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:explode: TRAUMA :explode:, Cognitive Disorders & Examples, Common…

- - - - Communication Styles
        
        2) Passive Aggressive
        
        Often involves sarcasm, manipulation, the silent treatment; Indirect, deny there is a problem then show you anger through your actions; Role of a victim of martyr in order to invoke guilt in others; May lead from feelings of powerlessness to resentment; May show facial expressions that do not match what is said
        
        3) Aggressive
        
        Gaslighting: Form of emotional abuse whereby intentionally make someone feel crazy and that what they believe and what they feel is not true.
        
        Direct and dominating; Does not often compromise; Blames others for the problem at hand; Often appears angry or explosive; Often uses threats or intimidation to get what they want; Portray a factual sense of right and wrong; Demonstrate a need for control and power; Forces needs and opinions onto others; might bully someone into agreeing
        
        4) Assertive (balanced)
        
        State your feelings, needs and wants clearly, appropriately and respectfully; Take responsibility for one's own thoughts, feelings and actions; Listens to and considers others points of view; Makes compromises; Makes eye contact when speaking; Stands up for one's rights without violating the rights of others; Knows what they want; Presents facts rather than judgements
        
        1) Passive
        
        Not speaking up for yourself; Putting your needs after others or abandon your needs, People pleasing, Often afraid of conflict or anger
      - Locus of Control (Internal v External)
        (what is in our control vs. what is not in our control)
      - Skill: Wise Mind
        (R = Rational / L = Emotional) Brain) - Venn Diagram, in which Emotional and Rational brain (middle) work in harmony (if one is in drivers seat, acknowledge, and invite the other one in to co-pilot)
      - F.A.I.L Harder
        
        First
        
        Attempt
        
        In
        
        Learning
      - Healthy Boundaries
        
        Enmeshed
        
        Dependent
        
        Co-Dependent
        
        It is difficult to distinguish one partner from the other. This is called enmeshment or collapsed boundaries. Parters in an enmeshed relationship generally try to merge with the other to avoid the emptiness they feel when alone. This is troublesome, because partners either seek to lose themselves in the other or expect their partner to become lost in them
        
        Healthy
        
        People with healthy boundaries have developed an identity separate and distinct from others and are not dependent upon other to nurture their personal and spiritual growth. Boundaries are flexible - they grow and change. Boundaries can be lowered to promote intimacy or extended to promote safety
        
        Distant
        
        Each partner self-contained, having little impact on the other and little emotional connection. This is an emotionally distant relationship, detached relationship, or rigid boundaries. The boundaries in this relationship tend to be more like walls and prevent intimacy
      - Honesty Vs Dishonesty
        
        Two types of Dishonesty:
        
        Active Lying: you say something that isn't true.
        
        Passive Lying: You don't say something that is true (i.e., masking)
        
        Times when Honesty is less of an option:
        
        When being honest is not safe (e.g., the environment is not safe, honesty risks aggression)
        
        When you have tried before and found the person could not "hear" you (e.g., expressing a contrary opinion, sharing a vulnerable emotion)
        
        When full honest is not necessary
      - Problem Focus vs Solution Focus #
        
        Problem Focus
        
        Feeling of being controlled by others
        
        Person was wronged
        
        Things are being done to them
        
        Believes in an external locus of control; uses words like 'unable' or 'can't
        
        Feel externally regulated or controlled
        
        Sees problems as unsolvable
        
        Solution Focus
        
        "I make things happen"
        
        Is an active participant (takes responsibility, control, power, takes risks, makes decisions and chooses)
        
        Believes in Internal locus of control, uses words such as "able" and "can"
        
        Develops alternative behaviors; Problem solves for solutions
      - The Spectrum of Trust
        
        Blind Faith
        
        everyone is trustworthy; trust without evidence
        
        Reasonable Trust
        
        some are trustworthy; trust with evidence
        
        Paranoia
        
        nobody's trustworthy; distrust without evidence
      - Grieving Process
        
        Shock:
        
        Denial and Isolation:
        
        Anger:
        
        Bargaining:
        
        Depression:
        
        Acceptance :
        
