1. university of connecticut 2. exceeds the individual’s · principles of effective school safety...
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Julian D. Ford, PhD, ABPP
Professor of Psychiatry
University of Connecticut
Disclosure: Dr. Ford is co-owner of
Advanced Trauma Solutions, Inc, the
sole Licensed Distributor of the
TARGET model for Complex Trauma
What is Psychological Trauma?
1. Survival Threat
2. Exceeds the Individual’s
Adaptive Capacities/Resources
What is Complex Trauma?
1. Survival Threat
2. Exceeds the Individual’s
Adaptive Capacities/Resources
3. Alters the Individual’s
Development of Self-Regulation
Copyright, CACourtois, PhD & JD Ford, PhD, 2014
Forms of Complex Trauma
Entrapment in Abusive Relationships
(Maltreatment, Bullying DV/IPV)
Prolonged Isolation & Emotional Abuse
Historical Trauma & Identity-based Violence
Prolonged Community/Family Violence
Human Trafficking/Slavery/Prostitution
Complex Trauma Undermines Safety
Self-dysregulation: hypervigilance &
impulsivity/dissociation (survival mode)
Relationships based on demands &
detachment (disorganized attachment, fear
of abandonment and closeness; includes
“borderline personality” terror of rejection)
Despair/numbing based on view of
self as damaged, future as hopeless
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PTSD (New features in Green Font)
B. Intrusive Re-experiencing (1+)
1. Spontaneous Involuntary Distressing Memories
2. Nightmares (content OR affect related to trauma(s))
3. Flashbacks (may be partial orientation x3)
4. Intense or prolonged distress 20 cues (inc. symbolic)
5. Marked physiological reactions to reminders
PTSD
C. Active Avoidance (1+)
1. Avoids internal reminders (thoughts,
feelings, physical sensations) of
traumatic event(s)
2. Avoids external reminders (people,
places, conversations, activities,
objects, situation) of traumatic events
PTSD (New features in Green Font)
D. Negative Alterations in Cognitions
/Mood Beginning In/After Trauma (2+)
1. Psychogenic amnesia (typically dissociative)
2. Persistent exaggerated negative expectations about
world/other (distrust), future (despair), self (damaged)
3. Persistent distorted blame of self or others re trauma
4. Pervasive negative emotional states
5. Anhedonia
6. Detachment/estrangement from others
7. Persistent inability to experience positive emotions
PTSD (New features in Green Font)
E. Altered Arousal or Reactivity
Beginning In/After Trauma (2+)
1. Irritable or aggressive behavior
2. Reckless or self-destructive behavior
3. Hypervigilance
4. Exaggerated startle response
5. Concentration problems
6. Sleep disturbance (restlessness or insomnia)
Dissociative Sub-Type of PTSD
Meets all PTSD criteria plus either:
1. Depersonalization
2. De-realization
Complex Trauma, PTSD, and the Brain (Teicher & Samson, 2013, p. 1127)
“Briefly, the thalamus and sensory cortex process threat[s]
… and convey this information to the amygdala.
Prefrontal regions … modulate amygdala response,
turning it down with the realization that something is not
actually a threat or … irrationally amplifying it. The
hippocampus also processes this information and plays a
key role in retrieving relevant explicit memories ... [and]
modulates … response to psychological stressors. …
The amygdala integrates this information and signals
[lower brain areas, e.g., locus ceruleus], which regulates
autonomic, [HPA], and noradrenergic response.”
