1) Traumatic Stress
What is Trauma?
According to SAMHSA’s (Substance Abuse and Mental Health Services Administration) Trauma and Justice Strategic Initiative, “trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual’s functioning and physical, social, emotional or spiritual well-being.” (SAMHSA Trauma and Justice Strategic Initiative http://media.samhsa.gov/traumajustice/).
These “traumatic” events may involve disasters, war experience, or interpersonal abuses (such as abuse within a family or intimate partner relationship); that includes exposure to significant violence, actual or threatened death, serious injury, or physical or sexual assault. They can be one-time occurrences, such as an airplane or auto accident, house fire, natural disaster or violent crime, or they can be chronic condition where events are repeated and ongoing, which is often the case in domestic violence, child neglect and abuse, and combat.
More examples of Traumatic Experiences include:
- Medical Disease
- Volcano Eruption
- Flood Epidemic
- Dust Storm
- Auto Accident
- Mine Collapse
- Aircraft Crash
- Oil Spill
- Accidental Shooting
- Sports Related Death
- Gas Explosion
- Mountaineering Accident
- Train Derailment
- Maritime Accident
- Mob Violence
- Bank Robbery
- School Violence
- Sexual Assault Or Abuse
- Homicide Or Suicide
- Domestic Violence
- Child Neglect Or Abuse
Trauma can affect people of every race, ethnicity, age, sexual orientation, gender, psychosocial background, and geographic region. Traumas can affect children, individuals, families, groups, communities, specific cultures, and generations. It will generally overwhelm an individual’s or community’s resources to cope and frequently produces a sense of fear, vulnerability, and helplessness.
Trauma is widespread. National community-based surveys finds between 55% and 90% of us have experienced at least one traumatic event over a course of a lifetime and some individuals report that, on average, they have experienced nearly five traumatic events! More than half of children report experiencing a traumatic event by age 16. (Presidential Task Force on PTSD and Trauma in Children and Adolescents, 2008 http://www.apa.org/pi/families/resources/task-force/child-trauma.aspx ).
What is Traumatic Stress?
Traumatic Stress occurs after exposure to a traumatic event and can involve a combination of reactions and symptoms.
These reactions or symptoms to traumatic events can vary considerably, ranging from fairly mild, creating minor disruptions in a person’s life, to severe and incapacitating. It is common for people to experience anxiety, fear, shock, and upset, as well as emotional numbness and personal or social disconnection. Sometimes, people can’t remember significant parts of what happened, and yet be overwhelmed by fragments of memories that return in psychological and physical flashbacks.
Nightmares of the traumatic experience can be common, so are depression, irritability, sleep disturbance, dissociation, and feeling jumpy. For families with children, please understand that children may experience trauma symptoms in different ways. Examples include; regress or act younger than their age, lose skills already learned, worry about dying or being hurt, or play games that may reenact the event.
Fortunately, for many people, the reactions to a traumatic event are temporary.
There are others that may have prolonged reactions that can move from acute symptoms to more severe, prolonged, or long lasting mental health consequences (like Post-Traumatic Stress and other anxiety disorders, mood disorders or substance use) and medical problems (that might include arthritis, headaches, and chronic pain).
For more information on the signs of Traumatic Stress, the signs and symptoms of PTS (Post -Traumatic Stress) and PTSD (Post-Traumatic Stress Disorder) please go to the “Signs of Traumatic Stress” section.
2) Signs of Traumatic Stress
It is important to remember that the effects of trauma depend on an individual’s:
- developmental level
- inherent resiliency
- coping skills
If you have two children with the same biological parents, raised in the same home, think about how likely is it that they both respond in exactly the same way to anything?
(That is why you and I could be in the exact same traumatic event at the exact time but respond differently because of your history and my history - the things that make me “me” and you “you.”)
Remember - it is not the event experienced by the person, but their inherent qualities, their learned skills and their support systems that will affect how someone views and heals from a traumatic experience.
