Crisis & Trauma: Identification, Assessment and Treatment for Acute and Prolonged Symptoms
Post-Traumatic Growth: Advanced Clinical Applications
Post-Traumatic Growth: Beyond Survival and Recovery
Post-Traumatic Stress Disorder: Defined, Described, Detailed, Debated
Treating Trauma, PTSD and Traumatic Brain Injury
Understanding And Treating Intergenerational Transmission of Trauma
Veterans: Assessment and Screening for PTSD & Suicidality
Table Of Contents
- For Clients
- For Clinicians
- PTSD and Service Dogs
- TBI References & Research
- Critique of Current Attitudes and Approaches to PTSD
- Treatment for Trauma
- Organizations Supporting Trauma Victims
- Other Resources for Trauma Survivors
- Critical Incident Stress Debriefing: CISD
- Resources Provided by Types of Trauma
- Assessment Tools
PTSD & TBI
Holocaust Survivors and Descendants:
Dogs and PTSD U.S. Department of Veterans Affairs
SERVICE DOG TASKS for PSYCHIATRIC DISABILITIES, Tasks to mitigate certain disabling illnesses classified as mental impairments under The Americans with Disabilities Act
How Dogs Can Help Veterans Overcome PTSD, New research finds that “man’s best friend” could be lifesavers for veterans of the wars in Iraq and Afghanistan. Smithsonian Magazine.
Wounded Warriors, Healing Hounds , Video Documentary
Psychiatric Service Dogs and PTSD Legislation proposing a pilot program that would provide service dogs to veterans with PTSD.
Four-Legged Therapy for Military Veterans with PTSD Pairing specially trained therapy dogs with PTSD vets.
How Dogs Can Help Veterans Overcome PTSD Paws for Purple Hearts, one of four experimental programs nationwide that pair veterans afflicted by PTSD with Labrador and golden retrievers.
Therapy dogs helping with more than PTSD, TBI Veterans Moving Forward provides service dogs, at no cost, to veterans with physical and mental health challenges, including those suffering from post-traumatic stress disorder and traumatic brain injuries.
Canine Therapy for Military PTSD The US Army is using canine therapy to help solders recovery from PTSD.
Dogs go the distance: Program provides service to veterans with PTSD Operation Wolfhound
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January 2015: “After PTSD, More Trauma”
2014: Expressive writing and post-traumatic growth
In the journal Traumatology, authors Hannah Stockton, Stephen Joseph, and Nigel Hunt describe an Internet-based study using expressive writing to facilitate post-traumatic growth. They find that 10 participants who wrote for 15 minutes on three separate occasions three days apart showed a significant decrease over a control group in intrusive thoughts and avoidant cognitions. The complete study may be found here:
Stockton, Hannah; Joseph, Stephen; Hunt, Nigel Traumatology: An International Journal, Vol 20(2), Jun 2014, 75-83. doi: 10.1037/h0099377
2014: DSM-5 Updates
In the DSM-5, PTSD has become part of a larger section on Trauma- and Stressor-Related Disorders. While the specific changes to the criteria for PTSD have been provided in another document, changes to the other diagnostic categories in this section follow:
“For a diagnosis of acute stress disorder, qualifying traumatic events are now explicit as to whether they were experienced directly, witnessed, or experienced indirectly. Also, the DSM-IV Criterion A2 regarding the subjective reaction to the traumatic event (e.g., experiencing “fear, helplessness, or horror”) has been eliminated. Adjustment disorders are reconceptualised as a heterogeneous array of stress-response syndromes that occur after exposure to a distressing (traumatic or nontraumatic) event, rather than as a residual category for individuals who exhibit clinically significant distress but whose symptoms do not meet criteria for a more discrete disorder (as in DSM-IV).
DSM-5 criteria for PTSD differ significantly from the DSM-IV criteria. The stressor criterion (Criteria A) is more explicit with regard to events that qualify as ‘traumatic’ experiences. Also, DSM-IV Criterion A2 (subjective reaction) has been eliminated. Whereas there were three major symptom clusters in DSM-IV – reexperiencing, avoidance/numbing, and arousal – there are now four symptom clusters in DSM-5, because the avoidance/numbing cluster is divided into two distinct clusters: avoidance and persistent negative alterations in cognitions and mood. This latter category, which retains most of the DSM-IV numbing symptoms, also includes new or reconceptualised symptoms, such as persistent negative emotional states. The final cluster – alterations in arousal and reactivity – retains most of the DSM-IV arousal symptoms. It also includes irritable behavior or angry outbursts and reckless or self-destructive behavior. PTSD is now developmentally sensitive in that diagnostic thresholds have been lowered for children and adolescents. Furthermore, separate criteria have been added for children age 6 years or younger with this disorder.
