•1.    Psychological and emotional      trauma
ØIntroduction
ØSymptoms of trauma
ØChildhood abuse & statistics
ØPrenatal traumatic experiences
ØTrauma and amnezia
oTheories why are they forgotten
oFalse memory
oHow might false memory develop?
oAn example for false memory
oHow often are childhood memories forgotten?
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o
2.PTSD-post traumatic stress
•disorder
ØIntroduction
ØSymptoms of PTSD
ØTypes of PTSD
•
•3.   Brain function and traumatic experience
ØThe impact of trauma on brain
ØEffects of trauma on amygdala and hippocampus
ØPTSD and the brain
•
4.Repressed memory therapy
ØHistorical overview
ØHow does trauma-focused therapy work?
ØTechniques used in RMT
ØTrauma treatment approaches




•The word “trauma” is rooted in a Greek word meaning: “wound – injury - damage“
•Traumatic experiences often involve a threat to life or safety, but any situation that leaves you
feeling overwhelmed and alone can be traumatic, even if it doesn’t involve physical harm. It’s not
the objective facts that determine whether an event is traumatic, but your subjective emotional
experience of the event. The more frightened and helpless you feel, the more likely you are to be
traumatized.
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•

Ø2 main types of trauma:

-single event trauma
-repeated trauma
•Emotional and psychological trauma can be caused by single-blow, one-time event, such as a
horrible accident, a natural disaster, or a violent attack.
1)
•Trauma can also stem from ongoing, relentless stress, such as living in a crime-ridden
neighborhood or struggling with cancer. People are more likely to be traumatized by a stressful
experience if they’re already under a heavy stress load or have recently suffered a series of
losses.
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•

ØSymptoms of trauma



•Nightmares
•Edginess
•Agitation
•Muscle tension
•Withdrawing from others, feeling disconnected, numb
•Mood swings
•Guilt, shame, self-blame
•Being startled easily

Childhood trauma results from anything that disrupts a child’s sense of safety and security,
including:
•Seperation from the parent
•Sexual, physical, verbal abuse, violence
•Neglect
•Bullying
•Serious illness
•Natural disaster, war
•Horrible accident
•

How common are claims of childhood abuse?






•Traumas and adversities in childhood may leave scars that last into adulthood and put a person at
risk for a variety of difficulties. This is true for all kinds of early traumas, including
accidents, disasters, and witnessing violence directed at others, but it is especially true for
child abuse and neglect, the victims of which have been studied extensively. Not all childhood
trauma survivors experience difficulties in adulthood. However, for many people, it may be
important to come to terms with past traumatic events. People who have been in treatment can gain
relief from anxiety and depression and are able to stop focusing on the disturbing memories and
feelings associated with traumatic childhood events.
•

From conception till birth, and beyond-
prenatal traumatic experiences
•
•The effects of prenatal traumatization cannot be predicted without knowledge of other factors, and
prenatal experiences are likely to have lifelong impact when they are followed by reinforcing
conditions or interactional trauma.
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•

•There is a growing number of studies that foetuses are vulnerable to traumatic stress felt by the
pregnant woman. In fact, research shows that pre-natal exposure to natural disasters and other
life-or-death situations can have a lasting effect on offspring. Studies have shown earlier births
among pregnant women who experienced an earthquake in California; delayed development among
children whose pregnant mothers suffered through an ice storm in Canada; and early signs of
post-traumatic stress syndrome in babies whose pregnant mothers experienced the 9/11 terrorist
attacks. I.Q. of such children are also found to be lower. Maternal stress is also linked with
imperfections in the developing nervous system
•

The memories, experiences, and traumas from conception till birth can also trigger memories of
traumatic experiences. As a result of this, many of our personality traits and physical and
emotional problems can be traced to experiences that we had while in the mother’s womb and also
during the process of giving birth. Many emotional and physical problems, such as feelings of loss,
alienation, rejection, loneliness, grief, relationship problems, separation anxiety, panic attacks,
depression, claustrophobia, paranoia, asthma, headaches, and sinus problems, can be traced back to
the traumas surrounding birth.

Trauma and amnezia
•For more than a hundred years, doctors, scientists, and other observers have reported the
connection between trauma and forgetting. But only in the past 10 years have scientific studies
demonstrated a connection between childhood trauma and amnesia. Most scientists agree that memories
from infancy and early childhood - under the age of two or three - are unlikely to be remembered.
Research shows that many adults who remember being sexually abused as children experienced a period
when they did not remember the abuse. Scientists also have studied child victims at the time of a
documented traumatic event, such as sexual abuse, and then measured how often the victims forget
these events as they become adults. They discovered that some people do forget the traumatic
experiences they had in childhood, even though it was established fact that the traumatic events
occurred.

