psykotraumatologi: historie, teori, praksis. - … korsgaard.pdfpsykotraumatologi: historie, teori,...

Efteruddannelse i Krisepsykologi.

Psykotraumatologi: Historie, teori, praksis.

Kursusdag 9. maj, 2007 med Anders Korsgaard.

Program for onsdag, 9. maj. 9.00 - 16.00:

• Formiddag:• Hvad er psykotraumatologi.• Hjælper kriseterapi det eller er det sundhedsskadeligt?• Hvad traumatiserer og hvorfor.• Akutte reaktioner og psykologiske senfølger efter

traumer. • Eftermiddag:• Oversigt over akutte og opfølgende behandlingsformer.• Organisering.• Den traumatiserede hjælper.

Historie:

• Vietnam-krig.• Terror.• PTSD og ASD diagnosen.• Terror i Danmark 1985.• Ulykker / katastrofer: Scandinavian Star,

Estonia, Bali, Busulykke Knippelsbro,NewYork 9-11, Tsunami, December 2004, Libanon 2006

Krisepsykologisk Enhed, RH:

• Siden 1985.• Kriseterapi i forbindelse med traumer på

jobbet ( vold, røveri, overværelse af andres traumatisering)

• Kriseterapi i forbindelse akut alvorlig sygdom ( fysiske traumer )

• Beredskab ved større ulykker.

Acute stress disorder

• Definition :• Acute Stress Disorder is a anxiety disorder that develops within

one month after a severe traumatic event orexperience. Distressing dissociative symptoms are common in theperson with Acute Stress Disorder, including depersonalization, derealization, or dissociative amnesia. These symptoms can effectany sex or age group. Anxiety, irritability, and depression are alsocommon in people who have Acute Stress Disorder. People withAcute Stress Disorder have a diminished ability to experiencepleasure. There may be problems falling or staying asleep. Aperson with Acute Stress Disorder will avoid any reminders of thetrauma but re-experiencing the event in dreams, nightmares, orpainful memories.

ASD• ONSET:• COMMON: Any age, symptoms start during or immediately after

trauma.

ASD:• Three or more of the following dissociative

symptoms that developed during or after theevent or experience:

• 1. Loss of emotion, numbing, or detachment.2. Diminished awareness of surroundings.3. Depersonalization.4. Derealization.5. Dissociative amnesia.

ASD:• The event or experience must be re-

experienced in at least one of thefollowing:

• 1. Distressing recollections of the event orexperience.2. Dreams that are reoccurring and distressful.3. Reliving the event or experience in theform of flashbacks, hallucinations, images, illusions, or thoughts.4. Reacting in a physiological manner to any aspect of the event or experience

ASD:• Persistent indicators of increased arousal. ( E.g.,

Problems with falling or staying asleep, Havingproblems concentrating, Hypervigiland, Responseto being startled is overstate. )

• Must be impairment in important areas offunctioning. (E.g., work, social life, ... )

• SYMPTOMS MUST LAST 2 DAYS TO 4 WEEKS. IF SYMPTOMS LONGER THEN 4 WEEKS SEE:POSTTRAUMATIC STRESS DISORDER ( PTSD. )

PTSD• Definition :• Posttraumatic Stress Disorder ( PTSD ) is a anxiety disorder that

develops after a severe traumatic event or experience. Severaldistressing symptoms are common in the person withPTSD, including Psychic numbing, emotion anesthesia, increasedarousal, or unwanted re-experiencing of the trauma. Thesesymptoms can effect any sex or age group. Anxiety, irritability, and depression are also common in people who have PTSD. People with PTSD have a diminished ability to experienceemotion, including tenderness or intimacy. There may beproblems falling or staying asleep. A person with PTSD will avoidany reminders of the trauma but re-experiencing the event in dreams, nightmares, or painful memories are common. Somepeople will turn to drugs or alcohol to escape the pain ofPTSD. While others may become suicidal or self-defeating.

PTSD:• ONSET:• COMMON: Any age, symptoms start within 3 months of trauma.

