DEALING WITH TRAUMADEALING WITH TRAUMA

TRAUMA IS TRANSFORMINGTRAUMA IS TRANSFORMING IT IS LIKE A SLOW HEALING SICKNESSIT IS LIKE A SLOW HEALING SICKNESS IT ISOLATES US FROM OTHERSIT ISOLATES US FROM OTHERS DEFENCE MECHANISMS ARE STRONGDEFENCE MECHANISMS ARE STRONG WE FEEL INSECURE IN THE WORLDWE FEEL INSECURE IN THE WORLD ALL HAS BECOME UNSAFEALL HAS BECOME UNSAFE WE FACE AND EXISTENTIAL CRISISWE FACE AND EXISTENTIAL CRISIS

TRAUMATOLOGYTRAUMATOLOGY

SEMINAR NOTES FROM SEMINAR NOTES FROM PRESENTATIONS DELIVERED IN 2004PRESENTATIONS DELIVERED IN 2004

BY DR JOHN C MCEWANBY DR JOHN C MCEWAN

ALL MATERIAL © DR JOHN C MCEWANALL MATERIAL © DR JOHN C MCEWAN 1 JANUARY 20041 JANUARY 2004

DEFINITIONSDEFINITIONS

1.1. FAILURE OF THE G.A.S. TO FAILURE OF THE G.A.S. TO HANDLE OVERWHELMING DEMANDS = HANDLE OVERWHELMING DEMANDS = THE HORMONAL SYSTEM COLLAPSESTHE HORMONAL SYSTEM COLLAPSES

2.2. TOO MUCH STIMULI OVERTAXING TOO MUCH STIMULI OVERTAXING COPING ABILITY = NO PROCESSINGCOPING ABILITY = NO PROCESSING

3.3. RESPONSE TO THREAT RESPONSE TO THREAT PARALYZES AS WE PERCEIVE WE ARE PARALYZES AS WE PERCEIVE WE ARE UNABLE TO COPE WITH THE DANGERS.UNABLE TO COPE WITH THE DANGERS.

A WORKING DEFINITIONA WORKING DEFINITION

““TRAUMA IS WHERE OVERWHELMING TRAUMA IS WHERE OVERWHELMING DEMANDS ARE PLACED INTENSELY ON DEMANDS ARE PLACED INTENSELY ON AN INDIVIDUAL, SO THAT THEIR AN INDIVIDUAL, SO THAT THEIR COPING RESOURCES ARE EXHAUSTED COPING RESOURCES ARE EXHAUSTED IN A VERY SHORT TIME. THE STRESS IN A VERY SHORT TIME. THE STRESS REACTION SWITCHES ON AND GOES REACTION SWITCHES ON AND GOES INTO OVERDRIVE. IT INVOLVES INTO OVERDRIVE. IT INVOLVES MULTI FOCAL STRESSORS, HAS A MULTI FOCAL STRESSORS, HAS A HEAVY GRIEF COMPONENT, AND HEAVY GRIEF COMPONENT, AND PROVOKES AN EXISTENTIAL CRISIS”.PROVOKES AN EXISTENTIAL CRISIS”.

WHAT IT DOES TO USWHAT IT DOES TO US

1.1. IT TAXES OUR RESOURCES FOR IT TAXES OUR RESOURCES FOR COPING. ASSESSMENT/APPRAISAL.COPING. ASSESSMENT/APPRAISAL.

2.2. PERCEPTION=WE CANNOT MEET PERCEPTION=WE CANNOT MEET THIS THREAT! HARM AND LOSS!THIS THREAT! HARM AND LOSS!

3.3. CONSEQUENCES ARE FEARED.CONSEQUENCES ARE FEARED. 4.4. THE SYSTEM TURNS ON ITSELF THE SYSTEM TURNS ON ITSELF

AND BY OVER-REVVING RUNS US AND BY OVER-REVVING RUNS US DOWNDOWN

THE VARIABLESTHE VARIABLES

1.1. THE TYPE OF DISASTERTHE TYPE OF DISASTER 2.2. DURATION AND INTENSITYDURATION AND INTENSITY 3.3. PERSONAL IMPACT/CONTROL FELTPERSONAL IMPACT/CONTROL FELT 4.4. POTENTIAL FOR RECURRENCEPOTENTIAL FOR RECURRENCE 5.5. CONTROL PERCEIVED 4 FUTURECONTROL PERCEIVED 4 FUTURE 6.6. PREVIOUS EXPERIENCESPREVIOUS EXPERIENCES 7.7. PERSONAL FITNESS/HEALTHPERSONAL FITNESS/HEALTH 8.8. AGE/STAGE LIFE TRANSITIONSAGE/STAGE LIFE TRANSITIONS

