to deal with other people's crap because you're barely
dealing with your own stuff on a day-to-day basis decreased activity
level as exhaustion sets in increased engagement in high-risk behaviors if
people are emotionally numb especially they may do this just so they can feel
something they may do it in order to also forget to have you know different
things going on increase use of alcohol or drugs can continue you know this is
one of the most common symptoms that continues on so if we look at what's the
function of your substance use when you started using it you know once people
start using substances the neural chemicals in their brain get messed up
because the brain starts expect the body and the brain start expecting those
chemicals to be coming in so the neuro chemistry and the brain changes and that
will precipitate or perpetuate the need for alcohol and drugs you know if the
brain chemicals get messed up and there's the withdrawal syndrome people
start using just to feel normal again so we can see problems develop but it's not
necessarily going to happen attachments and relationships trauma can impact
people's ability to develop strong healthy attachment to caregivers and
this is for children especially but also for adults when something happens you
know people may kind of break their attachments with other people they don't
want to love anybody because they don't want to get hurt like that again if they
you know had a loved one murdered you know I can't I can't do it it may break
their attachment or keep them from developing attachments with other people
again because they either don't want to trust don't want to love or can't trust
other people people who do not have healthy attachments and relationships
have been shown to be more vulnerable to stress have trouble controlling and
expressing emotions and may react violently or inappropriately to
situations well let's kind of take all these together that sounds like
emotional dysregulation going from zero to two fifty and one point two seconds
relationships are one of our greatest buffers against stress so when somebody
is like at their peak completely stressed out all the time and they don't
have anywhere to put it they don't have anybody to help them
deal with it it makes sense that every little thing could kind of send them
over the proverbial stress edge so we want to talk about you know you're
reacting to this with a 10 when it probably deserved it too so what's
fueling that reaction you know let's look at what's contributing to it and
generally it's the trauma stuff so if somebody for example doesn't call your
kid doesn't call and they're gonna be late for curfew and yeah you deserve to
be angry about that of course because they're breaking the rules but if you
react to it like as if they had gotten into a car accident and they're on
death's doorstep in the ICU that's probably an overreaction so
where's that coming from and you may look back to prior traumas when you know
maybe the person's best friend was killed in a car accident and so now
whenever they're kids late they just assume the worst there are people who have been sexually
abused who say they will never be able to trust somebody of the same gender as
their abuser again and may never be able to trust anybody
sexually again you know even if their abuser was was a man and they want to be
in a relationship with a woman making themselves vulnerable or interacting in
that way may be too overwhelming so they need help dealing with those issues and
compartmentalizing so yes that was a horrible experience but they need
hopefully to figure out how to be able to separate a sex between two loving
people and the traumatic experience and separate them even though some of the
physiological reactions are the same some of the feelings are the same
there's a lot of stuff that goes into recovering from sexual abuse or rape I
mean it doesn't have to be an ongoing thing
physical health the body and when a child grows up afraid or under
constant or extreme stress and this is true all the way up through 25
especially but it can be true later in life if somebody is in a domestically
violent marriage for twenty years for example it can change the brain the
immune system and the body stress response systems may not develop
normally or they may start to change as cortisol
levels stay high your immune system starts to change later on when the
person or adult is exposed to even ordinary levels of stress these systems
may automatically respond as if the individual is under extreme stress so we
already talked about that hypo cortisol ism and then the overreaction after that
or dysregulation stress in an environment can impair the development
of the brain and nervous system and it can also cause problems even in a fully
developed brain the absence of mental stimulation in neglectful environments
may limit the brain from developing to its full potential and we've seen with
older persons if the person is in an under stimulating environment symptoms
of cognitive decline come on more quickly so it's not just for kids you
know if you've got an elder who is being neglected if they're homebound and
they're being abused by their caregivers you know you can see cognitive decline
in in those people so you know it can go either way
failure to reach potential or rapid decline people with trauma histories may
develop chronic or recurrent physical complaints such as headaches or
stomachaches well number one serotonin is 80% here serotonin is in your gut so
when your serotonin gets out of whack generally your GI system gets out of
whack number two when you're under stress a lot you're also retaining a lot
of tension in your body which can contribute to stress headaches you may
be grinding your teeth which can contribute to headaches so we do want to
pay attention to that and some people will somatosensory they're gonna talk about fatigue and
lethargy and body aches okay you know let's talk about it however you want to
talk about it let's label it what it is but if you look at the diagnostic
criteria for depression for example fatigue and body aches and and stuff are
there and remember that serotonin is responsible for our pain perception so
if the stress is keeping cortisol levels high then serotonin levels are going to
be lower and estrogen which makes serotonin more available is going to be
lower same thing with testosterone which means
their people's pain tolerance is also going to be lower so it makes sense I
mean all of this stuff is interconnected trauma survivors may suffer from body
