TRMA 830 LU Psychology Traumatic Stress Disorder Discussion Replies – Description
DISCUSSION
Please respond to the following 3 discussion posts
1. Posted by Apr C
F43.10 Post-Traumatic Stress Disorder (Kathy)
A – 1 Kathy had actual exposure to sexual violation from her father (direct experience).
B – 1 Kathy has marked physiological reactions of chronic tightness in stomach, irritable bowel syndrome, and unrelenting lower back pain that reflect traumatic symptoms trapped in her body.
C – 1 Kathy avoids attending to the messages of her somatic symptoms and is disconnected from her body, her power, and her anger.
D-1 Kathy has persistent and exaggerated negative beliefs about herself, the world, and the future.
D-2 Kathy has persistent, negative emotional states of depression, shame, learned helplessness, hopelessness, despair, and low self-esteem.
E-1 Kathy is “constantly exhausted” which reflects a lack of self-care and rest. She is disconnected socially.
E-2 Kathy has anger which is misdirected to herself as evidenced by “what’s wrong with me?” and “I’m permanently damaged”.
Case Summary
Kathy is a single woman in her mid-forties, who is struggling with depression and PTSD. She was sexually abused by her biological father from the age of six to the age of eleven. He mother was ‘checked out’ and did not provide psychological support until Kathy directly disclosed the abuse. They then left Kathy’s father, removing Kathy from her childhood home and friends. Kathy has had several years of previous therapy, but it is assumed that no trauma work was done. Kathy has unresolved trauma, repressed anger, somatic symptoms, depression, and complicated grief.
Current Interventions
With her new therapist, Kathy is responding to talk therapy, anger processing, somatic psychotherapy, cognitive-behavioral therapy, and self-care work. She and her therapist have excavated ungrieved trauma-related loss and she is now actively grieving losses of her innocence, childhood, community, friends, home, and her abuser’s death. She is processing anger, relief, sadness, and redemption connected to her father dying. Yoga is helping Kathy regain her power and strength. She is evaluating her trauma belief that she is “permanently damaged” and realizing her dissociation from positive emotions like joy and hope. Survivors of childhood sexual abuse may need to learn tolerance for positive emotions (Schwartz, 2016), as they are unfamiliar and may feel threatening.
Additional Therapeutic Interventions
Healthy Need Fulfillment
Children who have experienced chronic trauma are usually deficient in emotional regulation (Blaustein & Kinniburgh, 2019). The adult part of Kathy may be stuck in depression because she is relying on immature strategies to manage her emotions. She has not learned healthy ways to process her feelings and resorts to crying, sadness, and hopelessness which is most likely how she responded as a child. Pathological behavior may be need fulfillment strategies, which Blaustein and Kinniburgh (2019) theorize to be futile attempts to get legitimate needs met. Kathy can realize that she is now an adult with adult resources at her disposal. Instead of the default of crying, she can use wisdom from Romans 14:5, “Let every man be fully persuaded in his own mind” (New International Bible, 2011/1978) and consider what does she actually need. Her current improvement with her therapist suggests that she needs to feel safe and powerful. When she is triggered by trauma reminders, she could move toward power and away from despair by employing strength-focused interventions like saying no to hopelessness, standing up straight, doing the warrior pose from her yoga class, taking a self-defense class, or communicating with directness.
Upregulation
Dan Siegel (n.d.) theorizes that all pathology is the result of impaired integration. The lack of integration results in rigidity, chaos, or both (Seigel, n.d.). Successful regulation of emotions requires one’s awareness of their internal state and the capacity to endure a range of arousal and mood (Blaustein & Kinniburgh, 2019). When Kathy is overwhelmed by sadness and despair, she is not within her “window of tolerance”, the optimal levels of psychological arousal (Blaustein & Kinniburgh, 2019). Complex trauma-related depression is associated with lingering feelings of collapse in the body (Schwartz, 2016). This is keeping Kathy outside the bottom of her window of tolerance in hypoarousal. She can up-regulate to energize constriction symptoms. Some suggestions include exercise, upbeat music, playing with a pet, feel-good books and movies, sniffing pleasant scents, planning a trip, bouncing on a trampoline, meeting up with friends, and finding ways to play. Since Kathy missed out on childhood joys, she can find ways to bring joy into her life now, like going to an amusement park, playing games, or swinging at a playground.
