week 5 (incomplete) Flashcards
what are the 3 components of trauma?
Potentially traumatic event
- Who, what, when, where, & how?
- Expected or unexpected event?
- Direct or indirect experience?
Exposure to the event OR individual’s experience of the event
- Individual’s interpretation of an event & beliefs/assumptions about the world affects how they will process, react to, & cope with a traumatic event; depends on factors (SDoH)
*SDoH; biology & genetics, gender, culture, personal health practices, social support networks, social status, social & physical environments, child development, education & literacy, employment & working conditions, living environments/conditions
*These factors influence an individual’s chances of experiencing a trauma OR recovering from trauma faster
Symptoms of physical, mental, social, emotional, or spiritual distress seen after the traumatic event
- Nightmares, difficulty sleeping, social withdrawal, emotional dysregulation ( fits of anger/general emotional lability, & loss of faith/hope in the future-
what are the 3 types of trauma?
acute trauma
- one, isolated traumatic event that is short; narrowly focused in nature
Ex: medical emergency, motor vehicle accident, physical assault, rape, mass shooting, terrorist attack, natural disaster
chronic trauma
- multiple traumatic events (can be diverse/vary) but are repeated/frequently experienced over a long period of time
Ex: prolonged adult abuse (+witnessing abuse), domestic abuse (of various forms – physical/verbal), bullying, prolonged exposure to war/combat, repeated sexual abuse, homelessness, starvation/deprivation, chronic medical illness w/ invasive medical procedures
complex trauma
- chronic trauma that began/occurred often before 5 y/o, or during periods of attachment & relational growth; done by trust figures *this is a child’s exposure to multiple traumatic events
Ex: childhood physical, sexual, or emotional abuse (+incest & profound neglect) OR often historical/intergenerational trauma
trauma: natural vs. human action
Natural: flood, earthquake, hurricane *faster recovery time!
Human action: war, terrorist acts
trauma (human action): intentional vs. unintentional
Intentional
- ex: loss of friends/social support d/t an optional job transfer
Unintentional
- ex: loss of friends/social support d/t escape from a war zone *faster recovery time!
what are the 3 types of CHRONIC trauma?
Domestic violence *A.K.A. family violence/intimate partner violence
- Characterized by harmful behaviour between family members/partners (often occurs at home, even when not experienced daily)
*Domestic violence can affect everyone at home & those close to the family (ex: caregivers & fam friends); they may see/hear violent incidents OR witness the aftermath of a violent incident
Interpersonal trauma
- Involves actions done w/ the intent to hurt, harm, or take advantage of another
- May occur w/in the context of domestic violence, but may also occur amongst acquaintances
- Often refers to actions that betray trust (whether or not there’s physical violence involved)
Ex: bullying or repetitive lying/deceiving
System-oriented trauma
- When services that are meant to help people unintentionally cause trauma
*Sometimes, moving through an unfamiliar system can be overwhelming & trigger feelings of helplessness & isolation r/t a traumatic experience
*Ex: lack of privacy in health care settings, poorly explained invasive medical procedures, minimizing or ignoring reports of bullying within a school system, or use of seclusion/restraint in mental health settings
what are the 5 types of COMPLEX trauma?
Developmental trauma
- Common complex trauma; reactions to harmful events that occur during developing years (infancy, childhood, adolescence, & young adulthood)
- Experiencing psychological trauma in childhood is linked to developing risk factors for both social well-being & physical health
Trauma at the community level
- Traumatizing events surrounding whole communities (group of people bound together by common hx, identity, or culture) *traumatic events can affect an individual that identifies w/ a certain community
Historical trauma
- Refers to reactions to widespread & severe events that affect a large group over a lifespan or beyond (ex: intergenerational trauma)
Ex: colonialism (forcible removal of one’s autonomy & possible destruction of culture & language), genocide, slavery, & war
Intergenerational trauma*
- Aspect of historical trauma* (describes psychological/emotional effects that can be experienced by those who have a long-term connection to trauma survivors
- Memories of trauma & inadequate coping methods are passed from one generation to the next
Ex: negative social impacts amongst indigenous people in Canada r/t colonization
Cultural trauma
- A community’s reaction to events that challenge & may even seek to destroy its culture
- Culture is an important part of the way people define themselves & helps create a sense of belonging & meaning in the world
Ex: loss of culture can compromise the ability of a group of people to avail themselves of opportunities & fully participate in society
what is acute stress disorder (ASD)?
*directly associated w /trauma
This is a normal response to high stress situations (ex: facing death, serious injury or sexual violation)
Occurs d/t 1 specific event rather than the experience of long-term or chronic exposure to trauma
S/S: emotionally “numb”, having distressing memories of the event, flashbacks, problems w/ sleep & concentration, angry outbursts, & exaggerated startle response
- s/s appear 2 days to 4 weeks after the event & resolve by 4 weeks
what is post-traumatic stress disorder (PTSD)?
*directly associated w /trauma
Most commonly diagnosed trauma-related disorder
S/S fall into 4 classes *s/s last longer than 4 months
- Re-experiencing (intrusive memories, flashbacks, nightmares)
- Avoidance of internal & external reminders of the event
- Cognitive & emotional dysregulation
- Hypervigilance & reactivity
explain the fight, flight, or freeze response.
In a traumatic situation, multiple organs & systems engage to create a response to the threat in the environment & prepare us to survive the threat.
“Fight, flight, or freeze response” helps us pay attention (freeze), & either fight off the threat or flee to safety; note: ‘freeze’ response may also signal an overwhelmed system which reduces the ability to pay attention.
S/S: increased HR, tachycardia, tension in muscles, & sweating
explain the prolonged stress & stress response.
