A Strengths Based Biopsychosocial Approach to PTSD
Instructor: Dr. Dawn-Elise Snipes Ph.D., LMHC

Continuing Education (CE) credits can be earned for this presentation at  https://www.allceus.com/member/cart/index/product/id/508/c/

Objectives
– Highlight the functional nature of most behaviors and reactions
– Define PTSD
– Examine the function and meaning of PTSD symptoms
– Develop an understanding of why some people develop PTSD and others do not
– Explore useful interventions for persons with PTSD

Reward and Survival
– Humans and animals experience reactions to prompt behavior
– Anger/Fight
– Fear/Flight
– Reactions are responses designed to
– Protect life
– Achieve a reward/avoid punishment
PTSD and Gradual Onset PTSD
– PTSD: Traditional exposure to an event or multiple events
– Military
– Crime Victims
– Gradual Onset PTSD: repeated exposure to horrific or threatening events causing a sense of helplessness
– Law Enforcement
– Military
– Child Abuse/Neglect
Definition
– Exposure to a horrifying event in which there was a sense of helplessness
– For each symptom that follows, we will identify
– The function
– What triggers that symptom or exacerbates it
– How the person deals with/mitigates that symptom
– Other things he or she could do
Symptoms
– Re-experiencing the traumatic event
– Intrusive, upsetting memories of the event
– Flashbacks (acting/feeling like the event is happening again)
– Nightmares
– Feelings of intense distress when reminded
– Intense physical (panic) reactions to reminders
Symptoms
– PTSD symptoms of avoidance and emotional numbing
– Avoiding reminders of the trauma
– Inability to remember important aspects of the trauma
– Loss of interest in activities and life in general
– Feeling detached from others or emotionally numb
– Sense of a limited future
Symptoms
– PTSD symptoms of increased arousal
– Difficulty falling or staying asleep
– Irritability or outbursts of anger
– Difficulty concentrating
– Hypervigilance (on constant “red alert”)
– Feeling jumpy and easily startled

Other common symptoms of PTSD
– Anger and irritability
– Guilt, shame, or self-blame
– Substance abuse
– Depression and hopelessness
– Suicidal thoughts and feelings
– Feeling alienated and alone
– Feelings of mistrust and betrayal
– Headaches, stomach problems, chest pain

Triage
– Similarity to the victim (or being the victim)
– Proximity to your safe zones (home, work)
– Social support after the trauma
– History of mental health problems
– Number of stressors in the past 6 months

Assessment
– If you were not the victim, how were you similar to the victim-
– How are people around you similar to the perpetrators-
– What was (or would have been) helpful for people to do after the trauma-
– Who can you rely on to do those things now-
Creating Safety
– What can you do to take back your “safe zones”
– How can your protect yourself from this in the future-
– How did the experience change
– How you view things-
– What is important to you-
– How you will live your life now-

Sleep
– Function
– Balances neurochemicals
– Helps reduce cortisol
– May improve adrenal fatigue
– Safety
– Environmental (Feng Shui)
– Common sense
Sleep
– Anchoring
– (So when you awake you can stay in/get in the present mom)
– Lights
– Safety item/dog
– Stimuli
– Sounds
– Smells
– Sights
Sleep
– Routine
– Let your body know when it is time to sleep
– Find ways to release stress and tension
– Medication
Create Safety Activity
– Brainstorm different ways to create safety
– At home
– At night
– In the car
– At your office
Social Support
– Nonjudgmental people
– Available 24/7
– Empathetic
– Help to meet health and safety needs
– Handle the details
– People in shock/traumatized cannot remember squat.  They need people to prompt them and write things down
Desensitization
– Some things you logically know are not threatening but still evoke a startle response
– Acknowledge the event
– Be kind to yourself
– Recognize the value of the startle response
– Identify times when your startle response might be greater (i.e. library vs. restaurant)
– Identify ways to mitigate your startle response

Cognitive Processing Therapy
– Some beliefs about safety, happiness, or people/situations in general can be distorted by trauma.  Ask yourself:
– What happened-
– What is the belief-
– Is this belief based on facts or feelings-
– How reliable is the source-
– Are you using extreme words-
– Is the belief based on only part of the picture-
– In what ways does this belief protect you-
– In what ways does this belief impair your life-
– How can you best use your energy-

Cognitive Errors
– Overgeneralization
– Control fallacy
– You could have controlled it
– You can change it (If I would have…)
– All-or-Nothing Thinking
– Catastrophizing
– Grandiosity
– Personalization

Stress Management
Can’t squeeze blood from a turnip

– Emotional Health
– Physical health
– Exercise
– Nutrition
– Sleep
– Socialization
Trauma Recovery
– A grief process
– Loss of control
– Loss of a sense of safety
– Loss of hope
– Loss of idealism
– Loss of ___________________________
– Grief Stages
– Denial
– Anger
– Bargaining
– Depression
– Acceptance
Grief Resolution
– What losses did you experience as a result of the trauma
– For each loss:
– What about this makes you angry-
– How can you deal with this anger healthfully-
– Anger protects you and pushes people away. What do you still need to be protected from-
– Depression signals a sense of hopelessness or helplessness.  About what can you be hopeful- Empowered-
Summary
– PTSD can be from a single event or multiple, ongoing stressors
– Traumatic Events can change people’s beliefs about the world in an extreme way
– For some people understanding the function of the symptoms can help them
– Desensitize
– Modify their beliefs
– Make positive, mindful choices