Shame Processing
Clients with childhood sexual abuse may absorb shame that rightfully belongs to the offender (Sanderson, 2013). Sexual abuse victims feel guilt and shame from complying with behavior that they were uncomfortable with and may view shameful sexual activity as their own behavior (Cohen et al., 2017). Kathy and her therapist can process shameful sexual experiences and evaluate who was responsible. Kathy can shift the full weight of responsibility onto her abuser’s shoulders. If Kathy wanted spiritual interventions, she could break ungodly soul ties (trauma bonds) of guilt and shame with her father through prayer. Trauma bonds are unhealthy emotional connections that develop between survivors and abusers (Sanderson, 2013).
Grieving Loss
In the safety of the therapeutic space, Kathy can explore ungrieved loss. She can give herself permission to recognize and grieve losses, including innocence, childhood, well-being, control of the body, protection, support, healthy relationships, sense of purpose, boundaries, trust in self or others, ability to play, and freedom to express emotions (Sanderson, 2013). Kathy can clarify which losses she misses the most and evaluate if any still can be reclaimed. Losses that cannot be restored can be processed through a daily grieving time and perhaps even a private funeral (Sanderson, 2013). She may benefit from writing a brutally honest obituary about her father for her complicated grief.
2. Posted by Shan S
F43.10 Post-Traumatic Stress Disorder (Kathy)
Kathy is a single woman in her mid-forties who was able to give a clear summary of her traumatic past. Kathy was sexually abused by her father starting at age six and has gone undetected for five years as her mother was “checked out” until she informed her mother of her abuse when she was eleven years old, resulting in them leaving the state and not seeing him again and has relocated five more times throughout her childhood. Kathy has spent several years in therapy and expressed that she continues to feel hopeless and despair.
Criteria for Post-Traumatic Stress Disorder
A1- Kathy shared that she was sexually abused by her father, starting from age six and continuing until age eleven.
B4- Kathy remained burdened by pervasive feelings of hopelessness and despair and shared, “I still feel so depressed, and I am constantly exhausted,” Kathy told me through tears.
C2- Kathy said, “I no longer feel like my past will keep me from having a good life.” And that she will no longer keep her from living a good and meaningful life. Kathy avoided taking risks, investing in her friendships, and dating.
D2- Kathy has been internalizing the belief that she is permanently damaged. “What is wrong with me that I can’t get better?” I have no hope that I will ever get better.”
D4- Kathy felt plagued by feelings of embarrassment and shame. She asked, “What is wrong with me that I can’t get better?” Kathy feared that she would always be depressed and feel defeated. Kathy said, “I have no hope that I will ever get better.”
D – Kathy expressed that she cannot experience positive emotion, evidenced by her stating, “I feel so depressed and constantly exhausted.”
E2- Kathy shared that she feared that she would always be depressed.
E6 – Kathy experienced impaired sleep as she shared the positive effect of yoga in helping her reclaim her ability to rest.
Current Interventions
Somatic symptoms played a major role in Kathy’s unresolved childhood trauma, affecting her mental and physical health. Somatic therapy is effective in the treatment of post traumatic stress disorder and depressive symptoms. Kathy has been attending yoga sessions regularly, which she reported has a positive effect, such as improving her confidence when she challenges herself and regaining her physical strength, flexibility, and ability to rest. In therapy, she was exposed to cognitive behavior therapy intervention to confront her negative view of herself, the world, and her future. Kathy learned to anchor insight into actions, thus gaining insight into her core belief that she was damaged. She then developed new positive beliefs and emotions after processing her trauma memories. The therapist also implemented cognitive processing interventions that aided Kathy in recognizing that unresolved grief can complicate recovery from post–traumatic stress disorder and led to her developing depressive symptoms. Using cognitive processing therapy interventions, the therapist aided Kathy in removing the barrier for her to grieve her loss and develop positive messages about herself and the work towards fostering healthier relationships.
Additional Interventions
Kathy could benefit from using Rational emotive behavior therapy. This cognitive behavioral treatment assumes that individuals who can reduce their irrational beliefs thus decrease their negative emotions and depressive symptoms. Researchers proposed rational emotive behavior therapy in treating individuals diagnosed with post-traumatic stress disorder (Grove et al., 2021). Another intervention that Kathy could benefit from is narrative therapy to aid her grief and loss and help her learn to find meaning in her experience. Using narrative approaches, clients can tell their stories in supportive settings that validate and normalize their experiences by writing letters, journaling, and learning to reframe and retell their stories. Kathy can also find meaning in the word of God that all things work together for those who love God and according to their purpose. (New International Version,1978/2011, (Romans 8:28).
