introduction to trauma & trauma informed care€¦ · joanna filidor, lmft, emdr certified...
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Introduction to Trauma &
Trauma Informed Care
Joanna Filidor, LMFT, EMDR
Certified
Trauma Program Manager
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Learning Objectives
1. To define trauma and understand its
relationship to the brain, addiction and
mental health.
2. To recognize signs that a trauma response
has been activated.
3. To integrate practical tools to implement
trauma informed care in a clinical setting.
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What is Trauma?
• Trauma is a set of experiences or situations
that are emotionally painful and distressing,
and that overwhelm an individual’s ability to
cope.
• Powerlessness
• Fear
• Helplessness
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Big ’T’ and Little ’t’
• Big T: A single event.
• Little t: A series of cumulative
experiences.
• Trauma often occurs when a person’s
basic life assumptions are shattered.
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PTSD Symptomatology
There are four types of PTSD Symptoms:
1.Reliving the event through flashbacks,
nightmares, and triggers.
2.Avoidance of people, places and things that
remind of the event
3.Negative changes in beliefs and feelings
about self and the world.
4.Hyper-arousal (agitation, restless, emotional
outbursts)
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Trauma, Addiction & Mental
Health
Addiction is a traumatic lifestyle.
Self-medication to handle trauma symptoms
and reactions.
Misdiagnosis potential
Trauma and mental health spiral
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The (Triune) Brain
• Reptilian Brain
• Responsible for Autonomic Nervous
System (ANS) also called fight, flight,
freeze.
• Limbic System
• Responsible for memory (hippocampus),
emotion (amygdala), and regulation
(hypothalamus).
• Neocortex
• Responsible for thinking, learning,
problem solving, language, executive
functions, etc.
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A Healthy Brain with Threat Present
Amygdala
Hippocampus
Hypothalamus ANS
Prefrontal
Cortex
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A Healthy Brain with Threat Present
Amygdala
Hippocampus
Hypothalamus ANS
Prefrontal
Cortex
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A Traumatized Brain with Threat Present
Amygdala
Hippocampus
Hypothalamus ANS
Prefrontal
Cortex
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Normalizing the Trauma Response
• Fight, Flight, Freeze
• Survival Response
• Important for trauma informed care
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Why is normalizing important?
• Reduces shame
• Strengthens therapeutic relationship
• Helps reframe “you vs me” into “we”
• Gives context to reactions
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Permanent Activation of
Trauma Response
• Fight: aggressive, anger outbursts, tense
body, impulsivity, defensiveness, making
themselves be “bigger”
• Flight: anxiety, panic, emotional flooding
and outbursts, fast speech, restless, unable
to focus or sit still, “running” from life
• Freeze: depression, dissociation,
numbness, shut down, disconnect, flat
affect
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Fight and Flight
Activated by Sympathetic System in ANS,
which increases:
blood pressure
heart rate
adrenaline
oxygen
peripheral vision
Behaviorally, a person can be aggressive,
violent, irritable, experience anger outbursts,
when in fight. Behaviorally when in flight mode,
a person can be restless, anxious and get
emotionally flooded.
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Freeze
Activated by Parasympathetic System in
ANS, which decreases:
clarity of thought
heart rate
blood pressure
energy expenditure
Behaviorally, a person can experience
chronic fatigue, numbness, feel as if in
“auto-pilot” and shut down physically and
emotionally.
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“If it’s hysterical, it is historical.”
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–Alameda County Trauma Informed Care
“TIC is grounded in and directed by a thorough
understanding of the neurological, biological,
psychological and social effects of trauma and
the prevalence of these experiences in persons
who seek and receive mental health services”
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The Trauma Lens
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Trauma Informed Care
• Understanding of trauma
• Awareness of the impact trauma has
on the individual, both during and after
the trauma
• Creating an environment of physical,
emotional and psychological safety
• Avoiding practices that could re-
traumatize the individual
• Integrate knowledge about trauma into
policies, procedures and practices.
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Understanding Trauma
• Psychoeducation for staff and clients
• Trauma and the Brain
• Fight, Flight, Freeze Reactions
• Relationship between trauma and
addiction
• Normalize response and symptoms to
traumatic experience
• Teach self-compassion and compassion
• Promote trauma awareness and
understanding
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Awareness of the Impact of
Trauma on the Individual
• Support, choice and autonomy after trauma
• Loss of power and control during trauma
• Conduct trauma screenings (PCL-C, Brief
Trauma Questionnaire, Life Stressor
Checklist, etc)
• Foster trauma resiliency skills
• adaptability to change
• resourcing
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Creating Safety
• Ensuring environment is physically safe and
conducive to recovery
• Providing emotional safety
• Skill development
• Management of triggers
• Creating an environment that is
psychologically safe
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Trauma Informed Practices
• Self of the therapist
• Preventing retraumatization
• Conduct trauma screenings (PCL-
C, Brief Trauma Questionnaire, Life
Stressor Checklist, etc)
• Show organizational and
administrative commitment to TIC
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Tools for the Tool Box
• Sensory experience
• Smell, Sight, Sound, Touch, Taste (5, 4,
3, 2, 1)
• Physical senses
• Deep breathing
• Body/cognitive awareness
• “You are safe right in this moment”
• Screening tools (PCL-C, LEC, ACE)
• Supportive and safe environment
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What are three ways in which you can enhance trauma
informed care?
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Post-Traumatic Growth
• Defined as “a construct of positive
psychological change that occurs as the
result of one’s struggle with a highly
challenging, stressful, and traumatic event.”
(Calhoun & Tedeschi, 2006)
• There is hope!
• It can occur throughout the trauma process.