The DSM-IV childhood diagnosis reactive attachment disorder had two subtypes: emotionally withdrawn/inhibited and indiscriminately social/disinhibited. In DSM-5, these subtypes are defined as distinct disorders: reactive attachment disorder and disinhibited social engagement disorder.”
Acute Stress Disorder Diagnostic Criteria, DSM-5
- Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways:
- Directly experiencing the traumatic event(s).
- Witnessing, in person, the event(s) as it occurred to others.
- Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
- Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).`
Note: This does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.
- Presence of nine (or more) of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred:
- Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways:
- Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
- Recurrent distressing dreams in which the content and/or affect of the dream are related to the event(s). Note: In children, there may be frightening dreams without recognizable content.
- Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific re-enactment may occur in play.
- Intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
- Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
- An altered sense of the reality of one’s surroundings or oneself (e.g., seeing oneself from another’s perspective, being in a daze, time slowing).
- Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).
- Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
- Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
- Sleep disturbance (e.g., difficulty falling or staying asleep, restless sleep).
- Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.
- Problems with concentration.
- Exaggerated startle response.
- Duration of the disturbance (symptoms in Criterion B) is 3 days to 1 month after trauma exposure.
Note: Symptoms typically begin immediately after the trauma, but persistence for at least 3 days and up to a month is needed to meet disorder criteria.
- The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The disturbance is not attributable to the physiological effects of a substance (e.g., medication or alcohol) or another medical condition (e.g., mild traumatic brain injury) and is not better explained by brief psychotic disorder.
Reactive Attachment Disorder, DSM-5 Diagnostic Criteria
- A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:
- The child rarely or minimally seeks comfort when distressed.
- The child rarely or minimally responds to comfort when distressed.
- A persistent social and emotional disturbance characterized by at least two of the following:
- Minimal social and emotional responsiveness to others.
- Limited positive affect.
- Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions with adult caregivers.
- The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:
- Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults.
- Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g. frequent changes in foster care).
- Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios).
- The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the lack of adequate care in Criterion C).
- The criteria are not met for autism spectrum disorder.
- The disturbance is evident before age 5 years.
- The child has a developmental age of at least 9 months.
Persistent: The disorder has been present for more than 12 months.
Specify current severity:
Reactive attachment disorder is specified as severe when a child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.
Post Traumatic Growth
Post-Traumatic Growth This video introduces Post-Traumatic Growth fundamental concepts, clinical implications, and current research. By first describing what classifies as a traumatic event and then processing the ways in which trauma can be growth producing, this video present the general process model for Post-Traumatic Growth as well as the different forms of growth that occur post trauma.
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Crisis & Trauma
- Austin Riggs Center
- Babette Rothschild, MSW
- Casa Palmera
- Christine A Courtois Ph.D. & Associates PLC: Trauma Treatment, Life Transitions & Wellness Services
- EMDR Institute Home Page
- EMDR – Europe Association
- EMDR-Institut: Deutschland
- FHE — Peter Levine’s Foundation for Human Enrichment
- Healing Heart Center
- McLean Hospital
- Menninger Clinic & Hospital
- NLP Works for PTSD
- Risking Connection
- Sensorimotor Psychotherapy Institute: Hakomi Somatics Institute
- Sheppard Pratt
- The Center at PIW
- The Institute for Staged Recovery
- The Meadows
- The Refuge: PTSD and Trauma Treatment Center
- The Retreat at Sheppart-Pratt
- The TARA Approach
- Timberline Knolls
- Traumatic Incident Reduction
- Two Rivers Psychiatric Hospital
American Trauma Society (ATS)
An organization supporting trauma care and trauma prevention in the United States as well as advocate for trauma victims and their families.
Brain Trauma Foundation (BTF)
Mission is to improve the outcome of Traumatic Brain Injury (TBI) patients by developing best practice guidelines, conducting clinical research and educating medical personnel.
Child Trauma Academy (CTA)
Helps improve the lives of traumatized and maltreated children – through education, service delivery and program consultation.
Orthopaedic Trauma Association (OTA)
Promotes excellence in care for the injured patient, through provision of scientific forums and support of musculoskeletal research and education of Orthopaedic Surgeons and the public.
- APA Topics: Trauma:
American Psychological Association webpage offers information on emotional trauma.
- International Critical Incident Stress Foundation
- A Critical View on Debriefing, by Richard Gist, Ph.D.
For Those Suffering with Combat Trauma
- PTSD Support Services
- VVA’s GUIDE on PTSD
Vietnam Veterans of America’s guide to obtaining benefits for exposure to traumatic events in combat leading to PTSD.
- Make the Connection
This site provides video testimonials and resources to help Veterans with mental health conditions such as PTSD and depression.
- Military Veterans PTSD Reference Manual
Website describes a 200+ page book for veterans with disability; available from the author.
