acute stress grief and trauma - nt...acute stress, grief and trauma light university 6 video-based...

AcuteStress,GriefandTraumaCrisisResponseandTrauma

CareSeries

P.O.Box739•Forest,VA24551•1-800-526-8673•www.AACC.net

AcuteStress,GriefandTrauma

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WelcometoLightUniversityandthe“AcuteStress,GriefandTrauma”programofstudy.Our prayer is that you will be blessed by your studies and increase your effectiveness inreaching out to others. We believe you will find this program to be academically sound,clinicallyexcellentandbiblically-based.Our faculty represents some of the best in their field – including professors, counselors andministers who provide students with current, practical instruction relevant to the needs oftoday’sgenerations.We have alsoworked hard to provide youwith a program that is convenient and flexible –givingyoutheadvantageof“classroominstruction”onlineandallowingyoutocompleteyourtrainingonyourowntimeandscheduleinthecomfortofyourhomeoroffice.Thetestmaterialcanbefoundatwww.lightuniversity.comandmaybetakenopenbook.Onceyouhavesuccessfullycompletedthetest,whichcoverstheunitswithinthiscourse,youwillbeawardedacertificateofcompletionsignifyingyouhavecompletedthisprogramofstudy.Thank you for your interest in this program of study. Our prayer is that you will grow inknowledge,discernment,andpeople-skillsthroughoutthiscourseofstudy.Sincerely,

RonHawkinsDean,LightUniversity

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TheAmericanAssociationofChristianCounselors

• Represents the largestorganizedmembership (nearly50,000)ofChristian counselorsandcaregiversintheworld,havingjustcelebratedits25thanniversaryin2011.

• Known for its top-tier publications (Christian Counseling Today, the Christian CounselingConnectionandChristianCoachingToday),professionalcredentialingopportunitiesofferedthroughtheInternationalBoardofChristianCare(IBCC),excellenceinChristiancounselingeducation, an arrayof broad-based conferences and live training events, radioprograms,regulatoryandadvocacyeffortsonbehalfofChristianprofessionals,apeer-reviewedEthicsCode, and collaborative partnerships such as Compassion International, the NationalHispanic Christian Leadership Conference and Care Net (to name a few), the AACC hasbecomethefaceofChristiancounselingtoday.

• With the needed vision and practical support necessary, the AACC helped launch the

International Christian Coaching Association (ICCA) in 2011, which now represents thelargest Christian life coaching organization in the world with over 2,000 members andgrowing.

OurMission

The AACC is committed to assisting Christian counselors, the entire “community of care,”licensedprofessionals,pastors,and laychurchmemberswith littleorno formal training. It isourintentiontoequipclinical,pastoral,andlaycaregiverswithbiblicaltruthandpsychosocialinsights that minister to hurting persons and helps them move to personal wholeness,interpersonalcompetence,mentalstability,andspiritualmaturity.

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OurVision

TheAACC’svisionhastwocriticaldimensions:First,wedesiretoservetheworldwideChristianChurch by helping foster maturity in Christ. Secondly, we aim to serve, educate, and equip1,000,000 professional clinicians, pastoral counselors, and lay helpers throughout the nextdecade.WearecommittedtohelpingtheChurchequipGod’speopletoloveandcareforoneanother.We recognize Christian counseling as a unique form of Christian discipleship, assisting thechurch in its call to bring believers to maturity in the lifelong process of sanctification—ofgrowingtomaturityinChristandexperiencingabundantlife.Werecognizesomearegiftedtodosointhecontextofaclinical,professionaland/orpastoralmanner.Wealsobelieveselected laypeoplearecalledtocareforothersandthattheyneedtheappropriatetrainingandmentoringtodoso.WebelievetheroleofthehelpingministryintheChurchmustbesupportedbythreestrongcords:thepastor,thelayhelper,andtheclinicalprofessional.ItistothesethreerolesthattheAACCisdedicatedtoserve(Ephesians4:11-13).

OurCoreValues

InthenameofChrist,theAmericanAssociationofChristianCounselorsabidesbythefollowingvalues:

VALUE1:OURSOURCEWearecommittedtohonorJesusChristandglorifyGod,remainingflexibleandresponsivetotheHolySpiritinallthatHehascalledustobeanddo.VALUE2:OURSTRENGTHWearecommittedtobiblicaltruths,andtoclinicalexcellenceandunityinthedeliveryofallourresources,services,trainingandbenefits.VALUE3:OURSERVICEWeare committed toeffectivelyandcompetently serve the communityof careworldwide—bothourmembership and the churchat large—withexcellenceand timeliness, andbyover-deliveryonourpromises.VALUE4:OURSTAFFWearecommittedtovalueandinvestinourpeopleaspartnersinourmissiontohelpotherseffectivelyprovideChrist-centeredcounselingandsoulcareforhurtingpeople.VALUE5:OURSTEWARDSHIPWe are committed to profitably steward the resourcesGod gives to us in order to continueservingtheneedsofhurtingpeople.

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LightUniversity• Establishedin1999undertheleadershipofDr.TimClinton—hasnowseennearly200,000

students from around the world (including lay caregivers, pastors and chaplains, crisisresponders,lifecoaches,andlicensedmentalhealthpractitioners)enrollincoursesthataredelivered via multiple formats (live conference and webinar presentations, video-basedcertificationtraining,andastate-of-theartonlinedistanceteachingplatform).

• Thesepresentations,courses,andcertificateanddiplomaprograms,offeroneofthemostcomprehensive orientations to Christian counseling anywhere. The strength of LightUniversity is partially determined by its world-class faculty—over 150 of the leadingChristianeducators,authors,mentalhealthcliniciansandlifecoachingexpertsintheUnitedStates. This core groupof facultymembers represents a literal “Who’sWho” inChristiancounseling. No other university in the world has pulled together such a diverse andcomprehensivegroupofprofessionals.

• Educational and training materials cover over 40 relevant core areas in Christian—

counseling, lifecoaching,mediation,andcrisis response—equippingcompetentcaregiversand ministry leaders who are making a difference in their churches, communities, andorganizations.

OurMissionStatement

TotrainonemillionBiblicalCounselors,ChristianLifeCoaches,andChristianCrisisRespondersbyeducating,equipping,andservingtoday’sChristianleaders.

AcademicallySound•ClinicallyExcellent•DistinctivelyChristian

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Video-basedCurriculum

• UtilizesDVDpresentations that incorporateover 150 of the leading Christian educators,authors,mentalhealthclinicians,andlifecoachingexpertsintheUnitedStates.

• Eachpresentationisapproximately50-60minutesinlengthandmostareaccompaniedbyacorrespondingtext(inoutlineformat)anda10-questionexaminationtomeasurelearningoutcomes.Therearenearly1,000uniquepresentationsthatareavailableandorganizedinvariouscourseofferings.

• Learning is self-directed and pacing is determined according to the individual time

parameters/scheduleofeachparticipant.• With the successful completion of each program course, participants receive an official

Certificate of Completion. In addition to the normal Certificate of Completion that eachparticipant receives, Regular and Advanced Diplomas in Biblical Counseling are alsoavailable.

Ø TheRegularDiploma isawardedbytakingCaringForPeopleGod’sWay,BreakingFreeandoneadditionalElectiveamongtheavailableCoreCourses.

Ø TheAdvancedDiplomaisawardedbytakingCaringForPeopleGod’sWay,BreakingFree,andanythreeElectivesamongtheavailableCoreCourses.

Credentialing

• LightUniversitycourses,programs,certificatesanddiplomasarerecognizedandendorsedbytheInternationalBoardofChristianCare(IBCC)anditsthreeaffiliateBoards:theBoardofChristianProfessional&PastoralCounselors(BCPPC);theBoardofChristianLifeCoaching(BCLC);andtheBoardofChristianCrisis&TraumaResponse(BCCTR).

• Credentialing is a separateprocess from certificate or diploma completion.However, theIBCC accepts Light University and Light University Online programs as meeting theacademic requirements for credentialing purposes. Graduates are eligible to apply forcredentialinginmostcases.

Ø Credentialinginvolvesanapplication,attestation,andpersonalreferences.Ø CredentialrenewalsincludeContinuingEducationrequirements,re-attestation,and

occureitherannuallyorbienniallydependingonthespecificBoard.

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OnlineTesting

TheURLfortakingallquizzesforthiscourseis:http://www.lightuniversity.com/my-account/.

• TOLOGINTOYOURACCOUNT

Ø You should have received an email upon checkout that included your username,password,andalinktologintoyouraccountonline.

• MYDASHBOARDPAGE

Ø Once registered, youwill see theMyDVD Course Dashboard link by placing yourmousepointerovertheMyAccountmenuinthetopbarofthewebsite.Thispagewill include studentPROFILE informationand theREGISTEREDCOURSES forwhichyouareregistered.TheLOG-OUTandMYDASHBOARDtabswillbeinthetoprightofeachscreen.Clickingonthe>nexttothecoursewilltakeyoutothecoursepagecontainingthequizzes.

• QUIZZES

Ø Simplyclickonthefirstquiztobegin.

• PRINTCERTIFICATE

Afterallquizzesaresuccessfullycompleted,a“PrintYourCertificate”buttonwillappearnearthetopofthecoursepage.YouwillnowbeabletoprintoutaCertificateofCompletion.Yournameandthecourseinformationarepre-populated.ContinuingEducationThe AACC is approved by the American Psychological Association (APA) to offer continuingeducationforpsychologists.TheAACCisaco-sponsorofthistrainingcurriculumandaNationalBoard of Certified Counselors (NBCC)ApprovedContinuing Education Provider (ACEPTM). TheAACC may award NBCC approved clock hours for events or programs that meet NBCCrequirements.TheAACCmaintainsresponsibilityforthecontentofthistrainingcurriculum.TheAACCalsoofferscontinuingeducationcreditforplaytherapiststhroughtheAssociationforPlayTherapy (APT Approved Provider #14-373), so long as the training element is specificallyapplicabletothepracticeofplaytherapy.It remains the responsibility of each individual to be aware of his/her state licensure andContinuing Education requirements. A letter certifying participation will be mailed to thoseindividuals who submit a Continuing Education request and have successfully completed allcourserequirements.

