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addictions to osteoporosis,
also obesity and insomnia |
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beyond health, wellness
at
work, nutrition |
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our
model for trauma support
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(Taken from Van Wyk, G. (2004).
Trauma debriefing debunked: A proposed alternative model for
assisting trauma victims. Paper presented at the Fourth International
Congress of Psychic Trauma and Traumatic Stress, Buenos Aires,
24 to 26 June 2004) |
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Background
to the Model
During the last decade a number of studies has shown convincingly
that trauma debriefing, as it has been practised widely for
many years, is of doubtful value and even potentially harmful
(Rose et al., 2003). In response to this the traumaClinic
decided to use its first-hand experience over the past 15
years to identify and re-examine those factors which research
studies have shown to indeed influence the outcome of traumatic
experiences with a view to developing a new model for assisting
people with recovery from such experiences. |
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From putting the available research
evidence into practice in the South African, mainly dealing
with criminal violence and work related trauma, the following
basic tenets of our approach emerged: |
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The
typical reactions to trauma are not only normal, but
are also functional. |
| • |
The
majority of trauma victims recover largely within two
to three weeks, with or without professional help. If
this does not happen it indicates the presence of risk
factors that are complicating the recovery process (See
below). |
| • |
The
natural recovery process is assisted by the utilisation
and optimisation of those factors that are known to
promote recovery from trauma, including
• validation and normalisation of experiences
• psycho-education regarding the effects of, and
recovery from, trauma
• availability of support structures - professional,
social and personal
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Trauma counselling is only
one form of help and serves to assist and inform victims,
family & friends and also management. |
| • |
Trauma counselling is only
one form of help and serves to assist and inform not only
victims, but also family and friends, and in the case
of work related trauma colleagues and management. |
| • |
A supportive environment
both increases trauma resilience and promotes recovery
from trauma. In fact, the best possible professional assistance
is often neutralised by input from the significant persons
in the world of the trauma victim, such as spouses, managers,
friends and colleagues. Hence it is evident that significant
others can have much more impact, both constructive and
destructive, than any professional help. |
| • |
Some people appear to deal
best with their experiences by distancing themselves and
not dwelling on bad experiences, contrary to the normal
process of CISD. Hence, under certain circumstances and
for certain persons, denial may be a functional defence
mechanism and not necessarily destructive as has generally
been thought to be the case. |
| • |
In work related trauma it
appears that the granting of sick leave after trauma increases
the incidence of avoidance behaviour leading to absenteeism
and staff turnover. |
| • |
People can cope with extreme
experiences without emotional “scarring”,
depending on the meaning which the traumatic experience
holds for them. |
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The available research has confirmed
some of the above findings resulting from the traumaClinic’s
experience and has highlighted a number of other factors that
have been proved to have a demonstrable effect on trauma recovery: |
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Pre-traumatic
characteristics of the victim: |
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Age
– children are more vulnerable |
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Previous
history of psychiatric diagnosis (McFarlane, 1989) |
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History of previous trauma
(Davidson et al.,1991; Bremner et al.1993; Nishith et
al., 2000; Resick 1988) |
| • |
Other life stressors (Ruch
et al., 1980; Wirtz & Harrell, 1987) |
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Lack of, or negative social
support systems (Davidson, 1991; Boscarino, 1995; Conte
& Schuerman, 1987) |
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Characteristics of the potentially
traumatic event: |
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The
subjective experience seems to be more significant than
the objective features of the event. |
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Post-trauma factors and factors
of the recovery environment: |
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The
degree and duration of re-experiencing and hyper-arousal
symptoms (Brewin et.al., 1999; Harvey & Bryant,
1999) |
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Social
supports (Bisson et al., 2000; Gist and Woodall, 2000;
Forbes & Roger, 1999; King et al, 1998; Hobfoll
conservation of resources theory (1995) |
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Validation (Herman, 1992) |
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Cognitive-behavioral and
exposure therapy (Foa et al., 1998; Bryant et al., 1998) |
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Medical intervention is not
necessarily advisable as research points to an increased
incidence of PTSD after administration of Benzodiazepine
(Gelpin et al., 1996) |
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traumaClinic’s
Model for Trauma Support
The above research findings and our own experience dictate that
effective assistance of trauma victims should extend to activities
or interventions beyond debriefing, counselling or therapy,
but does not exclude these activities. For example, it is felt
that under certain circumstances practical help is more helpful
than any debriefing, therapy or counselling could be.
Furthermore, it is suggested that an effective model of early
trauma intervention should have as objectives not only the
prevention of PTSD, but also the facilitation of the normal
recovery from trauma and the prevention of other related disorders
or problems. It is further postulated that a pragmatic model
should in essence consist of:
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Early
identification of, attention to, and treatment of, those
factors that can possibly complicate or hamper a victim’s
recovery from trauma. |
| • |
Optimising
and utilising those factors that are known to promote
recovery from trauma. |
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With these departure points in
mind a general outline of the typical trauma support process
followed by traumaClinic
is made up of three stages: |
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STAGE ONE: IMPACT PHASE/NUMBNESS
(hours to one or two days after incident)
- Ensure protection and safety
- Nurturance, practical assistance and guidance
- Support and containment
- Validation and normalisation of reactions and feelings
- Assessment of possible risk factors
- Psycho-educational guidance
- Assessment and activation of social supports
STAGE TWO: RECOIL PHASE/EMOTIONALITY (few days to two weeks
after incident)
- Further validation and normalisation of reactions and feelings
- Assessment of risk factors and personal resource
- Further emotional support and containment if necessary
- Further assessment of risk factors
- Information re trauma process
- Counselling/psychotherapy/controlled exposure (if applicable)
STAGE THREE: REORGANISATION PHASE/RATIONALITY (two to four
weeks)
- Reassess
- Cognitive restructuring
- Ascribe meaning to incident
- Further counselling/psychotherapy if necessary
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