impacts recovery chie maekoya
Chie Maekoya
Tokiwa International Victimology Institute
The 11th Asian Post Graduate Course on Victimology and Victim
1
What is a traumatic experience?
Possible reactions to a traumatic situation
Effects of victimization
Ecological view of psychological trauma
Recovery
Treatment
Resilience
Posttraumatic growth
2
Traumatic event
Experience that causes physical, emotional,
psychological distress, or harm. It is an
event that is perceived and experienced as
a threat to one's safety or to the stability of
one's world.
The person’s response involves intense
fear, helplessness or horror
e.g.) natural disaster, war, terrorism,
physical assault, sexual assault, spousal
abuse, child abuse, traffic accident
3
An event is likely to be traumatic if:
It happened unexpectedly.
It was unprepared.
Victim felt powerless to prevent it.
It happened repeatedly.
Someone was intentionally cruel.
It happened in childhood.
4
Emotional Effects
shock
terror
irritability
blame
anger
guilt
grief or sadness
emotional numbing
helplessness
loss of pleasure derived from familiar activities
difficulty feeling happy
difficulty experiencing loving feelings
5
Cognitive Effects
impaired concentration
impaired decision making ability
memory impairment
disbelief
confusion
nightmares
decreased self-esteem
decreased self-efficacy
self-blame
intrusive thoughts/memories
worry
dissociation (e.g., tunnel vision, dreamlike or "spacey"
feeling)
6
Physical Effects
fatigue, exhaustion
insomnia
cardiovascular strain
startle response
hyper-arousal
increased physical pain
reduced immune response
headaches
gastrointestinal upset
decreased appetite
decreased libido
vulnerability to illness
7
Interpersonal Effects
increased relational conflict
social withdrawal
reduced relational intimacy
alienation
impaired work performance
impaired school performance
decreased satisfaction
distrust
externalization of blame
externalization of vulnerability
feeling abandoned/rejected
overprotectiveness
8
egative emotion brings questions that sometimes damage
hat one believes about oneself, others, and the world
Basic assumptions victims hold
about themselves and their world
Traumatic event
• Belief in personal invulnerability
• Perception of the world as meaningful
• Perception of oneself as positive
change assumption
Threat
Danger
Insecurity
self-questioning
9
Individuals are not equally vulnerable to, nor
similarly affected by, traumatic events.
Persons, events, environments factors may
influence an individual post-traumatic
response and recovery.
Person
Traumatic
Event
Event Environment
Reaction to
the traumatic event
Recovery
10
Person
◦ Age
◦ Developmental stage
◦ Initial distress level
◦ Intelligence
◦ Personality
◦ Affects
◦ Cognition
◦ Coping styles
◦ Role
◦ Relationship between victim and offender
11
Event
◦ Frequency
◦ severity and duration of the event experienced
◦ degree of physical violence and bodily violation
involved
◦ the extent of the terror and humiliation
endured
◦ whether trauma was experienced alone or in
the company of others
12
Environment
◦ context within which the traumatic event was
experienced (home, school, work place or other context)
◦ victim’s natural support system
◦ the ability of that system to foster adaptive rather than
maladaptive coping
◦ the degree of safety and control afforded the victim posttrauma
◦ attitudes and behaviors of first respondents
◦ action and understanding of family, friends, caregivers,
significant individual/ group
◦ community attitude and values
◦ political and economic factors attending victimization
◦ the quality, quantity, accessibility and cultural relevance
of victims care and advocacy resources
13
Normal response to loss, particularly to the loss
of someone or something to which a bond was
formed.
Five Stages of Grief and Loss (Kubler-Ross, 1969)
Denial “This can’t be happening to me. ”
Anger “Why me?” “How can this happen to
me?”
Bargaining “Make this not happen, and in return
I will __.”
Depression “I’m so sad.”
Acceptance “It’s going to be okay.”
