Trauma And First Responders

Corey Pavelka

Who are First Responders

          Police Firefighters Emergency Medical Techinans Military Doctors Nurses Correctional officers Dispatchers Clergy Mental Health Professionals

What qualifies as a “traumatic event?

   According to the DSM-IV a traumatic event is one in which we experience a threat (actual or perceived) of death or serious injury to self or others , with a response of “intense fear, helplessness or horror.” Type I Type II

What is the normal response to a traumatic event?

        anxiety, feeling “revved up;” emotional instability fatigue irritability hyper-vigilance trouble sleeping exaggerated startle response        change in appetite feeling overwhelmed impatience isolation from family and friends shock nightmares somatic complaints

Quiz

1. What are 2 normal trauma reactions? 2. How many types of traumatic events are there? 3. Are clergy considered first responders?

Stress disorders

  Acute stress disorder Post traumatic stress disorder

Acute Stress Disorder

    Criterion A: exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, as follows by direct exposure, witnessing or indirectly learning about the trauma

Criterion B:

numbing, detachment, a reduction in awareness of the surroundings, derealization, or depersonalization; dissociative amnesia

Criterion C:

persistently re-experienced in at least one of the following ways: recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense of reliving the experience; or distress on exposure to reminders of the traumatic event. Criterion D: marked avoidance of stimuli that arouse recollections of the trauma.

Symptoms of Acute Stress Disorders

   

Criterion E:

marked symptoms of anxiety or increased arousal.

Criterion F

: significant distress or impairment in social, occupational, or other important areas of functioning or impairs the individual's ability to pursue some necessary task

Criterion G:

the disturbance lasts for a minimum of 2 days and a maximum of 4 weeks and occurs within 4 weeks of the traumatic event. The disturbance is not due to the direct physiological effects of a substance or a general medical condition, is not better accounted for by Brief Psychotic Disorder, and is not merely an exacerbation of a preexisting Axis I or Axis II disorder.

Treatment of Acute Stress Disorder

 Treatment for acute stress disorder usually includes a combination of antidepressant medications and short-term psychotherapy.

Medications

    Clonidine Propranolol Clonazepam Fluoxetine

Quiz

4. Name 2 symptoms of acute stress disorder?

5. What is the timeframe acute stress disorder must appear in? 6. Does Individual vulnerability and coping have any influence on the severity of acute stress disorder?

Post Traumatic Stress Disorder

   Criterion A: exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, as follows by direct exposure, witnessing or indirectly learning about the trauma Criterion B: recurrent, involuntary, and intrusive memories, flashbacks, intense or prolonged distress after exposure to traumatic reminders, marked physiologic reactivity after exposure to trauma-related stimuli Criterion C: avoidance of distressing trauma related stimuli

Post Traumatic Stress Disorder cont.

    Criterion D: negative alterations in cognitions and mood Criterion E: trauma-related alterations in arousal and reactivity Criterion F: symptoms longer than 1 month Criterion G: significant symptom-related distress or functional impairment

Treatment for PTSD

   Cognitive therapy Exposure therapy Eye movement desensitization and reprocessing (EMDR)

    Celexa Fluoxetine Paxil Zoloft

Medication

Acute Stress Disorder VS PTSD

Acute Stress Disorder

Present within 2 days to 4 weeks greater emphasis on dissociative symptoms Resolve within 1 month

PTSD

Present usually within 3 months not a focus dissociative symptom cluster Persist longer than 1 month

Quiz

7. For PTSD does the trauma have to be Direct or Indirectly exposure?

8. What is the most effective treatment modality for PTSD? 9. Does acute stress disorder focus on the dissociative symptoms?

10. True/False Eye movement desensitization and reprocessing is a new therapy used for PTSD?

Vicarious Trauma

 Vicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain, fear, and terror that trauma survivors have endured.

Signs of Vicarious Trauma

        having difficulty talking about their feelings free floating anger and/or irritation startle effect/being jumpy over-eating or under-eating difficulty falling asleep and/or staying asleep losing sleep over patients worried that they are not doing enough for their clients dreaming about their clients/their clients’ trauma experiences       diminished joy toward things they once enjoyed feeling trapped by their work as a counselor diminished feelings of satisfaction and personal accomplishment dealing with intrusive thoughts of clients with especially severe trauma histories feelings of hopelessness associated with their work/clients blaming other

Risk Factors for Vicarious Trauma

   The worker The situation The culture

Video

 https://www.youtube.com/watch?v=G95 7P6w1Xfs

Questions

Resources

          Kessler, R.C., Sonnega, A., Bromet, E. Hughes, M., & Nelson, C.B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048-1060.

Kessler, R. C., Berglund, P., Demler, O., Jin, R., & Walters, E. E. (2005a). Lifetime prevalence and age-of onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593-602.

Kulka, R.A., Schlenger, W.E., Fairbank, J.A. Hough, R.L., Jordan, B.K., Marmar, C.R., & Weiss, D.S. (1990). Trauma and the Vietnam War Generation: Report of Findings from the National Vietnam Veterans Readjustment Study, New York: Brunner/Mazel.

Tanielian, T. & Jaycox, L. (Eds.)(2008). Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Santa Monica, CA: RAND Corporation.

www.counseling.org

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Benner, A. (2000). Cop Docs. Psychology Today Nov/Dec2000, Vol. 33 Issue 6, p36, 4p, 1c Beutler, L. E., Nussbaum, P., & Meredith, K. (1988). Changing personality patterns of police officers. Professional Psychology: Research and Practice. Vol. 19 (5), 503-507. Bisson, J. I., McFarlane, A. C., & Rose, S. (2000). Psychological debriefing. In E. F. Foa, T. M. Keane, & M. J. Friedman (Eds.) Effective treatments for PTSD (pp. 39-59, 317-319). New York: Guilford. Bohl, N. (1995). Professionally administered critical incident debriefing for police officers. In M. I. Kurke, & E. M. Scrivner (Eds.), Police psychology into the 21st century (pp. 169-188). Hillsdale, NJ: Erlbaum.