Presentation by:

Natasha Sakchekapo-Lalande

Juliannas Case Study

PTSD: what it is, symptoms
Symptom Management
Pharmacological Treatment
Commonality in PTSD
Types of Trauma

Eye Movement Desensitization & Reprocessing

o What it is, brief history, how it works

Intensive Therapy

Julianna is a 26 year old, Aboriginal female. Julianna has a diploma and two certificates with
a background in mental health. She currently is not employed, and has a low income. She
works as a part-time cashier at a grocery store, and is doing online courses as it helps keep
her mind occupied. Julianna is physically healthy, but is encouraged to watch her weight and
sugar intake due to a large family history of diabetes. Julianna has a strong support network,
and is currently in an 8-year relationship with her high school sweetheart. They have a strong,
loving relationship with open communication. She has no mental health diagnosis and has
always refused to take any types of medication offered by physicians.
Julianna is accessing services at Joseph Smith Counselling Center. She feels she has reached
a breaking point. Julianna lost a 4 month old son in 2013, and following that loss, 6 months
later, she miscarried her second son, a 3 month-old fetus she named Noah. Julianna never
got to express her emotions or process her losses. She internalizes her problems, and is
always the one to help others. She has been experiencing intrusive thoughts, avoidant
behaviours, increased emotional arousal, and lastly, she has been re-experiencing her trauma.
From her past education and work experience, she feels she might have Post Traumatic Stress
Disorder. She does not want to take medication, but to try long-term counseling. She wants
and feels ready to unload her grief and trauma. The plan for her recovery is to try long-term
Eye Movement Desensitization and Reprocessing (EMDR), with intensive therapy and no
medication. Julianna is not interested in seeing a psychiatrist for a diagnosis as she wants to
see if her symptoms will alleviate after trying EMDR.

What is it:
Occurs after a traumatic event. During a traumatic event, you think that your life or others'
lives are in danger. You may feel afraid or feel that you have no control over what is
happening around you. Most people have some stress-related reactions after a traumatic
event.
Symptoms:

PTSD symptoms start after the traumatic event, but may not appear until months or years later.

1) Reliving the event (also called re-experiencing symptoms)

Bad memories, flashbacks or nightmares.
2) Avoiding situations that remind you of the event
You may try to avoid situations or people that trigger memories of the traumatic event.
3) Negative changes in beliefs and feelings
The way you think may change because of the trauma. Fear, guilt, or shame.
4) Feeling keyed up (also called hyper arousal)
Jittery, always alert and on the lookout for danger, trouble concentrating or sleeping.

Learn about trauma and PTSD

It is useful for trauma survivors to learn more about common reactions to trauma and about
PTSD. Find out what is normal, & what the signs are. It helps to know your problems are
shared by hundreds of thousands of others.

Talk to others for support

It is important not to isolate yourself, make efforts to be with others. With support from others,
you may feel less alone and more understood. You may also get concrete help with a
problem.

Practice relaxation methods

Use muscle relaxation & breathing exercises: Meditation, Swimming, stretching, yoga, Prayer,
Listening to quiet music, spending time in nature

Distract yourself with positive activities

Pleasant recreational or work activities help distract a person from his or her memories and
reactions. For example, art has been a way for many trauma survivors to express their feelings
in a positive, creative way. Pleasant activities can improve your mood, & limit the harm
caused by PTSD.

Talking to your doctor or a counselor about trauma and PTSD

It is important to reach out and call a counselor who can help, if needed. Your family doctor
can also refer you to a PTSD specialist. Talk to your doctor about your trauma and your PTSD
symptoms.

Unwanted thoughts:
It is natural to have some memories of
the trauma(s).

Sudden feelings of anxiety or panic:

These feelings often come with scary
thoughts, slowing down your breathing
may help.

Nightmares:
Engage in a pleasant, calming activity.

Difficulty falling or staying asleep:

Keep to a regular bedtime schedule.

Irritability, anger, and rage:

Get in the habit of exercise daily. Exercise
reduces body tension and relieves stress.

Flashbacks:
Talk to yourself. Remind yourself where
you are, what year you're in, and that you Difficulty concentrating or staying
are safe. The trauma happened in the
focused:
past, and you are in the present.
Write things down, make to-do lists, &
break tasks down into small do-able
chunks.

The PTSD Coach app can help one learn about and manage
symptoms that often occur after trauma.

Features include:

Reliable information on PTSD and treatments

Tools for screening and tracking your symptoms
Convenient, easy-to-use tools to help with symptoms
Direct links to support and help, always with you
PTSD Coach provides you with resources you can trust. The
questionnaire used in PTSD Coach, the PTSD Checklist (PCL), is
a reliable and valid self-report measure.
PTSD Coach was created by the VA's National Center for PTSD in partnership with the
Department of Defense's National Center for Telehealth and Technology.

In pharmacological treatment of PTSD, selective serotonin reuptake

inhibitors, including sertraline and paroxetine, are most commonly
prescribed to reduce PTSD symptoms and prevent relapse (McGuire, Lee
& Drummond, 2014, p. 278).
Medication is often prescribed to reduce symptoms of PTSD, but is not
solely depended on to help with the disorder. Therapy is the best
practice to PTSD, and it is known that medication should not replace
evidence-based psychotherapies as a primary treatment unless patients
are unable or unwilling to engage in therapy (McGuire, Lee & Drummond,
2014, p. 278).
SSRIs are usually prescribed because the brain is not receiving enough of
a chemical called serotonin. In taking SSRIs, there is a change in the
balance of serotonin. The change seems to help brain cells send and
receive chemical messages, resulting in higher moods. SSRIs address the
symptoms one feels, reduces them, and also assists as a sleeping aid.
SSRIs often come with significant side effects including weight gain,
nausea, vomiting, agitation, etc.