Not everyone who has experienced trauma is going to develop Post-Traumatic Stress (PTS) or Post-Traumatic Stress Disorder (PTSD) – but they may experience Traumatic Stress symptoms and behaviors such as:
- increased medical problems
- unexplained physical symptoms
- insensitivity to pain
- difficulty regulating their emotions
- difficulty knowing and describing their feelings and internal states
- at risk and unhealthy behavior
- poor impulse control
- aggression towards others
- self-destructive behaviors
- it can cause disrupted attachments
- teaching others that the world is uncertain and unpredictable
- socially isolated
- difficulty relating to others
- problems planning for and anticipating future events
- learning difficulties
- problems focusing on and completing tasks
- issues with self- concept
- disturbed body image
- low self esteem
Similarly, people who become more and more depressed or anxious or for whom the use of alcohol or other drugs increases significantly may not be experiencing traumatic stress but feeling the symptoms of PTS or PTSD and should be encouraged to seek treatment. (More information on seeking treatment or services can be found in the Seeking Services section 3.)
Post-Traumatic Stress or PTS:
PTS is the physical and emotional reaction from the memories of a traumatic event experience, and the shattered sense of personal safety. While uncomfortable and disconcerting, these reactions usually do not disrupt or interfere with an individual’s overall ability to function.
Symptoms can include all of those listed above along with:
- feelings of dissociation (feelings of disconnection or unreality)
- intrusive thoughts and images or flashbacks and nightmares
- avoiding reminders of the traumatic experiences
Most of the symptoms will usually occur within a month following the event. The symptoms may last a short time and recede but may come back later in no particular order when experiencing feelings of being overwhelmed or powerless over a situation.
Post-Traumatic Stress Disorder or PTSD:
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), has a set criteria or cluster of symptoms by which Post-Traumatic Stress Disorder is diagnosed.
Symptoms can occur at any age, beginning after the first year of life. The symptoms usually begin within 3 months after the trauma, although there may be a delay of months, or even years before criteria for the diagnosis are met. Duration of the symptoms varies, with complete recovery within 3 months (occurring in approximately one-half of adults) while some individuals can continue to experience the symptoms for longer than 12 months and sometimes for more than 50 years.
Any or all of these symptoms may occur right after the event(s) or worsen after the events, and may be present one at a time together, all at once, or in clusters, all in varied degrees, and may continue for a lifetime. This is even more likely in cases without an interruption or cases where appropriate treatment or intervention was not sought.
As listed in the DSM-5, the symptoms for PTSD are:
Intrusion or Re-experiencing Symptoms:
- distressing memories/intrusive thoughts
- nightmares or recurrent dreams
- distress and reactivity at exposure to reminders, internal or external
- psychological reactivity to reminders
- physiological reactivity to reminders
*Children under the age of six may reenact the traumatic events in play. There may be frightening dreams without recognizable content.
*Children older than six may experience repetitive play in which themes or aspects of the traumatic event(s) are expressed.
Avoidance Symptoms or Emotional Numbing
- avoiding thoughts, memories, feelings
- alcohol or substance use
- tobacco use
*Children may avoid or try to avoid people, conversations, activities, places, or physical reminders that arouse recollections of the traumatic event(s). They may show marked physiological or biological, physical, and functional reactions to those reminders.
Arousal Symptoms or Increased Arousal:
- exaggerated startle response
- reckless or self-destructive behaviors
- hyper vigilance
- irritability and angry outburst
- problems with concentration
- sleep disturbances
*Children may show difficulty in concentration, difficulty with falling asleep, staying asleep or restless sleep. They may have angry outbursts with little or no provocation, typically expressed as verbal or physical aggression toward people or objects. They may show exaggerated startle response to seemingly normal situations.
