TRAUMA PSYCHOLOGY The Symptoms: from Dissotiation to Shame

1. TRAUMA PSYCHOLOGYThe Symptoms: from Dissotiation to Shame Mário Resende AlmaSoma Earth, July, 2010

2. Trauma Psychology • UNSOLVED TRAUMA An unsolved trauma is A physical, emotional and mental memory of one or more experiences wich are felt until the present as profoundly threatning of survival and wich disturbs the way of being with yourself and the world.

3. Trauma Psychology • What happens in a trauma? • THE TRAUMATIZATION PROCESS (Levine and others): • Activation of a hug amount of energy in presence of danger to FIGH or FLIGHT (experiencing Rage or Terror) • Impossibility of resolving the threaten by fight or flight (experiencing Helplessness)

4. Trauma Psychology • Encapsulation of energy by Freezing The animal response to Freezing: Shaking The human response to freezing may be mediated by neo-cortex and inhibited at the reptilian brain instinctive responses level.

5. Trauma Psychology • DISSOCIATION • Encapsulation of Energy or it’s Dissociation by Peri-Traumatic Dissociation (or Secondary Dissociation) • The Peri-Traumatic Dissociation occurs as a defense mechanism, during a potentially traumatic event. Conscience appears to withdraw from the body, emotions and mind, and the person becomes devitalized, space-out, and may finally fall asleep or faint. It may also start to dream awake or to enter a psychotic crise (auditive, kinesthetic or visual hallucination).

6. Trauma Psychology • PERI-TRAUMATIC DISSOCIATION • Refers to a dissociation between the Observer Ego and Experiential Ego (appeals, at least in some cases, to the extra cerebral conscious dimension ) • Allows the person to observe his experience as an spectator, alleviating his pain or anguish. He becomes protected from the conscience of the hole event impact • Persons that dissociate during a trauma have more symptoms of post traumatic stress and develop more PTSD than the ones that don´t dissociate during the trauma.

7. Trauma Psychology • Peri-Traumatic Dissociative Experiences Questionnaire (PDEC) • Moments of loosing the «way»; blanking out • Be aware of being in “automatic pilot” • Time changing sensation during the event • The event seem unreal • Floating above the scene • Feeling disconnected from body or body distortion experience • Unable to distinguish what’s happening with him and with others • Not being aware of things happening during the event that, under normal situations, would be noticed • Not feeling pain during an physical injury (Marmar, 1996)

8. Trauma Psychology • Self Fragmentation and Information Fragmentation (Tertiary and Primary Dissociation)

9. Trauma Psychology • Difficulty in Processing the Information of the Environment • Reality becomes a stage where, uninterruptedly, the scenes of our deepest traumas roles on. • Loosing the ability of «seeing-what-it-is».

10. Trauma Psychology • Over-interpretation of current stimuli as trauma memories (minor stimuli with capacity to activate intrusive reminiscence of trauma) • Generalized hipper-arousal and difficulty in distinguish what is relevant from what isn’t

11. Trauma Psychology • Negative Beliefs and Expectations • The Trauma generates generalized negative concepts and expectations about reality : «Men are bad!», «Life is hard!». • In the origin of misinterpretation of the context • In the origin of inadequate responses

12. Trauma Psychology • Avoidance • Defense mechanism expressed as withdrawal from places, persons or situations concerning to Trauma or, directly or indirectly, related to it. Anxiety self-regulation mechanism. • In short term, avoidance alleviates the distress but prevent the experience required to learning how to distinguish between safe and risky situations. • Avoidance => exacerbate and perpetuate PTSD symptoms rather than promote adaptive behavior.

13. Trauma Psychology • AVOIDANCE OF: • Trauma location (e.g. driving – traffic accident); • Trauma subject (e.g. News – war veteran); • Repetition of trauma (ex. Eye contact with perpetrator – child physically abused); • Body sensations related to trauma (e.g. pain, physical palpitations due to household and other physical efforts); • Thoughts associated with Trauma (suppressing by forgetfulness, distraction) with paradox effect because it increases the thoughts related Trauma.

14. Trauma Psychology • Numbing • One way out from Trauma affliction is finding ways to stop feeling. • Examples: Food, cigarettes, alcohol, drugs, adrenaline (extreme sports, risk behavior associated with theft, sex, physical struggle), etc.

15. Trauma Psychology • Work, dedication to a political, social, religious cause, dedication to even more suffering others, etc., may be other forms of avoidance/numbing.