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Developmental Trauma Disorder
(van der Kolk, 2005; D’Andrea, Ford, et al., 2012; Ford et al., 2013)
Children exposed to complex trauma often meet some but not all PTSD criteria AND are given multiple co-occurring diagnoses due to:
Emotion/Somatic Dysregulation
Cognitive/Behavioral Dysregulation
Relational/Self Dysregulation
Copyright, JD Ford, PhD, 2014
Developmental Trauma Disorder
Traumatic victimization
(physical, sexual, emotional) +
Attachment disruption
(primary caregiver loss,
separation, neglect, or
emotional abuse)
Developmental Trauma Disorder
Affective/Physiological Dysregulation
B. 1. Inability to modulate or tolerate extreme
affect states (e.g., fear, anger, shame, grief),
including extreme tantrums, immobilization)
B. 2. Inability to modulate/recover from extreme
bodily states: aversion to (a) touch, (b) sound;
(c) unexplained bodily problems
Developmental Trauma Disorder
Affective/Physiological Dysregulation
B. 3. Diminished awareness/dissociation
of emotional or bodily feelings
B. 4. Impaired capacity to describe
emotions (alexithymia) or bodily states
Developmental Trauma Disorder
Attentional/Behavioral Dysregulation
C. 1. Attention-bias toward or away
from potential threats
C. 2. Impaired capacity for self-
protection, including extreme risk-
taking or thrill-seeking
Developmental Trauma Disorder
Attentional/Behavioral Dysregulation
C. 3. Maladaptive self-soothing
C. 4. Habitual (intentional or
automatic) or reactive self-harm
C. 5 Inability to initiate or sustain
goal-directed behavior
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Developmental Trauma Disorder
Self and Relational Dysregulation
D. 1. Persistent extreme negative
self-perception—self-loathing or
viewing self as damaged/defective
D. 2. Attachment insecurity: attempt
to care for caregivers, or difficulty
tolerating reunion after separation
from primary caregiver(s)
Developmental Trauma Disorder
Self and Relational Dysregulation
D. 3. Extreme persistent distrust,
defiance or lack of reciprocal
behavior in close relationships
D. 4. Reactive physical/verbal
aggression
Developmental Trauma Disorder
Self and Relational Dysregulation
D. 5. Psychological boundary deficits
(excessive seeking of intimate
contact or reliance on peers/adults
for safety/reassurance)
D. 6. Dysregulated empathic arousal
(intolerant/indifferent or overly
reactive to others’ distress
Defining Self-Dysregulation
“Hijacked by your brain” –
“survival brain displaces
the learning brain”
Ford, 2009, 2013
HIJACKED by Your BRAIN
How to Free Yourself
When Stress Takes Over
Dr. Julian Ford and Jon
Wortmann
ISBN-13: 978-1-4022-7328-5
9 781402 273285 51499
Principles of Effective
School Safety
“First, do no more
harm”
Services can help or hurt – both the
helper and the recipient(s)
Copyright, JD Ford, PhD, 2014
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Principles of Effective School Safety
Meets ethical and clinical standards of care
Client-centered, collaborative
Strengths-based, resilience-enhancing
Recovery-oriented, sensitive to culture/stigma
Evidence-based2 – Science x Engagement
Individualized2 – Assessment x Outcomes
Trauma-Informed – Enhances safety/control
Relational – Models Boundaries + Pos Regard
Empowering – Foster Autonomy, Prevent Relapse
Evidence-informed PTSD Psychotherapies
Traumatized Pre-Schoolers Lieberman’s Child-Parent Psychotherapy
Eyeberg and Urquiza’s Parent-Child Interaction Therapy (PCIT)
Traumatized Children and Adolescents Cohen, Deblinger & Mannarino’s Trauma-Focused Cognitive Behavior
Therapy for sexual abuse-, traumatic loss-, and violence-related
PTSD (TF-CBT)
Stein & Jaycox’s Cognitive Behavioral Intervention for Trauma in the
Schools (CBITS)
Layne, Olafson, Saltzman, and Kaplow’s Trauma and Grief
Components Therapy for Adolescents (TGCT-A)
Ford’s Trauma Affect Regulation: Guide for Education and Therapy
(TARGET)
Evidence-informed PTSD Psychotherapies
Traumatized Adults
Resick’s Cognitive Processing Therapy (CPT)
Shapiro’s Eye Movement Desensitization/Reprocessing (EMDR)
Schauer, Neuner, & Elbert’s Narrative Exposure Therapy (NET)
Foa’s Prolonged Exposure Therapy (PE)
Cloitre’s Structured Therapy for Affect and Interpersonal Regulation
with Modified Prolonged Exposure (STAIR-MPE)
Ford’s Trauma Affect Regulation: Guide for Education and Therapy
(TARGET)
Helping Children Overcome Complex Trauma
Increase capacity to modulate arousal/emotions
Understand how symptoms of PTSD, cPTSD, and
comorbid disorders are adaptive stress reactions
that have become maladaptive dysregulation
Reestablish normal stress response
Decrease numbing/avoidance strategies
Recognize signals from the body
Name rather than avoid distressing emotions,
thoughts, motives, impulses (mentalizing)
Recognize and draw upon personal strengths
(including healthy relational motives)
Early Stage: Engagement
Did you know you have an
alarm in your brain?