14
Post Traumatic Stress Disorder (PTSD)
◦ Re-experiencing the traumatic event
◦ Avoidance and emotional numbing
◦ Increased arousal
Acute Stress Disorder (ASD)
Anxiety disorders
Mood disorders
Substance abuse
Eating disorders
Sexual dysfunction
Self medicating
Suicide
15
A personal and unique process that reflects a change in
one’s attitudes, values, feelings, goals, skills, and roles,
and it involves the development of new meaning and
purpose in one’s life. It moves a person from the state of
pain, confusion, and anger to a state of normativeness.
Psycho/social coping theory (Dussich, 2006)
focusing on the presence and strength or the absence
and weakness of individual coping resources.
Three psychosocial recovery conditions:
Absence of major symptoms
Positive identity of self
Resumption of a functional daily life
16
Establishment of
safety
Remembrance
and mourning
Reconnection
with ordinary life
Herman, 1992
17
A guiding principle of achieving recovery is to
help a person regain power and control.
Establishing safety begins by focusing on control
of the body and gradually moves outward
toward control of the environment.
Indicators of the establishment of safety
Victims:
No longer feel completely vulnerable or isolated
Able to control most disturbing symptoms
Able to rely on self and others for support
Sense of deserving support and care
18
Reconstruction of the trauma involves the victims
telling the details of the trauma so that memory
can be integrated into the survivor’s life story.
Process involves intense grief.
Ultimately they are able to put the story,
including the imagery, into words. The victim
achieves the ability to construct not only what
happened but also what he felt.
19
The survivor faces the task of creating a
future
They develop
◦ New sense of self
◦ New relationships
◦ A meaning for life “faith”
Empowerment and reconnection are the
core experiences of recovery.
A sense of power and control will be
increased in this last stage.
20
Authority
over the remembering process
Integration of memory and affect
Affect tolerance
Symptom mastery
Self-esteem and self-cohesion
Safe attachment
Meaning making
21
An individual has a
new or renewed
authority over the
remembering process.
She can choose to
recall the event or not.
The balance of power
between the individual
and her memories is
reversed.
Authority over the
remembering process
Memory and affect are
joined.
The past is
remembered with
feeling.
An individual is able to
identify contemporary
feelings about the
past.
Integration of memory
and affect
22
Affects associated
with traumatic events
no longer overwhelm
or threaten.
Feelings can be felt
and named and
endured without
dissociation.
Affect tolerance
Persistent symptoms have
decreased and become more
manageable. Stimulus for trigger
of flashback are known and can
be avoided.
An individual might continuously
experience symptomatic arousal,
but she has mastered and
practices healthy coping routines
to reduce arousal and manage
stress.
An individual gains the ability to
predict and manage symptoms.
Symptom mastery
23
An individual feels sense of self and self
worse
Feeling of guilt, shame and self-blame are
decreased and new or newly restored sense
of self-worth is given.
Self-critical review is replaced by more
realistic appraisal, reflecting a more positive
new view of self.
Self esteem & Self Cohesion
24
An individual entails the
development or the repair
and restoration of a
survivor’s relational
capacities. The pull to
isolation is replaced by a
new or renewed capacity for
trust and attachment.
An individual is able to
negotiate and maintain
physical and emotional
safety in relationship and
views the possibility of
intimate connectedness with
some degree of optimism.
Safe Attachment
An individual assigns new
meaning to the trauma, to
the self as a trauma survivor
and to the world in which
traumatic events occur.
He might embrace the belief
that misfortune endured has
yielded new found strength
and compassion.
He names and mourns the
traumatic past and imbues
it somehow with meaning
that is both life affirming
and self-affirming.
Meaning Making
25
Incidence of dysfunction=
stress + risk factor
social supports + coping skills + self-esteem
(Swift, 1986)
Personal resources
◦ Physical assets
◦ Psychic assets
◦ Socio assets
Adequate resources result in resiliency, safety,
and an enhanced ability to recover
Recovery is best facilitated by the tailoring of
resources that are person-specific, culturesensitive & situation-realistic (Dussich, 2008).