- Tragedy Assistance Program for Survivors
TAPS offers services to any who have lost a loved one on active duty, via a peer support network.
- Rape Trauma Syndrome
Brief article by Amy Menna on rape trauma describes the symptoms and negative beliefs that may follow sexual assault.
- Survivors Network of those Abused by Priests
SNAP is a self-help organization of men and women sexually abused by spiritual elders; provides support to all victims of clergy abuse.
- Generation Five
Generation Five’s mission is ending child sexual abuse within five generations.
- Sex Abuse of Males: Prevalence, Lasting Effects, and Resources
Extended excerpts from a masters thesis on sexual abuse in males, written by Jim Hopper at U. Massachusetts at Boston.
- NOMSV: Male Survivor
Site focused on overcoming sexual victimization of boys and men: lots of information here.
- Dancing in the Darkness
An informative web resource for sexual abuse survivors; includes much useful information and a support chat room.
- What’s Your Fear? – For Abuse Survivors and Their Dentists
Practical article on dental fears common among survivors of childhood abuse, with good suggestions for dentists and their patients.
- SurvivorShip Home Page
An international forum on survival of sadistic sexual abuse, ritualistic abuse, mind control & torture.
- Sexual Abuse Treatment: Referral, Resource, and Research
Matthew Rosenberg’s site focuses on prevention, treatment and education re: sexual offending.
- Women Veterans: Sexual Harrassment and Assault
Captain Barb’s page on PTSD among women who experienced sexual trauma while in the military, and what to do.
- Victims of Crime: Justice Information Center
Information and many useful links from the National Criminal Justice Reference Service.
- Office for Victims of Crime
US Dept. of Justice site, focused on crime victims; includes information, training, funding, etc.
- National Organization for Victim Assistance
Home page for NOVA, an organization working on behalf of victims of crime and disaster.
- Center for the Study and Prevention of Violence
The CSPV, at UC-Boulder, assists those committed to understanding and preventing violence.
- National Crime Prevention Council: Online Resource Center
NCPC site includes useful information about crime prevention, community building, and planning.
- First Response to Victims of Crime
A handbook for law enforcement officers on how to approach and help crime victims.
- Police Occupational Trauma
John Violanti’s article describes consequences of trauma exposure in the police occupation.
- Peer Support Training Institute
PSTI’s specialized peer support training aims to reduce stress in police officers and others, in NYC.
- A Cybrary of the Holocaust
Site focuses on research and discussion forums, aiming to educate and preserve memories.
- Center for Victims of Torture
CVT works locally, nationally, and internationally to heal the wounds of torture, and to stop torture worldwide.
- Centre for the Study of Violence and Reconciliation
CSVR is a South African organization dedicated to peaceful transformation; many articles here.
- International Rehabilitation Council for Torture Victims
The IRCT, in Denmark, promotes treatment of torture victims and contributes to torture prevention.
- Trauma Exposure Measures
These assessment instruments measure the types of trauma a person has been exposed to, or the degree of severity of the traumatic event someone experienced. For each measure, a brief description, sample items, versions, and references are provided. Information on how to obtain the measure is also provided. The chart provides a comparison of the trauma exposure measures.
- Combat Exposure Scale
For use with those who have provided military service.
- Evaluation of Lifetime Stressors
The Evaluation of Lifetime Stressors (ELS) is an assessment protocol for adolescents or adults comprised of a self-report questionnaire and semi-structured interview that examines a range of traumatic experiences across the lifespan.
- Life Stressor Checklist – Revised (LSC-R)
The Life Stressor Checklist-Revised is a self-report measure that assesses traumatic or stressful life events. The questionnaire includes 30 life events, including experiences with natural disasters, physical or sexual assault, death of a relative and other events and follows a yes/no format.
- Traumatic Life Events Questionnaire (TLEQ)
The TLEQ is a 23-item self-report measure of 22 types of potentially traumatic events including natural disasters, exposure to warfare, robbery involving a weapon, physical abuse and being stalked.
- Trauma Exposure Measures
Trauma Sequelae and PTSD Measures:
- Trauma Symptom Checklist for Children™ (TSCC™)
The TSCC is a self-report measure of posttraumatic stress and related psychological symptomatology in children ages 8-16 years who have experienced traumatic events (e.g., physical or sexual abuse, major loss, natural disaster, witnessing violence).
- Trauma Symptom Checklist for Young Children™ (TSCYC™)
The TSCYC was developed to be the first fully standardized and normed broadband trauma measure for children as young as 3 years of age. Its 90items can be completed by an adult caretaker.
- Detailed Assessment of Posttraumatic Stress™ (DAPS™)
The DAPS is a 104-item, detailed, and comprehensive clinical measure of trauma exposure and posttraumatic stress in individuals ages 18 years and older who have a history of exposure to one or more potentially traumatic events.
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