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םיצלמומ םירתא

David Baldwin לש רתאהמ םירמאמ

TRAUMATOLOGY

Articles on the Web by Bessel van der Kolk, MD

Introduction to Survival Strategies
Paul Valent
Abstract
This is a version of an important chapter from Valent's 1998 book, From Survival to
Fulfillment: A framework for the life-trauma dialectic, published in Philadelphia by
Bruner/Mazel.

Paul Valent describes eight survival strategies in response to trauma - "stress
responses which include specific adaptive and maladaptive, biological, psychological
and social constituents". Valent's survival strategies evolved as discrete phylogenetic
templates to aid survival following specific stressors. Together, survival strategies
offer a framework for categorizing classes of traumatic responses and events beyond PTSD's
typical fight or flight responses. When trauma responses are unsuccessful, this framework
may also help clarify differences important in treatment.

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Innovation, Controversy, and Consensus in Traumatology
David V. Baldwin
Introduction -
Controversy follows innovation and threats to the status quo in many social domains,
including the sciences. This article briefly summarizes information from the philosophy
of science and data from studies of conflict in diverse fields. It then introduces two
independent contemporary controversies in traumatology -- a new clinical method called EMDR
and the Final Report of the APA Working Group on memories of childhood abuse - and
considers them within a broader context of the historical rift between psychological
research and practice. The aim is to step outside the frame of specific conflicts and
identify differences in philosophical orientation and values that contribute to communication
difficulties and associated conflict between partisans. Approaches are offered toward
building consensus within the field

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Trauma Treatment To Target Memory
A.J.W. Taylor PhD
Abstract
Although the processes of memory and recall are known often to be affected by critical
incidents, they are barely mentioned, if at all, in the training of operational emergency
personnel. Indeed they hardly feature in the training of health professionals who work in
a variety of settings, and they do not appear much even as key words in the relevant
research area. The omission came sharply into prominence not long ago in the High Court
in New Zealand when a discourse on memory was invited from expert witnesses, and for the
very first time a jury accepted 'flashback' and post traumatic stress disorder as a
defence of provocation to a charge of murder. The topic was taken further during a
stress/trauma assignment and two referrals that will be described. The aim is a) to
draw parallels for the consideration of trainers, peer-supporters, and emergency workers,
b) to underline the importance of bringing traumatic memories into the viable mainstream
of memory, and c) to suggest that various forms of critical incident stress management
do more than extend camaraderie and give occupational and social support.

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Posttraumatic Therapy
Frank M. Ochberg
Abstract
Most victims of violence never seek professional therapy to deal with the emotional
impact of traumatic events. If they did, they would be sorely disappointed. There are
not enough therapists in the world to treat the millions of men, women, and children
who have been assaulted, abused and violated as a result of war, tyranny, crime disaster,
and family violence. When people do seek help suffering With posttraumatic symptoms
they may find therapists who are ill equipped to provide assistance. The credentialed
clinicians in psychiatry, psychology, nursing, social work, and the allied professions
are only recently learning to catalog, evaluate, and refine a therapeutic armamentarium
to serve traumatized clients. The ambitious collection of chapters in this volume is
one such arsenal. The prodigious efforts of Charles Figley co-founder of the Society for
Traumatic Stress, and organizer of the Psychosocial Stress book series (Brunner/Mazel)
and the Stress and Coping Series (Plenum Press), are important resources for professionals
concerned with traumatic stress reactions. A cadre of clinicians have also shared insights
and approaches, face-to-face, and through written works, defining principles and techniques
that address the worldwide problem of posttraumatic readjustment. Recently, I assembled
a sampling of those clinical insights (Ochberg, 1988) and attempted to define the
commonalities in assumptions and approaches to therapy. The common ground is the foundation
of posttraumatic therapy (PTT). The individual distinctions that separate clinicians who
share this common ground are the inevitable differences of creative minds.

My purpose in this chapter is to enlarge upon the foundation of PTT and clarify some of
the clinical techniques that stand upon this foundation.

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The Neurophysiology of Dissociation and Chronic Disease
Robert C. Scaer
Abstract
Dissociation as a clinical psychiatric condition has been defined primarily in terms
of the fragmentation and splitting of the mind, and perception of the self and the body.
Its clinical manifestations include altered perceptions and behavior, including
derealization, depersonalization, distortions of perception of time, space and body
and conversion hysteria. Using examples of animal models, and the clinical features
of the whiplash syndrome, we have developed a model of dissociation linked to the phenomenon
of freeze/immobility. Also employing current concepts of the psychobiology of posttraumatic
stress disorder (PTSD), we propose a model of PTSD linked to cyclical autonomic dysfunction,
triggered and maintained by the laboratory model of kindling, and perpetuated by increasingly
profound dorsal vagal tone and endorphinergic reward systems. These physiologic events in
turn contribute to the clinical state of dissociation. The resulting autonomic dysregulation
is presented as the substrate for a diverse group of chronic diseases of unknown origin.