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AcuteStress,GriefandTraumaTableofContents:

CRAS101:IntroductiontoCrisisCounseling.................................................................................9TimClinton,Ed.D.;MG(Ret.)BobDees,M.S.;DianeLangberg,Ph.D.CRAS102:Grief,LossandComplicatedGrief.............................................................................17EricScalise,Ph.D.CRAS103:TraumaandAbuse.....................................................................................................25DianeLangberg,Ph.D.CRAS104:AnxietyandDepression.............................................................................................32ArchibaldHart,Ph.D.CRAS105:TraumaandAttachment............................................................................................41GarySibcy,Ph.D.CRAS106:CounselingStrategies.................................................................................................48EricScalise,Ph.D.;JenniferCisney,M.A.;KevinEllers,D.Min.CRAS107:ImpactDynamicsofCrisisandTrauma......................................................................56JenniferCisney,M.A.CRAS108:MethodsandTechniquesforImmediateResponse..................................................65ThomasWebb,Th.M.CRAS109:PeerSupportandAccountability...............................................................................75JoshuaStraub,Ph.D.CRAS110:SurvivorGuiltandFosteringResiliency.....................................................................82KevinEllers,D.Min.CRAS111:ManagingtheHighCostofCare................................................................................91EricScalise,Ph.D.CRAS112:CommunityResponseandCulturalDifferences........................................................98LeroyScott,M.S.,M.Div.andPatMiersma,Ph.D.

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CRAS101:

IntroductiontoCrisisCounseling

TimClinton,Ed.D.;MG(Ret.)BobDees,M.S.;DianeLangberg,Ph.D.

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CourseDescriptionThis lessonprovidesbasicdefinitionsoftermsthatstudentswillbediscussingthroughouttheentirecourse,providesreferencepointsandstatisticsregardingtrauma,andgivesanoverviewofhealingpointsandhowGodistheultimateantidotetotraumainaperson’s life.Sincethechurchiscalledtoministertothosewhoaresuffering,thisprogramwillhelpeducateandtrainleaderstorespondtoothersincrisis.

LearningObjectives:Bytheendofthislesson:

1. ParticipantswillbeabletoapplyrelevantScripturestotheissuesofcrisisandtrauma.

2. Participants will be able to learn the definitions of crisis and trauma, and how thisappliespracticallytothelivesofpeopletheywillbehelping.

3. Participantswillbeabletounderstandkeystatisticsandtheirimportanceinregardsto

crisisinterventioninvictimssufferingfromtrauma.

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I.Scriptures

A. Job5:7–“Yetmanisborntotroubleassurelyassparksflyupward.”

B. Job14:1–“Manbornofwomanisoffewdaysandfulloftrouble.”

C. John16:33–“ThesethingsIhavespokentoyou,thatinMeyoumayhavepeace.Intheworldyouwillhavetribulation;butbeofgoodcheer,Ihaveovercometheworld.”

D. 1John5:19-20–“WeknowthatwearechildrenofGod,andthatthewholeworldisundercontrolof theevilone.Weknowalso that theSonofGodhascomeandhasgivenusunderstanding, so thatwemayknowhimwho is true. Andweare inhimwhoistrue–eveninhisSonJesusChrist.HeisthetrueGodandeternallife.”

II.CrisisandTrauma

A. Crisis–Aneventinlifethatispredictableoranticipated.

• Lifeisfullofupsanddowns,butpeoplewillsometimeshitwalls.Theirabilitytoworktheirwaythroughthatchallengingissueiseverything.Iftheycan’t,disequilibriumorchaosoccurs.

• Chinese symbol for crisis: Danger andOpportunity. “Threat clears aman’s head.”Threat causes people to examine danger but also the opportunity to change theircourse of action, which can be a healthy relationship between danger andopportunity.

• Copingskills:Iftheydon’twork,thenpaniccanoccur.Itisdangerousifonecannotresolve; opportunity occurs because it is at this point when one is most open tochange,suchasnewwaysofthinkingornewvalues.

• Crisis causes self-reflection. Crisis is actually an opportunity for clarity; people can

“getbitterorgetbetter.”Itrevealsaperson’scharacter.Peoplecanbecomeawareofthingsinthemselvesthattheyarenothappyabout,butthattheycannowactuallymakethechoicetochange.

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B. Trauma–Aneventoutsidenormalhumanexperiences.• It often causes feelings of powerlessness and hopelessness. Because the event is

considered abnormal and outside of human experience, powerlessness is a keycharacteristicofaperson’sexperience.

• Theeventcausingtraumaisabnormal;itdiffersfromacrisisinthatapersoncannotusecopingskills;thereisnothingonecandotostoptheeventfromhappening.

• Peoplewillrespondincompletelydifferentways,eveniftheyaretrainedthesame.Even if two people experience the same event, their reactionsmay be completelydifferent,andthisisimportanttotakeintoconsideration.

• When violated, people can lose their sense of safety and security, regarding otherpeople,orevenGodHimself.Peopleoftenthinkthattheworldshouldn’tbethewaytheyjustexperiencedthroughthatcrisis,sotheyexperienceahorrificsenseofalossofsafety.Thiscausesasenseofisolation.

C. ExamplesofTraumaticEvents

• NaturalDisasters(hurricanes,floods,tornadoes,etc.)

• AccidentalDisasters(carcrashes,planecrashes,explosions,etc.)

• Intentional or Deliberate Disasters (bombings, robberies, suicides, rape, terrorism,hostagesituations,etc.)

• Sustained or Repeated Events (war, kidnapping, sexual abuse, terrorist threats,

spousalabuse,etc.)

III.Statistics

A. Thereare400,000untreatedcasesofPTSDfrompreviouswars.

B. OneinfiveIraqandAfghanistanveteranssuffersfromPTSDormajordepression.

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C. Itisthoughtthat70%ofhomelessveteranshavemajorissueswithPTSD.

D. One in three women and one in five men are sexually abused prior to age 18 bysomeonetheyaresupposedtoloveandtrust,andmanyoftheabusesarechronic.

E. OneinfourwomeninAmericaexperiencerapeduringtheirlifetime.

F. 30%ofwomenexperiencedomesticviolenceatthehandsofahusbandorpartner.

G. Women are twice as likely to experience PTSD asmen are. This could be becausewomenarenotascapableofcompartmentalizingasmenare.

H. About5.2millionU.S.adultsages18-54havePTSDinagivenyear.

I. 61%ofmenand51%ofwomenhaveexperiencedtraumaslinkedtoPTSD.

IV.HowaCrisisorTraumaAffectsPeople

A. TraumacanteachagrosslyunhealthywayofrelatingtoGodandotherpeople.

B. Someonewhoexperiencestraumaisfacingintrusivere-experiencingoftheevent.

C. Hyper-arousal–Aloudboom;forexample,fireworkscouldarouseextremereactionsinaveteranofwar.

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D. Numbing–Affectisflat.

E. FightorFlight– Ina situationperceivedasdangerous,oneeitherputsupa fightorrunsaway.

F. Dissociation–Themindtakesapersonsomeplaceelseotherthanthepresentinordertoescapetrauma.

G. SurvivorGuilt–Whenothersdied,butapersonsurvived.Forgivenessistheantidotetothis.

H. Addiction–Self-medicatingunresolvedtrauma.

I. Whatdeterminesthetypeofimpactanddurationofimpactontheperson?• Frequency

• Intensity

• Age

• PreviousTrauma

• HelpGiven

J. PTSDisanormalhumanresponsetoanabnormalsituation.

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K. Post-TraumaticGrowth.“Traumacan leadtopositivechange, improverelationships,the possibilities for one’s life, a greater appreciation for life, a greater sense ofpersonalstrengthandspiritualdevelopment…[thereis]abasicparadoxachievedbytraumasurvivors,thatsomewhereintheway,theynowseetheirlossesasproducingvaluablegainsforthem.Theymayfindthemselvesbecomingmorecomfortablewithintimacy and having a greater sense of compassion for others who experience lifedifficulties.”(LawrenceCalhounandRichardTedeschi,professorsatUNC-Charlotte)

V.HealingGrace

A. Psalm46:1–“Godisourrefugeandstrength,anever-presenthelpintrouble.”

B. Psalm46:10–“Bestill,andknowthatIamGod;Iwillbeexaltedamongthenations,Iwillbeexaltedintheearth.”

C. Psalm91:1,4–“HewhodwellsintheshelteroftheMostHighwillrestintheShadow

oftheAlmighty.HewillcoveryouwithHisfeathers,andunderHiswingsyouwillfindrefuge;Hisfaithfulnesswillbeyourshieldandrampart.”

D. Isaiah45:3–“Iwillgiveyouthetreasuresofdarknessandhiddenwealthofsecretplaces,sothatyoumayknowthatitisI,theLord,theGodofIsrael,whocallsyoubyyourname.”

E. Thoughthisisadifficultarea,thereisagreatmessageofhope.

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CRAS101StudyQuestions

1. Discuss the implications of the Chinese symbol that represents “danger andopportunity,” andwhy this is importantwhen dealingwith issues regarding crisisintervention.

2. Whywouldapersonwhohasexperiencedtraumainlifebedealingwithfeelingsofpowerlessnessandhopelessness?

3. Whatarethefourcategoriesoftraumaticevents?

4. AccordingtotheDepartmentofVeteransAffairs,howmanyuntreatedcasesofPTSDare there from previous wars in the United States today, causing a “nationalepidemic?”

5. What is post-traumatic growth, and why is this important to understand whendealingwithsymptomsofpost-traumaticstress?

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CRAS102:

Grief,LossandComplicatedGrief

EricScalise,Ph.D.

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CourseDescriptionGrief can only be experiencedwhen there has been a loss of an intimate relationship or anobjectofconcernoraffection.Peoplegrievebecausetheylove;andunfortunately,loveandlifecanhurt.Ifpeoplerefusetodealwithgriefandtraumaticevents,theywillwithdrawfromlifeand only exist in emotional exile and never be able to benefit from the joys of humanexperience.Rarelyarethereeasyanswerswhenpeopleexperiencetragickindsof lossesthatareoftenuntimely.However, there isamessageofhope,andGodcanusepeopletoconveythatmessagetoaworldthatishurting.

1. Participants will be able to learn the nature and consequences of stress, as well asfactors that might help determine the intensity, severity, and duration of a griefresponse.

2. Participantswillbeabletounderstandthegriefcycleanditsstages.3. Participantswillbeabletounderstandcomplicatedgriefandhowitdiffersfromnormal

griefandloss.

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I.TheNatureandConsequencesofStress

A. Grieving isanormal response to loss,andoften includes feelingsof intensesorrow,anger,depression,loneliness,andpossiblephysicalsymptoms.

B. Griefisoftentimescrisis-oriented.Thecrisiscanbereal,anticipated,and/orimagined;however,theimpactcanbethesame.

C. Griefisuniversal,buthowapersonwalksthroughgriefisindividual.C.S.Lewissaid,

“Godwhisperstousinourpleasures,speakstousinourconscience,butshoutsinourpains:itisHismegaphonetorouseadeafworld.”