16. Trauma Psychology • Self-destructive Behaviors Emotional self-regulation form (anxiety control procedure): - provoke a physical pain to lessen the emotional or mental pain (e.g. self-mutilation) • discharge the tension against the self (related to shame and guilty feelings)

17. Trauma Psychology • Memories Intrusion

18. Trauma Psychology • Memories and Thoughts Intrusion • The symptoms of intrusive experiences consists in repetitive thoughts, images, memories and impulses related to trauma. Normally they are difficult to control and against the will.

19. Trauma Psychology Threaten and Danger “ Am I Safe”? Negative Thoughts about the Self “Am I a Bad person?” Thoughts about the Meaning of the Event “Why did this happen to me?”

20. Trauma Psychology • Systematic or Partial Hipper Vigilance • Alert state of eminent danger in total life experience or, partially, in relation to a specific aspect of life. • Generates Anxiety Disorders and Reality Interpretation Deficits.

21. Excessive Alarm Reaction • In a psychophysiological perspective, the alarm response designs an constellation of reflex motor movements, automatic responses and voluntarily oriented responses that occurs in response to a sudden and intense change in the stimuli intensity. • Hesitate or retreat in response to a unexpected touch; • Wake up suddenly in face of an unexpected evening sound and stay awake, unable to fall asleep; • Throw into the ground or to let down immediately upon hearing the noise of a car brake.

22. Trauma Psychology • Impulse Control and Emocional Self Regulation Problem • Physical and emotional violence phenomena: persons known for their RAGE explosions • Self-Mutilation phenomena for anxiety control • Indirectly they react to the original trauma and it may happen retraumatization

23. Trauma Psychology • Impulse Control and Emotional Self Regulation Problem • Related to Borderline Disorder • Related to Impulse Control Disorder

24. Trauma Psychology • HELPLESSNESS (Feelings of…) • Feelings of HELPLESSNESS makes you unable to respond in a adaptive way to the environment. It’s easily followed by despair and depression. • The resources are reduced in the traumatized person. Usually, any stimuli will activate the fear, freezing or dissociation response, instead of an appropriated oriented response.

25. Trauma Psychology • LEARNED HELPLESSNESS (Seligman) • May result from the experience of being unable to control the environment, usual experience in trauma. • Feelings of Helplessness, Depression (and despair) dominates or manifests in face of difficulties or risks. • Inability to recognize new opportunities when they occur.

26. Trauma Psychology • Retraumatization • By similar circumstances but less intense • Apparent attraction by similar traumatic circumstances (compulsive re-exposition to trauma in severe cases)

27. Trauma Psychology • Attachment Problems - Difficulty in the emotional connection with caregivers (parents) or with others in general

28. Trauma Psychology • GUILT • Emotion that shows up when a person realizes that his behavior caused negative damages to other (pain, suffering...) Examples of Guilt in Trauma context: • Survival Guilt – I suffered less then the others. I should had gone also. You feel guilty because you suffered less then the others (common in war survivals). • Victim – I should had prevented it. I should had done more. I was to weak. You feel guilty because you where a victim (common in domestic violence , child abuse, genocide and torture victims) • Observer – I couldn’t do nothing. You feel guilty because you could not interfered or prevented traumatic damages that you witnessed or that happen to people under your responsibility.

29. Trauma Psychology • SHAME: Related to a negative self evaluation. • Easily associated with pathological guilt feelings

30. Trauma Psychology • Somatization and Immunity • Psychological Trauma (mental and emotional) may generate physical symptoms (pain and organic dysfunctions) without other cause • Correlation evidences: Stress causes Immunity Reduction and the effectiveness of the blood cells that fight latent viral activity. Higher incidence of herpes, Candida, autoimmune diseases, HIV progression, chronic fatigue syndrome, increased tumor cells, etc

31. Trauma Psychology • Trauma Studies Group: • Ana Paula Mourato, Clara Leitão, Conceição Costa, Felícia Lisboa, Idalina Freitas, João Martins, Margarida Santos, Mário Resende, Marta Modas, Nuno Pinto, Pedro Lisboa, Rita Coelho, Susana Oliveira, Tânia Baptista

32. Trauma Psychology • Main References • Elhai, J.D., Reyes, G. & Ford, J.D. (2008). The Encyclopedia of Psychological Trauma New Jersey: Wiley. • Levine, P.  & Frederick, A. (1997). Waking the Tiger. Healing Trauma. Berkeley: North Atlantic Books • van der Kolk, B. A., McFarlane, A. C. & Weisaeth, L. (1996). Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society New York: Guilford