26
traum
a
victi
m
Their world
view reduced
to a narrow
focus on their
physical
health and
basic needs
citizen
survivor
Beginning to find
their place in their
world
make adjustment
to accommodate
their new situation
reestablishing
connection with their
friend and
community
Fulfillment of
the individual’s
rights
social
integration and
access to all
aspects of
society
Ferguson, Richie and Gomez
(2004)
27
The
process of recovery is highly
individualistic.
Victim
services
The purpose is to reduce victims suffering and to
facilitate victim recovery (Dussich, 2006).
Victim service providers need to gather appropriate
resources.
Services which facilitate victim’s recovery
health and psychological care
Advocacy
Personal social support
Justice system services
Financial reparation
28
Treatment is necessary if survivors have..
Experienced of difficulty in social/ personal life
Long persistence of symptoms
Risk for suicide and self harming behavior
Possible treatment methods
Psychotherapy
Psycho education
◦ Normalization, self blame, give information to help
understanding
Cognitive Behavioral Therapy (CBT)
working cognitions to change emotion, thoughts and
behaviors
Eye Movement Desensitization and Reprocessing (EMDR)
accelerated information-processing model to account for
resolution of traumatic memories
Group therapy
Play therapy (children)
Pharmacotherapy (medication)
29
Factors in resilience
◦ Caring and supportive relationship within and
outside the family
◦ Capacity to make realistic plan and take steps
to carry them out
◦ A positive view of yourself and confidence in
your strength and abilities
◦ Skills in communication and problem solving
◦ Capacity to manage strong feelings and
impulses
30
Make connections
Avoid seeing crises as insurmountable
problems
Accepting that change is a part of living
Move toward the goal
Take decisive actions
Look for opportunities for self-discovery
Nurture a positive view of yourself
Keep things in perspective
Maintain a hopeful outlook
Take care of yourself
31
Positive changes which occur as a result
of coping with a traumatic event.
PTG includes:
Improvement of relationships with others
Openness to new possibilities
Greater appreciation of life
Enhancement of personal strength
Spiritual development
32
33
Tokiwa International Victimology Institute
The 11th Asian Post Graduate Course on Victimology and Victim
1
What is a traumatic experience?
Possible reactions to a traumatic situation
Effects of victimization
Ecological view of psychological trauma
Recovery
Treatment
Resilience
Posttraumatic growth
2
Traumatic event
Experience that causes physical, emotional,
psychological distress, or harm. It is an
event that is perceived and experienced as
a threat to one's safety or to the stability of
one's world.
The person’s response involves intense
fear, helplessness or horror
e.g.) natural disaster, war, terrorism,
physical assault, sexual assault, spousal
abuse, child abuse, traffic accident
3
An event is likely to be traumatic if:
It happened unexpectedly.
It was unprepared.
Victim felt powerless to prevent it.
It happened repeatedly.
Someone was intentionally cruel.
It happened in childhood.
4
Emotional Effects
shock
terror
irritability
blame
anger
guilt
grief or sadness
emotional numbing
helplessness
loss of pleasure derived from familiar activities
difficulty feeling happy
difficulty experiencing loving feelings
5
Cognitive Effects
impaired concentration
impaired decision making ability
memory impairment
disbelief
confusion
nightmares
decreased self-esteem
decreased self-efficacy
self-blame
intrusive thoughts/memories
worry
dissociation (e.g., tunnel vision, dreamlike or "spacey"
feeling)
6
Physical Effects
fatigue, exhaustion
insomnia
cardiovascular strain
startle response
hyper-arousal
increased physical pain
reduced immune response
headaches
gastrointestinal upset
decreased appetite
decreased libido
vulnerability to illness
7
Interpersonal Effects
increased relational conflict
social withdrawal
reduced relational intimacy
alienation
impaired work performance
impaired school performance
decreased satisfaction
distrust
externalization of blame
externalization of vulnerability
feeling abandoned/rejected
overprotectiveness
8
egative emotion brings questions that sometimes damage
hat one believes about oneself, others, and the world
Basic assumptions victims hold
about themselves and their world
Traumatic event
• Belief in personal invulnerability
• Perception of the world as meaningful
• Perception of oneself as positive
change assumption
Threat
Danger
Insecurity
self-questioning
9
Individuals are not equally vulnerable to, nor
similarly affected by, traumatic events.