II.FactorsThatMightHelpDeterminetheIntensity,Severity,andDurationofaGriefResponse

A. Intensity(HowStrongareFeelingsandDynamics?)

B. Severity(OftenIndividualized)

C. Duration(HowLong?)

• TypeofLoss

• PriorKnowledgeandAnticipation

• LackofSupportSystem

• PersonalBeliefSystem

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III.GriefCycle

A. Shock(Initialparalysisthatcomesassoonasapersonbecomesawaretheeventhastakenplace).

B. Denial (As soon as the shock hits, people are often trying to avoid the inevitable

realityofwhatthatmeans.Itiseasiertosay“itcan’tbeso”).C. Anger(Releaseofalltheoverwhelmingemotionsthatmightbebottledup;tryingto

pushitaway.Peoplemaygothroughanexplosiverelease).D. Bargaining(Seekinginvaintofindawayoutofthecrisisandtrytobargainoutofthe

reality.BelieversoftentrytobargainwithGod).E. Depression(Finalrealizationoftheinevitablerealityofthatlossoreventinlife).F. Testing(Personbegins,thoughacceptedreality,howtogooninlife,howtogoonin

life).G. Acceptance(Personfinallydiscoversawayoutofthatplaceandcanmoveoninlife).

IV.ComplicatedGriefA. Complicatedgriefoccurswhenapersonbecomes stuckandstruggles tobreak free

fromthepowerfulgripoftraumaticcircumstances.

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B. Complicatedgriefisanextremeversionofnormalgrief,anditcansometimesmimicPTSD. Some examples of this include the symptoms of survivor guilt, extremeagitation, depressive episodes, suicidal ideation, very intense sensitivity to mostthingsthatwouldstimulateaperson,andintrusivethoughts.

C. Someone experiencing complicated grief could have great coping skills, but

complicated grief is more connected to the original relationship with a person,object, or some process that is going on. A person could experience difficultyspeakingabouttheevent,constantlybringingupthemesofdeathandlossincasualconversations, sleepandappetitedisturbance, self-destructivebehaviors, excessiveavoidanceand isolation, significant impairment innormalareasof functioning,andverystrongreactionstotriggersinnormalevents.

D. Approximately 10-20% of people who experience significant loss are at risk for

developingcomplicatedgrief.

V.DynamicsThatContributetoComplicatedGrief

A. Themodeofthelosswasincomprehensible.

B. Thelossisconsideredexceptionallyuntimely.

C. Thereisasenseofsurvivalguilt.

D. Theircultureorenvironmentdisallowsthegriefprocess.

E. There is an excessive attachment and proximity to the deceased person’spossessions.

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F. Normalactivitiesareresumedwithoutallowingfornormalgrief.

VI.MinistryOpportunities:Acts3:1-11

A. Acts3:1-11givesabiblicalexampleofworkingwithpeoplewhoexperiencegriefandloss. The beggar had experienced the loss of physical ability, the ability to earnincome, certain social statuswithin culture, aswell as independenceand freedom.Hewastrulyinneed.

B. ThefirstthingPeterandJohngavethebeggarwasasenseofworthbygivingtheir

timeandattention,bynotjudging,andbyinvitinghimtojoininwhatGodwasdoing.C. ThesecondthingPeterandJohngavethebeggarwasareasontohopebycreating

someexpectancy,bycommandingattention,andbybuildingfaith.D. ThethirdthingPeterandJohngavethebeggarwasrealhelpbybeing involved,by

beingpractical,andbybeinggenuinelyauthentic.E. The fourth thing Peter and John gave the beggar was an introduction to Jesus by

acknowledgingHisname,byacknowledgingHisdeity,and lastly,byacknowledgingHishumanity.

F. ThefifththingPeterandJohngavethebeggarwasasenseofbelongingbyaccepting

himwhere hewas, leading him in a new direction, and by changing his life script(fromlame,begging,andoutsidethehouseofGod,towhole,belonging,andinsidethe house of God). When people experience tragic grief, their lives as they knewthemareshattered.Thislossandgriefmayusherintheendofachapter,butnottheendofthestory.

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G. ThesixththingPeterandJohngavethebeggarwastheopportunitytobeawitnessby being visible and present, by confirming the impossible, and by drawing thehungry.

VII.Conclusion

Beahealingbridgetoacommunitythat ishurting,bothwithinthechurchandwithinthe community and beyond. God can use people to touch those who have beenimpactedby tragedy,grief,and loss. Be sensitive topointout theway, to showthatthereareanswers, and to show thatbelievers serveaGodofhope, and thathope isChrist,whoistheHopeofGlory.

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1. Listanddiscussthedifferentfactorsthatmighthelpdeterminetheintensity,severity,anddurationofagriefresponse.

2. Whatarethestagesofthegriefcycle,andwhyaretheyimportanttounderstand?

3. What are some similarities between physical symptoms of complicated grief andphysicalsymptomsofPTSD?

4. What are some of the dynamics that can contribute to complicated grief within apersonwhohasjustexperiencedatragiclossinhis/herlife?

5. Discuss the six things Peter and John gave the beggar in the Acts 3:1-11 passagediscussedbyDr.Scaliseinthepresentation?

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CRAS103:

TraumaandAbuse

DianeLangberg,Ph.D.

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CourseDescriptionAbusehasbecomemoreprominentintheUnitedStates,whichindicatesthattheterm“abuse”hasbeenoverusedandmisappliedattimes.Thisunderminestherealityandprofoundnegativeimpactthatabusehasonindividualsandtheirrelationships.Dr.Langbergwilladdresssourcesofabuse,generalresponsestoabuse,andnormaltraumaresponsepatterns.

1. Participantswillbeabletobefamiliarwiththedifferenttypesofabusethatoccurs intheUnitedStatestoday.

2. Participantswill be able to understand the impact that abuse has on the lives of the

victims.3. Participants will be able to learn how Christians can respond to those victims in a

healingway.

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I.TypesofAbuse

A. PhysicalAbuse–usingphysicalpower tocontrol,manipulate,or intimidateanotherperson.• Between25and30%ofmaleandfemalechildrensufferphysicalabuse.• 31%ofadultwomenintheUnitedStateswillexperienceoneepisodeofviolenceat

thehandsofahusbandorpartner.• Morethan3womenaremurdereddailybyhusbandsorpartners.• Pregnantwomenaremorelikelytobevictimsofhomicidethantodiefromanyother

cause.• Physicalabusecanoccur,beterrifying,oppressive,anddamagingevenwhenphysical

evidenceisnotonthebody.

B. Verbal Abuse – using verbal power to control, manipulate, or intimidate anotherperson.

C. EmotionalAbuse–thesystematictearingdownofanotherhumanbeingbyrejecting,ignoring,terrorizing,isolating,orcorruptingthem.• It is also the use of emotional power in a relationship to control, manipulate, or

intimidateanotherperson.• Emotional abuse is often more subtle, and often accompanies physical or verbal

abuse.

D. Spiritual Abuse – the use of spiritual power, position, or information to control,intimidateormanipulateanotherperson.• AlwaysinvolvesadistortionofthewordofGod

• AlwaysinvolvesadistortionofthecharacterofGod

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E. SexualAbuse–anysexualactivity–visual,verbal,orphysical–engaged inwithoutconsent.• Achildisneverconsideredabletoconsent.

• Mostsexualabuseofchildrenisperpetratedbyafamilymemberorsomeoneknown

tothechild.

• IntheUnitedStates,thereareabout80,000reportedincidentsofchildsexualabuseeachyear.

• OneinfivegirlsreportbeingsolicitedforsexontheInternetpriortotheageof18.

• 20%ofmenintheUnitedStatesreportbeingsexuallyabusedpriortotheageof18.

• Atleast20%ofwomenand12%ofadolescentgirlshaveexperiencedsexualassaultorrapeduringtheirlifetimes.

• About700,000womenaresexuallyassaultedeachyear in theUnitedStates,which

equivocatestomorethanoneperminute.

• Closeto100,000menarerapedeachyear.

• Twothirdsofrapevictimshadapriorrelationshiptotheiroffender.

• 70%ofreportedassaultsarecommittedagainstvictims17yearsofageoryounger.• Between 50 and 85% of American females will experience some sort of sexual

harassmentduringtheiracademicorworkinglives.

F. Rape – non-consensual sexual penetration obtained by physical force, by threat ofbodilyharm,oratatimewhenthevictimisincapableofgivingconsentduetomentalillness,mentalretardation,orintoxicationofsomekind.

G. SexualHarassment–anyactionoccurringwithintheworkplacewherebyonepersonistreatedastheobjectofanother’ssexualprerogative.

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II.TheImpactofAbuse

A. Duration,frequency,andintensityallimpacttheimpactoftrauma.• Untreatedabusecanresultinsomaticproblems.• Abuse of children causes stress that can disrupt early brain development and

developmentofthenervousandimmunesystems.• Repeatedabusecanteachavictimto“turnoff”his/heremotions.• Problemsstemmingfromabusecanimpactrelationships.

B. ATraumaReactiontoAbuse• Thereisanongoingre-experiencingofthetrauma.• Thereisanumbingofresponsiveness.• Thereareongoingincreasedarousalsymptoms.

C. Tobeavictimmeanstobesomeonewhohassufferedfromaninjuriousaction.

D. Tobe a survivormeans to be someonewhohas continued to function and learnedhowtoprosperinspiteofabuse.

III. HowCan ChristianHelpers Respond to ThoseWhoHave BeenAbused SoThatTheyAreHelpedandTransformed?

LearnfromtheLord:

A. Theymustfirstleaveglory.

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B. Theymust“becomelittle.”

C. Theymustenterdarkness.

D. TheymustbearthecharacteroftheFather,fullofGraceandTruth.

E. Theymustnotabandonthoseinneed.

F. Theymustnotloseperspectiveandallowtheirthinkingtobedistorted.

IV.Conclusion

A. Isaiah45:2-3–“Iwillgobeforeyouandmaketheroughplacessmooth;Iwillshatterthe doors of bronze and cut through iron bars. I will give you the treasures ofdarknessandhiddenwealthof secretplaces, so that youmayknow that it is I, theLORD,theGodofIsrael,whocallsyoubyyourname.”

B. Whenonepartofthebodysuffers,theentirebodyisaffected.Sufferinglimitshowlifeislived.

C. ThebodyofChristmustchoosetobeasanctuaryfortheabused.

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1. Discussthesimilaritiesandthedifferencesofphysical,verbal,emotional,spiritual,andsexualabuse.

2. Discusschildreninregardstosexualabuse.Whywouldtheyneverbeconsideredabletoconsent?

3. According toDr. Langberg,duration, frequency, and intensityall affect the impactoftrauma.Discussthesethreefactorsregardinghoweachfactorwouldimpactavictimofabuse.