LESS COMMON: Symptoms start after 3 months or years oftrauma.

PTSD:• Must have been exposed to a traumatic event or experience

involving intense fear, horror, or helplessness. The event orexperience must involve a threat of death, serious injury, orphysical integrity. The event or experience may be to yourself orto others around you.

• A. The event or experience must be re-experienced in at least oneof the following:

• 1. Distressing recollections of the event or experience that is bothintrusive and reoccurring.2. Dreams that are reoccurring and distressful.3. Reliving the event or experience in the form offlashbacks, hallucinations, or illusions.4. If exposed to any aspect of the event or experience a intense psychological distress followed.5. Reacting in a physiological manner to any aspect of the event or experience

PTSD:• B. Avoiding any thing associated with the trauma and a numbing

of responsiveness. Indicated be at least three of the following:• 1. Avoiding any thoughts or feelings about the trauma, including

not wishing to engage in any conversation about the event orexperience.2. Avoidance of places, persons, or things that set off feelingsabout the trauma.3. Can not recall import face about the event or experience.4. A marked disinterest in significant activities.5. Feelings of being detached or alienation from others.6. Changes in range of affect. ( E.g., loss of loving feelings )7. Feelings of no real future.

PTSD:• C. Persistent indicators of increased arousal, at least two of

the following:• 1. Problems with falling or staying asleep.

2. Irritability or outbursts of anger, sometimes unexpectedand for no apparent reason.3. Having problems concentrating.4. Hypervigilant.5. Response to being startled is overstate.

• A, B, and C must be for more then one month.• Must be impairment in important areas of functioning.

(E.g., work, social life, ... )

PTSD:• ACUTE: Symptoms less then three months long.

CHRONIC: Symptoms longer then three months.WITH DELAYED ONSET: Onset of symptoms start six monthsafter event or experience.

Hvad opnås ved debriefing ?:

• Debriefing giver deltagerne mulighed for at dele deres belastende oplevelser med andre i et trygt og beskyttende miljø.

Der skabes forudsætninger for:

• Klargøring af fejlagtige opfattelser af hændelsen og dens konsekvenser - medvirker til at skabe et

helt billede af hændelsen• Genkendelse, accept og diskussion af følelser

og stressreaktioner

• Reduktion af symptomdannelse ( forebyggelse af PTSD, udbrændthed m.m.)

• Hvilke kollegaer har behov for yderligere hjælp.• Styrkelse af deltagernes evne til at hjælpe

hinanden

Orientering om muligheder for yderligere hjælp• Styrkelse af team-spirit

• At man lærer på baggrund af hændelsen ( kan være til hjælp ved en senere hændelse der ligner)

Gruppen er handlekraftig igen i forhold til ny indsats

Behandling af post-traumatisk stress:

• Psykodynamisk orienteret behandling

• Fokal psykoanalytisk terapi ( Lindy)

• Kognitivt orienteret behandling.-social-kognitiv terapi. ( Janoff-Bulman)

• Eksistentielt orienteret behandling ( van Deurzen-Smith )

• EMDR, TIR, CISM, Fysisk orienteret behandling.

• Biologisk / farmakologisk behandling.

Hvem skal have professionel hjælp?:

• Personlighedsfaktorer: Tidligere traumer, tidligere psykiske problemer, aktuelle livssituation

• Forebyggende faktorer: Træning og erfaring, social støtte.

• Faktorer ved den traumatiske hændelse:Hvad er der sket og hvordan har personen været involveret. Hvordan er hændelsen oplevet.

Forslag til litteratur:

• Dyregrov, Atle: Katastofepsykologi, 2004.

• van der Kolk, B., McFarlane, A. & Weisæth, L. eds.: Traumatic Stress. The effects of overwhelming experience on mind, body and society. 1996.

• Horowitz, Mardi: Essential papers on Posttraumatic Stress Disorder, 1999.

• Foa, Edna et. al.: Effective treatments for PTSD, 2000.

• Journal of Traumatic Stress. 1988 -