Repeated & chronic stress causes wear/tear on body & mind
Chronic prolonged stress is linked to many problematic health outcomes
- ex: cardiovascular, metabolic, immune, & nervous system problems; also causes brain changes that may contribute to anxiety, depression, & addiction
Prolonged stress response to repeated traumatic events that occur in childhood can have more serious effects; early exposure to trauma is harmful to a developing brain & body
what are adverse childhood experiences (ACES)?
Harmful experiences that happen during developing years; can be acute, chronic, or complex
- These events usually begin in the childhood home & involve parents & other trusted caregivers
- Study showed that experiencing trauma in childhood is directly r/t risk factors for health & social well-being; ACEs harm neurological, endocrine & immune systems, increasing a one’s risk of physical, mental, & substance use disorders.
list the types of ACES.
Acute
- ex: a single exposure to an episode of domestic violence
Chronic
- ex: lack of adequate nutrition throughout pre-school years
Complex
- ex: being raised by parents w/ substance use issues
what should you consider when applying trauma-informed care (TIC)?
Personal level: self-awareness & understanding of indirect trauma
- Strategies: reflect on self & biases/assumption about trauma survivors & recovery
*Reflect on strengths, triggers, & background
Practice level: trauma awareness & use of language
- Strategies: relationships are vital in helping trauma survivors learn new coping skills, interactions w/ survivors & staff must be respectful, supportive, collaborative, & strengths-focused, be mindful of language use
Organizational level: staff training, education, & supervision
true or false: a person doesn’t need to disclose their trauma hx to receive TIC
true; disclosure NOT required
*ask only for the necessary details
*review & clarify limits to confidentiality
*ask about strengths, interests, goals, coping, etc.
*keep conversations safe, contained, & present-focused
*provide rationales for questions & normalize the process where possible
*watch for common signs of trauma & stop when necessary to assist w/ grounding & regulation
***TIC can help people recognize the connection b/w their past experiences & current situations
- Can provide relief from suffering, give hope, & help survivors in developing stories about their past
what are the 6 broad components/principles of TIC?
- Safety: is everything being done to ensure the client’s physical & emotional safety?
- Trustworthiness & transparency: are expectations & interactions for everyone clear & consistent? (boundaries, respect, nonjudgmental approach)
- Peer Support: those w/ lived experiences can be critical resources for support
- Collaboration & mutuality: members of the organization can contribute equally
- Empowerment, voice & choice: developing plans of actions that require patient-centered approaches & empower clients
- Cultural, historical & gender issues: culturally sensitive, free of biases & stereotypes
true or false: in acute care mental health settings, use of restraints (& seclusion as a form of restraint) are encouraged
false; recognizing the use of restraints may be re-traumatizing/triggering, based on own past experiences
*when all other attempts to calm a situation fail, the use of seclusion &/or restraints may be needed to ensure the pt. is safe, & everyone else on the unit
what is the six core strategies approach?
an approach to care that emphasizes importance of working WITH the individual to find a solution, rather than creating power struggles to enforce rules.
what does it mean to call for a “show of support?”
calling for more staff to help manage a situation involving an individual who’s demonstrating aggressive behaviour.
what is seclusion? when can it be implemented?
Voluntary/involuntary confinement of a pt. alone in a room, locked from outside for care & treatment; requires physician order
Used in Mental Health settings but only as a LAST RESORT
- Decision to use seclusion must be made in consultation w/ other members of the healthcare team & physician’s order is required
Indications:
- ONLY IN EMERGENCIES when danger is imminent *whether voluntary or involuntary status
- To help pt. re-establish behavior control
- Seclusion or restraint should only be used when behavior of the pt. shows a greater risk than risks associated w/ using seclusion
- Should be used ONLY when ALL OTHER LESS RESTRICTIVE MEASURES have been ineffective & should be used for the least amount of time possible!
after a restraint has been used, what is the most important thing to do?
Debrief!
- For the person affected
- For the staff
- For other pts. or visitors if appropriate
Gives a chance to reflect, learn & modify the care plan to prevent recurrence *important for recovery
what are the goals of debriefing?
To assess physical & emotional wellbeing of all staff & individuals involved in a crisis event
To re-establish therapeutic rapport w/ the person who experienced a crisis event
To reduce the adverse & potentially traumatizing impact on involved staff/patients & bystanders
To reduce likelihood of future crisis events by finding changes that can be made by individual/staff/both
what is anxiety?
a subjectively distressing experience triggered by perceived threat, which has both a potential psychological & physiological etiology & expression
what’s the difference b/w anxiety & fear?
Anxiety: is a vague sense of dread r/t unknown danger; affects one at a deeper level – it attacks the main core of our personality & destructs self-esteem & personal worth
Fear: a reaction to a real or perceived specific danger
what is “normal anxiety”?
a healthy reaction needed for survival
- It provides us energy to do daily tasks & strive towards goals;
- Motivates us to make & survive change; &
- Prompts constructive behaviours
Ex: studying for exam, being on time an interview, preparing for a presentation
when can anxiety be positive, a motivating factor, bring attention to detail, etc?
Anxiety as a warning sign
- To bring attention to a current situation or changes that may need to be made in one’s life.
Anxiety as a motivator
- Could provide encouragement to take action.
*Ex: to address a situation, study for an exam, etc.
- Anxiety as a built-in warning system Could alert you, or help one react as to keep self safe.
Anxiety as a positive trait in one’s character
- People who’ve experienced lots of anxiety may be more empathetic, understanding & supportive of others.
Anxiety as a leadership trait
- People who have experienced anxiety may make good leaders: problem-solvers, decision-makers, or contemplating consequences of decisions.
what are the levels of anxiety?
none -> mild -> moderate -> severe -> panic