Persons, events, environments factors may
influence an individual post-traumatic
response and recovery.
Person
Traumatic
Event
Event Environment
Reaction to
the traumatic event
Recovery
10
Person
◦ Age
◦ Developmental stage
◦ Initial distress level
◦ Intelligence
◦ Personality
◦ Affects
◦ Cognition
◦ Coping styles
◦ Role
◦ Relationship between victim and offender
11
Event
◦ Frequency
◦ severity and duration of the event experienced
◦ degree of physical violence and bodily violation
involved
◦ the extent of the terror and humiliation
endured
◦ whether trauma was experienced alone or in
the company of others
12
Environment
◦ context within which the traumatic event was
experienced (home, school, work place or other context)
◦ victim’s natural support system
◦ the ability of that system to foster adaptive rather than
maladaptive coping
◦ the degree of safety and control afforded the victim posttrauma
◦ attitudes and behaviors of first respondents
◦ action and understanding of family, friends, caregivers,
significant individual/ group
◦ community attitude and values
◦ political and economic factors attending victimization
◦ the quality, quantity, accessibility and cultural relevance
of victims care and advocacy resources
13
Normal response to loss, particularly to the loss
of someone or something to which a bond was
formed.
Five Stages of Grief and Loss (Kubler-Ross, 1969)
Denial “This can’t be happening to me. ”
Anger “Why me?” “How can this happen to
me?”
Bargaining “Make this not happen, and in return
I will __.”
Depression “I’m so sad.”
Acceptance “It’s going to be okay.”
14
Post Traumatic Stress Disorder (PTSD)
◦ Re-experiencing the traumatic event
◦ Avoidance and emotional numbing
◦ Increased arousal
Acute Stress Disorder (ASD)
Anxiety disorders
Mood disorders
Substance abuse
Eating disorders
Sexual dysfunction
Self medicating
Suicide
15
A personal and unique process that reflects a change in
one’s attitudes, values, feelings, goals, skills, and roles,
and it involves the development of new meaning and
purpose in one’s life. It moves a person from the state of
pain, confusion, and anger to a state of normativeness.
Psycho/social coping theory (Dussich, 2006)
focusing on the presence and strength or the absence
and weakness of individual coping resources.
Three psychosocial recovery conditions:
Absence of major symptoms
Positive identity of self
Resumption of a functional daily life
16
Establishment of
safety
Remembrance
and mourning
Reconnection
with ordinary life
Herman, 1992
17
A guiding principle of achieving recovery is to
help a person regain power and control.
Establishing safety begins by focusing on control
of the body and gradually moves outward
toward control of the environment.
Indicators of the establishment of safety
Victims:
No longer feel completely vulnerable or isolated
Able to control most disturbing symptoms
Able to rely on self and others for support
Sense of deserving support and care
18
Reconstruction of the trauma involves the victims
telling the details of the trauma so that memory
can be integrated into the survivor’s life story.
Process involves intense grief.
Ultimately they are able to put the story,
including the imagery, into words. The victim
achieves the ability to construct not only what
happened but also what he felt.
19
The survivor faces the task of creating a
future
They develop
◦ New sense of self
◦ New relationships
◦ A meaning for life “faith”
Empowerment and reconnection are the
core experiences of recovery.
A sense of power and control will be
increased in this last stage.
20
Authority
over the remembering process
Integration of memory and affect
Affect tolerance
Symptom mastery
Self-esteem and self-cohesion
Safe attachment
Meaning making
21
An individual has a
new or renewed
authority over the
remembering process.
She can choose to
recall the event or not.
The balance of power
between the individual
and her memories is
reversed.
Authority over the
remembering process
Memory and affect are
joined.
