Healing and Modalities of Therapy

1. Healing and Modalities of Therapy Bob Campbell, Psy.D., M.Div. MKSN Conference April 20, 2013

2. Adult Survivors of Childhood Trauma • Every case is unique • Not every person will develop a disorder • The type or severity of trauma does not determine the probability of developing a disorder • Diathesis/Stress Model • Any extreme stressor • Physical, sexual, psychological abuse

3. Symptoms of Traumatic Stress • Stuck between fight and flight and freeze • Flashbacks • Re-experiencing • Avoidance • Hyperarousal • Irritability • Restricted range of affect

4. PTSD – Posttraumatic Stress Disorder • PTSD • Usually related to a specific event or series of discrete events • Car accident, natural disaster, war • Complex PTSD - DESNOS • Disorder of Extreme Stress, NOS • Prolonged, repeated trauma • Additional symptoms • Developmental Trauma Disorder – DESNOS in children

5. Disorders of Extreme Stress, NOS • Long-term trauma • Person held in a state of captivity, physically or emotionally • Unable to get away from the danger • Examples: • Concentration camps • Prisoner of War camps • Prostitution brothels • Long-term domestic violence • Long-term child physical abuse • Long-term child sexual abuse

6. DESNOS – Additional Symptoms • Emotional dysregulation • persistent sadness, suicidal thoughts, anger • Dissociation • Helplessness, shame, guilt, stigma, feelings of isolation • Distorted Perceptions of the Perpetrator • attributing total power, becoming preoccupied with relationship or revenge • Difficulty forming relationships • Loss of meaning • loss of faith or a sense of despair

7. DESNOS in Trafficked Females Williamson, Dutch, and Clawson, 2010.

8. Other DESNOS issues • Misdiagnosis as PD • Poor assertiveness due to avoidance of topic • Self-medication • Self-mutilation • Lack of understanding from others

9. Neurobiological Etiology of PTSD Memory Hippocampus Amygdala Anterior Cingulate Cortex

10. Evidence-Based Treatments for PTSD • What is “evidence-based”? • Many are based on exposure and response prevention • Exposure • Scary movies • Response prevention • Stay present • These treatments focus on symptom reduction

11. Types of Treatment • CBT – Cognitive Behavioral Therapy • CPT – Cognitive Processing Therapy • Prolonged Exposure • EMDR – Eye Movement Desensitization and Reprocessing • EFT (Tapping) – Emotional Freedom Techniques • ACT – Acceptance and Commitment Therapy

12. CBT • Cognitive • Exposure • Relaxation • Education

13. CPT • Cognitive Therapy • Written accounts • Exposure elements

14. Prolonged Exposure • Classical conditioning • antecedents • Operant conditioning • consequences

15. EMDR • Alternating side stimuli • Exposure elements • Potential neurological change

16. EFT • Tapping points • Exposure elements • Acupressure elements • Relaxation elements

17. ACT • Meditation • Acceptance • Willingness • Values • Defusion • Self as context • Increases flexibility

18. Non-Evidence-Based Therapies (that work) • Existential • Psychodynamic • Self-Psychology (Not Do-it-yourself Psychology) • Humanistic • Family therapy • Hypnotherapy • Solution-focused therapy

19. Medications • Anti-depressants • SSRIs - paroxetine (Paxil) and sertaline (Zoloft) • SNRIs - venlafaxine • Atypicals – Wellbutrin, mirtazapine, bupropion • Anti-psychotics • Risperidone • Quetiapine • Avoid benzodiazepines • Not effective for PTSD • Serious side effects

20. Additional DESNOS Treatment • Address interpersonal difficulties • Restoration of control and power • Develop healing relationships which create safety • Remembrance and mourning • Promote reconnection with everyday life

21. Some things to begin today • Self-care • Exercise • Eating right • Enjoying life • Meditation • Finding meaning • Telling your story • Finding the help you need

22. Dr. Bob Campbell rcampbell@willowwellness.com www.willowwellness.com