4. Whataresomeofthespiritualimplicationsofabusethatavictimmayface?

5. DiscussthewaysthatChristianhelperscanlearnfromtheLordinhowtohelpvictimsofabuseobtainhealingintheirlives.

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CRAS104:

AnxietyandDepression

ArchibaldHart,Ph.D.

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CourseDescriptionThislessonwillfocusonhowPost-TraumaticStressDisordercreatesanxietyanddepression.Dr.Hartwill discuss definitions of terms, the prevalenceof different types of trauma, risk signs,significant statistics, and prevention and intervention strategies that helpers can utilize.Studentswill learn the connectionbetweenPTSDand anxiety anddepressionproblems, andtheywillbecomemoreeducatedonhowthoseproblemscanbepreventedand/ortreated

1. Participants will be able to understand how trauma, stress, and depression/anxietyrelateinsufferersofPTSD.

2. Participantswillbeabletounderstandwhatitisabouttraumathatputspeopleatrisk

fordevelopingdepressionand/oranxietyproblems.3. Participantswill be able to learnpreventionand intervention strategies regarding the

depressionandanxietycomponentsofPTSD.

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I.HowDoTrauma,Stress,andDepressionRelate?

A. PTSD,depression,andanxietydisorder frequently followtraumaticexposure–bothseparatelyandconcurrently.

B. Intheimmediateaftermath(acutePTSD),theyappeartobeseparatedisorders.

C. InchronicPTSD,theybecomecomorbid.

II.PrevalenceofTypesofTrauma

A. Assault–38%

B. SeriousCarAccidents–28%

C. OtherAccidentsorInjury–14%

D. Fire,Flood,Earthquakes–17%

E. LifeThreateningIllness–5%

F. SuddenDeathofFriend/FamilyMember–60%

G. LearningAboutOther’sTrauma–60%

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H. War-???

III.RisksofDevelopingDepression/AnxietyProblemsFollowingPTSD

A. Traumaticstressisfarmorepowerfulandseriousthanordinaryday-to-daystress.

B. PTSDsufferersexperiencetwicetheriskformajordepressionandanxietydisorders.

C. Preexisting depression and traumatic childhoodmemories are two risk factors thatwillexacerbatetheeffectsoftrauma.

IV.AnxietyOrdersTriggeredbyPTSD

A. PanicAttacks

B. Agoraphobia

C. OtherPhobias

D. ObsessiveCompulsiveDisorder

E. GeneralAnxietyDisorders

F. SeparationAnxiety

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V.DepressionDisordersTriggeredbyPTSD

A. MajorDepression

B. UnstableMoodDisorder

C. BipolarDisorder/ManicEpisodes

VI.Definitions

A. Endogenous Anxiety or Depression – Anxiety or depression “fromwithin” which isprimarilybiochemical

B. Exogenous Anxiety or Depression – Anxiety or depression “fromwithout” which isbroughtonduetolifecircumstances

VII.NeurobiologyofMoodDisorders

A. TheTraumaTriangle• Prefrontal Cortex – Orchestrates thoughts and actions with internal goals; takes

controlofemotions• Amygdala – Primary role in the processing and memory of emotional reactions,

especiallyfear• Hippocampus–Vitaltoemotionalarousalandtheformationoflong-termmemories

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B. Cortisol• Oneofthestresshormonesreleasedbytheadrenalsystem• The surge of cortisol creates the effects in the Trauma Triangle that then leads to

depressionoranxiety

VIII.Statistics

A. MajorDepressionandPTSDoccurtogetherearlyonafterthetraumain30%(PTSDat1month)

B. 17.5%hadPTSDat4months

C. 45%ofPTSDpatientshadcomorbiddepressionat4months

D. WhendepressionandPTSDarecomorbid,symptomseveritywasmoresevereoverall.Theyinteracttoincreasedistress.

IX.RiskFactors

A. RiskFactorsforDevelopingSeriousDepressionandAnxietyFollowingTrauma• Preexistingmorbidity• Lackofsocial/environmentalsupport• Prolongationoftraumaticstress• Lackofcopingskills,helplessness

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• Antisocialorborderlinepersonalitytraits

B. SuicideRiskinPTSD-RelatedDepression• Amongstcombatsoldiers,suiciderateisthehighestithaseverbeen• Suicideisseenasacopingmechanism• RiskFactors:

1. Male

2. alcoholuse3. abuse4. familyhistoryofsuicide5. poorsocialenvironment6. historyofattemptingsuicide

• CombatTraumaRiskFactors

1. multiplewounding2. extremeguiltreaction3. lossofclosefriend4. senseofhopelessness

X.ClinicalIntervention

A. ReducetheCortisolStressResponse

B. Long-termSSRI’stoCounterHippocampalAtrophy

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C. CognitiveBehavioralTherapy

D. RelaxationandMeditation

E. TargetedFamilyInterventions

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1. Discussthedifferenttypesoftraumaandtheirprevalence.Areanyofthesesurprising;ifso,whichones?

2. WhataresomefactorsthatcouldworsentraumawithinasuffererofPTSD?

3. Define “endogenous anxiety or depression” and “exogenous anxiety or depression.”Why is understanding these definitions importantwhen examining people displayingsymptomsofPTSD?

4. Discuss the Trauma Triangle, and the importance of the prefrontal cortex, theamygdala,andthehippocampus.

5. DiscusstheclinicalandbiblicalinterventionsthatwerementionedbyDr.Hart.

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CRAS105:

TraumaandAttachment

GarySibcy,Ph.D.

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CourseDescriptionIn this lesson, Dr. Sibcy discusses the attachment theory and how it relates to trauma.Attachment is a theory of relationships and emotion,with safety being a key component inunderstandingproblems.Dr.Sibcywillteachstudentshowtoapplytheattachmenttheorytotraumasituations,andstudentswilllearntobetterunderstandthecorrelationbetweentraumaandhowpeopledorelationships.LearningObjectives:Bytheendofthislesson:

1. Participantswillbeabletounderstandthefivecomponentsoftheattachmentsystem.

2. Participantswillbeabletounderstandthefourattachmentstylesthatpeoplecanhave,

andwhateachofthestylesmeanregardinghowpeopleactinrelationships.3. Participantswillbeabletolearnhowattachmentstylesrelatetotrauma,PTSD,aswell

asunderstandingthecomponentsofeffectivetherapiescounselorscanutilize.

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I.WhatisAttachment?

A. Attachmentisatheoryofrelationshipsandemotion,wheresafetyisakeycomponentinunderstandingproblems.

B. Affect Regulation – how people learn to deal with their deepest ad strongestemotions.

C. Two sets of beliefs develop from interactions with the attachment figure: beliefsaboutselfandbeliefsaboutothers.

II.FiveComponentsoftheAttachmentSystem

A. Acaregiver’sresponsetoachildindistressaffectsthatchild’sunderlyingbeliefsabouttrust.

B. Acaregiverisa“securebase”or“safehaven”forachild.

C. Secure Base Phenomena – when children feel calm and secure, they feel free toexploretheworld.

D. Separationleadstoanxietyandanger.

E. Lossofattachmentfigure leadsto intensegriefandasenseofnotwantingtomoveon.

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III.FourAttachmentStyles

A. SecureAttachment–positiveviewofself;positiveviewofothers

B. Dismissing/AvoidantAttachment–overlypositiveviewofself;overlynegativeviewofothers

C. PreoccupiedAttachment–overlynegativeviewofself;overlypositiveviewofothers

D. Disorganized/FearfulAttachment–negativeviewofself;negativeviewofothers

IV.PTSD,Trauma,andAttachment

A. WhatisPTSD?• Exposuretoalife-threateningevent• Intenseemotionalreactiontotheevent• Re-experiencingoftheevent• Avoidanceofanythingthatcouldtriggertheemotionalresponseexperiencedduring

theevent• Hyperarousalorhyperstartletendencies

B. It is important to understand that not everyone exposed to a traumatic event willdevelopPTSD.

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C. NaturalRecovery• Re-exposuretostressfuleventswillactivatestress• When the negative expectation doesn’t happen, there is a disparity which causes

anxietytonaturallyextinguishitself• Withrepeatedpractice,anxietymayleaveentirely

D. PTSD&OtherAnxietyDisorders• Re-exposuretostressfuleventsover-activatestheemotionalsystem• Thereisnoexperienceofdisparityduetoavoidancestrategies• Unhealthytension-reductionstrategiesmaybeusedtocalmtheiremotionalsystems

E. ComponentsofEffectiveTherapies• Employtitratedexposure• Createdisparitytobringabouthealing• Usecognitiveinterventionstohelpchangenegativethinkingpatterns• Workonaffectregulationstrategies• Dealwith“relatedness”issues

F. AttachmentandtheCounselor• TherapeuticWindow– creating enough stress – but not toomuch stress – so that

disparitycanbeexperienced• Individualswithavoidantattachmentaremorelikelytohavedifficultyusingyouasa

securebase

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• Preoccupiedindividualstendtobeoverwhelmed,andtheyareverydemandingandsensitive

• Adisorganizedattachmentstylemaygiveavery inconsistentpatternofresponding

tothecounselor.

V.Attachment,PTSD,andtheFamily

A. TheangerandirritabilitycommontoPTSDcanbeverytraumatictothefamily.

B. ChildrenwhohaveaparentwithPTSDlivelife“onedge.”

C. PTSD survivors struggle with a deep sense of hollowness and emptiness. Familymembersexperiencethisemotionaldetachmentascoldnessandrejection.

D. HappyPhobia–thebrainequatespositiveemotionswithvulnerabilityinanattempttoavoidunexpectedtrauma.

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1. Describe the attachment theory in general, and how it is important in understandpeopleandtheirrelationships.

2. Whatarethefivecomponentsoftheattachmentsystem?

3. Discussthefourattachmentstylestaughtinthevideo,andcompareandcontrasthowthesedifferentattachmentstylesaffectrelationships.

4. WhatcomponentsarerequiredforapersontobeconsideredtohavePTSD?

5. Discussthecomponentsofeffectivetherapies,andwhyeachofthesewouldbeusefulwhencounselingpeoplesufferingfromtrauma.

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CRAS106:

CounselingStrategies

EricScalise,Ph.D.;JenniferCisney,M.A.;KevinEllers,D.Min.

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CourseDescriptionThis lesson, led by an expert panel, will expose students to counseling strategies regardingtrauma survivors. Dr. Scalise, Dr. Ellers, and Jennifer Cisney will explain different models ofcounselingthatcanbeusedwithtraumasurvivors,indicationsandcontraindicationsrelatedtocaregiving, the importance of a multidisciplinary intervention approach, and the need forsupport systems. Finally, the panelwill discuss the recovery processwith a biblicalmodel ofhealingandrestoration.