        ("Does not mean you are okay with the loss, agree with the loss, that the loss was fair, or that the loss was not tragic.")
      - Dissociation & Dissociative Disorders
        
        Dissociation is thought of as a discontinuity in conscious awareness. One's conscious awareness can become disrupted in the realm of memory, identity or perception.
        These experiences exist along a continuum. On far end, dissociative disorders may develop asa reaction to trauma as a means of protecting oneself from intrusive emotions and memories
        
        Disorders:
        
        Depersonalization:
        
        Derealization:
        
        Dissociative amnesia:
        
        Identity alteration:
      - From Comfort Zone to Courage Zone
        
        (circle inside a circle)
      - Self Compassion = Self-Kindness + Common Humanity + Mindfulness
      - Stages of (intentional) Change
        
        Prochaska DiClemente, late 1970's
        
        Procontemplation:
        
        Contemplation:
        
        Preparation:
        
        Action:
        
        Maintenance:
        
        Relapse:
        
        <--(Circular Process)
    - - 7 Keys of Mindfulness
        (Kabat-Zinn)
        
        2. Patience: A form of wisdom, patience demonstrates that we accept the fact that things sometimes unfold in their own time. Allow for this
        
        3. Beginner's Mind: Remaining open and curious allows us to be receptive now possibilities and prevents us from getting stuck in the rut of our own expertise
        
        4. Trust: Develop a basic trust with yourself and your feelings. Know its OK to make mistakes
        
        5. Non-Striving: The goal is to be with yourself right here, right now. Pay attention to what is unfolding without trying to change anything
        
        6. Acceptance: See things as they are. This sets the stage for acting appropriately in your life no matter what is happening
        
        7. Letting Go: When we pay attention to our inner experience, we discover there are certain thoughts, emotions and situations the mind wants to hold onto. Let your experience be what it is right now.
        
        1. Non-Judging: Be an impartial witness to your own experience. Become aware of the constant stream of judging and reacting in inner and outer experience
    - - Assists in contacting the thoughts, emotions, memories and physical sensations associated with past traumas (that have previously been avoided)
      - Help prove a contained way for individuals to contact these internal experiences related to past trauma
      - Addresses patterns of avoidance inherent in trauma-related symptoms
    - - Treating the overlap of trauma-related symptoms and addition (think substance use, behavioral addictions, avoidant behaviors)
      - Integrates elements of CBT and interpersonal skill building to increase safe coping - with group focus on various topics such as ground, recovery thinking, and coping with triggers
    - - Combines elements of Behavioral Activation and CBT. Premise (adapted/diluted/integrated in Compass approaches) is - supposably weekly - individuals set goals for themselves aligned with individually identified treatment goals.
        At the end of the week, group will focus on pursuit of these goals and provide support and generate ideas to increase movement toward individually identified goals.
  - - - Defusing
        
        "I feel fear AND I am safe" (dialectic)
        Wise Mind - Middle Venn Diagram, Between Left Hemisphere (Logical) and Right (Emotional)
        
        Defusion Techniques
        
        "Is this moving me toward my values? Otherwise, let it go." --> Move toward your body and your values
        
        Labeling your thoughts: by saying, "I'm having the thought that..."
        
        Watching your thoughts come and go: Practice 'Leaves on a Stream', 'Clouds in the Sky, Balloons in the Sky, etc.
        
        Say it very slowly: Try saying your thoughts very slowly
        
        "Bad News Radio"
        
        Defusion (definition): Separating or distancing from our thoughts, letting them come and go instead of being caught up in them.
        
        Looking at thoughts rather than from thoughts (take "thought sunglasses" off)
        
        Noticing thoughts rather than getting caught up in them (we all have a lot of thoughts)!
        
        Letting thoughts come and go rather than holding onto them
        
        Able to notice the process of thinking and learn experientially that our thoughts do not control our actions
        
        Fusion (definition): Getting caught up in our thoughts and allowing them to dominate our behavior
      - "Getting Unstuck" (Dr. Isaac)
        
        F) Alternative Response
        
        "I am not my Thoughts"
        
        Thought Defusion
        
        Thought Challenge
        
        E) Cognitive Distortions (7 in CPT)
        
        Mind Reading?
        
        Oversimplifying (Compression) or Overgeneralization?
        