And that it’s job is to help you
be alert and pay attention?
And to help you survive if you
are in great danger? Copyright University of Connecticut All Rights Reserved Copyright University of Connecticut All Rights Reserved
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Early Stage: Engagement
Did you know that after an
emergency, your brain’s alarm
can get stuck on high alert?
And that this can cause anyone to
“over” react to small stressors?
And that PTSD is when a stuck
alarm “hijacks” your brain? Copyright University of Connecticut All Rights Reserved
Early Stage: Engagement
Did you know the brain can re-set
and turn down a stuck alarm?
And that this begins with the
brain’s memory filing center?
And that the filing center needs
help finding useful memories if
the alarm is stuck on emergency? Copyright University of Connecticut All Rights Reserved
Copyright University of Connecticut All Rights Reserved
Early Stage: Engagement
Did you know the brain can re-set
and turn down a stuck alarm?
And that this begins with the
brain’s memory filing center?
And that the filing center needs
help finding useful memories if
the alarm is stuck on emergency? Copyright University of Connecticut All Rights Reserved
Copyright, CACourtois, PhD & JD Ford, PhD, 2014
Middle Stage: Self-Regulation
Did you know the brain has a
thinking center that can focus
the filing center so it can find the
right memories?
And the thinking center has a
way of focusing called “SOS”?
Copyright University of Connecticut All Rights Reserved
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SOS: 3 Steps to FOCUSING Step I: Slow Down
Stop, Step Back, Sweep your Mind clear Step II: Orient Yourself
Focus on ONE THOUGHT that YOU CHOOSE: what is MOST IMPORTANT IN YOUR LIFE, YOUR CORE VALUES and WHO YOU ARE AS A PERSON
Step III: Self Check
How Much Stress? How Much Control?
Optional: Strength of Urges to Use?
Optional: Sense of Connection/Support?
Copyright University of Connecticut All Rights Reserved Copyright University of Connecticut All Rights Reserved
Optimal Window of Arousal/Affect
0
1
2
3
4
5
6
7
Danger zone: Survival Alarm
Optimal window of arousal:
Thinking, Filing, and Alarm
Systems Partner Together
Time/Experience
Shut-down: Survival Alarm
Arousal/Affect
Adapted from Van der Hart, Nijenhuis, & Steele, 2000 Copyright University of Connecticut All Rights Reserved
Focusing and Recognizing Triggers
Shifts from avoidant hypervigilance to
proactive/reflective mindfulness/readiness
Increases calm attentiveness, empathic
attunement, constructive problem solving
Every alarm reaction is based on a MAIN
goal that otherwise tends to be forgotten
Copyright University of Connecticut All Rights Reserved
Peanuts Classics ®
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FREEDOM Steps to Self-Regulation
Focus (SOS) Recognize Trigger(s)
Alarm/Reactive
Emotion
Evaluate (Thoughts)
Decide (Goals)
Options
Mobilize for Action
MAIN
Emotion
Evaluate (Thoughts)
Decide (Goals)
Options
Make a Contribution Copyright University of Connecticut All Rights Reserved
MAIN Emotions, Thoughts,
Goals, Options = Revisiting the
Orienting Step in SOS
My core values, beliefs, loyalties, and …
Attachments that give security, love, and …
Inner peace, and calm confidence.
Nothing is more important to me than this.
Copyright University of Connecticut All Rights Reserved
The Final Step in FREEDOM –
Making a Contribution
by being a role model for
responsible self-regulation
Copyright University of Connecticut All Rights Reserved
Emotionally Regulated
Caregivers Inspire Hope
and Calm Confidence
Published 2013, co-edited Published, 2013, co-authored
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Published, 2009, co-edited