LearningObjectives:Bytheendofthislesson,students:

1. Will beable to learn the characteristicsof acute care, andhowpsychological first aiddiffersfrompsychotherapy.

2. Will be able to learn the contraindications of acute care, and when a person needs

immediatementalhealthintervention.3. Will be able to learn how to structure a community team that ismultidisciplinary, as

wellaswhattheroleofthechurchcanberegardingcrisisinterventionstrategies.

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I.AcuteTraumaandStress

A. Theinitialresponsetoacrisisisnotpsychotherapy.

B. PsychologicalFirstAid–Immediateresponsethatcanbeperformedbyanyonewhoistrained.

C. CharacteristicsofAcuteCare• Supportive• Stabilizing• Practical

D. In a crisis, people aren’t processing information, but rather they are feelinginformation.

E. Crisis responders canhelp alleviate acute stress by giving information to help themunderstandwhytheyarefeelingandexperiencingwhattheyare.

F. Whoneedsacutecareandwhodoesn’t?• Psychologicaltriageisextremelyimportant.• Forexample,alittlebitofconfusionfollowingtraumaisnormal.However,notbeing

intouchwithrealityrequiresintervention.• Suicidal ideation,extremeangerorviolence, self-destructivebehaviors,oranything

thatcanbeofimmediatedangertothepersonneedstobeaddressedimmediately.

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G. Whatarethecontraindicationsofacutecare?

• Homicidal, suicidal, psychotic, loss of touch with reality – Any of these behaviors

requirementalhealthcare• Sometimeswhenacrisiscomesuponsomeonewhoalreadyhasapreexistingissue

he/sheisstrugglingwith,thenormalcopingmechanismsarenotjustoverwhelmed,butarecompletelyshutdown

• If someone cannot be stabilized, he/she will need immediate mental health

intervention

H. StrategiestoDealwithImmediateGriefifSomeoneisFacingaLoss• Cometotermswiththerealityofwhat’shappened• Note:Debriefingsareonlydoneinagroupsetting.Crisisinterventionsmaybedone

oneonone.

II.MultidisciplinaryApproach

A. Churchescancreatecommunityteamsforcrisisintervention.

B. Amultidisciplinary teamwouldhavementalhealthprofessionals, clergy,peers, andpeoplewhohavehadlosses/traumathemselves.

C. Empowerthelocalstoformcommunityteamsandhavelocalresources.Peopleoftenshowupatthebeginningbutthenaregone. Aperson’scrisismayhitmonthslater,notduringtheacutestage

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III.RoleoftheChurchAftertheTrauma

A. Bealong-termsupportsystem.

B. Some symptoms are normal responses, but how, when, and to what level peopleexperiencethosesymptomswillvaryfrompersontoperson.

C. TheRoleChanges:Thelong-termroleofthechurchshapesthewaypeopleintegratethetraumaticexperienceintheirliveswhetherinapositiveornegativeway.Thiscanbecriticalforpeoplewhentheyareputtingtheirlivesbacktogether.

D. Thechurchshouldbethereforpeopleastheyprocesscognitively.

E. Peopleneedtohavethefreedomandspacetoprocesswhathappened.

F. Peopleneedtohavetimetocalmthemselvesinordertoquietthemselvesandcalmtheirsystemdown,beingcarefulnottoisolatethemselvesfromothers.

IV.GoodIntentionsvs.GoodResults

A. Itisveryimportanttobetrainedincrisisintervention.

B. Somepeoplemakethemistakeoftryingtofixsomething,whenpeoplereallyneedalovingpresence.

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C. TheHoly Spirit’s presence in the responder’s life can speak volumes to a person incrisis.

D. Bediscerningandwise.

E. Provideasafe,lovingenvironmentwherepeoplecantalk.

F. Beasafepersonwhoisnotafraidofother’spain.

G. Believersengagingpeopleincrisisortraumamustunderstandthatthepeopleincrisisareoftenhavingacrisisoffaith.

H. Dothisworkoneselfandknowone’sowntheologyofsuffering. BelievershavethehopeofChrist–Hecanhealthepainandtransformtheperson.

V.Conclusion

A. Importantcounselingstrategiesincludebeingthereinthemoment,notdoinglotsofcognitivework,psychological triage,prioritize,understand theprocess,havea teamapproachthat ismultidisciplinary,andhavingthechurchoffer long-termcommunitysupportandcare.

B. Crisisinterventionisnotasmuchaboutdoingasitisaboutbeing.

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C. Crisisinterventionisoneofthetoughestministriestobeapartof,becausethehelperwill be walking through some of people’s darkest times. If one chooses to do so,he/shewillhavetheblessingandhonorofbeingthereforsomeonewhenhe/she ismostopentoGod’stransformativepower.

D. Peoplearenothumandoings;theyarehumanbeings.ThevalueofpresenceiswhatChristcallsbelieversto.

E. It is a sacred trust to engagewith people at theirmoment of crisis and need, andbelievershavetheopportunitytobethebodyofChristonthisearth

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1. Discuss the characteristics of acute care and how it differs from traditionalpsychotherapy.

2. Whatispsychologicaltriage?

3. Discussthecontraindicationsofacutecareandwhenitmightbenecessarytoreferapersonformentalhealthintervention.

4. Whataretheadvantagesofhavingamultidisciplinarycommunityteamwhenengagingincrisisintervention?

5. Discuss the role of the church after trauma, and why it is important to a localcommunitytohavethesupportofthechurch.

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CRAS107:

ImpactDynamicsofCrisisandTrauma

JenniferCisney,M.A.

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CourseDescriptionInthislesson,JenniferCisneywilldefinepsychologicalfirstaidincrisisinterventionanddiscusstheimpactofcrisisandtraumaontheindividualinabroadcontext.Furthermore,studentswillbecome familiarwith the variousways people battle symptoms. Studentswill learn the firststepsregardingassessmenttoolsandprotocolsinrespondingtosomeoneincrisisandtraumasituations.

1. Participantswillbeabletolearnthehistoryandbackgroundofcrisisintervention,basicdefinitions,andtheimportanceofcrisisinterventionbystudyingabroadercontext.

2. Participantswillbeabletounderstandthegeneral,emotional,behavioral,physical,and

spiritualsymptomsofpost-traumaticstress.3. Participantswillbeabletolearnbasicprinciplesregardingthefirststepsinresponding

topeopleincrisis.

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I.BackgroundofCrisisIntervention

A. Crisisinterventionisarelativelynewfield,andmoderndaycrisisinterventionhasitsrootsinthemilitary.

B. Studiesshowthatearlyinterventionreduceschronicpsychiatricmorbidity.

C. DynamicsofModernCrisisIntervention• Immediacy• Proximity• Expectancy

D. Definitions• CriticalIncident–thecatalystforemotionalorpsychologicaltrauma• Crisis–thereactionoftheindividualtotheincidentthathasoccurred• CrisisIntervention–theapplicationof“psychologicalfirstaid”

E. PsychologicalFirstAid• Stabilizepeopleoftheirsymptoms• Symptomreduction• Reestablishafunctionalcapacity• Seekahigherlevelofcare

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F. “Whilemostsurvivorsofviolenceandmassdisasterwillrecovernormallyfromtheirpsychological post-traumatic stress, it is important to do early psychologicalinterventions to thosewho are in need. The interventions should be phasicmulti-component integrated intervention systems.” (Mental Health and Mass ViolenceReport,2002,NIMH)

G. ConsiderFollow-UpServicesFor:• Thebereaved• Thosewithpreexistingpsychiatricdisorders• Thoserequiringmedicalsurgicalintervention• ThosewithAcuteStressDisorder• Thosewithchronicorintenseexposure• Thosewhorequestadditionalcare

H. BroaderContext• 90%ofU.S.citizenswillbeexposedtoatraumaticeventintheirlifetime.Ofthose,

13%offemalesand6%ofmaleswilldevelopPTSD.• CrisisinterventionseekstopreventtheonsetofPTSD• SuicideFollowingTraumaticEvents

1. 63%increaseinfirstyearafteranearthquake2. 31%increaseinfirsttwoyearsafterahurricane3. 14%increasefouryearsafteraflood

• U.S.citizensaged12orolderexperienced37millioncrimesin1996.• Eachyear,approximatelyonemillionpeoplebecomevictimsofviolentcrimewhileat

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• In 1994, U.S hospital emergency rooms treated approximately 1.4 million injuriesresultingfrominterpersonalactsofviolence.

• In1997,therewere304actsofinternationalterrorismwithone-thirddirectedatU.S.

targets.• AmongurbanU.S.firefighters,almost32%wereassessedwithsymptomsconsistent

withadiagnosisofPTSD.

II.SignsandSymptoms

A. Post-traumaticstressisactuallyahelpfulmechanism,createdbyGod,asaresponsetothreatsofsafety.

B. In thecrisismoment, the frontal lobeof thebrainbecomesdisabled,anddecision-makingishandledbytheamygdala.

C. In the crisismoment, blood flow is redirected from vital organs to themuscles toincreasephysicalstrength.

D. Inthecrisismoment,awarenessofpainislessened.

E. Post-traumaticstressisthenormalreactiontoanabnormalevent.

F. GeneralSymptomsofPost-TraumaticStress• ConfusionandanInabilitytoConcentrate

• DifficultyMakingDecisions

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• SensoryDistortions• InappropriateGuiltandRegret• PreoccupationwiththeEvent• InabilitytoUnderstandtheConsequencesofTheirBehavior• PsychosisandLossofTouchwithReality

G. EmotionalSymptomsofPost-TraumaticStress• HighlevelsofAnxietyandIrritability

• InappropriateLevelsofAnger• Panic• VegetativeDepression• ExtremeFear,Phobia• ExtremeGrief

H. BehavioralSymptomsofPost-TraumaticStress• ImpulsivenessandRiskTaking

• Hyper-StartledResponse• CompulsiveBehaviors• WithdrawalandIsolation• FamilyDiscord• CryingSpellsandDisconnectedStares• ViolenceandAntisocialBehavior

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I. PhysicalSymptomsofPost-TraumaticStress• RapidorSlowedHeartbeat

• Headaches• HyperventilatingorMuscleSpasms• PsychogenicSweating• ExtremeFatigueorExhaustion• Indigestion,Nausea,Vomiting• BloodinStool,Sputum,Vomit,orUrine• ChestPainorLossofConsciousness

J. SpiritualSymptomsofPost-TraumaticStress• AngerDirectedatGod

• WithdrawalfromFaith-BasedCommunity• ClingingtoFaith

K. Learningskillsofassessmentiskeytoeffectivecrisisintervention.

L. Crisis interventionists need to help victims understand that the symptoms they areexperiencingareanormalreactiontoanabnormalevent.

