Impacts of Victimizations and Victim Recovery

1. Impacts of Victimizations and Victim Recovery Chie Maekoya Tokiwa International Victimology Institute The 11th Asian Post Graduate Course on Victimology and Victim Assistance

2. Main Topics which will be Discussed Today • What is a traumatic experience? • Possible reactions to a traumatic situation • Effects of victimization • Ecological view of psychological trauma • Recovery • Treatment • Resilience • Posttraumatic growth

3. What is a Traumatic Event? • Traumatic 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 e.g.) natural disaster, war, terrorism, physical assault, sexual assault, spousal abuse, child abuse, traffic accident

4. What is a Traumatic Event? (cont.) 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. • It happened in childhood.

5. Possible reactions to a traumatic situation-normal responses in an abnormal situation- Emotional Effects • shock • terror • irritability • blame • anger • guilt • grief or sadness • emotional numbing • helplessness • loss of pleasure derived from familiar activities • difficulty feeling happy • difficulty experiencing loving feelings

6. Possible reactions to a traumatic situation-normal responses in an abnormal situation- 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" feeling)

7. Possible reactions to a traumatic situation-normal responses in an abnormal situation- Physical Effects • fatigue, exhaustion • insomnia • cardiovascular strain • startle response • hyper-arousal • increased physical pain • reduced immune response • headaches • gastrointestinal upset • decreased appetite • decreased libido • vulnerability to illness

8. Possible reactions to a traumatic situation-normal responses in an abnormal situation- Interpersonal Effects • increased relational conflict • social withdrawal • reduced relational intimacy • alienation • impaired work performance • impaired school performance • decreased satisfaction • distrust • externalization of blame • externalization of vulnerability • feeling abandoned/rejected • overprotectiveness

9. How is our cognition effected?（Janoff-Bulman, 1985） Negative emotion brings questions that sometimes damage what one believes about oneself, others, and the world Basic assumptions victims hold about themselves and their world Traumatic event Threat Danger Insecurity self-questioning • Belief in personal invulnerability • Perception of the world as meaningful • Perception of oneself as positive change assumption

10. Ecology View of Psychological Trauma (Harvey, 1996) • 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. Person Event Environment Traumatic Event Reaction to the traumatic event Recovery

11. Influences on the Trauma Response • Person • Age • Developmental stage • Initial distress level • Intelligence • Personality • Affects • Cognition • Coping styles • Role • Relationship between victim and offender

12. Influences on the Trauma Response (cont.) • 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 • whether trauma was experienced alone or in the company of others

13. Influences on the Trauma Response (cont.) • 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 • the quality, quantity, accessibility and cultural relevance of victims care and advocacy resources

14. Grief • 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.” • Acceptance “It’s going to be okay.”

15. Possible symptoms to Have after a Traumatic Event • 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 • Suicide

16. What is recovery ? • 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 • Resumption of a functional daily life

17. Stages of Recovery Establishment of safety Remembrance and mourning Reconnection with ordinary life Herman, 1992

18. Establishment of Safety • 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 • Able to rely on self and others for support • Sense of deserving support and care

19. Remembrance and Mourning • 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, including the imagery, into words. The victim achieves the ability to construct not only what happened but also what he felt.

20. Reconnection with Ordinary Life • 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. • A sense of power and control will be increased in this last stage.

21. Recovery as a Multidimensional Phenomenon (Harvey, 1996) • Authority over the remembering process • Integration of memory and affect • Affect tolerance • Symptom mastery • Self-esteem and self-cohesion • Safe attachment • Meaning making

22. What will individuals be like when they are recovered? • 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 past. Authority over the remembering process Integration of memory and affect

23. What will individuals be like when they are recovered? (cont.) • 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 predict and manage symptoms. Affect tolerance Symptom mastery

24. What will individuals be like when they are recovered? (cont.) • 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 realistic appraisal, reflecting a more positive new view of self. Self esteem & Self Cohesion

25. What individuals will be like when they are recovered? (cont.) • 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 traumatic past and imbues it somehow with meaning that is both life affirming and self-affirming. Safe Attachment Meaning Making

26. What Influences One’s Recovery? 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 resources that are person-specific, culture-sensitive & situation-realistic (Dussich, 2008).

27. How do Victims See Themselves in a Recovery Process? citizen survivor victim trauma • 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 integration and access to all aspects of society • Their world view reduced to a narrow focus on their physical health and basic needs Ferguson, Richie and Gomez (2004)

28. Victims Support • 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 • Financial reparation

29. Treatment 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) • Pharmacotherapy (medication)

30. Resilience • 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 impulses

31. Way to Build Resilience • 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 • Keep things in perspective • Maintain a hopeful outlook • Take care of yourself

32. Post Traumatic Growth • 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 • Enhancement of personal strength • Spiritual development

33. Thank you for your attention!Chie Maekoya (maekoya@tokiwa.ac.jp)