Trauma and Trauma Informed Care

Question 1

What is the neurobiological explanation of trauma?

Answer 1

• Amyglada (threat detection, affects identification of emotion, perceives danger- sends signal to hypothalamus)
• Sustained cortisol secretion
• Cortisol inducted damage of neural circuits in hippocampus

Question 2

What is the impact of attachment on development?

Answer 2

• Exploratory behaviour and infant’s developing brain
• Emotional development and ability to self regulate
• Internal working model or sense of self
• Social interaction
• Emotional regulation (managing ones feeling without being overwhelmed and loosing capacity to reflect).

Question 3

What are examples of insecure attachments?

Answer 3

• Insecure avoidant
• Insecure ambivalent
• Disorganised attachment

Question 4

What is insecure avoidant attachment?

Answer 4

Downplays emotions, withdraws when distressed, appears independent, doesn’t think others will help during times of stress.

Question 5

What is insecure ambivalent?

Answer 5

Low level dependency, emotionally labile, lacks confidence & initiative, difficulty controlling own distress.

Question 6

What is disorganised attachment?

Answer 6

Chronic anxiety, mistrust, tries to control caregiver, aggressive or dissociative behaviour

Question 7

What are implications of early attachment experiences on mental illnesses?

Answer 7

• Risk factor to poor developmental outcomes for children

- Illness (physical or mental) generally stimulates attachment behaviour

Question 8

Describe trauma within context of caregiving system and what this impacts

Answer 8

• Physical attributes (height, head circumference)
• Cognitive function e.g. Problem-solving
• Language

Question 9

Describe impact of trauma on socio emotional development and psychological adjustment

Answer 9

• Attachment relationships
• Emotional recognition, regulation
• Self-system development
• School functioning
• Romantic relationships

Question 10

What is the long term health-related outcomes of trauma?

Answer 10

• Arthritis
• High blood pressure
• Asthma
• Bronchitis
• Autoimmune disorders -Cancer
• PTSD
• Dissociative disorders
• Anxiety
• Phobias
• Substance abuse
• Depression
• Increased suicide risk

Question 11

What are characteristics of hyperarousal?

Answer 11

Hypervigilance, emotional tantrums, anxiety.

Question 12

What are characteristics of hypoarousal?

Answer 12

Flat affect, numbness, feeling detached, passive aggression.

Question 13

What are characteristics of a traumatised adults?

Answer 13

• Intrusion of traumatic memories
• Hyperactivity, hyper vigilance
• Compulsive exposure to dangerous situations= reenactments
• Dissociation: altered ability to attend and process information
• Loss of trust in world
• Poor self perception
• Extreme difficulty with emotional regulation
• Split off parts of self

Question 14

What are examples of conditions related to trauma and adult mental health?

Answer 14

• PTSD (or Acute Stress Disorder or Adjustment Disorders)
• Anxiety
• Phobias
• Substance misuse
• Depression
• Increased suicide risk
• Dissociative identity disorder
• Personality disorders (Borderline Personality Disorder)

Question 15

What is DSM 5’s description of PTSD

Answer 15

• Witnessed / experienced trauma, threatened death, threat to physical safety or sexual violence
• Traumatic events occurring to loved one
• Extreme exposure to aversive details of traumatic event
• Recurrent, involuntary, intrusive, distressing recollections/dreams
• Psychological distress and reactivity when exposed to cues
• Persistent avoidance of stimuli associated with trauma
• Increased arousal/reactivity

Question 16

What is DSM 5’s description of dissociative identify disorder?

Answer 16

-Disruption of identity: two or more distinct personality states.
-Disruption or marked discontinuity in sense of self and sense of agency, changes in affect, behavior, consciousness, memory, perception, cognition, sensory-motor functioning
-Recurrent gaps in the recall of everyday events, important personal
information, traumatic events.

Question 17

What are the 4 practical steps of trauma informed care?

Answer 17

• Trauma aware
• Trauma sensitive
• Trauma responsiveness
• Trauma informed care

Question 18

What are aspects involved in trauma informed care?

Answer 18

• Safety, trustworthiness, choice, collaboration, empowerment
• Promotes impacts of trauma as fundamental to health/wellbeing
• Incorporates message of optimism and hope to all interactions with patients

Question 19

What are principles of trauma informed care?

Answer 19

• Safety
• Trustworthiness
• Choice
• Collaboration
• Empowerment
• Safety
• Trustworthiness and transparency
• Peer support
• Collaboration & mutuality
• Empowerment , voice, choice
• Cultural, historical and gender issues

Question 20

What are guidelines for clinical intervention for people what have experienced trauma

Answer 20

• Establish client safety & end sessions safely
• Promote client resources, coping strategies, support networks
• Establish appropriate boundaries, regular supervision and take care of self, appropriate duration & frequency of session, continuity of care, collaborative approach

Question 21

What are the important aspects of to understand when dealing with those who have trauma?

Answer 21

• How experience shapes the brain & impact of childhood trauma, both physical and psychological symptoms
• Dissociation and treatment implications
• Attachment issues & neurobiological changes
• Arousal levels & help clients stay in ‘window of tolerance’
• That symptoms are adaptive & work from strengths-based approach
• Self harm serves as coping strategy
• Risk of suicide for people who experience complex trauma symptoms

Question 22

What should you be aware of in relation to intervention with trauma?

Answer 22

• Various treatment for trauma, important to select approach with care.
• Therapy should be tailored & individualised
• Recovery process diverse
• Phased treatment approach gold standard

Question 23

What are examples of trauma-related interventions?

Answer 23

• CBT
• Dialectical Behaviour Therapy
• Exposure therapy
• Psychodynamic psychotherapy
• Family therapy
• Group work
• Medication (e.g. antidepressants)
• Attachment based interventions e.g. Circle of Security; Attachment, Regulation, Competence model
• Acceptance and Commitment Therapy

Question 24

What is self-regulation?

Answer 24

Refers to the extent to which people influence, modify, or control their own behavior (including thoughts and feelings) according to goals or standards.

Question 25

Describe role of therapeutic use of self in OT practice for trauma

Answer 25

- The therapeutic relationship involves collaboration between the therapist and client to negotiate goals and methods of intervention. - Responsible for facilitating the client's involvement (often called enablement, i.e. helps the client in achieving what is important to him/her, taking into account the specific circumstances and uniqueness of the individual).

Question 26

What is the benefits of mindfulness training?

Answer 26

-Be fully present, here and now -Experience unpleasant thoughts and feelings safely -Become aware of what you're avoiding -Become more connected to yourself, to others and to the world around you -Become less judgmental Increase self-awareness -Less disturbed reactive to unpleasant experiences -Learn the distinction between you and your thoughts -More direct contact with the world, rather than living through thoughts -Learn everything changes; that thoughts and feelings come and go like the weather -More balance, less emotional volatility -Experience more calm and peacefulness -Develop self-acceptance and self-compassion