        Exaggerating/Minimizing?
        
        Hindsight Bias?
        
        Jumping to Conclusions?
        
        Emotional Reasoning?
        
        Is the Source Dependable?
        
        D) Questions (To Challenge the Belief):
        Habit or Fact*?
        Based off Feelings or Facts?
        All-or-none terms?
        
        C) Emotions: What did you feel after telling yourself this?
        
        B) Belief (What is the Thought / Stuck Point that went through my mind?
        
        A) What Happened? (Was there something internal/external that prompted this automatic thought/stuck-point?
        
        Goal: "Did we create any space between you and the thought?"
        "Do I still buy in 100%?"
        
        "Do I still buy in 100%?"
    - - 5 Themes
        
        1. Intimacy
        
        2. Trust
        
        3. Safety
        
        4. Esteem
        
        5. Power & Control
  - - - Values:: A North Star for self, like a moral compass - or the frame of a ladder with goals as the individual wrings.
        Beliefs we choose that drive us toward our goals...
        Values are not achievable. Goals are.
        
        Barriers to Value-Based Living: F.E.A.R
        
        Fusion
        
        *Getting caught up in the content of thoughts, letting them dominate thinking, behaviors, and other sources of behavioral regulation*
        
        Something was factual and true once and cling on to it
        
        Polarizing Force (Chess Metaphor)
        
        Exiting the present moment
        
        Avoidance of discomfort
        
        Remoteness from values
        
        Goals
        
        S.M.A.R.T.E.R Goals
        
        Measurable: You know when you have completed your goal
        
        Achievable: Meet yourself where you are at
        
        Relevant: Make sure the goal addresses something that is a priority for you
        
        Timely: Set a reasonable and realistic time-frame to accomplish your goal
        
        Ethical: Setting a goal in line with your values
        
        Resourced: Having the tools to accomplish your goals
        
        Specific: The more details, the better
        
        Motivation = G+E+C
        
        Goals + Energy + Choice
        
        Thought Defusion
        
        Antidote to Barriers: D.A.R.E
        
        Acceptance of discomfort
        
        Reunite through present through mindfulness
        
        Embracing values
        
        Defusion
        
        Creating distance between myself and my thoughts/emotions
        
        Looking at thoughts, rather than from thoughts (Observer Stance)
        
        Workability rather than the accuracy of the thought
    - - 1. Mindfulness: Bringing your awareness to the here-and-now with openness to new (ideas)
      - 2. Willingness: Making room for feeling sensations and urges
      - 3. Defusion: Recognizing thoughts, images, and memories for what they are - just words and pictures. Allowing them to come and go as they please, without struggling with them
      - 4. Values: Clarifying what is most important to you
      - 5. Committed Action: Taking action and making goals that are in line with your values no matter how many times you might get off track or struggle to succeed
      - 6. The Observing Self: Remembering that there is a you across time
    - - IMAGE: PAIN Vs. PAIN & SUFFERING
  - - - Distress Tolarence Skills
        
        "Wise Mind" A.C.C.E.P.T.S
        
        Activities
        
        Contributing
        
        Comparisons
        
        Different Emotions
        
        Pushing Away
        
        Neutral Thoughts
        
        Sensations
        
        I.M.P.R.O.V.E The Moment
        
        Imagery
        
        Meaning
        
        Prayer / Gratitude
        
        Relaxing: (an effort, a verb, action)
        
        One thing in the Moment
        
        Vacation (brief)
        
        Self-Encouragement
        
        T.I.I.P - Changing Body Chemistry
        
        Temperature Change
        
        Intense Exercise
        
        Paced Breathing or PMR (Paired Muscle Relaxation - Slow Breathing --> Tense and Relax Isolated muscle groups)
        
        Self-Soothing or Grounding with Five Senses:
        Vision, Hearing, Smell, Taste, Touch
        
        Mental Grounding
        
        Categories: Example: A-Z for actors, movies, countries, cars
        
        Counting: Example: Count backwards from 100 by 7
        
        Favorite Things: Example: Name 3 favorite meals, songs, shops
      - Interpersonal Effectiveness Skills
        
        D.E.A.R M.A.N
        (objective effectiveness)
        