*Children when de-personalizing, may have persistent or recurrent experiences of feeling detached from the body or mental process or as if in a dream or as if time is moving very slowly. When children experience de-realization, they may have persistent or recurrent experiences of unreality of surroundings or as if the world around them is experienced as unreal, dreamlike, distant, or distorted.
Negative Mood & Cognitions:
- inability to remember
- negative personal and world view
- negative emotional state – fear, horror, anger, guilt, shame
- diminished interest or participation
- feelings of detachment of estrangement
- inability to feel positive emotions
*Children may show substantially increased frequency of negative emotional states (fear, guilt, sadness, shame, confusion). They may begin to show an interest in certain activities, including playtime, hobbies, and social events. They may also begin to show a reduction in expression of positive emotions.
People who have experienced traumatic life experiences cope the best way they can with the memories and painful effects. For many, reactions gradually lessen over time. Some find it helpful to talk about what happened and their feelings, to get support from people who can be trusted, or to be involved in other activities that help them to reconnect with people and find meaning in their lives. In many cases, it is highly improbable that these individuals will have any long-lasting mental or physical health problems from these situations.
For some people, the symptoms and disturbing reactions persist or even worsen over time. This can lead people to find other ways to cope, ways that are not so helpful, such as withdrawing from friends and family, using drugs or alcohol, or avoiding activities that are empowering.
Therefore, it is important to consider seeking help if important areas of life, such as relationships, work, or school, are being affected by traumatic stress or if you become more and more depressed or anxious and/or begin using alcohol or other drugs in excess. (More information on seeking treatment or services can be found in Seeking Services section 3).
3) Seeking Services
Deciding whether you need help…
Unexpected tragedies, especially those caused by caregivers or intimate partners can be especially traumatic. These are individuals that you are supposed to trust and rely on to keep you safe. Certainly that may affect someone’s sense of safety, trust, and meaning in the world, as well as generating feelings of fear and anxiety. In some cases these tragedies will cause long-lasting mental or physical health problems from these situations.
However, people who have been exposed to additional tragic events may find themselves thinking about events that they hadn’t thought about in a long time, revisiting issues or problems they thought they had resolved, or experiencing symptoms that they experienced in the past. And, individuals coping with ongoing stressful life experiences or have ongoing mental or physical health problems may find themselves feeling more stressed, fatigued, irritable, and distracted.
For some people, the symptoms and disturbing reactions persist or become worse over time. This can lead people to find other ways to cope, ways that are not so helpful, such as withdrawing from friends and family, using drugs or alcohol, or avoiding activities that are empowering.
Therefore, it is important to consider seeking help if important areas of life, such as relationships, work, or school, are being negatively affected by traumatic stress or if one becomes more and more depressed or anxious and/or their use of alcohol or other drugs increases significantly
Some individuals first discuss their concerns with a family physician, clergy member, or school counselor and may then be referred to a mental health professional. Your local mental health association, state psychiatric, psychological, behavioral health, or social work association, or your health insurer may be helpful in providing a referral to a counselor or therapist with experience in treating others affected by traumatic stress. In Oklahoma 211 is a resource for finding centers throughout the state of Oklahoma. ODMHSAS access coordinator is another resource that can help you find a center close to your home. Contact ODMHSAS 405-522-3908 and ask for the Access Coordinator.
There are many types of treatment for people experiencing traumatic stress, so finding the right mental health provider can often seem challenging. In Oklahoma every county has a community mental health center that may be able to provide services needed. To find a center in your area go to www.odmhsas.org and then to “mental health” and then to Community Mental Health Centers. The centers will be listed by cities.
Research supports the effectiveness of medication, anxiety management, processing therapy, cognitive therapy, trauma-focused cognitive behavioral therapy (focusing on thoughts and beliefs), and exposure therapy (helping the person confront painful memories and situations that are realistically safe although still frightening, though talking about or imagining them) for reducing traumatic stress, post-traumatic stress and post-traumatic stress disorder and related symptoms.
