Read Therapeutic Groups with Adult Trauma Survivors text version

Anita S. Treloar, Ph.D. April 29, 2011

4/29/2011

Therapeutic Groups With Adult Trauma Survivors - Anita Treloar (copyright)

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Presentation Objectives

Participants will understand the basic theoretical basis

for Seeking Safety and Acceptance and Commitment Therapy (ACT) groups for adult trauma survivors. Participants will learn the basic structure of Seeking Safety Groups. Participants will learn the structure and content of one example of an ACT group which can be provided for trauma survivors.

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Therapeutic Groups With Adult Trauma Survivors - Anita Treloar (copyright)

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Credits

Information on Seeking Safety Treatment and

Acceptance and Commitment Therapy is derived from resources noted in Resource List.

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Therapeutic Groups With Adult Trauma Survivors - Anita Treloar (copyright)

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Post-traumatic Stress Disorder (PTSD)

Person exposed to traumatic event that Involved actual or threat of death or injury Involved experience of intense fear, helplessness, or horror Traumatic event is persistently reexperienced Persistent avoidance and numbing Persistent symptoms of increased arousal

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Co-occurrence of PTSD and Substance Abuse

High co-occurrence of PTSD and Substance Abuse PTSD can elicit substance abuse (e.g., for coping),

which can make client more vulnerable to further trauma Recovery from substance use can trigger PTSD or memories the substance had been blunting Therapy re. PTSD can trigger substance abuse to cope with memories Therefore best to treat them together (e.g., Seeking Safety approach)

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Stages of Healing from PTSD and Substance Abuse*

1.

Safety: Goals ­

Free self from substance abuse Stay alive Build healthy relationships Gain control over own feelings Learn to cope with day-to-day problems Protect self from destructive people and situations Not hurt self or other Increase functioning Attain stability

*From Seeking Safety p. 101, derived in part from Herman, 1992.

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Stages of Healing from PTSD and Substance Abuse (continued)*

2. Mourning the past: losses and pain experienced. 3. Reconnection with the world in joyful ways: thriving, enjoying life, able to work and relate well to others. *From Seeking Safety p. 101, derived in part from Herman, 1992.

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Theoretical Considerations: Learning Curve

Individuals learn best at moderate levels of challenge.

Too low challenge: boredom, inattention Too high challenge: overload, shut down Moderate challenge: optimal learning

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Theoretical Considerations: Therapeutic Pacing

Pace therapeutic challenge for clients' moderate range. "Building emotional muscle." Building ego strength, client's "observing ego."

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Theoretical Considerations: Session Cognitive-Affective Curve

Generally: start with cognitive, move to affective work,

end with cognitive.

Don't go deeper than the client can contain.

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Advantages of Group Treatment of Trauma Survivors

Reduces stigma and feeling of isolation; they know

they are not alone Clients can learn from each other's experiences Mutual support is empowering

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Challenges to Group Treatment of Trauma Survivors

Contagion of trauma stories/pain can trigger

memories or "flooding" One client's trauma can "hijack" a group session Boundary problems can create rescuer, victim, persecutor roles, etc.

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Seeking Safety Treatment Approach

Considered an evidence based best practice Can be used individually or in groups Focus on Safety Stage of Healing Mourning work may take place in parallel individual

sessions. During mourning work, participants may often need to return to safety stage.

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Seeking Safety Content

Four content areas: cognitive, behavioral,

interpersonal, and case management Structured format of each session Present- and problem-oriented to reduce symptoms Psycho-educational Affective components are contained in a cognitive structure.

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Seeking Safety Topics

Examples: Safety PTSD: Taking Back Your Power Detaching from Emotional Pain (Grounding) When Substances Control You Taking Good Care of Yourself Integrating the Split Self Recovery Thinking Healthy Relationships

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Seeking Safety Group Description

Women's Seeking Safety Group First Nations Community HealthSource What is the Women's Seeking Safety Group Approach? The Women's Seeking Safety Group is for women who have experienced trauma and related issues such as substance abuse and domestic violence, and are seeking a safer, healthier life. Sessions will include both information and the opportunity to share. Participants are usually also involved in individual counseling. Is this group right for me? This group may be right for you if: You are experiencing consequences of unhealthy choices in your life. You have experienced a traumatic event or events. You have difficulty maintaining positive, safe relationships. Memories or feelings about the traumatic event make it hard to stay clean and sober, or to make healthy choices. Focus on safety The #1 goal of these sessions is to help you be safe. "Safety" includes the ability to: Manage trauma symptoms (such as flashbacks, nightmares and negative feelings) Cope with life without using substances Take good care of yourself Find safe people who can be supportive of you Free yourself from domestic violence or other abusive relationships Prevent self-destructive acts (such as cutting, suicidal thoughts, unsafe sex) Find ways to feel good about yourself and enjoy life.