dysregulation meaning they over respond or under respond to sensory stimuli for
example they may be hypersensitive to sounds something that doesn't bother you
at all may drive them crazy you know I won't call it a trauma but we
had a tornado come through and took down you know a couple hundred feet of our
fencing and I walked out the next morning and I was just like taken aback
from it and now whenever I hear the wind start to pick up you know it doesn't
have to even be that loud I'm like kind of on alert because I want to make sure
that the fence doesn't fall down again not that that was a trauma but that was
a big stressor for me you know we'll stop short of trauma so
imagine what somebody who's traumatized may experience smells something that you
don't really even smell that much can be traumatizing to somebody especially if
it reminds them of their trauma because smell is our greatest memory trigger
touch or light you know some people may be hypersensitive to touch or they may
suffer from anesthesia and analgesia where none of this I mean they can hurt
themselves they can pick it themselves they can cut themselves and it doesn't
even hurt they just don't feel anything emotional responses they may have
difficulty identifying expressing and managing emotions and may have limited
language for feeling states so we want to use as many tools as we can to help
people develop an emotional vocabulary that works for them not everybody likes
those feeling words like happy mad sad glad and afraid whatever terms they're
going to use they feel like they got kicked in the gut they're feeling
drained they're feeling you know really tense right now okay
whatever words you want to use but let's start encouraging people to when they do
their mindfulness scans in the morning and the evening and preferably at lunch
too I usually say do it right before every meal that they can identify at
least one emotion that they're feeling and I always remind people that emotions
are like onions there's multiple layers to them so don't if you can identify
multiple emotions great but tell me at least one thing you're feeling they may
internalize or externalize stress reactions and as a result may experience
significant depression anxiety or anger and their emotional responses may be
unpredictable or explosive since traumas are often interpersonal in nature even
mildly inner stressful interactions with others may serve as a trauma reminders
and trigger intense emotional responses so if a child was abused and they told
their caregiver and they weren't believed then that disbelief you know
hit them really hard later on in life they may be telling their boss something
and their boss doesn't believe them or is dismissive of them and they react
very explosively to it or they take it you know react with a 10 instead of a
two and we might look at you know what did that remind you of when you felt
like you were being dismissed what did that remind you of so again it doesn't
have to be the same type of situation you know those are two very different
situations but they triggered the same response having learned that the world
is a dangerous place with and people are often vigilant and guarded in their
interactions with others and are more likely to perceive
situations as stressful or dangerous they're scanning they're looking around
in the environment for people who remind them in some way of the person or
persons that hurt them or the situation that hurt them dissociation and going
back even some of those you know like hurricanes they may be harboring
resentment and anger towards those people they felt did not help them so
maybe it wasn't somebody that directly hurt them but it was somebody who showed
apathy or didn't help them in their time of need once people have learned to
dissociate as a defense mechanism they may automatically dissociate during
other stressful moments or when faced with trauma reminders they just spaced
out dissociation can affect people's ability to be fully present in
activities of daily life and can significantly fracture a person's sense
of time and continuity sometimes people don't even realize when they're
dissociating they just kind of spaced out for a minute
or a few minutes it can have adverse effects on learning classroom or work
behavior and social interactions because when they get stressed they may just
kind of and it's not even going to a happy place they zone out for a second
and they're like how what what were you saying again and they're not trying to
be rude but it may can't come off to a teacher as daydreaming or to a
supervisor as being disrespectful or not paying attention in a meeting it's not
always evident when someone's dissociating and at times it may appear
if the person is just simply spacing out or not paying attention a person with
complex trauma histories may be very easily triggered or set off and are more
likely to react very intensely remember complex traumas are ongoing repetitive
traumas and they can be you know mild in intensity but ongoing or they can be
severe in intensity but it's not a one-and-done it's a consistent thing now
think about that whether you're an adult or your child or a child if the
bad thing keeps happening think domestic violence for example how is that going
to impact the way you think the way you see the world the way you see yourself
you know it starts eroding your self-esteem your self-confidence your
trust in others your belief in a just society people may struggle with self
regulation and may lack impulse control or the ability to think through
consequences before acting or may behave in ways that appear unpredictable
oppositional volatile and extreme if you're continually having all these
stressors you know eventually you may just say enough and people are like whoa
don't know where that came from sorry I'll come back later
and a lot of times these behaviors come to light if you will because people
start having problems either in their relationships or at work and they don't
really understand why they are being more volatile traumatized people are
more likely to engage in high-risk behaviors such as self-harm unsafe
sexual practices and excessive risk-taking such as operating a vehicle
at high speed now not everybody's gonna do this but this can be a way that
either they feel like they're controlling things they're putting
themselves in a risky situation and they're getting out and they're
mastering that situation or it can be an adrenaline rush so they're trying to
