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

Section 14
Appendix: Reproducible Client Worksheets
Based on CD

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Trigger Coping Questionnaire
Replay CD track 2 for more information about this technique.
Client answers following questions related to their trigger and trigger coping style to help develop goals.

  1. What are your fears about this trigger?  Cho answered, "I have fear that I will embarrass myself and throw up in sight of strangers."
  2. How have you usually reacted in the past?  Cho wrote, "I run to bathroom or run away from the smell.  I get angry, too.  In prison, I screamed and cursed the guards.  I tried to throw up on them when they beat me.  When I smell the rice, I want to tell people around me that I hate them."
  3. What have been the costs of avoiding this trigger or of handling the trigger with fear, anger, or other emotions associated with the trauma?  Cho answered, "My favorite foods are Asian foods.  I can’t eat at Asian restaurants with friends anymore."
  4. How would you like to react in the future?  Cho wrote, "I want to be happy with my friends and eat the foods I like and go to restaurants I like."
  5. What do you stand to gain if you react in a way you feel would be more beneficial?  Cho responded, "I would have more friends.  I would be happy and forget the prison."
  6. How can you break down this trigger so you can face it more easily?  Because she had trouble with this step, we worked out a system together.  Cho decided to stand outside a restaurant that cooked rice for no more than five minutes while practicing some of the relaxation techniques we will discuss later.  Then, when she could cope after five minutes, she stood there for ten.  Eventually, she entered the restaurant itself where the smell was the strongest.  Gradually, Cho reduced her fear of the trigger, rice, but could never fully bring herself to eat it again, understandably.  However, the negative effect it had on her social life diminished and she could even sit at the same table while those around ate it.

Abdominal Breathing Exercise
Replay CD track 2 for more information about this technique.
Client completes the following deep breathing exercise to relieve tension resulting from a trigger attack.

  1. Note the level of tension you’re feeling.  Then place one hand on your stomach right beneath your ribs.
  2. Inhale slowly and deeply through your nose into the "bottom" of your lungs—in other words, send the air as low as you can.  If you’re breathing from your abdomen, you hand should actually rise.  Your chest should move slightly while your abdomen expands. 
  3. When you’ve taken in a full breath, pause for a moment and then exhale slowly through your nose or mouth, depending on your preference.  As you exhale, allow your whole body to just let go.  You might like to visualize your arms and legs going loose and limp like a rag doll.
  4. Do ten slow, full abdominal breaths.  Try to keep your breathing smooth and regular, without gulping in a big breath or letting your breath out all at once.  Remember to pause briefly at the end of each inhalation.  Count to ten, progressing with each exhalation.  The process should go like this:

               Slow inhale…pause…slow exhale (count one)
               Slow inhale…pause…slow exhale (count two)
And so on up to ten.  If you start to feel light-headed while practicing abdominal breathing, stop for 30     seconds and then start up again.

  1. Extend the exercise if you wish by doing two or three sets of abdominal breaths, remembering to count up to ten for each set. 

Self-Forgiveness Examination
Replay CD track 3 for more information about this technique.
Client completes the following questions to help them identify any feelings of guilt that they still may be harboring.

  1. Looking back over the trauma, for which behaviors, attitudes, and feelings do you still castigate or blame yourself?
  2. What would it take for you to forgive yourself for some of these behaviors, attitudes, and feelings?
  3. Is it possible for you to do whatever you have listed above so that you can forgive yourself?  If so, what is keeping you from pursuing whatever you need in order to make peace with this part of your past?
  4. Is there information you need that you might never be able to obtain before you can forgive yourself?  If so, your options are to try to forgive yourself anyway or to continue to punish yourself.  Who are you helping and what good are you doing in this world by punishing yourself?  Who would you harm if you forgave yourself?

Counting Method
Replay CD track 4 for more information on this technique.
Client gets one hundred seconds to emotionally recall a traumatic event.  Therapist counts to one hundred.

