114 -PTSD: Understanding the Functional Nature of Symptoms
Counselor Toolbox

 
 
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PTSD
Exploring the Functional Nature of Symptoms
Instructor: Dr. Dawn-Elise Snipes LPC-MHSP, LMHC, CCDRC
Executive Director: AllCEUs
Host: Counselor Toolbox and Happiness Isn’t Brain Surgery Podcasts

Continuing education Credits for this podcast are available at https://www.allceus.com/member/cart/index/product/id/59/c/

Objectives
~    Review PTSD Symptoms and explore their functional nature
Purpose
~    By understanding the function of symptoms we can
~    Normalize the behavior
~    Identify alternate ways to meet that same need or address the issue
~    Re-Experiencing
~    Trying to replay it to figure out how to integrate into your schema (like fitting a puzzle piece)
~    Reminding the person of similar situations to “protect” them
Purpose
~    Avoidance
~    The system is already over taxed.  Avoiding upsetting stimuli by blocking out most stimuli, memories of the event.
~    Avoiding unnecessary use of energy by not getting “excited.”
~    Changes in Beliefs
~    Protects against future “surprises”
~    Tries to assimilate the experience into schema
~    Increased Arousal
~    Protects the individual

Re-Experiencing
~    You re-experience things every day
~    Access schema that guide your actions
~    When you go to work
~    When you encounter a particularly volatile client
~    When you approach a stop light
~    Re-Experiencing in PTSD
~    The context is often overgeneralized
~    The precipitating factors are often unknown
~    In many cases the resolution was not one of empowerment, resulting in trying to continually figure out how to not be disempowered

Re-Experiencing: Assimilation or Accommodation
~    Intrusive distressing memories of the traumatic events
~    In children repetitive play may occur in which themes or aspects of the traumatic events are expressed.
~    Recurrent distressing dreams in which the content or feeling of the dream is related to the events
~    In children there may be frightening dreams without recognizable content.
~    Flashbacks or other dissociative reactions in which the individual feels or acts as if the traumatic events are recurring
~    In children trauma-specific reenactment may occur in play.

Re-Experiencing
~    Intense or prolonged psychological or physiological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic events
~    The event represents a time in which the person experienced or witnessed something horrifying
~    The brain is trying to help the client
~    Avoid future similar situations
~    Learn how to protect during future similar situations

Avoidance
~    Purpose: Avoidance of Recurrence of Pain or Arousal of Stress Response System
~    Emotional numbness and avoidance of places, people, and activities that are reminders of the trauma.
~    Inability to remember an important aspect of the traumatic events (not due to head injury, alcohol, or drugs)
~    Purpose: An exhausted system conserves energy in case there is another threat
~    Markedly diminished interest or participation in significant activities
~    Feelings of detachment or estrangement from others
~    Persistent inability to experience positive emotions

Hypocortisolism
~    Cortisol is the stress chemical
~    After extreme stress and/or under chronic stress the brain may reduce the responsiveness of the stress response system by reducing the cortisol
~    This is protective, it keeps the organism from using precious resources by getting “excited” about anything (including pleasure)
~    Due to fear conditioning, when a stressor is detected, the stress response is exaggerated.
Changes in Beliefs
~    Purpose: The need for order and meaning (Regaining control, Ability to predict)
~    Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world
~    “I am bad”
~    “No one can be trusted”
~    “The world is completely dangerous”
~    Persistent, distorted blame of self or others about the cause or consequences of the traumatic events

Changes in Beliefs
~    Persistent
~    Fear, horror
~    Anger
~    Guilt, shame
~    Trauma taps in to nearly every basic fear
~    Loss of Control
~    The Unknown
~    Death (Am I going to die?  I could have died. I was unable to prevent someone from dying)
~    Isolation
~    Failure

Beliefs Interventions
~    After a trauma people’s lives are changed forever.
~    It is often necessary to grieve the loss not only of tangible things like property, but also existential things like belief in a just world and the goodness of people.
~    Identifying the threats and associated thoughts the person had/is having
~    Addressing cognitive distortions using Cognitive Processing Therapy

CPT Challenging Questions
~    What is the evidence for and against this belief?
~    Are the sources of this evidence reliable?
~    Is my reasoning based on facts or feelings?
~    Is this belief based on habit or facts?
~    Habits can be persistent negative interpretations or old “tapes” that have never been checked.
~    Am I basing my belief on the whole picture, or a small aspect of it?
~    Does my belief contain all-or-none terms?
~    In what ways is this belief confusing high probability and low probability events?