3. Posted by Brit S
Discussion Thread: Post-Traumatic Stress Disorder (Kathy)
“Kathy is a single woman in her mid-forties who was able to give a clear summary of her traumatic past. Kathy was sexual abused for five years starting at the age of six by her father. She reported that her mother was “checked out,” however when she told her mother they moved out of state away from father, her friends, and her community. Kathy never saw her father again and has feelings of anger and sadness around this. Kathy fears that she will always feel depressed, she has seen many therapists in the past and nothing has seemed to help and she continues to feel hopeless. She expressed feelings of shame, grief, and depression. She experiences chronic tightness in her stomach and unrelenting back pain and does not think that it will ever go away. At times she will constantly cry and this with her physical symptoms all affects her work and personal life” (Schwartz, 2017).
A –1 (one required): Kathy directly experienced the repeated “sexual abused starting at the age of six, by her father. The abuse had gone on for five years undetected” (Schwartz, 2017, p.221).
B – 5 (one required): Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event. Kathy suffers from “stomach problems and chronic back pain,” she is burdened by pervasive feelings of hopelessness and despair “I am constantly exhausted” (Schwartz, 2017, p. 221).
C – 2 (one required): Kathy has avoid ever seeing her father again, “her mother moved them out of the state away from her father, her community, and her friends” (Schwartz, 2017, p. 221 ). As an adult Kathy avoided seeing her father and did express some difficult emotions surrounding his death.
D – 2 (one of two required): Persistent and exaggerated negative beliefs or expectations about herself. Kathy felt that “she would always be depressed, she had a core belief that she was permanently damaged” (Schwartz, 2017, p. 223).
D – 4 (two of two required): Persistent negative emotional state Kathy has been feeling untrusting of people and expressed feelings of helplessness. She expresses depressive symptoms and the toll that her trauma has taken on her mind and body. She shared that “I have no hope that I will ever get better” (Schwartz, 2017, p.223).
D – 6 (three of two required): Kathy has feelings of detachment or estrangement from others. Kathy was raised by untrustworthy caregivers her father sexual abused her and her mother was checked out (Schwartz, 2017). She does not invest in relationships and is not dating.
D – 7 (four of two required): Kathy expressed persistent inability to experience positive emotions, even as she works through therapy she expressed “she sometimes struggles with allowing herself to experience positive emotions like joy and happiness” (Schwartz, 2017, p.252).
E – 2 (one of two required): Kathy has self-destructive behavior which stem from her core beliefs that she is damaged, that she has no hope, and is helpless (Schwartz, 2017). She has chronic tightness in her stomach, unrelenting lower back pain, and feelings of heaviness and depression.
E –3 (two of two required): Problems with concentration. Due to the physical feelings Kathy was experiencing as well as her consistent crying she was unable to concentrate and be at work.
F – Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.
G –The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
H –The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
Current Interventions
Kathy is starting her journey of healing. She has been in therapy for many years and has not found success until recent interventions. She told her therapist that she felt unfixable and helpless. Kathy is still experiencing many symptoms of her chronic PTSD and is depressed. Currently with her new therapists intervention have been focused around addressing her feelings of shame, helplessness, and working to support her physical and emotional well-being. Kathy’s therapist uses Trauma Focused Cognitive Behavior Therapy (TF-CBT), Eye Movement Desensitization and Reprocessing (EMDR) therapy, and talk therapy to work on no longer blaming herself for the abuse and changing her thinking pattern surrounding her feelings of shame and processing some of the abuse she experienced as a child. Another intervention that has been working for Kathy is Somatic Experience that integrates body awareness into the psychotherapeutic process and this practice has worked great along with her daily yoga practice.
Recommendations
My first suggestion for Kathy would be to start a journal as a way to get out some of the thoughts and feelings that she is experiencing. She could do this each morning when she wakes up to check in with herself and how she is feeling. She can also look back and see her growth through her entries.
My second recommendation for Kathy would be to start practicing Therapeutic Yoga. She is currently practicing yoga on her own, however therapeutic yoga with a licensed profession could help her even more to become more aware and present with her thoughts and feelings to cultivate self-compassion (Schwartz, 2017). This would be good to work on her continued feelings of hopelessness and overall confidence.
The third recommendation I would suggest is to continue Eye Movement Desensitization and Reprocessing (EMDR) therapy. Using this therapy to target specific traumatic memories and attuning bodily sensations and eye movement to help desensitize and process her feelings specifically the sensations that she is hold onto in her body (Shapiro, 1990).
The last recommendation if Kathy is open and a Christian then speaking with her about her faith. This could happen in the morning when she is journaling, she could read scripture and pray as a way to help her find inner peace and trust in His path for each day. This could also be a way to bring the hope back into her life for her future. “May the God of hope fill you with all joy and peace as you trust in him, so that you may overflow with hope by the power of the Holy Spirit” (NIV Bible, 2001).
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