        Describe: describe the situation using facts and removing judgements and being specific
        
        Express: use "I" statements to express thoughts and emotions
        
        Assert: ask for what you want or say - not to what you don't want
        
        Reinforce: explain how meeting your request may help you & the other person
        
        Mindful: stay focused on your objective
        
        Appear Confident: use a clear tone, open body language, and maintain eye contact
        
        Negotiate: be willing to compromise if possible and ask if they have solutions to offer
        
        G.I.V.E
        (relationship effectiveness)
        
        Gentle: be kind and respectful, use a clam tone, avoid threats / attacks / judgements
        
        Interested: actively listen by using eye contact, reassuring, and not interrupting
        
        Validate: acknowledge the person's thoughts and feelings as understandable and important
        
        Easy Manner: incorporate lightheartedness when appropriate and be respectful
        
        F.A.S.T
        (Self-Respect Effectiveness)
        
        Fair: be fair to yourself by speaking and validating your own thoughts / feelings
        
        Apologies: you have a right to ask for what you want and/or say no without apologizing
        
        Stick to your values: behave in line with your values even when the other person is not
        
        Truthful: maintain honesty and authenticity
      - Mindfulness
        
        Mindfulness of Current Emotions
        
        Paying attention to the very emotion you are experiencing and allowing it be what it is
        
        This may be uncomfortable at first, however, trying to ignore, suppress or get rid of emotions is not effective long term
        
        This skill involves reminding yourself that you are not your emotion and that you can tolerate your emotions.
        
        When you are mindful of your emotions, you just observe then without judging them or trying to change your experience. Emotions are transient, they come and go. No emotion will last forever.
        
        Exercise Examples:
        1) Safe Relaxed Place;
        2) Thought Defusion;
        3) Progressive Muscle Relaxation (PMR);
        4) Deep Belly Breathing;
        5) Color Breathing
      - Emotional
        Regulation
        
        S.E.E.D.S of Mastery
        
        Sleep: Get an amount of sleep that enhances your well-being
        
        Eat: Balanced nutrition
        
        Exercise: Incorporate movement into your day
        
        Doctors: See your doctors when sick and take prescribed medications as prescribed
        
        Self-Care (or Sobriety, Spirituality, Showering, etc.) - Make self-care a priority
        
        "Of Mastery" = Do something that makes you feel competent and in control
        
        OEA: Opposite to Emotion Action
        
        Object is to act "oppositely" in situations where our action urges do not fit the facts of a situation or will not be effective
        
        Example: If you are feeling anxious in a non-threatening social situation and want to leave, you would take small steps to help yourself stay in the situation, such as taking a break and coming back.
        
        Opposite action involves both validating our emotions and acting in line with our goals and our values
        
        R.I.D.E the Wave
        
        Recognize your emotion
        
        Information
        
        Distress Intolerence
        
        Experience your emotion
        
        Remember to W.A.I.T
        
        *Watch your emotion*
        
        (note its presence; observe your emotion without judgement or analyses; allow yourself to detach slightly from the emotion to gain perspective; you are experiencing an emotion, but you are not your emotion; try not to block or repress your emotion; try not to get rid of your emotion of push it away; try not to keep the emotion around, hold onto it, or amplify it (balance)
        
        Action is NOT necessary
        
        (resist urges to "fix" your emotion; you don't need to do anything; Allow yourself to sit with your emotion before taking action; you can acknowledge your emotion without complying with behavioral urges; use distress tolerance skills to help yourself get through the peak of your emotion
        
        Internally experience your emotion
        
        (experience it as a wave coming and going; notice where in your body you are feeling emotional sensations, experience the sensations as fully as you can, observe how long it takes before the emotion goes down, 'ride the wave' of the emotion, letting it run its course. No emotion lasts forever
        
        Think of your painful emotions as "helpers" or "red flags"
        
        (emotions are not there to make you miserable; they have a purpose; take a nonjudgemental stance, emotions inform you about your world and yourself; they help motivate you to act effectively; practice willingness and radical acceptance with your emotions
        
