C@W18 September 21, 2022 – Post Traumatic Stress Disorder – Highlights of Presentation by Clinical Psychologist, Mark Besen (Part 2)

consciousness@work 18 – September 21, 2022
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Post Traumatic Stress Disorder - Part 2
Highlights of Presentation by Clinical Psychologist, Mark Besen
2022 FAERF Institute Summer Webinar Series

Written by: Carolyn V. Coarsey, Ph.D.

September 21, 2022

 The third and final webinar of the 2022 Summer Series was held on August 28th. Well over 100 members attended the Zoom meetings, which were held at three different times of the day/night. Foundation’s clinical advisor, Dr. Mark Besen, a clinical psychologist in private practice in North Carolina who specializes in psychological and neuropsychological assessment/testing, and numerous related activities, provided the educational session. The webinar was conducted in a Question & Answer format, where participants were asked to respond to ten true or false questions.  As the attendees listened to Dr. Mark discuss the topic presented in the question, they could determine if the statement was true or false. Below is Part 2 of the webinar.

6. Q: So is it true that compassion fatigue is not usually experienced by care and special assistance team members? True or false? 

A: The question is about compassion fatigue. Who might be more prone to experience compassion fatigue? If you think about when somebody gets worn down in a situation, it's when you have prolonged exposure to particular stress that's lasting, and you don't have any way of getting away from it. So my practice, for example, I do a lot of neuropsychological evaluations with people who have Alzheimer's disease and the family members of folks who have Alzheimer's disease. 

    I'll also throw in Autism Spectrum Disorder because we do a lot of work with parents of children, but also adults who have Autism Spectrum Disorder who are living with the family. And you're there 24/7, and you're always on, and you're always having to make sure the environment is safe. You can't really get away from the situation. Over time, it wears you down. So anything related to your interacting with somebody where you're taking on that level of responsibility that you're always exposed to, whatever the stressful thing is, you don't have the ability to escape from it.

It's over a prolonged period of time, and it wears you down in it. 

    (CVC) So we know in this situation there is some confusion about it. Still, based on our experience and what we've seen in the research about who actually comes down with compassion fatigue, the answer would actually be true. We are not, as care team members, typically experiencing compassion fatigue if we're doing our job right. Because the average response where a care team member is involved with a family is seven to ten days. At that time, our assignment as Care Team is over and we go back to our normal job, which does not include caregiving.

7. Q: The next question then pertains to resilience. Is it true or false that resilience includes self-care? 

A: The question is, what is resilience in the face of trauma or life stress? And I'm going to come back to the question of what causes stress to begin with. So it's a balance between perceived threat or harm in a situation and the resources that you believe you have to code. So the more tools that you have in your toolkit to deal with whatever's happening, the better you can face whatever the situation is and be resilient. And there are really only three things that anybody can do when they're under a stressful situation. One is to change how you feel, which is what most people think about coping. That's basically self-care, sleep, eating/ nutrition, exercise, rest, being able to meditate, relax, do something to distract yourself. So basically, managing your feelings doesn't change the situation. The second thing is doing something to try to alter the situation. So focusing on what you have control over, if I was doing behavioral interventions or problem-solving therapy, where you're looking at all the options you have in front of you, what you have control over, and choosing different things that can improve your current situation or change the problem. And the third is something everybody always has control over, and that's changing the way that we think about the situation, which I've spoken about before. Still, it's being able to identify where you're contributing to making the problem more overwhelming and how you can change your perspective to be able to look at things more accurately in a more helpful way. So it's a combination of tools you have in those three areas which makes a person resilient.

8. Q: What's the prevalence of PTSD? All combat veterans exposed to trauma will develop PTSD. True or false?

A: The question is about the prevalence of Post Traumatic Stress Disorder. The statistics change depending on what population you're looking at. The most recent statistics are cited in the Diagnostic and Statistical Manual of Psychiatric Disorders, which is now up to the 5th Edition TR version. Still, typically, it's about 4% to 8% range in the general population. Whether you're looking worldwide or whether you're looking within the United States depends on the study that you cite. But if you divide it up by different groups, for example, people who've been exposed to combat, you're looking at a third to a half of the people who are developing symptoms of Post Traumatic Stress Disorder. But in the general population, really, it's an uncommon thing. So it's roughly about 5-6%, which is pretty much on par with the prevalence of most psychiatric disorders. 