DEATH AS A STRESSORDEATH AS A STRESSOR

1.1. CLOSENESSCLOSENESS 2.2. AGE OF THE DEADAGE OF THE DEAD 3.3. ACCEPTANCE, ATTITUDESACCEPTANCE, ATTITUDES 4.4. SUPPORT STRUCTURESSUPPORT STRUCTURES 5.5. EXPRESSION OF EMOTIONEXPRESSION OF EMOTION 6.6. CHANGES THAT DEATH WILL CHANGES THAT DEATH WILL

MAKEMAKE 7.7. NUMBER/MANNER OF DEATHNUMBER/MANNER OF DEATH

THE PRIMAL RESPONSETHE PRIMAL RESPONSE

FOCUSFOCUS SIGHTSIGHT FEELFEEL TEAM WORKTEAM WORK FLEXIBILITYFLEXIBILITY SUSTAINABLE ROUTINESSUSTAINABLE ROUTINES TENACITYTENACITY SMELLSMELL STRENGTHSTRENGTH FOODFOOD COMMUNICATIONCOMMUNICATION PLANNINGPLANNING

DEBRIEFING AROUND THE FIREDEBRIEFING AROUND THE FIRE SONGS, POEMS, ART, SPEACHESSONGS, POEMS, ART, SPEACHES

TRAUMA COPING “VIRTUES”TRAUMA COPING “VIRTUES”

ANCESTRAL VIRTUES HAD COPING ANCESTRAL VIRTUES HAD COPING VALUE AFTER PRIMAL VALUE AFTER PRIMAL CONFRONTATIONS WITH DEATH!CONFRONTATIONS WITH DEATH!

CHARACTER SURVIVAL AIDSCHARACTER SURVIVAL AIDS TENACITYTENACITY STRENGTHSTRENGTH COURAGECOURAGE LOYALTYLOYALTY JUSTICEJUSTICE HONESTYHONESTY TEAM WORKTEAM WORK INDEPENDENCEINDEPENDENCE

COMPLICATORSCOMPLICATORS

1.1. PHYSICAL ENVIRONMENTPHYSICAL ENVIRONMENT 2.2. PERCEIVED CONTROLPERCEIVED CONTROL 3.3. RELATIONSHIPSRELATIONSHIPS 4.4. HOME BASEHOME BASE 5.5. RECOGNITIONRECOGNITION 6.6. LIFE CHANGES EXPERIENCEDLIFE CHANGES EXPERIENCED 7.7. PERSONAL PROBLEMS BEFOREPERSONAL PROBLEMS BEFORE

STRESS BUFFERSSTRESS BUFFERS

1.1. EMOTIONAL SUPPORTEMOTIONAL SUPPORT 2.2. ESTEEM SUPPORTESTEEM SUPPORT 3.3. PHYSICAL SUPPORTPHYSICAL SUPPORT 4.4. INFORMATION SUPPORTINFORMATION SUPPORT 5.5. SOCIAL NETWORKSOCIAL NETWORK 6.6. TEMPERAMENT HARDINESSTEMPERAMENT HARDINESS 7.7. CONDITIONED HARDINESSCONDITIONED HARDINESS 8.8. PERCEIVED CONTROLPERCEIVED CONTROL

HARDINESS PROFILEHARDINESS PROFILE 1.1. LEADERSHIPLEADERSHIP 2.2. THEY GET STUCK INTO TASKSTHEY GET STUCK INTO TASKS 3.3. SUPPORT WITHOUT COMPLAINTSUPPORT WITHOUT COMPLAINT 4.4. INTELLIGENTINTELLIGENT 5.5. CALM UNDER PRESSURECALM UNDER PRESSURE 6.6. EMOTIONALLY STABLEEMOTIONALLY STABLE 7.7. RELATIONSHIPS STABLERELATIONSHIPS STABLE 8.8. GOOD HEALTHGOOD HEALTH 9.9. FAST WITH MOTOR SKILLSFAST WITH MOTOR SKILLS 10.10. EXTROVERTEXTROVERT 11.11. NOT THE OLDEST IN FAMILYNOT THE OLDEST IN FAMILY 12.12. FULLY TRAINEDFULLY TRAINED

CONTROL ENHANCERSCONTROL ENHANCERS

1.1. ACTIVITYACTIVITY 2.2. INFORMATIONINFORMATION 3.3. FAITH/PHILOSOPHYFAITH/PHILOSOPHY 4.4. RELAXATION STRATEGIESRELAXATION STRATEGIES 5.5. PERSONAL LIFE GOALSPERSONAL LIFE GOALS 6.6. NO UNSOLVED ISSUESNO UNSOLVED ISSUES 7.7. GOOD ROLE MODELS GOOD ROLE MODELS

ACUTE STRESS DISORDERACUTE STRESS DISORDER

PTSD IS PTSD IS NOTNOT SPOKEN OF BEFORE SPOKEN OF BEFORE THREE MONTHSTHREE MONTHS

ACUTE STRESS DISORDER INVOLVESACUTE STRESS DISORDER INVOLVES HIGH INTRUSION – DREAMS, FLASHBACKS HIGH INTRUSION – DREAMS, FLASHBACKS