How can I join this group? Individuals interested in joining this group may contact Anita Treloar at 262-6586 or the Behavioral Health receptionist at 262-6520. Membership is open to clients involved in individual therapy through FNCH Behavioral Health services. Sessions will be Wednesdays from 4:00-5:30 p.m. New members may join by coming at 3:30 p.m. on their first Wednesday to meet with Anita for group orientation.

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Seeking Safety Treatment Agreement

Includes safety, honesty, confidentiality Group treatment agreement includes Not discussing details of trauma or substance use Contact with members outside sessions is discouraged

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Seeking Safety Group Structure

Check-in: How are you feeling? What good coping have you done? Any substance use or other unsafe behavior? Did you complete your commitment? Community resource update? The quotation (with discussion) Session topic: readings and discussion related to participants'

lives Check-out

One thing got out of today's session New commitment What community resource will you call?

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Seeking Safety Approach

Questions; Discussion

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Acceptance and Commitment Therapy (ACT)*: Core Concepts

Mindfulness: being in the present Acceptance (not the same as agreement) Commitment to valued action

*Steven Hayes; see Resource List

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Goals of ACT

Psychological flexibility (see pre- post-assessment

tool) Requires facing pain that individual may have been avoiding: this confronts the avoidance strategy of PTSD

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Clients Most Appropriate for ACT Group*

Preferably clients have demonstrated ability to keep

themselves safe. Some may have completed Seeking Safety Group. Ability and willingness to use a complex cognitive approach. Especially helpful with clients who have felt stuck in their progress and want to move forward in their lives. *Note: Group is developed from resources noted in Resource List

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ACT Group

Acceptance and Commitment Therapy (ACT)

Helps individuals to:

Accept Your Reactions and Be Present Choose a Valued Direction Take Action

This approach is helpful for those experiencing: Depression, anxiety, substance abuse, post-traumatic stress, chronic pain, medical issues, and stress.

New twelve week cohort for men and women will start December 3, 2010 at 2:00 p.m. at FNCH Behavioral Health Services, and will meet Fridays from 2:00-3:30. The group is open to FNCH BH clients with assigned individual therapists. Come join us! For information, contact Anita Treloar at 262-6520.

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ACT Group Topics*

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

Introduction: ground rules, introduction, pre-test Avoidance and Control; Pain and Suffering Pain and Suffering (continued) Acceptance and Willingness Passengers on the Bus Defusion: Handling the Passengers Defusion (continued) Who Am I? Values #1 Values (continued) Committed Action Graduation *Developed from materials in Resource List by Anita Treloar.

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ACT Group Format: 12 week cohort model

Check in (thoughts and feelings since last session;

application of last sessions material) Information Application through discussion and/or written material Check out (what learned, reactions, application to the week ahead) Mindfulness exercise (ground in present)

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ACT Group

Comments Discussion

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Resource List

Follette, V.M. & Pistorello, J. (2007). Finding life beyond

trauma: Using Acceptance and Commitment Therapy to heal from Post-traumatic Stress and trauma-related problems. Oakland, CA: New Harbinger. Hayes, S.C. (1999). Acceptance and Commitment Therapy: An experiential approach to behavior change. New York: Guilford Press. Hayes, S.C. (2005). Get out of your mind and into your life. Oakland, CA: New Harbinger. Herman, J.L. (1992). Trauma and Recovery. New York: Basic Books. Najavits, L.M. (2002). Seeking Safety: A treatment manual for PTSD and substance abuse. New York: Guilford Press.

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Resource List (continued)

First Nations Community HealthSource, Behavioral

Health Services, 5608 Zuni Rd. SE, Albuquerque, NM 87108, 505-262-6520. [email protected]

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