    (CVC) So we know that Mark said a very small percentage of people will develop PTSD; although many of us will have symptoms, but they usually go away after a few days. What we know then is that all the studies across time indicate that most people with the proper support and their needs met, which we talked about earlier, both personally, psychologically, emotionally, and spiritually, most of us will be able to integrate trauma and go on and transcend and have a meaningful life.

9. Q: Is it true or false that because of these changes in brain function, helpers should make all the decisions for a survivor?

A: So the question is about brain changes in response to crisis situations, to severe trauma. The example that I guess I would give is when a person is very depressed, their pre-frontal cortex, the area that controls thinking, reasoning, planning, and problem-solving. If you look at PET scans of electrical activity in the brain, that is like lights out. So your brain is not operating on all cylinders when there is some type of traumatic event that you might be experiencing symptoms of depression or shock. So a lot of times, when people are facing trauma, they have so much that they're reacting to that the brain isn't operating in the way that it would normally react. The intervention that, as a behavioral health professional, you would do in response to trauma is you're trying to help somebody's pre-frontal cortex. So if someone is no longer able to think in a way that's logical or with the same level of reasoning that they would otherwise, you're helping guide them in making their own decisions and understanding what's happening to them, knowing that they're not reacting to the world in the way that they would typically react. It's a biological condition. It's; basically, your brain isn't working in the way that it normally works because it's been disrupted by depression, trauma, anxiety, and a million thoughts going through your head at the same time, which makes it difficult to take in information. So your immediate memory is going to be impacted because you have too much interference from the things that are going on in your mind. You have to take that into account when you're talking to people who are in crisis. Those who are in shock and have undergone trauma might be severely depressed, is that they are not rationally interacting with the world in the way that they would normally interact. Making huge life decisions is not something that you want to do in the immediate circumstances following trauma or when you're severely depressed. 

    (CVC) So we know then, and I see so many of you, you're trainers, you use this material, you're familiar with it. We know that even though the person's pre-frontal cortex is not engaged the way it would on a normal day for decision-making, it doesn't mean they've lost their minds. And we know that to empower someone means we give them choices and options. 

    And so the words that Mark used he talked about helping guide people with their decisions, which we know is not the same thing as it's further disempowering them by taking away all their choices. So even if it's a choice of coffee or tea or something simple, we know that we don't make decisions for them. We simply give them the options that we have in front of us.

10. Q: Every person exposed to a traumatic event needs to tell their story in great detail within a few days after the incident to heal. True or False? 

A: The question is, what degree should a person have to discuss in detail the situation that's happened to them? Kind of relive various aspects of the trauma to be able to get through a situation, particularly in an immediate crisis situation. I do think there's this belief that's out there that a person needs to be able to expand in detail about the horrific things that they've observed and how it's affecting them. And that's not something you want to do right away when you're facing an immediate crisis situation. It can actually be re-traumatizing for folks in therapy. I really just started going into reliving any of the details of the significant things that have happened that are terrific, at least in the beginning. You need to be able to survive. You need to be able to get what you need day to day. You need to be able to think in very short-term time frames. So what do I need to do tonight? What do I need to do tomorrow? If you're going to go into depth about understanding past trauma and the impact on you, that's down the road. When you develop some resources to be able to cope and manage your emotional reaction, the immediate thing is to be able to get support, to be able to be around people that care about you, and to be able to have the resources you need. To have some resilience and then to be able to understand what's going on now. And what do I do with it? A practical way, right away, at least, would be my take on how to approach therapy. You don't always need to do a deep dive into every single thing that happens. Still, it's important for a person to talk, to be able to express their anxiety, emotions, and their concerns, so they're not alone in the situation. 

    (CVC) We know that this is an area that has been widely misunderstood about uniform services (e. g., public safety employees) to many groups that we work with. There was a push along about the late 80s, early 90s, where people really were being, in a sense, forced into debriefing, where they would tell what they saw, what they heard, using all the five senses, right? After 9/11, there were many opportunities to study the effectiveness of the intervention. There were many opportunities to evaluate if requiring responders to express their feelings in the immediate aftermath of the response helped or harmed them. It became clear that forcing people to express their feelings wasn't necessarily helpful. Today, most meetings held after a traumatic response allow responders to talk if they choose to and choose who they speak with. At the Foundation we believe that just as other survivors are given choice, employees should also be.


    As stated earlier, the Foundation’s new FAERF Institute is developing a certificate in International Humanitarian Assistance Response. Participants in the program will learn much more about the essential nature of Safety Management Systems in an organization's Humanitarian Assistance Response Program. Watch this space for how you can sign up for the Introductory Course for the certificate due this Fall.


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