About 6 of every 10 (or 60%) of men and 5 of every 10 (or 50%)

of women experience at least one trauma in their lives. Women
are more likely to experience sexual assault and child sexual
abuse. Men are more likely to experience accidents, physical
assault, combat, disaster, or to witness death or injury.

Here are some facts (based on the U.S. population):

About 7 or 8 out of every 100 people (or 7-8% of the population)
will have PTSD at some point in their lives.
About 5.2 million adults have PTSD during a given year. This is
only a small portion of those who have gone through a trauma.
About 10 of every 100 (or 10%) of women develop PTSD
sometime in their lives compared with about 4 of every 100 (or
4%) of men. Learn more about women, trauma and PTSD.

 Combat

exposure war, shooting, seeing

death
Child sexual or physical abuse
Terrorist attack
Sexual or physical assault
Serious accidents, like a car wreck
or sudden child loss
Natural disasters, like a fire, tornado,
hurricane, flood, or earthquake

Brief History:

In 1987, psychologist Dr. Francine Shapiro made the observation

that eye movements can reduce the intensity of disturbing thoughts,
under certain conditions.
Dr. Shapiro studied this effect scientifically, and in a 1989 issue of
the Journal of Traumatic Stress, she reported success using EMDR
to treat victims of trauma. Since then, EMDR has developed and
evolved through the contributions of therapists and researchers all
over the world.
Today, EMDR is a set of standardized protocols that incorporates
elements from many different treatment approaches.

EMDR seems to have a direct effect on the way that the brain processes
information. Normal information processing is resumed, so following a
successful EMDR session, a person no longer relives the images, sounds, and
feelings when the event is brought to mind. EMDR appears to be similar to what
occurs naturally during dreaming or REM (rapid eye movement) sleep.
Therefore, EMDR can be thought of as a physiologically based therapy that
helps a person see disturbing material in a new and less distressing way.
During EMDR, the therapist works with the client to identify a specific problem
as the focus of the treatment session. The client calls to mind the disturbing
issue or event; what was seen, felt, heard, thought, etc., and what thoughts and
beliefs are currently held about that event. The therapist facilitates the
directional movement of the eyes or other dual attention stimulation of the
brain, while the client focuses on the disturbing material; and the client just
notices whatever comes to mind without making any effort to control direction
or content. Sets of eye movements are continued until the memory becomes
less disturbing and is associated with positive thoughts and beliefs about ones
self.
During EMDR, the client may experience intense emotions, but by the end of
the session, most people report a great reduction in the level of disturbance.

Phase 1: Achieving patient safety, reducing symptoms and increasing competencies: This is
the skills building phase and clinicians can use any evidence based therapy that has
outcomes of improving emotion regulation, increasing distress tolerance, mindfulness,
interpersonal effectiveness, cognitive restructuring, behavioral changes, and relaxation.
Phase 2: Review and reappraisal of trauma memories :There are different techniques for doing
this, but the success of this phase hinges on someones ability to tolerate the discomfort of
reviewing the memories. People with single incident trauma may be ready to withstand
exposure with minimal distress tolerance training, while people with complex trauma may need
months of skills building support in order to be ready to process their trauma.
Phase 3: Consolidating the gains: The therapist is helping the client apply new skills and
adaptive understanding of themselves and their trauma experience. This phase can also
include booster sessions to reinforce skills, increase professional and informal support
systems, and create an ongoing care plan.
How it helps with PTSD:
Talk therapy treatment for PTSD usually lasts 6 to 12 weeks. Research shows that support from family and friends can be an
important part of therapy. Therapy targets the symptoms of PTSD. It also focuses on social, family, or job-related problems.

Chen, Y., Hung, K., Tsai, J., Chu, K., Chung, M., & Chen, S. Chou, K. (2014). Efficacy of eye-movement desensitization and
reprocessing for patients with post-traumatic stress disorder: a meta-analysis of randomized controlled trials. Plus One, 9
(8), 1-16.
Gupta, M. A. (2013). Review of somatic symptoms in post-traumatic stress disorder. International Review of
Psychiatry, 25(1), 86-99. doi: 10.3109/09540261.2012.736367
McGuire, T. M., Lee, C. W., & Drummond, P. D. (2014). Potential of eye movement desensitization and reprocessing therapy
in the treatment of post-traumatic stress disorder. Psychology Research and Behaviour management, 7, 273-283.

Niagara Stress and Trauma Clinic. (2014). Consultation and training for emdr therapists. Retrieved from
http://stressandtraumarelief.com/emdr-training-schedule.php
Rothmayr, C. (2003, September 24). Treating post-traumatic stress disorder (ptsd) with emdr. Retrieved from
http://healthpsych.psy.vanderbilt.edu/EMDR_PTSD.htm
Sareen, J. (2014). Post-traumatic stress disorder in adults: impact, comorbidity, risk factors, and treatment. The Canadian
Journal of Psychiatry,59(9), 460-467.
Staggs, S. (2015). Psychotherapy treatment for ptsd. Retrieved from http://psychcentral.com/lib/treatment-ofptsd/000665
USDVA. (2014, November 11). Ptsd. Retrieved from http://www.ptsd.va.gov/public/PTSD-overview/basics/index.asp