        H.A.LT
        
        Hungry
        
        Angry
        
        Lonely
        
        Tired
  - - - Skill: Thought Stopping
        
        1. Mindfulness: Become aware of the distressing thought
        
        2. STOP: Shout (aloud or in-head) "STOP", or imagine a big red STOP sign in your head. Identify consequences of continuing your thought pattern
        
        3. SWITCH: Use distress tolerance, acknowledge positive goals and positive activities, and call or talk to a supportive person to help you gain perspective or help distract you
      - Skill: Positive Self Talk
        
        Examples: "Change is a process - I am taking steps" & "This discomfort is temporary"
        
        Notice when you are being self-critical and validate its purpose as well as its consequences
        
        Soften your critical voice, but do so with compassion rather than judgment
        
        Reframe the observations made by your inner-critic. If struggling, imagine what a very compassionate friend would say to you in this situation.
      - Skill: Thought Challenging - Self-Guided Questioning
        
        Have I had any experiences that show that this thoughts is not completely true all the time?
        
        If my best friend or someone I loved had this thought, what would I tell them?
        
        If my best friend or someone I loved knew I was having this thought, what would they say to me? What evidence would they point out to me that would suggest that my thoughts were not 100% true?
        
        When I am not feeling this way, do I think about this type of situation any differently? How?
        
        When I have felt this way in the past, what did (I do) or think about that helped me feel better?
        
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      - Skill: Behavior Change Analysis
        
        Identify the chain of events that led to engagement in a problematic behavior as well as skills we could have used to intervene, or "break the chain".
        
        Goal: Reflect upon the past event as a way of increasing the likelihood that we will use healthy coping skills in similar situations in the future, rather than engaging in the given problematic behavior
      - Skillset(s): GROUNDING
  - - - Integrates evidence-based approaches (Broken down in this mind-map), includes: Action and Commitment Therapy (ACT), Cognitive Behavioral Therapy (CBT), Cognitive Processing Therapy (CPT), Dialectical Behavioral Therapy (DBT), Mindfulness, Skills Training in Affective and Interpersonal Regulation (STAIR) and Seeking Safety.
        
        & I am sure more, with activities/tools/skills that are integrations of various modalities
      - Format: Two Group Sessions with focus on teaching various skills to address trauma-related symptoms. General (non-specific) communication is mandated from participants, so details of an individuals particular trauma are handled with their individualized team of specialists which exist outside of group. Patients will be called out of group into meetings with these designated specialists or if urgent issues arise they become accessible.
        
        Separate tracks exist, including Substance Use, which as an example meets once a week
        
        Average time in the Compass program: Approx. 8 weeks
      - Compass Trauma Program
      - Two Levels Of Care
        
        IOP (Intensive Outpatient Program)
        
        9:30 am - 12:30 pm M-F
        
        PHP (Partial Hospitalization)
        
        9:30 - 2:30 pm M-F
- - - - The hippocampus is responsible for processing information about your life and expereinces and storing it away in long term memory for later use
        
        The amygdala actives the body's alarm system (fight-flight-(freeze-fawn) response). When the brain perceives a threat, the amygdala becomes active and sends messages to the rest of the body to prepare for danger. The amygdala also participates in processing emotional memories.
        
        Under normal circumstances, these regions communicate with one another and with the rest of the brain in smooth fashion
        
        Traumatic stress, however, disrupts the communication between these different areas.
        
        - The logical, rational parts of your brain cannot get the messages through to the amygdala that the danger is over and it's okay to relax.
        
        - The Hippocampus cannot take the emotional information processed by the amygdala and store it away as a long term memory - so your memories of trauma stay with you all the time and you continue to feel as if you are in constant danger
        
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  - - - Avoidance is a main method of control; Avoidance of memories, emotions, interactions, places, people, etc. Avoidance feels like the way to protect oneself from future trauma. For many people who have experienced trauma, their world seems to get smaller and smaller as avoidance gains space. Eventually, this strategy proves to be hopeless
      - Alternative: What might you be willing to tolerate in pursuit of what matters to you?
        
        With avoidance as main 'coping strategy', they often find themselves distant and cut off from those things that bring their life a sense of meaning. Relationships feel more distant, previously enjoyed activities are neglected, negative emotions linger and positive emotions seem to be harder to access