ØTheories why they are forgotten:
•Forgetting becomes an adaptive response important for survival to avoid stress.
•Stress levels, emotional arousal and altered attention focusing during the experience prevent
proper encoding.
•The traumatic experience sometimes causes global impairment that is people fail to construct an
accurate memory of their present and past events.
•

ØFalse memories
•Misremembering may result from confusion of memories of perceived and imagined events, as there
may be overlap between features of the stored information comprising memories for perceived and
imagined events - incidents that had not occurred
•One could experience intense emotions but without the thoughts or actual memories
•Distortions such as switching the roles of people in one's memory are quite common
•Adults can have vivid memories, of which they are extremely confident, that are nevertheless
wrong. Once those false memories have been established, they are not easily changed by contrary
evidence

ØHow might false memories develop?
•A great deal of laboratory research involving normal people in everyday situations demonstrates
that memory is not perfect. Evidence shows that memory can be influenced by other people and
situations; that people can make up stories to fill in memory gaps, and that people can be
persuaded to believe they heard, saw or experienced events that did not really happen. Studies also
reveal that people who have inaccurate memories can strongly believe they are true.

ØAn example for the false memory:
•Jean Piaget, the great child psychologist, claimed that his earliest memory was of nearly being
kidnapped at the age of 2. He remembered details such as sitting in his baby carriage, watching the
nurse defend herself against the kidnapper, scratches on the nurse's face, and a police officer
with a short cloak and a white baton chasing the kidnapper away. The story was reinforced by the
nurse and the family and others who had heard the story. Piaget was convinced that he remembered
the event. However, it never happened. Thirteen years after the alleged kidnapping attempt,
Piaget's former nurse wrote to his parents to confess that she had made up the entire story. Piaget
later wrote: "I therefore must have heard, as a child, the account of this story...and projected it
into the past in the form of a visual memory, which was a memory of a memory, but false" (Tavris)
•
•

ØHow Often are Childhood Memories Forgotten?
•This is an extremely controversial subject. There is general agreement among memory researchers
that memories of events which happened before the age of 2 are never remembered into adulthood and
cannot be recovered; memories before the age of 3 are rare and not particularly reliable. Claims by
Ross et al that 27% of their patients recall abuse that occurred before 3 years of age are probably
based on false memories. A claim by Rosanne of abuse when she was 6 months old is certainly a false
memory. Claims by some adults that they can remember being a just-fertilized ovum stuck in their
mother's fallopian tube are totally devoid of credibility.
•Some survivor's memories of childhood sexual abuse have always been present from the moment when
they occurred until the present time. Unfortunately, with the publicity given to false memories,
these survivors are sometimes ignored or belittled.
•Some memories are simply forgotten. This includes almost all early experiences. It is quite
possible that a child could have a mild molestation experience and permanently forget about it,
just as children forget most painful bicycle accidents, falling down stairs, etc.
•Some therapists believe in the concept of repressed memories. i. e. that memories of hundreds of
incidents of serious sexual abuse and ritual abuse can be actively repressed so that the events
cannot be recollected in adulthood. They believe that through intensive techniques (hypnotism,
"truth serum" sessions, guided imagery, dream analysis, etc) such memories can be recovered.
•Other therapists believe that a single instance of serious abuse after about age 4 or 5 is very
rarely forgotten, and that repeated abuse is perhaps never forgotten.

•
•
•The concept of
•Repression & Suppression

•Reppression process is a completely automatic psychological defense against emotional trauma and
does not involve conscious intent. A fundamental, usually unconscious function of the ego maintains
equilibrium in the individual by repressing inappropriate, unfeasible, or guilt-causing urges,
memories and wishes (all usually of the id) to the level of the unconscious, where they will be out
of sight, if not out of mind. As a natural psychological defense mechanism that serves to keep
painful and traumatic memories out of awareness. in response to trauma
•Suppression means consciously, deliberately  forcing the unwanted information out of awareness -
however, this removal of anxiety-provoking memories from our awareness are believed to occur
unconsciously

2.
Post Traumatic Stress Disorder (PTSD)


ØPTSD
•it was first described by Jacob Mendes Da Costa, a doctor during the American Civil War. Marked by
chronic tachycardia (high heart rate), and reactivity (increase in heart rate due to a stressor),
it looked very much like cardiac disease, but Da Costa recognized the possibility that it was
brought on by wartime trauma. PTSD was first noticed on a massive scale during World War I.
•PTSD can develop in people who have never set foot on a battlefield. The disorder occurs in men,
women and children, as a result of a number of traumatic experiences.