feel something thinking and learning can be impacted
traumatized people may have problems thinking clearly reasoning or
problem-solving may be unable to plan ahead anticipate the future and act
accordingly so if someone has been traumatized we want to help them figure
out how to stop take a breath think you know before they make a decision we want
to help them get into their wise mind so to speak when people live under
conditions of constant threat all of their inner internal resources go
towards survival so they may struggle with sustaining attention or curiosity
or be distracted by reactions to trauma reminders so they may have difficulty
focusing in their own life in their relationships people learn their
self-worth from reactions of others particularly those closest to them such
they're such as their caregivers or their spouse caregivers have the
greatest influence on a child's sense of self-worth and value an abuse and
neglect make a child feel worthless and despondent shame guilt low self-esteem
and a poor self-image are common among people with trauma histories so you know
those are for treatment plan issues you can identify right away people exposed
to violence learn they can not trust the world is not safe and that they are
powerless over their circumstances negative expectations interfere with
positive problem-solving and the ability to make a difference in their own lives
so they expect that they're gonna fail they expect that bad things are going to
happen a traumatized person may view himself as powerless damaged and
perceived planning as a positive action and therefore futile you know why should
I plan because you know the world's gonna dump crap on my head anyway they
have trouble feeling hopeful and have learned to operate in survival mode
living from moment to moment without pausing to think about plan for or even
dream about the future so figuring out what things and people are important in
your life and you know where do you want to be six months from now that might not
be something they've even pondered because they're just trying to survive
the day so helping them you know be able to
plan and think about the future so they can make more effective choices in the
present to get them closer to those goals is going to be super helpful
results demonstrated the connection between trauma exposure high risk
behaviors chronic illness such as heart disease cancer and early death a lot of
the chronic illnesses are chronic as they would call them stress-related
illnesses which makes sense because a person who's been traumatized
repeatedly or hasn't dealt with their trauma is going to continue to have
higher stress levels than the average Joe out there
so let's look briefly at the family trauma changes families as they work to
survive and adapt to their circumstances and environment so weather is one person
in the family who was traumatized or the whole family it's going to change the
family dynamics adult relationships can be a source of strength in coping with a
traumatic experience and it's aftermath but the adults have to be emotionally
present if it's thrown the adults for a loop – and the children are looking to
the adults for guidance and the adults are just kind of spinning out of control
there's gonna be problems when coping resources are stretched too thin and
stress is too high partners can have difficulty communicating managing
emotions being intimate all of this stuff can increase the chance for
separation or even violence in the relationship
helping people look at what are the impacts of the stress that's going on
and how can we reduce the stress we're not even talking about the trauma right
now we're talking about stress parents protection nurturance and guidance
speeds recovery and supports their child's coping in the face of trauma
when parents are not available or struggling with their own reactions they
have difficulty effectively responding to and parenting their children so when
junior starts acting out in order to try to get some comfort if you will get mom
to give them a hug and tell them it's going to be okay or put some boundaries
on them so they're they feel like mom still got some control over what's going
on or or dad and instead parent reacts by yelling at
them and sending them away then juniors just like oh my gosh I don't know how to
deal with all this on my own so a lot of times children will become more agitated
because they're looking for or they're needing the parent to set some
boundaries and to help them develop the skills to cope with this because they've
never been exposed to anything like this before so they need help developing
those tools because they don't know what to do with it it's kind of like if you
grabbed a whole handful of earthworms and you're just holding them and you're
like okay now now what do I do with them you know they're they're kind of Wiggly
and you're trying to keep them from falling out of your hands but you know
sibling relationships are important sources of daily support especially when
living under stress or impacted by trauma but when sibling relationships
become overtaxed just like you know marital relationships developmentally
normal rivalries can turn into intense conflict or feelings of rejection which
can also lead to violence and you know aggressiveness extended family can offer
the day-to-day assistance as well as emotional support they found that
families separated from their extended family often develop a new kinship
network so if the extended family was the perpetrator of the abuse it doesn't
mean all is lost because a lot of times people will develop their own extended
non-blood family the family as a whole provides resources to meet the basic
needs of each family member and support the family's well-being and day-to-day
functioning traumatic circumstances though drain the family's resources such
as time money and energy and interfere with growing learning and working you
know if you've got mom and dad and they're exhausted and the kids are you
know exhausted and they're all trying to struggle with trauma they may be you
know not able to go to work as much so income goes down they may be going to
the doctor more you know there may be other expenses they may have had to move
you know there are a lot of things that can drain and add additional stressors
that drain the the energy and effectiveness of the family so we need
to help them again not even looking at it so much as the
trauma but how can we help you relieve some of this stress so you can breathe
burdens often associated with trauma such as costly court proceedings moving