Increased Arousal
~    Irritable or aggressive behavior
~    Anger/threat reaction to continue to self-protect
~    Interventions:
~    Help the person identify and address triggers
~    Develop skills to address emotional and behavioral dysregulation (STOP Stop Think Observe Participate)
~    Reckless or self-destructive behavior
~    Stop the pain (I don’t care if I die, because…)
~    Distract (Numb through thrill)
~    Regain control (Lightening doesn’t strike twice)

Increased Arousal
~    Exaggerated startle response (Hypocortisolism)
~    Think how exhausting it would be to go from 0 to 100 each time you were startled.
~    Because of hypervigilance, people with PTSD are aware of more things that may startle
~    Interventions
~    Help client understand brain changes that resulted from the brains “decision” that continuing to use energy to fight was futile
~    Develop tools to reduce vulnerabilities and increase energy reserves
Increased Arousal
~    Hypervigilance
~    Purpose: Protective because the world seems dangerous and unpredictable
~    Other Symptoms
~    Problems with concentration
~    Hypervigilance prevents filtering out extraneous stimuli
~    Intervention: Create places that are “peaceful and safe”
~    Difficulty falling or staying asleep or restless sleep
~    You are vulnerable when you are asleep
~    Create a safe sleeping space and ability to easily re-ground
~    Emotional support dogs can be helpful here

Final Thoughts
~    Tormenting thoughts and feelings and attempts to stop or avoid those thoughts and feelings are central to PTSD
~    In the song “Wrong Side of Heaven” by Five Finger Death Punch the artist speaks of this torment.
~    Imagine you have been in a situation in which you
~    Had to kill to protect others
~    Had to let someone die to protect yourself and be there for your kids/family
Wrong Side of Heaven
~    I spoke to God today and she said that she's ashamed. What have I become. What have I done
~    I did some awful things in the spirit of what was right
~    I spoke to the devil today and he swears he's not to blame, and I understood 'cause I feel the same.
~    I accept that the devil did not make me do it.  I chose it, but at what cost.
~    Arms wide open, I stand alone.  I'm no hero and I'm not made of stone.
~    I feel totally isolated.  I don’t believe people could understand.  I did not do it to be a hero.  I am tormented by what I felt I had to do for what I felt was right.
Wrong Side of Heaven
~    Right or wrong, I can hardly tell.  I'm on the wrong side of heaven and the righteous side of hell.
~    I know what I did, I did for the right reasons, but I don’t feel deserving of forgiveness, but I also don’t believe I should be damned because I was trying to do what was right.
~    I heard from God today and she sounded just like me.  What have I done and who have I become.
~    Like God, I talk, believe, pray about doing things for the right reasons
~    I saw the devil today and he looked a lot like me
I looked away, I turned away
~    Like the devil, I have done a lot of things I don’t know if I can forgive myself for, and am not sure if I deserve forgiveness.  I can’t stand to see the potential for evil in myself.
Summary
~    Increased Arousal
~    The traumatic threat was unpredictable, ergo future events are unpredictable.
~    Increased arousal keeps people alert to potential threats.
~    Using CPT Challenging Questions help the client examine his/her beliefs about the event and his/her current safety
~    Avoidance and numbing helps the person survive since nobody can be “alert” and agonizing for that long
~    Helping the person understand that during a traumatic event, certain chemicals in the body prevent effective memory formation.  This is protective.
~    Numbing helps preserve precious energy.

Summary
~    Changes in beliefs
~    Keeps the person from being vulnerable again
~    Helps the person try to make sense of it.
~    Re-Experiencing
~    Like trying to fit a puzzle piece, the brain is trying to make sense of how this fits into current schema
~    The brain may have to develop new schema based on likely faulty memories from the trauma, so many stimuli are overgeneralized and cause “triggers” for anxiety to be everywhere.