•PTSD - the continuation of disturbing thoughts, emotions, and feelings that persist even after the
trauma is over
•Post-traumatic stress disorder is a term used to explain mental health condition marked by severe
anxiety, flashbacks and uncontrollable thoughts about a terrifying event. Although the disorder was
typically associated with soldiers who have been in military combat, PTSD can occur after any event
that causes fear and stress.
•

ØSymptoms of PTSD
•Post-traumatic stress disorder symptoms typically surface within three months of a traumatic
event; however, in some people, they may not appear until years after the event
•The National Institute of Mental Health (NIMH) notes that PTSD symptoms are generally grouped into
three types:
•Re-experiencing symptoms
•Avoidance symptoms
•Hyperarousal symptoms
•

•Re-experiencing symptoms:
•flashbacks, or reliving the event, with physical reactions such as sweating and a racing heart;
nightmares; and frightening thoughts. These symptoms can intrude on a person's everyday life.
People, places and activities can remind the person of the event and trigger the reactions
•Avoidance symptoms:
• include trying to avoid thinking or talking about the event. People with PTSD will often steer
clear of places, events or situations that remind them of the experience for fear of having a
flashback and being unable to control their actions. They may also feel emotionally numb
•Hyperarousal symptoms:
•include feelings of stress, and being "on edge" and easily startled. These symptoms are usually
constant rather than being triggered by reminders of the event. These symptoms may make it hard to
eat, sleep or concentrate.
•

•A family or personal history of mental health risks, such as an increased risk of anxiety and
depression, can affect the likelihood of experiencing a PTSD episode. Another factor is the way
that the brain regulates the chemicals and hormones that the body produces in response to stress.
Temperament also plays a role, according to the NIMH.
•Children can exhibit different symptoms than adults do. Some children who are suffering from PTSD
will regress, sometimes wetting the bed or being unable to talk, although they had mastered these
tasks prior to the event.
•

3.
The brain function and the traumatic experience


ØThe impact of trauma on the brain
•All trauma effects the physical body, consequently the traumatized people have alterations in
their brain. Memory is affected by lapses-there are deficits in verbal recall. The frontal cortex
ability is decreased. Less ability to do left-brain functions--it can’t distinguish a real threat
from a false threat. Intense stress or trauma is accompanied by the release of hormones. A nerve
running out of the brain to the adrenal glands triggers adrenaline and noradrenaline secretions.
Adrenaline and noradrenaline surge through the blood stream causing the heart to beat faster and
prime the body for an emergency. Then these hormones activate receptors on the vagus nerve running
back to the brain. This causes the heart to continue to beat faster, but also signals various parts
of the brain to supercharge that intense emotional memory. These hormones assist the individual to
mobilize in the event of emergency. They also sweep through the body, return to the brain, and
trigger the release of more equally powerful hormones (cortisol, epinephrine and norepinephrine,
oxytocin, vasopressin and opioids).

•Trauma researchers have looked inside the brains of people who have suffered serious emotional
trauma. The first scan was while they remembered neutral events in their lives. The second scan was
taken as they were exposed to scripted versions of their traumatic memories. During the scanning,
the images actually showed dissociation happen in the brains of these PTSD patients. When they
remembered a traumatic event, the left frontal cortex shut down, particularly Broca's area (the
center for speech). But areas of the right hemisphere, associated with emotional states and
autonomic arousal, lit up, particularly the area around the amygdala. This suggests that when
people relive their traumatic experiences, the frontal lobes become impaired and, as a result, they
have trouble thinking and speaking.

ØEffect of trauma on amygdala and hippocampus
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Amygdala - It becomes highly active during and while remembering a traumatic incident. When someone
has been in trauma it’s hypersensitive-overreacts to normal stimuli.
Hippocampus- Researchers have looked at the size of the hippocampus in people with and without
PTSD. They have found that people who have severe, chronic cases of PTSD have smaller hippocampi.
The researchers have taken this to suggest that the experience of constant stress as a result of
severe and chronic PTSD may ultimately damage the hippocampus, making it smaller. The shrinkage is
induced through trauma.