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Can the Different Cerebral Hemispheres Have Distinct Personalities?
Evidence and Its Implications for Theory and Treatment of PTSD and Other Disorders
Fredric Schiffer, M.D.
Abstract
The author presents an evidence based psychological theory which is derived from clinical
observations, a review of the literature, especially the split-brain literature, and
experimentation with lateral visual field stimulation which has been found to induce
changes in patients' cognitive and emotional status thought to be associate with the
relative activation of one cerebral hemisphere or the other. The evidence from lateral
visual field stimulation suggests that often each hemisphere can have distinct psychological
perspectives differing especially in their level of neuroticism with one visual field
evoking a more immature perspective than the other. One of the central tenets of the
hypothesis is that psychological traumas are associated more with one cerebral hemisphere
and than the other, and that the ultimate aim of psychiatric care then becomes the teaching
of the mental entity associated with this troubled hemisphere that it is now safer and
more valued than it had been at the time of the trauma.

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Dependency in the Treatment of Complex Posttraumatic
Stress Disorder and Dissociative Disorders
Kathy Steele, M.N., C.S.
Abstract
Dependency is a major and ubiquitous issue in the treatment of chronically traumatized
patients, such as those with complex posttraumatic disorder (PTSD), trauma-related
borderline personality disorder, and dissociative disorders. Within this context, the
concept of dependency is often paired with pejorative adjectives, and is dichotomized
and negatively compared to a preferred state of independence. This paper explores
prevailing sociocultural and theoretical beliefs regarding dependency in the psychotherapy
of trauma survivors, provides a working definition of dependency, offers an analysis
of its complex nature, and describes the theory of structural dissociation, which helps
illuminate the often contradictory manifestations of dependency in chronically traumatized
patients. A distinction is made between secure and insecure dependency. Finally, this paper
outlines the collaborative therapeutic process required to manage insecure dependency
productively within a phase-oriented treatment model. Countertransference responses that
interfere with a patient's conflicts regarding dependency are also discussed.

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Approaches to the Treatment of PTSD
Bessel A. van der Kolk, M.D.,Onno van der Hart, Ph.D. & Jennifer Burbridge, M.A.
introduction
Terrifying experiences that rupture people's sense of predictability and invulnerability
can profoundly alter the ways that they subsequently deal with their emotions and with
their environment. The syndrome of Post Traumatic Stress Disorder (PTSD) can follow such
widely different stressors as war trauma, physical and sexual assaults, accidents, and
other natural and man-made disasters. Mirroring the confusion and disbelief of people
whose basic assumptions are shattered by traumatic experiences, the psychiatric profession
periodically has been fascinated by trauma, followed by sudden disbelief in the importance
of trauma in the genesis of psychopathlogy. Over the past decade our profession has
experienced the third intense wave of efforts to grasp the reality of trauma on body and soul,
after the first at the Salpetriere during the closing decades of the 19th century, and the
second, spearheaded by Abram Kardiner (1941), in the 1940s. The findings about the consequences
of trauma and what constitutes effective treatment have been extraordinarily consistent
over these 120 years. ..."

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Dissociation, affect dysregulation and somatization:
the complex nature of adaptation to trauma
Bessel A. van der Kolk, M.D.
introduction
PTSD, dissociation, somatization and affect dysregulation can be different expressions
of adaptation to trauma. While they often go together, traumatized individuals may suffer
from different combinations of symptoms over time. When treating individuals with
histories of psychic trauma, it is critical to attend to the dimensions of dissociation,
somatization, and affect dysregulation, even when intrusive recollections of the trauma
currently are not prominent symptoms.

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Psychological Trauma Assessment Package
Bessel A. van der Kolk, M.D.
introduction
The Trauma Center has developed a package of self-administered questionnaires that
assess psychological traumas and their sequelae, including features associated with
"disorders of extreme stress" or "complex PTSD". The test instruments included in this
package provide a comprehensive assessment of trauma histories at different ages and the
broad spectrum of posttraumatic adaptations encountered in clinical work. Clinicians
can chart patients' progress over time by collecting information at the initial intake
visit and three follow-up visits. Data files are easily imported to SPSS or SAS for further
analyses of patient data.

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PTSD לש הדידמ

Measures of Traumatic Stress & Secondary Traumatic Stress

Assessment Instruments - National Center for Post-Traumatic Stress Disorder
Abstract
This section is designed to provide clinicians and researchers with descriptive, reference,
and contact information about child and adult measures of trauma exposure and responses.
Measures included in these pages are those with published psychometric studies and those
that are widely used or are innovative.

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