Dr Björn Ogéus, anaesthetist, trauma therapist DB Hälsospecialisten bjorn.ogeus@outlook

1. ”There is a time for everything” - how to cope with a traumatized person and when it´s time to go into rehabilitation and trauma treatment. Dr Björn Ogéus, anaesthetist, trauma therapist DB Hälsospecialisten bjorn.ogeus@outlook.com

3. ILSKA غضب HÄPEN دهشه RASERI غضب RÄDD خائف HAT حقد FRUKTAN خوف AVSKY كره SKRÄCK رعب AVSMAK نفورÅNGEST خوف SVARTSJUK غيره ORO قلق AVUND حسد NERVÖS متوتر MISSUNSAMHET حسد SPÄNDHET تشنج ÖVERGIVENHET حاله من الوحده STRESS مضطرب BORTSTÖTT مبعد PRESS ضغط ENSAM وحيد SKULD دين RATAD اهمال SKAM عار LEDSEN حزين FÖRÖDMJUKADذليل SORG حزن KRÄNKT أهانه FÖRTVIVLAN يأس FÖRNEDRAD أذلال VEMOD حزن UTSATT مًعرض KVAL معانات LURAD مخدوع PINA ألم INTRESSE هوايه HANDLINGSFÖRLAMNING مشلول IVER حماس OTILLRÄCKLIGHET عدم ملائمه VÄLBEHAG متعه BEROENDE التعود GLÄDJE فرح FRUSTRERAD محبطÖMHET حنان BESVIKEN خيبة أمل TILLGIVENHET عاطفه RESIGNERAD مكتئب RESPEKT أحترام HJÄLPLÖS عاجز VÖRDNAD تبجيل MAKTLÖS عاجز KÄRLEK حب

5. The meeting/consultation Confirm the meeting (connection,why wemeet ). ”Tell me…! - let the person talk freely whitout leading questions - give them time to finish - signal that you are accepting (body language) - listen actively Confirm the message -”I hear what you are saying”! - ”Have I understood you correctly”? - ”Do you have anything to add”? Key questions – What do you believe it depends on that you feel as you do? - What have you uptill now done to cope with the problem? - What are your expectations of our meeting? - What can I do for you?

6. Self-image The picture could show: Emotions/feelings Thoughts Behavior Regrediation Context Crisis reaction Anchoring in time Fantasies Self confidence

7. Questions to consider 1) Is the person´s self-image negative or positive? 2) Does the picture suggest any movement or possible change? 3) How does the person feel? 4) Are all parts of the body represented? 5) How old is the person? 6) What would you like to say to the person, or do with him or her? 7) What kind of pain? 8) How do you read the body language?

8. Focus What can you control in your life? …………………………. ……………………….... …………………………. ………………………..... …………………………. …………………………. What can´t you control in your life? ………………………….. ………………………….. ………………………….. ………………………….. …………………………..

9. Key questions to reflect on during a conflict • Is it dangerous? If yes you have to act immediately! If no you have time to consider! • Whose responsibility? Who carries the responsibility? • What do you want to do? What is it you don´t want to do?

10. Useful Measuring instruments • SMBQ; utmattningsgrad,(Shirom-Melamed Burnout Questionnare). • SCI;stresspåslag,(Stress and Crisis Inventory). • HAD; ångest & depression,(Hospital Anxiety and Depression scale). • PHQ-15; somatiska symtom, (Patient Health Questionnaire 15-Item Somatic Symptom Severity Scale). • PHQ-9; 9-Items,screening and diagnosing , monitoring and measuring severity of depression • KASAM ; känsla av sammanhang,delskalormeningsfullhet,begriplighetochhanterbarhet (SOC -Sence Of Coherence).

11. Psychosomatic Medicine Clinic The design is a non-controlled single-group study with pre-and post measurements. “Patients with Posttraumatic stress disorder– estimation of anxiety, depression and somatic symptoms before and after a team treatment with therapeutic conversations with eye movements-method , DEM (debriefing with help of eye movement technique)“. The study were presented in a C- study report in physiotherapy by Cathrine Svanberg and Josefine Hansson. UPPSALA UNIVERSITET Institutionen for Neuro- science Program for Physiotherapi Eleven patients admitted to the Psychosomatic Clinic in Västerås, Sweden, were diagnosed with PTSD, and selected to participate in the study. Measuring instruments used were the Hospital Anxiety and Depression Scale (HAD) and the Patient Health Questionnaire-15 (PHQ-15).

12. DEM (Debriefing with Eye Movement technicue) including: * Therapeutic conversation/debriefing sessions with eye movement technique (to get in touch with suppressed emotions and traumatic memories) by a doctor. * Body Awareness Therapy (to increase body awareness and reduce traumatic stress reactions) by a physiotherapist. * Comforting and respectful holding during the process by a nurse.

13. Background/data (N=11). Gender female/male 6/5 Age median (min – max) Total no of diagnoses besides PTSD. Median (min – max) 3 (0-4) Marital status single/couple 2/9 39 (29-65)

16. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-15 comprises 15 somatic symptoms from the PHQ, each symptom scored from 0 (“not bothered at all”) to 2 (“bothered a lot”). Stomach pain Back pain Pain in your arms or legs or other joints Menstrual cramps or other problems with your periods (womenonly) Headaches Chest Pain Dizziness Faintingspells Feeling your heart pound or race Shortnessofbreath Pain or problems during sexual intercourse Constipation, loose bowels, or diarrhoea Nausea, gas, or indigestion Feeling tired, or having low energy Troublesleeping

19. Drawings from a patient during Debriefing sessions and Body awareness therapy showing changes in stress reaction, reprocessing and a new coping strategy. It also reflect changes in body images. 4-months’ follow up start after treatm. 4- months HAD: depr 126 5 anxiety 1610 6 PHQ-15 19 12 8

20. Result: The participants in the study experienced a significant improvement in all parameters. Median value for estimated anxiety decreased from 15 to 7 points (HAD) four months after ended treatment (p=0.008). The same values for estimated depression (HAD) decreased from 10 to 5 points (p<0.001) and somatic symptoms (PHQ-15) decreased from 17 to 8 points (p<0.001). Conclusion: The results provide some support for the use of DEM-method as a treatment for patients with PTSD. The patient participation was however low and further studies with more participants and with a long-term follow-up is desirable for a more reliable result.

21. Self injuring behaviouroften concern difficulties with: • Routines (eating, movement and sleep). • Acknowledgement (to be seen as an autonomous individual). • Alexithymi (difficulties to express feelings). • Social isolation. • Security and predictability. • Reconciliation with the past. • Self image and self respect. • Personal borders.

22. ACE -study Vincent Felitti, professor in preventive medicine and internal medicine, San Diego, Centers for Disease control, has been involved in the study for many years. The study started 1995. The aims of the study was to survey the effects of adverse childhood events (hostile/frightening/negative experiences) later on in life, for the person involved and to the society as a whole. The study has showed that adverse childhood events has a strong statistical relation not only to psychiatric diseases, but also many somatic diseases and premature death. ACE -study has lead to more than 20 publications in epidemiology.

23. Trauma treatment Trauma treatment is about getting the lose ends together to form a pattern - a comprehensible ”structure”of memories

24. ”The Good Life’s Cake” Context and meaning For each one of the words below, write a short text (a few lines or so) that will create Joy Curiosity Pleasure/enjoyment Health Meaning Hope for you!