  1. Schedule this exercise at the beginning of the session so that you have enough time to discuss the emotions and recall during the rest of the session.
  2. Identify which traumatic memory the client wishes to recall. 
  3. Ask the client to recall the memory mentally and not to speak of what he or she is remembering.
  4. Begin counting from 1 to 100, keeping your eyes on the clock and counting off one number each second.
  5. At 93 or 94, say such statements as, "Back here" to assist the client’s return to reality.
  6. If the client appears dazed or confused, he or she had been able to recollect a trauma. 
  7. Reflect on the emotions the client underwent and try to end on a positive note. 

Gestalt Chairs
Replay CD track 5 for more information about this technique.
Client completes following exercises to help release feelings of guilt and blame.

  1. Arrange two chairs facing each other at an angle and have the client sit in one.
  2. Ask the client to take two, easy, deep breaths.  Tell them to relax and calm themselves as they prepare to touch honestly with their feelings. 
  3. Tell the client to imagine the target of their anger sitting in the other chair.  Ask them to notice what it is like being with this person. 
  4. Ask them to begin a dialogue starting with a positive statement. 
  5. Then ask them to move on to explain what they want. 
  6. Ask the client to tell their target what they are thinking or feelings by describing what happened and the impact of the offense. 
  7. Ask the client to change seats and ask them to voice the feelings of the target. 

Percentage of Responsibility
Replay CD track 6 for more information about this technique.
Using the following format, the client relates how he or she contributed to the traumatic event.

  1. Verbalize the details of the event in the first person. 
  2. What percentage of the event are you responsible for?  Are you sure?  Is it possible that the percentage is more than that; or less?
  3. Who else shared responsibility?  Others at the scene, people distant from the scene?  Societal influences? 
  4. Recalculate responsibility so that the total is 100 percent, and accurately focus on what you did and did not do.
  5. Describe how much you have suffered for the responsibility you have assigned yourself.

Taking Inventory
Replay CD track 7 for more information about this technique.
Client completes the following questions regarding his or her progress during therapy.

  1. What have you learned about how the conditions of trauma distorted your view of what occurred during the trauma, your role in causing the trauma, or influencing its outcome, your self-esteem, and you view of other people?
  2. What have you learned about yourself emotionally?
  3. Which emotions do you still struggle with?
  4. What are your most trying emotional situations today?
  5. Do you have any unfinished emotional work to do regarding the trauma or secondary wounding experiences?  If so, what?
  6. How did the trauma change your view of the meaning of life?
  7. How did the trauma change your view of human nature?

Refinding Yourself
Replay CD track 7 for more information about this technique.
Client answers the following questions regarding his or her life before the traumatic event.

  1. What did you do for fun?
  2. What were your major worries and anxieties?
  3. What did you like about yourself then?
  4. What didn’t you like about yourself?
  5. Who were your friends?
  6. How were you getting along with your family?
  7. Did you have any religious or spiritual beliefs?  If so, what were they?
  8. Did you have any firm philosophical or existential convictions?  If so, what were they?
  9. What dreams or goals did you have for your life, and what were your interests?
  10. Of the goals and interests you had prior to the trauma, which ones would you like to pursue now in the near future?
  11. Of the pretrauma goals and interests you are still drawn to, which would you realistically be able to pursue?  What obstacle would stand in your way?

Accentuating the Positive
Replay CD track 7 for more information about this technique.
Client completes the following steps to aid in building their self-esteem.

  1. Develop a list of ten positive statements about yourself that are meaningful, realistic, and true.
  2. Write these ten statements on a piece of paper. 
  3. Find a place to relax for fifteen to twenty minutes.  Meditate upon one statement and the evidences for its accuracy for a minute or two.  Repeat this for each statement.
  4. Repeat this exercise for ten days, adding an additional statement each day.
  5. Several times each day, look at an item on the list, and for about two minutes meditate on the evidence for its accuracy.
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