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III.Cautions

A. Bewareoftheprincipleofvicarioustraumatization.• Peoplecanbetraumatizedbyhearingabouttraumathatsomeoneelseexperienced• Circles of Impact/Homogenous Groups – people grouped together should all have

beenimpactedsimilarlyandallshouldbewitnessesofthetraumaticevent

B. Thecrisisresponseproviderwillneedtogetcareforhimself/herself.

IV.Conclusion

A. Anyonewhohasadequatetrainingcanprovidecrisisintervention.

B. Crisisinterventionshouldbeperformedbyteams.

C. Churches should form crisis response teams, support groups, and training programsforhelpingthosethathaveexperiencedcrisis,trauma,orloss.

D. Crisis intervention isabout immediate response, so respondersmustbeprepared inadvance.

E. Christianshavetheprimarycomponentofhealingtooffertothosewhoarehurting,andthatcomponentishope.

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1. Discussthethreedynamicsofmoderncrisisintervention.

2. Whatarethepurposesofpsychologicalfirstaid?

3. Whoshouldcrisisrespondersconsiderforfollow-upservices?

4. Compare and contrast the general, emotional, behavioral, physical, and spiritualsymptomsofpost-traumaticstress.

5. Discusstheprincipleofvicarioustraumatization,andhowthispracticallyappliestocrisisresponse.

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CRAS108:

MethodsandTechniquesforImmediateResponse

ThomasWebb,Th.M.

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CourseDescriptionThislessonoverviewstheprocessofCriticalIncidentStressManagement(CISM)withafocusonspiritual crisis intervention.Howdoes one bear another’s burdenwhen the victim expressesdeepspiritualdistressintheformofquestionssuchas“WhydidGodallowmychildtodie?”or“I feel like God has abandoned me!” Chaplain Thomas Webb will guide students throughassessmentcriteriaforcrisisintervention,particularlythatofaspiritualnature.

1. Participantswill be able to know thebasic termsof crisis intervention, aswell as themultipletypesofCISMinterventions.

2. Participants will be able to know the identity and purpose of a spiritual crisis

interventionist.3. Participantswillbeabletoknowtheassessmentcriteriaforspiritualcrisisintervention.

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I.Definitions

A. Thefieldof“crisisintervention”encompasses(1)providingmaterialaid,suchasfood,shelter,clothing,aidinprocessinginsuranceand(2)providingcrisiscaretoindividualsoverwhelmedfromthetraumaticstressofacriticalincident.

B. The term “crisis” refers to the state of impairment in functioning that a personexperiencesfirstphysically,cognitively,andemotionallyandthenlaterimpairmentinrelationshipshorizontallywithfamilyandfriendsandverticallywithGod.

C. The term “critical incident” refers to any event that an individual experiences andresults in a state of impairment in functioning physically, psychologically, andrelationally.

D. AnOverviewChartofExistingCrisisInterventionModels

CriticalIncidentStressDebriefing

(Dr.JeffMitchell)

PsychologicalDebriefing

(Dr.A.Dyregrov)

GroupCrisisIntervention

(NationalOrganizationforVictimAssistance)

Multiple-StressorDebriefing

(AmericanRedCross)

CriticalEventDebriefing

(Dr.J.Stokes)

1.Introduction Introduction Introduction Event Introduction

2.Fact Fact Event FeelingsandReactions

ChronologicalReconstruction

3.Thought Thought Aftermath CopingCognitive–AffectiveReactions

4.Reaction Sensory ExpectationsFuture Termination Symptoms

5.Symptoms Normalization Education Teaching(Coping

Strategies)6.Teaching

(CopingStrategies) Closure Conclusion Wrap-up

7.Re-entry Follow-upDebriefing

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E. The common goal of each of thesemodels is to help small groups of individuals toregain normal functioning (homeostasis or balance) physically, psychologically, andrelationally.

F. Themosteffectivemeansofconductingcrisisinterventionisusingamulti-componentresponsesystemthatstrategicallyassessestheimpairmentofindividualsandemploysthemostsuitableinterventiontouseattheappropriatetime.

G. “Inallthecontroversy,criticismandresearchdebateonthemeritsofdebriefing[earlyintervention], certain constants are emerging. The most effective methods formitigatingtheeffectsofexposuretotrauma…,thosewhichwillhelpkeepourpeoplehealthy and in service,are thosewhich use early intervention, aremulti-modal andmulti-component. That is, they use different ‘active ingredients’…, and thesecomponents are used at the appropriate time with the right target group.” (Dr.HaydenDuggan)

II. Critical Incident Stress Management (International Critical Incident StressFoundation)

A. TheICISF’smodelofCISMisrecognizedbytheUnitedNationsandbyfederalandstate

agencies.

B. CISMrepresentsanapproachtocrisisintervention,whichis• Comprehensive(inscopeofpre-,mid-,andpost-crisis)• Phasesensitive(tochangingstatesofindividuals’levelofimpairmentandfunctioning)• Integrated(interventionscomplimentaryinrestoringfunctioning)• Multi-component(varietyofinterventionstoaddressspecificneeds)

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C. ChartofICISFMulti-ComponentCrisisInterventionTacticsIntervention Timing TargetGroup PotentialGoals

Pre-incidentPlanningandPreparation

Priortocriticalincidentoccurring

Anticipatedpopulationgroups

AnticipateguidanceFosterresistanceto

stressPromoteresilience

Assessment Pre-intervention Thosedirectlyandindirectlyexposed

Determineneedforintervention

StrategicPlanning Pre-eventandduringevent

Anticipatedexposedandvictimpopulations

Criticallyplancrisisresponse

IndividualCrisisIntervention Asneeded Individualsas

identified

AssessmentPsychologicalandspiritualfirstaid

EducationFacilitatecontinued

support

Intervention Timing TargetGroup PotentialGoalsLargeGroupCrisis

Intervention

A. Demobilization Atshiftdisengagement

Emergencypersonnel

DecompressionEasetransition

TriageFacilitatefollow-up

B. RespiteCenter On-goingatlargescaleincidents

Emergencypersonnel

RefreshmentTriageSupport

C. CrisisManagementBrief Asneeded Heterogeneous

largegroups

InformControlrumors

Increasecohesion

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Intervention Timing TargetGroup PotentialGoalsSmallGroupCrisis

Intervention

D. CrisisManagementBrief

Asneeded

Heterogeneoussmallgroupsseekingresources&information

InformControlrumors

Increasecohesion

E. DefusingOn-goingevents

Post-eventswithin12hours

Smallhomogeneousgroups(similar

experienceoftraumaexperience)

StabilizationReduceacutedistress

InformationFacilitateresilience

F. GroupDebriefing(CISD)

Post-EventH. 1-10daysfor

acuteeventsI. 3-4weeks

post-disasterrecoveryphase

Smallhomogeneousgroups(similar

experienceoftraumaexperience)

AssessmentPsychologicalandspiritual

firstaidEducation

Facilitatecontinuedsupport

Intervention Timing TargetGroup PotentialGoals

FamilyCrisisIntervention

Pre-eventAsneededduringand

post-eventFamilies

Pre-eventpreparationIndividualandsmallgroup

interventions(CMB,Defusing,CISD)

Organizational/Community

InterventionandConsultation

Pre-eventAsneededduringand

post-event

Organizations/Communitiesaffectedby

criticalincident

Improveorganizationalpreparednessand

responseConsultleadership

PastoralCrisisIntervention Asneeded

Individualsorgroupswhodesirefaith-basedpresence

andcrisisintervention

Faith-basedsupportRestorespiritualfunctioning

inrelationshipwithGod

Follow-up/Referral Asneeded

Interventionrecipientsand

exposedindividuals

Assurecontinuityofcare

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III.ApplicationofCISMintheCommunity

A. RequirementsofFormingofaChurchCISMTeam • Identifyingthepeopletheteamwillserve(churchmembersandcommunity)• Establishing the business operating identity (a separate non-profit corporation or

functionasaministryofthechurch)• Recruitingandtrainingteammembers(mentalhealthprofessionalandpeers)• Developingrelationshipswiththeidentifiedpopulationtobeserved• Raisingfundingfortheteam’soperation

B. BenefitsofaCISMTeam• Provides an effective and efficientmeans to show the love ofGod to neighbors in

needofspiritualandemotionalfirstaid,whichotherwisemightbeneglected• BuildsrelationshipbondsthatmayopendiscussionsabouttheGospel• Enableschurchestohaveacadreoftrainedcrisiscare-giverstoattendtomembers’

crisis needs (when hospitalized, after learning of a life threatening illness, such ascancer,orsuddenunemploymentorlossofahome)

• Providesarecognizedmeanstoworkwithgovernmentofficialsatdisastersites

IV.AssessingandRespondingtoaSpiritualCryofDistressVersusaCrisisofFaith

A. Assessfirstthenatureandseverityofthecriticalincident—“Howbigwastherock

tossedintothepond?”• Typeofcriticalincident(fire,flood,caraccident,shooting,bombing,etc.)

• Severity(ofinjuries;ofdeaths;ofnatureofviolence;ofpropertyloss)

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• Primaryshockwavevictims(thoseclosesttocriticalincident)

• Secondaryshockwavevictims(thoseimpactedbyripplesofshockwave)Durationoftheevent

B. AssesstheImpactontheIndividual

• Byobservingthefollowingaboutimpactedindividuals

1. Speech(rapid,slow,halting)

2. Emotion(fear,panic,anger,despair,shock)

3. Appearance(disheveled,tattered,bloody)

4. Activitylevel(hyperalert,hyperactive,lethargic)

5. Alertness(concretethoughts,tangentialthoughts)

• Bynotingthesymptomsinthefollowingcategories

1. Physical(vacantstare,rapidheartandbreathingrate,sweating)

2. Cognitive(troublemakingdecisions,difficultywithmemory)

3. Emotional(fear,panic,anger,helplessness,hopelessness,despair)

4. Behavioral(withdrawaland/ordifficultyinrelationships,eating/sleepingchanges)

5. Spiritual(angeratGod,despair,lossofspiritofthankfulness,nodesiretocontinuewithrighteousliving)

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C. AssessingandRespondingtoaSpiritualCryofDistressandaCrisisofFaith

AssessmentCriteria SpiritualCryofDistress CrisisofFaith

Timeelapsedfromtheimpactofthecriticalincident Relativelysoon

Later(aftersomedaysofattemptingtointeractin

relationships)

PrevalentTraumaSymptoms

• Physicalshockconditions(vacantstare)

• CognitiveImpairment• EmotionalDistress

• Behavioralimpairmentinhorizontalrelationshipswith

family,etc.Ø Withdrawal(Retreatsfromsocialinteractionoffamily

andworkplace)Ø Inabilitytocommunicate

andgainsupport(Arguments/Frustration/Despair)

• SpiritualimpairmentinverticalrelationshipswithGod

Ø Lackofaspiritofthankfulness

Ø Godseemsdistantandone’snormaltheological

worldviewseemsuselessinmakingsenseoflife

RelationalContext Focusonselfandone’sstateofbeing

• Focusonimpairmentinrelationshipshorizontallyand

vertically• “Nooneseemsto

understand--notmywife,notmyfriends,notevenGod!”

