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Trauma
The term this trauma has to do with an extreme sudden or ongoing outer threat, often with bodily pain or injury, that exceeds the limits of a persons physical as well as emotional and biological coping ability. It shatters one’s sense of security and leaves one completely vulnerable, and results in the feeling of helplessness, and hopelessness or the feeling of imminent death of the person themselves or of another. German Trauma researcher, Michaela Huber describes this situation as the "traumatic vice ", because the person can neither defend themselves nor get out of danger. The traumatic event is usually unpredictable and uncontrollable. Trauma may be caused by natural catastrophe, traffic / plane accidents, terror attacks, military combat, physical abuse, physical/sexual abuse, emotional abuse, abandonment, life threatening diseases, hospitalization, loss of a loved one. etc. The event does not have to be one in which a person is directly involved; sometimes the news of the death of someone close to us, or watching a terrorist attack on TV can be traumatic.
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Post traumatic Stress Disorder (PTSD)
The mind like the body has the capacity to heal itself and therefore many survivors of trauma return to normal given a little time. However, some people will have stress reactions that do not go away on their own, or may even get worse over time. These individuals may develop PTSD. People who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged, and these symptoms can be severe enough and last long enough to significantly impair the person's ability to function in their daily social, family and professional life. Problems such as occupational instability, marital issues and divorces, and difficulties in parenting may result. Behavior involving substance abuse, physical self-abuse, sexual promiscuity, and/or compulsion, for example, may be indicators of advanced (untreated) PTSD. Available data suggest that about 8% of men and 20% of women go on to develop PTSD, and roughly 30% of these individuals develop a chronic form, complex PTSD that persists throughout their lifetimes. The traumatic events most often associated with PTSD for men are rape, combat exposure, childhood neglect, and childhood physical abuse. The most traumatic events for women are rape, sexual molestation, physical attack, being threatened with a weapon, and childhood physical abuse
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Symptoms of PTSD
Through years of research, 17 PTSD symptoms have been identified. These are symptoms that can develop following the experience of a traumatic event and are listed in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (or DSM-IV). These 17 symptoms are divided into three separate clusters. The three PTSD symptom clusters, and the specific symptoms that make up these clusters, are described below. To be diagnosed with PTSD, a person does not need to have all these symptoms.
- The “Re-Experiencing” Symptoms
Frequently having upsetting thoughts or memories about a traumatic event.
Having recurrent nightmares.
Acting or feeling as though the traumatic event were happening again, sometimes called a "flashback."
Having strong feelings of distress when reminded of the traumatic event.
Being physically responsive, such as experiencing a surge in your heart rate or sweating, to reminders of the traumatic event.
- the Avoidance Symptoms
Making an effort to avoid thoughts, feelings, or conversations about the traumatic event.
Making an effort to avoid places or people that remind you of the traumatic event.
Having a difficult time remembering important parts of the traumatic event.
A loss of interest in important, once positive, activities. Feeling distant from others.
Experiencing difficulties having positive feelings, such as happiness or love.
Feeling as though your life may be cut short.
- Hyperarousal Symptoms
Having a difficult time falling or staying asleep.
Feeling more irritable or having outbursts of anger.
Having difficulty concentrating.
Feeling constantly "on guard" or like danger is lurking around every corner.
Being "jumpy" or easily startled.
Many of these symptoms are an extreme version of our body's natural response to stress. Understanding our body's natural response to threat and danger (the fight or flight response) can help us better understand the symptoms of PTSD.
Who is most likely to develop PTSD?.
1. Those who in general have difficulty dealing with stress, unpredictability, uncontrollability, victimization, real or perceived responsibility, and betrayal
2. Those with prior vulnerability factors such lack of supportive environment in infancy and early childhood; lack of or problems in bonding with primary care giver during infancy; lack of functional social support, and concurrent stressful life events
3. Those who report greater perceived threat or danger, suffering, upset, terror, and horror or fear
4. Those with a social environment that produces shame, guilt, stigmatization, or self-reproach
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Do You Need All of These Symptoms for a Diagnosis of PTSD?
To be diagnosed with PTSD, a person does not need to have all these symptoms. In fact, rarely does a person with PTSD would experience all the symptoms listed above. To receive a diagnosis of PTSD, you only need a certain number of symptoms from each cluster. Additional requirements for the diagnosis also need to be assessed, such as how the person initially responded to the traumatic event, how long the symptoms have been experienced, and the extent with which those symptoms interfere with a person's life.