The past is
remembered with
feeling.
An individual is able to
identify contemporary
feelings about the
past.
Integration of memory
and affect
22
Affects associated
with traumatic events
no longer overwhelm
or threaten.
Feelings can be felt
and named and
endured without
dissociation.
Affect tolerance
Persistent symptoms have
decreased and become more
manageable. Stimulus for trigger
of flashback are known and can
be avoided.
An individual might continuously
experience symptomatic arousal,
but she has mastered and
practices healthy coping routines
to reduce arousal and manage
stress.
An individual gains the ability to
predict and manage symptoms.
Symptom mastery
23
An individual feels sense of self and self
worse
Feeling of guilt, shame and self-blame are
decreased and new or newly restored sense
of self-worth is given.
Self-critical review is replaced by more
realistic appraisal, reflecting a more positive
new view of self.
Self esteem & Self Cohesion
24
An individual entails the
development or the repair
and restoration of a
survivor’s relational
capacities. The pull to
isolation is replaced by a
new or renewed capacity for
trust and attachment.
An individual is able to
negotiate and maintain
physical and emotional
safety in relationship and
views the possibility of
intimate connectedness with
some degree of optimism.
Safe Attachment
An individual assigns new
meaning to the trauma, to
the self as a trauma survivor
and to the world in which
traumatic events occur.
He might embrace the belief
that misfortune endured has
yielded new found strength
and compassion.
He names and mourns the
traumatic past and imbues
it somehow with meaning
that is both life affirming
and self-affirming.
Meaning Making
25
Incidence of dysfunction=
stress + risk factor
social supports + coping skills + self-esteem
(Swift, 1986)
Personal resources
◦ Physical assets
◦ Psychic assets
◦ Socio assets
Adequate resources result in resiliency, safety,
and an enhanced ability to recover
Recovery is best facilitated by the tailoring of
resources that are person-specific, culturesensitive & situation-realistic (Dussich, 2008).
26
traum
a
victi
m
Their world
view reduced
to a narrow
focus on their
physical
health and
basic needs
citizen
survivor
Beginning to find
their place in their
world
make adjustment
to accommodate
their new situation
reestablishing
connection with their
friend and
community
Fulfillment of
the individual’s
rights
social
integration and
access to all
aspects of
society
Ferguson, Richie and Gomez
(2004)
27
The
process of recovery is highly
individualistic.
Victim
services
The purpose is to reduce victims suffering and to
facilitate victim recovery (Dussich, 2006).
Victim service providers need to gather appropriate
resources.
Services which facilitate victim’s recovery
health and psychological care
Advocacy
Personal social support
Justice system services
Financial reparation
28
Treatment is necessary if survivors have..
Experienced of difficulty in social/ personal life
Long persistence of symptoms
Risk for suicide and self harming behavior
Possible treatment methods
Psychotherapy
Psycho education
◦ Normalization, self blame, give information to help
understanding
Cognitive Behavioral Therapy (CBT)
working cognitions to change emotion, thoughts and
behaviors
Eye Movement Desensitization and Reprocessing (EMDR)
accelerated information-processing model to account for
resolution of traumatic memories
Group therapy
Play therapy (children)
Pharmacotherapy (medication)
29
Factors in resilience
◦ Caring and supportive relationship within and
outside the family
◦ Capacity to make realistic plan and take steps
to carry them out
◦ A positive view of yourself and confidence in
your strength and abilities
◦ Skills in communication and problem solving
◦ Capacity to manage strong feelings and
impulses
30
Make connections
Avoid seeing crises as insurmountable
problems
Accepting that change is a part of living
Move toward the goal
Take decisive actions
Look for opportunities for self-discovery
Nurture a positive view of yourself
Keep things in perspective
Maintain a hopeful outlook
Take care of yourself
31
Positive changes which occur as a result
of coping with a traumatic event.
PTG includes:
Improvement of relationships with others
Openness to new possibilities
Greater appreciation of life
Enhancement of personal strength
Spiritual development
32
33