CrisisInterventionGoalRestorefromthestateofshocktofunctioninginrelationshipshorizontallyandvertically

Restorehopeandaspiritofthankfulnessinrelationships

D. RespondinginSpiritualAlignmenttoIndividualsOverwhelmedwithTraumaticStress• Hearing the cry of the individual requires hearing accurately their expression of

spiritualandemotionaldistressandvalidatingthroughaparaphrase.• Exploringthesignificanceoftherelationshipimpactedbythecriticalincidentfurther

providesasenseofvalidationoftheindividualandbolstershopeastheambassadorofGodhasheardtheircry.

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1. Whatarethepurposesofcrisisintervention?

2. Inassessingacriticalincident,whatshouldoneexamine?

3. Inassessingtheimpactonanindividual,whatshouldoneexamine?

4. Discuss the implications of spiritual crisis intervention, and when crisis respondersshouldapproachasituationusingspiritualcrisisintervention.

5. Definetheterms“crisisintervention,”“crisis,”and“criticalincident.”

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CRAS109:

PeerSupportandAccountability

JoshuaStraub,Ph.D.

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CourseDescriptionThis lesson discusses the importance of peer support and accountability regarding crisisintervention.JoshuaStraubwilladdresskeyprinciplesregardingcrisisinterventionasitrelatesto having a strong support system in place for the individualswhoexperience crises in theirlives.Hewillalsogivestudentscautionsregardingpeersupport,sothattheywillknowhowtoproperlyinterveneinacrisiscontext.LearningObjectives:Bytheendofthislesson:

1. Participantswillbeabletounderstandtheroleofthefamilyandofthechurchincrisis

intervention.

2. ParticipantswillbeabletolearnwhattheSAFERmodelis,andhowitshouldbeused.3. ParticipantswillbeabletounderstandwhattheBiblesaysaboutcrisisintervention.

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I.EffectiveInterventionsforPreventingPTSD

A. Proximity

B. Immediacy

C. Expectancy

II.CrisisIntervention

A. The purpose of crisis intervention is to intervene effectively, as immediately aspossible,asclosetotheeventaspossible,creatingexpectancytoheal.

B. Crisis responders help victims of crisis put language to the event, allowing them toeffectivelytalkaboutwhattheyhavebeenthrough.

C. Itiscriticallyimportanttoestablishpeersupportandaccountability.

D. PTSDPrevalence• 10-15%ofLawEnforcementofficers• 10-30%ofFirefighters• 16%ofVietnamVeterans• 20%ofIraqWarVeterans

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II.PeerSupport

A. EstablishingCredibility• Useapeerwhenrecipientgroupmemberisspeciallyeducatedortrained• Developrapportandcredibilityamongthegroupmembers• Useapeerwhenthegroupmemberextendsminimaltrusttooutsiders• It isnottypicallynecessarytousepeerswhenworkingwithageneralpopulationof

victims

E. CautionsRegardingPeerSupport• Considertheneedforamentalhealthprofessional• Understandthatcrisisinterventionispsychologicalfirstaid• Knowwhenoneisoverhis/herheadandmakeareferral• Bemindfulofcountertransferance

F. ImportanceofFamilyandFamilyIntervention• Educatethefamilyaboutimportantfactorsandconsiderations• Teachstressmanagementtechniques• Teachfamilyhowtotellthestoryinasafeway• Recognizewhentoreferasafamily

G. WhatNottoDo• Donotargueabouttheirexperienceorminimizetheirproblem

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• Donotover-spiritualizetheirexperience• DonotuseChristianclichés

III.TheS.A.F.E.R.Model

A. Stabilizethesituation.

B. Acknowledgethecrisis.

C. Facilitate theunderstanding that they arehaving anormal reaction to an abnormalevent.

D. Encourageeffectivecopingandmechanismsofaction.• Teachstressmanagement• Information is king– crisis responders can’tovereducate the symptoms theymight

experience• Whathelpedtheminthepast?• Frontallobenotfunctioningcorrectly;don’tmakemajorlifedecisions.• Helpthemresolveconflict• Don’tdiscountthepoweroftheHolySpirittotransformandchangelives,andtoheal

people.

E. RecoveryandReferral

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IV.WhattheBibleSaysRegardingCrisisIntervention

A. Psalm 19:14 – “Let the words of my mouth and the meditation of my heart beacceptableinYoursight,OLord,myRockandmyRedeemer.”

B. Acts 4:13 – “When they saw the courageof Peter and John and realized theywereunschooled,ordinarymen,theywereastonishedandtheytooknotethatthesemenhadbeenwithJesus.”

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1. DiscusstheeffectiveinterventionsnecessaryforpreventingPTSD.

2. What does it mean to establish peer support and accountability in a crisis context?Whatwouldthislooklike?

3. Discusstheimportanceoffamilyandfamilyintervention.

4. Whataresomeofthecautionsthatwerediscussedregardingpeersupport?

5. DiscusseachcomponentoftheS.A.F.E.R.model.

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CRAS110:

SurvivorGuiltandFosteringResiliency

KevinEllers,D.Min.

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CourseDescriptionFollowing traumatic events, survivors frequently struggle with a broad range of thoughts,feelings,andreactionsastheytrytoputtheir livesbacktogetherinthepost-traumajourney.Feelings of guilt are common during this road to recovery. Dr. Kevin Ellers will discuss thecritical role that the church can play through this process in helping to help people growthroughtheadversecircumstancesbyenhancingresiliencyinthepreandpost-traumajourney.

1. Participantswillbeabletodefinecriticalelementsofsurvivorguilt,andidentifywaysto

helppeopledistinguishbetweentrueandfalseguiltwhilelearningthepurposeofguilt.

2. Participantswillbeabletoeffectivelydiscussspecificinterventionsforsurvivorguilt,aswellasdefinekeyelementsofresiliency.

3. Participants will be able to identify biblical principles for coping with adversity, and

discusswaysinwhichthechurchcanfosterandsustainresiliencyandhope.

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I.SurvivorGuiltFollowingTraumaticEvents

A. Typical Definition –wondering “why them and notme” after surviving a traumaticincidentinwhichotherslosttheirlives.

B. BroaderDefinition–the“ifonly”statementsthatcancolor,ordiscolor,therestofaperson’slife.

C. Guilthasbothaffectiveandcognitiveelements.Guiltstemsfrominternalbeliefsnotbytheexternalcause.

D. Guiltmaybeviewedintwocategories:• Realguilt–involvedactsofomissionorcommissionthatendangeredorcontributed

toharmofselfand/orothers• Imaginedguilt–wishfulthinkingaboutone’sabilitytohavechosenadifferentcourse

ofactionthatwouldhaveinsomewayimpactedtheeventandalteredtheoutcome

E. Shameistheclosecousinofguilt.Guiltsays“Ididsomethingwrong,”andshamesays“IamabadpersonforwhatIdid.”

F. FourFunctionsofGuilt• Defendsagainsthelplessness• Effectsself-punishment• Inhibitsimpulses• Preventstheeventfrombecomingmeaningless

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G. GuiltCanAlso• Stoppeoplefromdoingsomethingthatiswrong• Motivatepeopletomakeamendsforintentionallyorunintentionallyhurtingothers• Helppeopleanticipatebaddecisionsbeforeengaginginharmfulbehavior• Maskotherissuessuchasgrief• Defendpeopleagainstpowerlessness

II. HelpingSurvivorsProcessFeelingsofGuilt intheAftermathofTraumaandLoss

A. Tohelp,provideasafeenvironmentforpeopletoexpresstheirfeelingsofguilt.

B. Tohelp,letpeopleunderstandtheirtraumastory.

C. Helppeopleunderstandhowtheyfeelguilt.

D. Explorethefactorsthatcontributetofeelingsofguilt.

E. Romans4teachesthatactionsshouldbebaseduponinternalconvictions.

F. Shameislethal.

G. Mourningthelossisanimportantstepinhealing.

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H. Teachsurvivorsthebody’snaturalresponsetostress.

I. Helpsurvivorsunderstandthehumansurvivalresponse.

J. Thebodymayshutdowntotallyortimemayseemtoslowdown.

K. TrueguiltcomesfromGod.FalseguiltcomesfromSatan.

L. HelpsurvivorsseetheirsurvivalasagiftfromGod

M. Guilt canbeadaptivewhen it serves to leadto transformativechangeswithinone’scharacter,perceptions,andactions.

III.FosteringResiliencyinTraumaSurvivors

A. Churcheshaveapowerfulroleinenhancingresiliency.

• Importanceofpaintingarealpictureofsufferingandadversityinlife.• Nietzsche’s famous statement, “That which does not kill memakes me stronger,”

ringstrueformanysurvivors.• ManyScripturesconfirmtheadversityof lifeformosthumanbeingsandyetclearly

portraythatinthisadversity,believerscangrowandmature.

1. Ecclesiastes11:82. 1Peter4:12-19

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• GodhaspromisedtobewithHispeopleandthatHeunderstandstheirsuffering.

1. Isaiah53:3

2. Hebrews4:14-16

B. ResiliencyistheAbilityTo• Copewellwithhighlevelsofongoingdisruptivechange• Sustaingoodhealthandenergyinthemidstofstress• Bouncebackfromsetbacks• Overcomeadversity• Changetonewwaysofworkingandlivingwhenanoldwayisimpossible• Accomplishallofthiswithoutactingdysfunctionally.

C. PersonalityTraitsofResilientPeople

• Extroversion• Highself-esteem• Assertiveness• Hardiness• Internallocusofcontrol• Cognitiveleveloffeedback

D. Ego-Resistance – Flexibility, energy assertiveness, humor, transcendent attachment,andagoodcapacityforaffectregulation.

E. Resiliencyissomethingpeopledo,ratherthansomethingthattheyhave.

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F. TheLatinrootofresiliencymeansto“jumpback.”

