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Treating PTSD: Natural Disasters, Sexual Abuse & Combat
Treating PTSD: Natural Disasters, Sexual Abuse & Combat

Section 3
Track #3 - Treating Clogged Survival Instincts & the 'Easy Questions' Exercise for Young Clients

CEU Question 3 | CEU Answer Booklet | Table of Contents | PTSD
Social Worker CEUs, Psychologist CEs, Counselor CEUs, MFT CEUs, Nurse CEUs

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On the last track, we discussed the three ways clients re-experience a traumatic events via sleep disturbances; flashbacks; and emotional recall.  We also included a technique to help you identify what type of trauma re-experience your client is undergoing called the “Re-experiencing Trauma Quiz.” found in your manual.

On this track, we will examine types of adaptation reactions to trauma to include emotional numbing, trigger avoidance, and hypervigilance.  In this track, we will also discuss PTSD resulting from sexual abuse and natural disasters.  As you listen to these ask yourself if playing this track would be appropriate for your next session with a PTSD client.

3 Adaptation Reactions to Trauma

Share on Facebook #1 Emotional Numbing
The first type of adaptation reaction is emotional numbing.  As you are aware, emotional numbing is a survival technique which occurs in much the same way that physical numbing does.  When a client experiences extreme physical pain, his or her body releases a natural anesthetic that keeps the client from feeling the wound immediately. 

Likewise, those clients exposed to psychological trauma experience a complete shutdown of their emotions so that their feelings will not clog their survival instincts. 

A trauma client, Christie age 18, was raped by a stranger when she was 16.  Christie stated that during the assault, she doesn’t remember specific feelings.  She said, “Right before it happened, I remember being scared and alert, but while it was happening, I could only think about how I was going to stay alive.  How I was going to keep him from killing me.  He left me in the back of a truck and went into a gas station.  That’s when I got loose and ran for help.” 

As you can see, Christie’s mind sent out an emotional anesthesia that kept the emotion of fear from taking over her mind.  Because she wasn’t overwhelmed by this emotion, Christie was able to escape from her captor and survive the ordeal. 

Think of your trauma client.  Has he or she experienced emotional numbing, like Christie had?  Would it be beneficial to discuss this in your next session or play this track in the session?

Share on Facebook #2 Trigger Avoidance
A second type of adaptation reaction is trigger avoidance.  As we discussed on track 2, re-experiencing a trauma is a painful reliving of the ordeal and may call up some of the emotions that a client underwent or numbed during the trauma. As a result, survivors avoid triggers that might incite the powerful emotions to once again take over. 

Have you found, like I, that each individual trauma client has his or her own set of triggers? 

Joel, a client of mine, had survived an earthquake which killed two other people, including his fiancée.  Because of this, Joel could not stand the sound of breaking glass or any sort of rumblings.  Such things as construction sights where workers would be using loud equipment would cause Joel to hyperventilate.  As you can see, loud rumbling noises are clearly Joel’s triggers resulting from the fatal earthquake.  We will discuss triggers more thoroughly on a later track.

Share on Facebook Technique:  Calming Breath
To help Joel with his hyperventilation, I suggested he try the “Calming Breath” exercise which would control his intake of oxygen.  Would calming breaths be a good topic in your next session? 

I asked Joel to listen and complete the following instructions when he felt his breathing getting shallow:

  1. Breathing from your abdomen, inhale slowly to a count of five.  Count slowly as you inhale.
  2. Pause and hold your breath to a count of five.
  3. Exhale slowly, through your nose or mouth, to a count of five, or more if it takes you longer.  Be sure to exhale fully.
  4. When you’ve exhaled completely, take two breaths in your normal rhythm, and then repeat steps 1 through 3 in the cycle above.
  5. Keep up the exercise for at least three minutes.  This should involve going through at least ten cycles of in-five, hold-five, and out-five.  Remember to take two normal breaths between each cycle.  If your client starts to feel light-headed while practicing this exercise, stop for 30 seconds and then start again.
  6. Throughout the exercise, keep have your client keep breathing smooth and regular, without gulping in breaths or breathing suddenly.
  7. If you wish, each time your client exhales, you suggest they say “relax,” “calm,” “let go,” or any other relaxing word or phrase silently to yourself.  Allow your whole body to let go as you do this.

The next several times that Joel felt he was beginning to lose control of his breathing, he used this exercise and later stated, “Incredible.  I felt so much calmer.  Not completely calm, but just enough that I wouldn’t pass out with so much oxygen.”  As you can see, by sometimes treating just the symptoms of a re-experience attack, the client may become more in control of their surroundings and bodily reactions.

Share on Facebook #3 Hypervigilance Technique:  Easy Questions
The third type of adaptation reaction is hypervigilance.  As you are probably well aware, hypervigilance is the state in which a trauma client undergoes fight-or-flight and freeze reactions even when no real danger exists.  Adrenalin or noradrenalin is pumped into the client’s system.  When adrenalin is produced, clients may feel extremely alert and such things as heart rate, blood-pressure, and blood-sugar are heightened. 

This is what is known as the fight-or-flight reaction.  On the other hand, if a client’s adrenal glands produce noradrenalin, an opposite reaction occurs:  freezing

Have you ever heard a trauma client say, “I don’t know what happened, I just froze”?  Some have described it as moving or thinking in slow motion. 

Daniel, a 9 year old client of mine, had witnessed his mother raped and beaten by his father.  However, when I asked him if he had been experiencing hypervigilance, he didn’t quite understand. 

To make the concept more comprehensible for the young boy, I asked him the following, more specific questions.  You may consider using this questionnaire for those young or mentally handicapped clients who have a hard time understanding these ideas. 

I call this kind of inquiry “Easy Questions”.

  1. Is it hard to fall asleep or stay asleep at night?  Do you have bad nightmares?  Do you sometimes wake up and your sheets are all over the bed?
  2. Do you sometimes get mad for no reason?  Do you sometimes get so mad that you throw things or break things?  If you do get that mad, do you feel you can’t feel better until you’ve broken something?  Do you ever shout at your family or friends?
  3. Are you always afraid something might happen to your friends or family now?  Do you feel like they are always in danger?
  4. Do you jump at loud noises, like a bat hitting a ball?

After I had finished asking these questions, I had learned that Daniel had excessive nightmares, all involving his father.  Also, he had become gradually more irritable over the weeks, throwing toys, pillows, and pushing over furniture.  Most notably, Daniel appointed himself protector over his family. 

Even though he was living at his grandmother’s house and his father was in jail, Daniel was always the first one to tell people to buckle up, wear a helmet, look both ways when crossing the street, and other ways that a nine-year-old knows how to protect others. As you can clearly see, Daniel was suffering from severe hypervigilance and at such an early age, if not treated, this sense of over-protecting his loved ones may spill over into his adult life.

On this track we discussed types of adaptation reactions to trauma.  These were emotional numbing, trigger avoidance, and hypervigilance.

On the next track, we will examine depression and its various manifestations when linked to PTSD:  behavioral depression. We will link depression to learned helplessness; repressed anger; and loss and grief.

Online Continuing Education QUESTION 3
What are three types of adaptation reactions to trauma? To select and enter your answer go to CEU Answer Booklet.

 
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Treating PTSD: Natural Disasters, Sexual Abuse & Combat

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