MEMORIES COMING IN UNWANTEDMEMORIES COMING IN UNWANTED AVOIDANCE AND NUMBING RESPONSES AVOIDANCE AND NUMBING RESPONSES

AS WE TRY TO BLOCK OUT DISTRESSAS WE TRY TO BLOCK OUT DISTRESS HYPER-AROUSAL – STARTLE RESPONSE HYPER-AROUSAL – STARTLE RESPONSE

AND IRRITABILITY AND ANGERAND IRRITABILITY AND ANGER

CISMCISM CRITICAL INCIDENT STRESS MANAGEMENT CRITICAL INCIDENT STRESS MANAGEMENT

INVOLVES MANY FACTORS WORKING INVOLVES MANY FACTORS WORKING TOGETHER.TOGETHER.

CLEAR POLICIES /ACCOUNTABILITYCLEAR POLICIES /ACCOUNTABILITY EDUCATION ON STRESS/TRAUMA FOR ALLEDUCATION ON STRESS/TRAUMA FOR ALL PEER SUPPORT PROGRAMPEER SUPPORT PROGRAM TRAINING/SUPPORT FOR PEERSTRAINING/SUPPORT FOR PEERS COUNSELLING ONE TO ONECOUNSELLING ONE TO ONE DEBRIEFINGS/DEFUSINGSDEBRIEFINGS/DEFUSINGS SPOUSAL SUPPORTSPOUSAL SUPPORT

DEBRIEFING Part 1DEBRIEFING Part 1

STAGE ONESTAGE ONE INTRODUCTIONINTRODUCTION ACKNOWLEDGE, SUPPORT, HEAR,ACKNOWLEDGE, SUPPORT, HEAR, REASSURE, STRESS MANAGE, NOT ANREASSURE, STRESS MANAGE, NOT AN OPERATIONAL BRIEF.OPERATIONAL BRIEF. CONFIDENTIALITYCONFIDENTIALITY NO BREAKS UNTIL FINISHEDNO BREAKS UNTIL FINISHED QUESTIONSQUESTIONS

DEBRIEFING Parts 2 and 3DEBRIEFING Parts 2 and 3

STAGE 2STAGE 2 FACTS STAGEFACTS STAGE INTRODUCE YOURSELFINTRODUCE YOURSELF EXPLAIN WHAT YOUR ROLE WASEXPLAIN WHAT YOUR ROLE WAS

STAGE 3STAGE 3 THOUGHTS STAGETHOUGHTS STAGE WHAT WERE YOUR FIRST THOUGHTSWHAT WERE YOUR FIRST THOUGHTS WHAT WERE YOU THINKING AT THE TIMEWHAT WERE YOU THINKING AT THE TIME WHAT THOUGHTS DID YOU TAKE AWAYWHAT THOUGHTS DID YOU TAKE AWAY WHAT THOUGHTS HAVE STAYED WITH YOUWHAT THOUGHTS HAVE STAYED WITH YOU

DEBRIEFING STAGES 4 AND 5DEBRIEFING STAGES 4 AND 5

STAGE 4STAGE 4 REACTIONS STAGEREACTIONS STAGE WHAT WAS THE WORST THING FOR YOUWHAT WAS THE WORST THING FOR YOU WHAT HAD THE GREATEST IMPACTWHAT HAD THE GREATEST IMPACT IF YOU COULD ELIMINATE ONE THINGIF YOU COULD ELIMINATE ONE THING

STAGE 5STAGE 5 SYMPTOMS STAGESYMPTOMS STAGE HOW DO YOU KNOW THIS HAD IMPACTHOW DO YOU KNOW THIS HAD IMPACT HOW HAS YOUR BEHAVIOUR CHANGEDHOW HAS YOUR BEHAVIOUR CHANGED ANYTHING DIFFERENT ABOUT YOUANYTHING DIFFERENT ABOUT YOU ANY DISTRESS SINCE THE INCIDENTANY DISTRESS SINCE THE INCIDENT

DEBRIEFING STAGES 6 AND 7DEBRIEFING STAGES 6 AND 7

STAGE 6STAGE 6 TEACHING STAGETEACHING STAGE PHYSIOLOGY OF STRESS/TRAUMAPHYSIOLOGY OF STRESS/TRAUMA SYMPTOMS - DANGERS - GPSYMPTOMS - DANGERS - GP RECOVERY STRATEGIESRECOVERY STRATEGIES

STAGE 7STAGE 7 RE-ENTRY STAGERE-ENTRY STAGE ACTIVE NOT PASSIVEACTIVE NOT PASSIVE SUPPORT NETWORKSSUPPORT NETWORKS WHAT IFSWHAT IFS QUESTIONSQUESTIONS