G. Resiliencyismulti-dimensional.Peoplearebothtraumatizedandresilientatthesametime.

H. Helppeopleunderstandthattheexperienceoftraumawillchange.

I. Continental Divide Principle – “Stress can strengthen some people or break othersaltogether.”–AbrahamMaslow.

J. Post-traumaticresilienceisassociatedwithegoresiliencewhichincludes:• Flexibility• Energyassertiveness• Humor• Transcendentdetachment• Goodcapacityforaffectregulation

K. Howdopeopleenhanceresiliency?• Thecaregivershouldexplorecoredisruptionsinthefollowingareastohelpsurvivors

rebuild.

1. Safety2. Trust

3. Control4. EsteemIntimacy

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• AssessingVulnerability

1. Copingstrategiesandstyles2. Ageordevelopmentallevelofthetraumatizedindividual

3. Personalgender-specificcharacteristics4. Social-cognitivefactors5. Thestressandsymptomsexperiencedbyclosefamilymembers

• AssessingtheSurvivor’sView

1. Definetherealityofthesituation2. Acceptresponsibilityandavoidblame3. Maintaingoodphysical,emotional,andspiritualhealth4. Developgoodthinkingandproblemsolvingskills5. Establishhealthyboundariestokeepgoodinandbadout6. Mobilizetowardpositive,manageableactionssteps

• JohnHopkin’sModel–CreateResistance,EnhanceResiliency,andSpeedRecovery

IV.Conclusion

A. Romans5:1-5-“...AndwerejoiceinthehopeofthegloryofGod.Notonlyso,butwe also rejoice in our sufferings, because we know that suffering producesperseverance; perseverance, character; and character, hope. And hope does notdisappoint us, becauseGodhaspouredout his love intoour hearts by theHolySpirit,whomhehasgivenus”

B. “Thebeautifulpeoplearethosewhohaveknowndefeat,knownsuffering,known

struggle,known lossandhave foundtheirwayoutof thedepths. Thesepeoplehaveappreciationandsensitivityandanunderstandingoflifethatfillsthemwithcompassion, gentleness, ad adeep loving concern. Beautiful peopledonot justhappen.”–ElizabethKubler-Ross

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1. Compareandcontrastrealguiltandimaginedguilt.

2. Discuss the functions of guilt, andwhy it is important to understand guilt’s role in aperson’slife

3. Howcanonehelp survivors process feelingsof guilt in the aftermathof traumaandloss?

4. Howcanthechurchhelpfosterresiliencyintraumasurvivors?

5. Discuss the importance of assessing both vulnerability and the survivor’s viewwhenprocessingguiltandfosteringresiliencyintraumasurvivors.

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CRAS111:

ManagingtheHighCostofCare

EricScalise,Ph.D.

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CourseDescriptionIn this lesson,Dr. Eric Scalisewill discuss the importanceof self-careandgive resources andclearguidanceregardingself-assessment.Theworldtodayisonefullofstressandtrauma,andthose in the ministry or helping profession need to become educated on the topic ofcompassionfatigue.Dr.Scalisewilldiscusshowcaregiverscantakecareofthemselves,developapersonalstresspreventioncareplanandsurvivecounselingstress.LearningObjectives:Bytheendofthislesson:

1. Participantswill be able to understandboth the building blocks and consequences of

stress,andlearnhowpeoplehandleexpectations.

2. Participantswillbeabletounderstandtheconceptofcompassionfatigueandwhyitisimportanttothoseinthehelpingprofession.

3. Participants will be able to learn practical ways to self-assess and survive counseling

stress.

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I.GeneralPrinciplesRegardingStress

A. Thisworldisfullofstressandtrauma.

B. Thechurchneedstobethepeoplewhohelpaddressthistraumaandstress.

C. Culture today tends to define success in quantitative numbers, but people need toconsiderqualitativeindicators.

D. Individualexpectationsmightbe legitimate,but thecompositeexpectationsmaybeoverwhelming.

E. Counselorsandministryleadersareoftennotallowedtofail,hurt,orbehuman.

F. Asstressincreases,sodoesresistancetogettinghelp,producingcrises.

G. Peoplemustconsiderboundariestobeanimportantprinciple.

H. Itisoftenthejourneyandtheprocessofworkingthroughthepain,trauma,grief,andlossthatbringssurvival,health,andgrowth.

I. HowExpectationsareOftenHandled• Preoccupationwithstress-producingsituationsorindividuals• Overindulgenceinescapebehaviors

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• Avoidanceofintimacyinfavoroffantasy

• Controllingtheenvironment• Leavingtheprofessionorministry

J. BuildingBlocksofStress• RoleAmbiguity–“WhatamIsupposedtobedoing?”• RoleConflict–“AmIdoingtherightthing?”• RoleOverload–“AmIdoingtoomuch?”• RoleInconsequentiality–“IswhatI’mdoingreallymakingadifference?”• RoleIsolation–“AmIalonetoomuch?”• RoleRigidity–“AmIstillincontrol?”

K. ConsequencesofStress• Stressis“thenonspecificresponseofthebodybonanydemand.”–Dr.HansSelye• Canhaveapsychosocialorbiogenicorientation• Adrenalineandcortisol

1. Constrictscapillaries2. Reducesthebody’sabilitytoflushoutbadcholesterol3. Promotesheartdisease4. Impacts a person’s ability for short-term memory and can cause cognitionproblems

• 25%ofallprescriptionswrittenareforpsychotropicdrugs.–U.S.Dept.ofHealthand

HumanServices

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II.CompassionFatigue

A. Thetermwasfirstcoinedintheearly1990sbyCharlesFigley.

B. Itissometimesreferredtoassecondaryorvicarioustrauma.

C. Theeffectsofstress,likesleeploss,arecumulative.

D. TwoTypesofStress• Thestressoftheministryorprofession• Thestressbroughtintotheministryorprofession• “Ismy profession causing the stress and problems inmy life, or is it revealing the

stressandproblemsinmylife?

E. SurvivingCounselingStress• Learntodepersonalizetheprocessandlimittimearoundnegativepeople.• Don’tforgetone’sFirstLovebecauseapersonisnottheministry.• Learntorestandslowdownthepaceofchange.• Learntobesilentandstill.• Seektogiveone’sburdenstoGodeveryday.• Learntotriageone’sdailyandlifeevents.• Learntohaverealisticexpectationsofoneselfandothers.

• Laugh.Donotlosethecapacityforjoy.

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• Payattentiontoone’sdietandexercise.• Learntoresolvethosethingsthatcanbeattendedtoquicklyandeasily.

• Learntomanageone’stimebysaying“no.”• Learntodelegate.• Findoneortwokeypeopleinone’slifetobeaccountableto.

III.Conclusion

A. John16:33-“ThesethingsIhavespokentoyou,thatinMeyoumayhavepeace.Intheworldyouwillhavetribulation;butbeofgoodcheer,Ihaveovercometheworld.”

B. WhatisGodimpressingonone’slifetochange?

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1. What were some of the ways mentioned in the video that people tend to handleexpectations?Arethesewayshealthy?

2. Discussthebuildingblocksofstress.

3. How are adrenaline and cortisol linked to stress, and why is this important tounderstand?

4. Whatiscompassionfatigue?

5. What are some areas that one needs to personally change thatwould foster betterself-careandhelponesurvivethestressofcounseling?

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CRAS112:

CommunityResponseandCulturalDifferences

LeroyScott,M.S.,M.Div.and

PatMiersma,Ph.D.

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CourseDescriptionCulturalcompetenceisanimportantelementofworkingwithindividualsthathaveexperiencedtrauma or crisis situations. Community responses and cultural differences impact theeffectivenessof servicedelivery. Thepresenterswill address issues suchashow toengageaclient from a different culture, the importance of community and involvement in urbancommunities,andhowtogetthroughtheredtape,politics,andprotocoltoprovidethehighestquality service possible. This lesson defines the basic components of cultural competence intreatingvictimsofcrisisandtrauma.

1. Participantswillbeabletodevelopanunderstandingoftheneedforculturalsensitivity

incrisisandtraumaresponses.

2. Participants will be able to identify strategies for addressing issues concerningcommunitybasedresources,politics,andredtape.

3. Participantswillbeabletoreviewtheimpactofmulticulturaldifferenceswithinfamilies

inprovidingcrisisintervention.

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I.WhyBeCulturallySensitive?

A. God cares for humanity, which encompasses a variety of people, ethnicities, andcultures.

B. Culture impacts a person’s thoughts, understanding, relevance of suffering, andexpressionoffeelings.

C. Languageinfluencesbothexpression,aswellasoptions,forobtaininghelp.

II.CulturalCompetency

A. Amain focusofculturalcompetencyshouldbe joiningandconnectingwitha familymembertoempowerthatfamilytowardthetruth.

B. Whenthehelperreallybeginstounderstandthecultureofanotherperson,thereisanopportunitytodifferentiatethemselves,aswellasanopportunitytoavoidprejudices.

C. The culturally competent helper spends a vast amount of time learning about theculturetheyseektohelp.

D. DonottakeforgrantedthatacommonAmericanresponsetoacrisiswillbethesameforapersonfromadifferentculture.

E. Domesticcrisisresponseoccursatthreelevels:Federal,State,andLocal.

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F. Themore impoverished, disenfranchised, and economically broken the community,thelessresourcesareavailable.

G. Thechurchhasasignificantresponsibilityinreachingouttothecommunity.

III.TraumaandCulture

A. Whenpeopleexperiencetrauma,theyseektofindmeaningandawaytoexpressthatmeaning.

B. Not only is the body affected in a trauma, the mind, the soul, and the spirit areimpacted.

C. TheWordofGodcanbreakthroughandtranscendcultures,byvaluingandaffirmingculture, but also by bringing light to show how things in culture can lead peopleastray.

D. Thefirst72hoursarecriticalandtheonlythingpeopleneedtoknowisthatsomeoneistheretohelp.

E. Inacrisisoffaith,acounselorcanbethereuntilapersonisreadytodealwiththeirquestions.

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1. Discuss various reasons regarding why it is important to be culturally sensitive assomeoneinthehelpingprofession.

2. Specifically,whatdoescultureimpactaboutaperson?

3. The presenters discussed the role of the church, and how it has a significantresponsibilityinhelpingpeopleofalldifferentculturesintraumasituations.Whatcouldthispracticallylooklikeinaperson’slocalcity?

4. Discussthefollowingstatementreferencedinthevideo:“TheWordofGodcanbreakthroughandtranscendcultures…”

5. Whataresomewaysthatonecanpersonallyenhancehis/herculturalcompetency?

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Nopartofthispublicationmaybereproducedinanyformwithouttheexpressedwritten

permissionoftheAmericanAssociationofChristianCounselors.

AACCPOBox739

Forest,VA24551

MemberServices:1-800-526-8673

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