1. university of connecticut 2. exceeds the individual’s · principles of effective school safety...

Julian D. Ford, PhD, ABPP

Professor of Psychiatry

University of Connecticut

[email protected]

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

mailto:[email protected]

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


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


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.”

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


Traumatic victimization

(physical, sexual, emotional) +

Attachment disruption

(primary caregiver loss,

separation, neglect, or

emotional abuse)


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


Affective/Physiological Dysregulation

B. 3. Diminished awareness/dissociation

of emotional or bodily feelings

B. 4. Impaired capacity to describe

emotions (alexithymia) or bodily states


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


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


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)



D. 3. Extreme persistent distrust,

defiance or lack of reciprocal

behavior in close relationships

D. 4. Reactive physical/verbal

aggression



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

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


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


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


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”?


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


Peanuts Classics ®

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.


The Final Step in FREEDOM –

Making a Contribution

by being a role model for

responsible self-regulation


Emotionally Regulated

Caregivers Inspire Hope

and Calm Confidence

Published 2013, co-edited Published, 2013, co-authored

Published, 2009, co-edited

1. university of connecticut 2. exceeds the individual’s · principles of effective school safety...

Documents