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Treatment of Post Traumatic Stress Disorder (PTSD)
Regardless of the therapy, the treatment concept, must include at öeast 3 essential process steps: stabilization – exposition –integration .The goal is removal of symptoms and ultimately the integration of the “traumatic” experience in the persons present daily reality. Trauma treatment is successful when the person can talk about the experience with the appropriate amount of emotion but without experiencing distress.
Up to 80% of patients with PTSD have an accompanying disorder such as depression, anxiety disorder, substance abuse, somatization or panic disorder. These disorders have to be treated first when possible. Medication may be required in conjunction with this treatment.
Then the therapeutic work proceeds according to the 3 phases which with regard to time, is “tailored” to the individual situation and needs of the patient.
1. Stabilizing - Because a traumatic experience usually results in extreme sense of vulnerability, the foremost priority of the therapy (Step 1) is the reconstruction of a basic feeling of personal safety. This is achieved by identifying positive / constructive elements in the persons present living situation and identifying skills necessary to have "survived", and amplifying the effect of these experiences on the person’s self esteem.
The stabilizing phase may be short, days or weeks (in the case of acute PTSD) or it may take several years in cases where the illness has gone untreated and is in advanced stages. The treatment proceeds according to the motto "Stabilize - Stabilize - Stabilize - Stabilize - Stabilize ..
Medication: medication may be necessary if the person is experiencing extreme mood swings or other extreme symptoms. Antidepressants, for example, lower anxiety and reduce sleep disturbances, startle reactions, intrusive memories and other symptoms. Two drugs, Paxil and Zoloft, have been found in large clinical trials to help many people with PTSD. Other medications in the same family are also likely to work, though they have not been extensively tested. The best medicine, when efective, the use of the resource-activating Psychotherapy methods already mentioned.
2. Exposition – As far as we know it is necessary to look at the past again if the trauma experience is to be integrated. An old Freudian theory regains validity in this concept. The difference is that in the trauma therapy one enters the past equipped with all the resources that they've accumulated throughout the years, like: knowledge, wisdom capabilities, strengths and especially recently required techniques for getting in touch with other inner resources,. One has learned to create distance between himself and the memory of the experience and thus avoids being re-traumatized. Only under these conditions is it safe to go there. Trauma processing can be achieved using techniques such as :
Imaginative Therapies (Screen technique)
Body Therapies (Somatic Awareness, Biofeedback, Somatic experiencing)
EMDR
and others
3. Integration - The last phase of treatment has the goal of formulating answers to the questions :
What have I learned about myself?
What false / negative ideas or concepts about myself have contributed to my
problems?
Who am I now ?
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Eye Movement Desensitizing and Reprocessing (EMDR)
EMDR was developed by Francine Shapiro in the late 1980's following the discovery that rapid movement of the eyes in sweeps from side to side for a brief period, while maintaining attention on a traumatic experience, produces a dramatic release of painful affect and a shift in negative beliefs about the event The initial focus of the method was on the treatment of Post Traumatic Stress Disorder. Currently there are many case reports and a growing library of controlled studies verifying the efficacy of the method in reducing symptoms of PTSD. The method has also been adapted and applied to other disorders including phobias, addictions, obsessions, personality disorders and pathological grief.
In a typical EMDR session a patient concentrates on stress-producing experience while he simultaneously follows the side to side hand movements of the therapist with his eyes. (Other “bilateral” tactile, or auditory stimulation can also be used. A typical EMDR treatment follows a precise “standard protocol” consisting of 8 phases.
Use of the method requires a diagnosis indicative of the need for trauma processing and a solid therapeutic relationship based on trust.
EMDR appears at first glance to be a relatively simple procedure. It is however a powerful technique that isn’t without side effects and in some situations contraindicated. For this reason EMDR treatment must be conducted only by appropriately trained therapists who are licensed to practice psychotherapy and have proof of certification in the EMDR therapy. zurück
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Finding a qualified EMDR Therapist - EMDR should be administered only by licensed clinicians who have completed the basic training in EMDR (a two-part course). They will have the Title “Federally Recognized Psychotherapist” and be licensed by the Kanton in which they are practicing. They must be familiar or experienced in treating your particular problem. In addition, it is important that you feel a sense of trust and rapport with the clinician. Every treatment success is an interaction among clinician, client, and method.
