VIOLENCE AND PTSD

1. VIOLENCE AND PTSD Human Responses and Healing Brenda Wiewel, LCSW

2. “Your vision will become clear only when you can look into your own heart. Who looks outside, dreams. Who looks inside, awakes.” Carl Jung

3. Dayton, Tian, PhD., 2000. Ending the Cycle of Trauma and Addiction: Ending the Cycle of Pain Through Emotional Literacy, Deerfield Beach, Florida, Health Communications, Inc. Napier, Nancy J., 1994. Getting through the Day: Strategies for Adults Hurt as Children, New York, New York, W.W. Norton and Company, Inc. SOURCES:

4. “Persons are traumatized when they face uncontrollable life events and are helpless to affect the outcome of those events.” (Lindemann, E., 1944) Events may include: … Possible death or injury … Physical or sexual attack … Childhood scenes of adult rage PTSD can result with exposure where: one experiences, witnesses, or is confronted with events that involve actual/threatened death or serious injury or threat to physical integrity of self or others and reacts with intense fear, helplessness, and/or horror (DSM lV, 1994) DEFINITION OFPOST TRAUMATIC STRESS DISORDER

5. Short Term PTSD Symptoms • Recurrent/intrusive memories (images, thoughts, perceptions) • Reliving parts of event through hallucinations or flashbacks • Intense physiological arousal (rapid heartbeat, sweating, general anxiety, stomach queasiness, head pounding) • Difficulty falling or staying asleep • Difficulty concentrating • Irritability or angry outbursts • Hypervigilance • Exaggerated startle response

6. Long Term PTSD Symptoms • Trouble with intimacy or commitment • Unable to set or set overly rigid boundaries • Inability to relax, have fun, be spontaneous • Difficulty with trust • Fixation on PTSD or Trauma (as if constantly reoccurring) • Changes in personality • Chronic depression with despair • Psychosomatic symptoms • Sensation seeking or numbing behavior (high risk acts or self-medicating)

7. COMPLEX PTSD • This occurs due to repeated early and later experiences of chronic and/or severe traumatic events and experiences • Symptoms include: • Affect disregulation • Destructive behavior toward self and others • Dissociation (separating self into parts) • Distortions in concept of self or others • Inability to use emotions as signals so misread internal and external cues and significantly over or under react to present situations

8. INTENSITY OF PTSD Severity and long term response based on: • Genetic predisposition • Developmental phase (firm sense of identity and strong social support helps) • Prior traumatization • Preexisting personality (e.g. untreated phobias and maladaptations to previous life stressors more likely to result in psychiatric reactions) Nazi survivors: 99% psychiatric disturbances, 87% cognitive disturbances, 85% persistent nervousness and irritability, 60% sleep disturbances, 52% nightmares

9. UNDERSTANDING THE BRAIN • Fear, horror, and helplessness of traumatic event activates the amygdala (moderates hormones for flight, fight, or freeze) and basil forebrain (stimulates arousal and reward). This reaction evolved for human survival. • Trauma aroused feeling states get frozen and stored as memories in the lower brain without any conscious thought processing. When these memories are triggered by external associations, the trauma is relived physiologically and hormonally leading to automatic reactions of fight, flight, or freeze (shutting down). • There is no conscious knowledge or awareness of what is happening because the conscious part of the brain that ordinarily processes and provides meaning or context has not been activated. • Feedback loop: arousal triggered by environmental stimuli causes release of stress hormones which increase anxiety, which increases stress and a circular loop develops, often leading to acting out behaviors or emotional shutdown/numbness to manage the high levels of “physiological flooding”. This state interferes with ability to learn and improve coping.

10. EMOTIONAL ILLITERACY • Lack of conscious processing of reactions • Feelings not “processed”: experienced, labeled, or communicated. • Interferes with development of healthy self-soothing and supportive relationships

11. TRAUMA TREATMENT GOALS • Ensure physical and emotional safety • Create relationships where there is safety to share feelings and real support is consistently available • Maintain sense of curiosity during exploration to find new parts of self with a story to tell and triggers with important bridges to unremembered experiences • Monitor for self- frustration due to getting triggered and be gentle with self • Work on how to listen to body’s distress and translate to feelings so symptoms have a voice • Remember that the healthy adult self is a compassionate resource

12. HOW TO PROMOTE HEALING • See PTSD when it is in front of you • Educate about how PTSD works • Manage “over or under reactive” behaviors calmly • Work toward emotional literacy by helping to convert sensed feelings into words to decode the inner world and create meaning within self • Support communication of inner state to others • Learn to recognize triggers, separate past from present, and create a new life narrative • Help with grief work to prevent relapse • Use letters, journaling, emdr, psychodrama

13. BREATHING EXERCISE • Sit quietly and settle into your chair. • Feel your body as it touches the chair and your feet as they connect to the ground. • Focus on your breathing. • As you breathe in, say to yourself: “May I dwell in the heart of healing” • As you breathe out, say to yourself: “May I heal into my full self!”