changing schools can result in cascading effects such as loss of income as well
as time with family and friends when trauma limits access to needed
resources and social support families have difficulty carrying out daily
routines and sustaining important traditions that bind them together like
family dinners or you know whatever it is so we need to educate our clients we
need to frame reacts perience events such as hyper arousal sleep disturbances
and other physical symptoms as physiological but adaptive reactions to
extreme stress it totally makes sense you're not broken
you're not pathological you're trying to survive now let's see if we can help you
sleep a little bit better so you're having a higher quality of life
communicate that treatment and other wellness activities can improve both
psychological and physiological symptoms discuss traumatic stress syndrome
symptoms give them a checklist have them look over it and check which ones they
experience each week explain the links between traumatic stress syndrome or
symptoms and substance use disorders if appropriate and normalize trauma
symptoms explaining that they're not a sign of weakness
a character flaw or a sign of being damaged or going crazy it's just how
they managed to survive and adapt in the face of really abnormal circumstances we
want to support clients and provide a message of hope that they're not alone
and they're not at fault and recovery is possible and totally expected and
anticipated resilient responses that we can encourage include increased bonding
with family and community helping them redefine or increase their sense of
purpose and meaning you know what does this trauma mean to you and what's your
purpose in life you know how can you integrate this into your story you have
this narrative that you're writing and this was a chapter it was an unpleasant
chapter now what happens in the next chapter in the
next season of your life if you want to look at it as a television play
increased commitment to a personal mission you know help them use this
energy you know now's a chance for you to decide what's important in your life
they can revise their priorities and they may have an increase in charitable
giving and volunteerism these are ways people try to reconnect with the good in
the community so to speak trauma impacts the person emotionally cognitively
physically developmentally interpersonally and spiritually it just
hits the whole gamut so we want to make sure that people understand that and
they're not just focusing on the emotional symptom or the flashbacks we
want to help them see that there could be an array of symptoms but as they
start dealing with the trauma those symptoms will start to remit and as they
start taking care of themselves you know sometimes they're not ready to
deal with the trauma but they're willing to work on improving their sleep you
know start wherever you know wherever you start is going to have positive
impacts at reducing the stress increasing their social support and
helping them deal with the trauma when the entire family system is experienced
a trauma is difficult to even have a trusting relationship to turn to within
that system yes that's very true after a hurricane for example if you lost
everything you know it may be difficult to turn to somebody else in the family
for children to turn to parents or even for parents to turn to each other
because none of them is functioning really well right now they're all kind
of reeling from the trauma so if I look to my husband for support and he's not
able to even deal with his own stuff then he's not going to be able to
provide me support so then I may feel let down and betrayed by him so you know
helping families understand it you know everybody's feeling the effects and
everybody's reeling right now so how can we help you re stabilize and when you
work with families you know if they've got support people whether
they're kin or not encourage them to bring them into the treatment process
they may not want to come into therapy they may not want or need to hear the
nitty-gritty of what's going on but it may be helpful to occasionally touch
base and talk about talk with those people about how can you help the
identified patient or patients you know what can you do and provide some
education in community disasters you can really do a lot of that in the shelter's
you can go in there and talk to people because they're kind of a captive
audience at that point and yes whenever you bring anybody in to therapy
you're not bringing them the client is bringing them so you're not going to
call you know their aunt sally and go hey I think it'd be a good idea for you
to show up always remember that you need releases of information and to talk to
anybody and the client has to be the one to initiate bringing people into into
treatment if they don't want the other people involved that's totally cool we
want to make sure that they have a sense of personal power and control over their
treatment especially any other questions comments I appreciate all the stuff that
you gave me to work with today and I think
I got to everything I'm reviewing just in case I didn't get to everything yeah one of you pointed out you're in
Texas and after hurricane Harvey every person that was influenced or impacted
by hurricane Harvey they may have had very similar losses but they the family
itself may react differently and remember we want to look back at the
family or the individual and say when we're looking at these two what's their
history of stressors in the past six months what's their social support like
what's their how many losses did they experience as a
result of it you know looking at and is their history
of mental illness or substance use or abuse within that family all of those
can be factors that are subtle in you know helping us figure out who may be
more traumatized or experienced trauma symptoms more greatly alrighty everybody
have an amazing weekend and I will see you on Tuesday for the to finish up this
series if you enjoy this podcast please like and subscribe either in your
podcast player or on YouTube you can attend and participate in our live
webinars with doctor Snipes by subscribing at all CEUs comm slash
counselor toolbox this episode has been brought to you in part by all CEUs com
providing 24/7 multimedia continuing education and pre certification training
to counselors therapists and nurses since 2006 use coupon code consular
toolbox to get a 20% discount off your order this month