The Screen Technique for Resource installation and Trauma Treatment
The Screen Technique was used originally in Europe by Sachse und Reddemann 1998/2000) and more recently refined by L. Besser. It is a differentiated tool for amplifying resources for increasing self-awareness, self-image and self-esteem. Its above all useful as a gentle tool in Trauma exposition and Processing. Like all Trauma treatment tools it require a detailed diagnosis indicative of the need for trauma processing and a solid therapeutic relationship based on trust. The method involves an imagination exercise in which the stress producing experience is viewed as a film clip from the life history. The patient has the control of distancing himself from the images in many ways again through use of the imagination. During the viewing all details of the event are visualized on an imaginary screen. The patient is encouraged to acknowledge and express whatever emotions, visual and tactile perceptions, feeling, or thoughts that are associated with the event and only perceivable from the new perspective. The synthesis of the trauma corresponds to the feelings “it’s over”, It was horrible but I survived, and I’m healthy and I’m safe” zurück
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Ego-State-Therapy was developed initially by Paul Federn (1932, 1943) and extended by John Watkins and Helen Watkins (1995), Richard Erskine (1997), Eric Berne (1963), and Richard Schwartz (1997). It is based on the premise that the personality of every individual is made up of different parts (ego-states). They can also be thought of as being integral parts of coping mechanisms that enable the individual to function (differently) in different situations.
Ego-states evolve as a result of normal development and differentiation and also as a result of traumatic experiences which require "special" coping strategies that have have to do with survival. As an example of the normal situation we can remember the experience of expressing the conflict in making a decision, by saying for example " on one hand I want and need a vacation and can actually afford it, but at the same time I can't let myself spend the money. In this example there are obviously two parts, one that is associated with need fulfillment and the outer reality, a rational part. The other appears to be associated with some beliefs about money, pleasure, the right to fulfill needs etc., that don't correspond to the outer reality of the person or situation, and seem to be irrational. They seem to be based on another logic. In order to make the decision the person needs to resolve the conflict between the two parts.
Another way of understanding normal ego states is to think of them as parts of an inner team or family that each have a certain strength or competence that enables the person to function differently in different daily situations. For example there might be "the profi" part that takes over when the person needs to give a presentation for business purposes; or the Host or hostess part who can entertain and meet the needs on a feeling level of their guests,; or the part that seeks challenge risk-taking sport activities....etc. These are all parts of the same individual that are at their disposal when the situation calls for a particular competence. The ego-states in these examples are delineated by their function.
Some ego states are delineated by time dimensions: for example many adults experience visiting the parents after having been away from home for a longer time and at the end of the day feeling like the 7-year old again or experience (in retrospect) how they were acing like a child or a teenager in response to the parents behavior.
When infancy, childhood or adolescence is colored by traumatic experiences like physical/sexual or emotional abuse, or fighting parents or even parental withholding of the intimate expression of love for the child, then the parts or ego-states that evolve have the function of protection and survival. For example: a child learns that by withdrawing his own emotions he won't be hurt and so a protective part evolves that keeps watch and tells the child when to do this. In extreme experiences of brutality and intrusion there may be even states that evolve that may take the side of the perpetrator, according to the saying "if you can't beat them join them".
The ego-states that evolve as a result of childhood survival tactics usually function maladaptively in adult life situations. The part that protects the emotionally neglected child sees to it that the person never allows a partner to get to emotionally close. The person with an ego-state that evolved to save their life by siding with the perpetrator has a self-destructive side. Furthermore it seems as though the survival strategies are improved and honed to perfection throughout life and survival tactics are carried out long after the actual need for them is nonexistent. It's easy to understand how adult functioning can as a result become very complicated and lead to the inability to have a relationship or sometimes to even be able to carry out normal daily functions.
The ego-states however also have the capacity to transform and adapt their functions to accommodate adult needs. Ego-state therapy utilizes this capacity. The therapy essentially involves a learning process that includes the client's acknowledgment and understanding of the coping strategies and the ego-states involved, and then the use of their imagination and innate creative potential to resolve the conflicts. zurück
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