Understanding of Trauma
Through this course, I have developed a much clearer understanding of trauma and its psychological and behavioral manifestations, neurobiology and physiology, effects on survivors, PTSD diagnostic criteria, and treatment approaches. Traumatized clients present with various adaptive and pathological reactions based on their age or developmental stage, recurrent exposure, psychological functioning, culture, etc., (Mills & Hulbert-Williams, 2012). Moreover, direct exposure, re-experiences of trauma, and the nature of the stressor (e.g., parental abuse, accident) also affect trauma-related responses.
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It is now clear to me that traumatized individual exhibits either a gradual improvement intolerance or an exacerbation of symptoms. While some individuals display effective cognitive coping and resilience, others show pervasive adverse reactions, such as social dysfunction, attention deficit, and maladaptive behavior. After exposure to trauma, most survivors experience intrusion symptoms that manifest within days or persist until a later developmental stage due to delayed expression. Van der Kolk (2015) states that in most cases, the reliving and re-experiencing of the trauma affect the survivor’s emotional response and determines how well he or she copes with the symptoms. While in most trauma victims these repetitive intrusion symptoms increase tolerance, others show symptoms of hyperarousal and avoidance that are characteristic of PTSD (APA, 2013). In my understanding, the traumatic memory of these people is impaired; therefore, every memory replay serves to enhance sensitization and emotional stress.
Exposure to trauma also involves dissociative reactions ascribed to limbic system alterations. Van der Kolk (2015) describes dissociation as an information organization process that results in compartmentalized experiences. In dissociative reactions, the integration of components related to the trauma into conscious memory does not occur. Thus, survivors may experience desensitization and depersonalization to minimize distressing beliefs and feelings.
Through learning the neurobiology of trauma, most of the symptoms related to PTSD now make sense to me. The activation of the fight, flight, or freeze reaction and elevated cortisol and adrenaline concentration accounts for the DSM V criterion E symptoms of aggression, hypervigilance, reckless behavior, exaggerated startle response, loss of focus, and sleep disturbances (APA, 2013). If the flight response is not possible, the individual freezes – a form of dissociation or derealization meant to decrease sensitization and distress. Based on the understanding of these neurobiological and physiological processes, the focus of trauma-focused cognitive behavioral therapy is to develop individualized, needs to be based, and strengths have driven interventions that will ensure effective coping strategies. These strategies may include psychoeducation, relaxation training, affect modulation or expression (self-talk), etc.
Rest of the Course
Throughout the remainder of this course, I anticipate learning appropriate treatment protocols for different client categories based on affective responses to traumatic events. Specifically, I expect to learn effective treatments for traumatized children and adolescents – including psychotropic medications – as well as methods of identifying trauma triggers (Schneider, Grilli, & Schneider, 2013). These concepts will be critical in creating behavioral plans tailored to adolescent needs. This developmental stage is characterized by negative affect, and therefore, a strong therapeutic relationship is required when treating traumatized adolescents.
I also look forward to learning how to control my counter-transference and emotions when treating a client. I recognize that uncontrolled emotional stimulation by a therapist can hamper trust and commitment from the traumatized individual. Working with trauma survivors exposes the therapist to compassion fatigue related to hearing gruesome stories of abuse or trauma narrated by victims. I anticipate learning about compassion fatigue manifestations and coping methods for professionals.
American Psychiatric Association [APA]. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: APA.
Mills, S., & Hulbert-Williams, L. (2012). Distinguishing between treatment efficacy and effectiveness in post-traumatic stress disorder (PTSD): Implications for contentious therapies. Counselling Psychology Quarterly, 25(3), 319-330. Web.
Schneider, S. J., Grilli, S. F., & Schneider, J. R. (2013). Evidence-based treatments for traumatized children and adolescents. Current Psychiatry Reports, 15, 332–341. Web.
van der Kolk, B. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. London, UK: Penguin Books.