There is interpersonal, relational, or psychodynamic psychotherapies, which focus on the meaning of the event and how the experience has affected relationships, may also help people understand the source of their current problems and how these relate to their traumatic experiences. Using a combination of psychotherapy and medication if often helpful for depression and anxiety following traumatic experiences.
No single treatment is effective for everyone, and it may take some time, as well as trial and error, to find the right treatment. There also may be some difficult periods during treatment, therefore, it is important to find a trained clinician , preferably one with experience treating people with traumatic stress, who can work together with the survivor to find the treatment approach that best makes sense for the individual.
Where to go for help:
People considering treatment should select a mental health professional who is knowledgeable about traumatic stress.
Questions to Ask Mental Health Providers:
- Does/Did the individual/agency that provides therapy conduct a comprehensive trauma assessment?
- What did your assessment show?
- What were some of the major strengths and/or areas of concern?
- Is the clinician/agency familiar with/trained in evidenced-based treatment models designed and tested for treatment of trauma-related symptoms?
- How do you approach therapy with traumatized adults, or families, regardless of whether they indicate or request trauma-informed treatment?
- Describe a typical course of therapy? For example: can you describe the core components of your treatment approach?
Portions of the above information are from the National Child Traumatic Stress Network (NCTSN), along with Chadwick Trauma Informed Systems Project (CTISP).
Trauma-Focused Evidence Based Treatment Options in Oklahoma
Regardless of age or the types of trauma experienced, healing is possible.
Some of the intervention models available in Oklahoma include:
- Trauma Recovery and Empowerment Model (TREM):
This model is intended for trauma survivors, particularly those with exposure to physical or sexual violence. It is gender specific: TREM for women and M-TREM for men. For more information: Navigate to SAMHSA’s National Registry of Evidence-based Programs and Practices at http://www.nrepp.samhsa.gov/find.aspand enter Trauma Recovery and Empowerment Model in the search domain. You can also visit the Community Connections – Trauma Recovery and Empowerment Model website at http://www.communityconnectionsdc.org
Seeking Safety is designed to be a therapy for trauma, post-traumatic stress disorder (PTSD), and substance abuse. This model works for individuals (adults and adolescents) or with groups, with men, women or with mixed gender groups. For more information: Navigate to SAMHSA’s National Registry of Evidence-based Programs and Practices at http://www.nrepp.samhsa.gov/find.aspand enter Seeking Safety in the search domain. You can also visit the Seeking Safety website at http://seekingsafety.org.
- Cognitive Processing Therapy:
Based on principles of cognitive therapy, Cognitive Processing Therapy or CPT was developed by Drs. Patricia Resick, Candice Monson, and Kathleen Chard. CPT involves a structured, sequenced approach to address the unique needs of each patient suffering from PTSD and/or depression. Specifically, CPT is a short-term treatment that may work in as few as 12 treatment sessions. Of course, treatment may be provided for longer periods depending on each individual's needs.
For children resources please go to SHARE Children, Youth and Families section
- Parent Child Interaction Therapy (PCIT):
This intervention model is for children, ages 2 – 8, and their parents or caregivers, focusing on decreasing externalized child behavior problems (such as defiance and aggression), increasing positive parent behaviors, and improving the quality of the parent-child relationship. For more information, you can visit the Parent Child Interaction Therapy website: http://www.pcit.org/
- Strengthening Families Program (SFP):
The Strengthening Families Program is focused on families with children, ages 6 to 11, and is a family skills training program found to significantly reduce problem behaviors, delinquency, and alcohol and drug abuse in children and to improve social competencies and school performance. Originally developed and tested on a research grant with children of substance abusing parents, this program continues to be reviewed by researchers and rated as an exemplary, evidenced success for over 30 years and available in 26 countries. For more information, you can visit the Strengthening Families Program website: http://www.strengtheningfamiliesprogram.org/
4) Additional Resources