4.
REPRESSED MEMORY THERAPY


ØHistorical overview
•Freud introduced the concept of memory repression to the public and advocated that the brain
represses traumatic memories automatically
•Inspired partly by the Freudian-based concept - In his theory the mind automatically banishes
traumatic events from memory to prevent overwhelming anxiety. Freud further theorized that
repressed memories cause "neurosis," which could be cured if the memories were made conscious. For
Freud, repression was the unconscious mechanism whereby unacceptable impulses or memories were kept
hidden from awareness, as a basic defense which the ego uses to ward off anxiety
•One of the issues Freud struggled with was the status of the childhood memories recovered in his
therapy from repression. Freud's repressed memory theory joined his philosophy of psychoanalysis.
Repressed memory has remained a heavily debated topic inside of Freud's psychoanalysis philosophy

...from devastation to hope...
•RMT refers to the attempts to recover long forgotten or repressed memories and is a psychotherapy
term for therapy using one or more method or technique for the purpose of recalling memories.  It
does not refer to a specific, recognized treatment method, but rather several controversial
interviewing techniques, such as hypnosis and guided-imagery. Proponents of recovered memory
therapy claim that traumatic memories can be buried in the subconscious and affect current
behavior, and that these can be recovered.
•

ØHow does trauma-focused therapy work?
•The point of trauma - focused therapy is not to make people remember all the disturbing things
that ever happened to them. People do not need to remember every detail in order to heal. Rather,
the goal of psychotherapy is to help people gain authority over their trauma - related memories and
feelings so that they can get on with their lives. To do this, people often have to talk in detail
about their past experiences. Through talking, they are able to acknowledge the trauma - remember
it, feel it, think about it, share it, and put it in perspective. At the same time, to prevent the
past from continuing to influence the present negatively, it is vital to focus on the present,
since the goal of treatment is to help individuals live healthier, more functional lives in the
here and now.

ØTechniques used in RMT
•hypnotism
•guided imagery (talking the client through an imaginary trip)
•dream work (analyzing dreams for suggestions of abuse)
•age regression (taking the client back in time to early childhood)
•"truth serum": use of drugs to enhance recall of memories
•automatic writing (having the client write freely without thinking about what they are writing)
•Tension and Trauma Releasing Exercises (TRE)

ØTrauma therapy treatment aproaches:
•Pharmacotherapy
•Exposure Therapy
•Cognitive Behavioral Therapy (CBT)
•Eye Movement Desensitization and Reprocessing (EMDR)
•Hypnotherapy
•Psychodynamic Therapy
•Group Therapy
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•

vPharmacotherapy
•Management of PTSD may involve the use of various treatment modalities, involving both nondrug
treatments and pharmacotherapy. It is an important adjunctive treatment for trauma in conjunction
with either cognitive behavior therapy or psychoanalytic psychotherapy
•The current medications of choice are the selective serotonin reuptake inhibitors (SSRI), which
are beneficial for posttraumatic reexperiencing, hyperarousal, and avoidant symptoms. Other
medication classes including non-SSRI antidepressants, mood stabilizers, anticonvulsants, and
anti-adrenergic agents have shown efficacy for some trauma symptoms. Because beneficial responses
may be slow to appear, pharmacotherapy of trauma requires a medication trial of adequate length and
dose to determine effectiveness.

vExposure therapy
•Exposure therapy, previously known as imaginal flooding therapy, involves carefully exposing the
patient to prolonged and repeated imagined images of the trauma until the images no longer cause
severe anxiety.
•In PTSD, exposure therapy is intended to help the patient face and gain control of the fear and
distress that was overwhelming in the trauma, and must be done very carefully in order not to
re-traumatize the patient

vCognitive Behavioral Therapy (CBT)
•A branch of psychotherapy which is based on the premise that the way we think (cognitive)
determines how we respond to those thoughts (behaviour). Over years these negative thinking and
behaviour patterns become fixed, and cognitive behavioural therapy hopes to challenge those
behaviours, bringing about positive feelings and behavioural changes
•CBT for PTSD is aimed at teaching sufferers ways to help them modify negative thought patterns so
they are able to gain control of their fear. Though techniques will vary from practitioner to
practitioner, often-mental imagery is used to help individuals through their trauma
•

vEye movement desensitisation and reprocessing (EMDR)
•Eye movement desensitisation and reprocessing (EMDR) is a form of treatment which has been found
to benefit a variety of behavioural and emotional issues in both adults and children. The treatment
itself involves performing a series of right to left eye movements whilst simultaneously recalling
a traumatic event.
•Though it is not known exactly how the treatment works, it is thought that it may be linked to the
left and right stimulation of the brain whilst we are in REM (rapid eye movement) sleep, during
which our eyes rapidly move from one side to another.
•The eye movements are designed to help the brain process unconscious material and flashbacks so
that in due course, sufferers are able to come to terms with the harrowing event they experienced
and are able to adopt a more positive thinking approach moving forward.
•

vPsychodynamic Therapy
•Psychodynamic approaches to PTSD focus on a number of different factors that may influence or
cause PTSD symptoms, such as early childhood experiences (particularly our level of attachment to
our parents), current relationships
•Psychodynamic psychotherapy places a large emphasis on the unsconscious mind
•Bringing about change in symptoms or behavior requires getting in touch with and "working through"
those painful unconscious feelings. To do this, the psychodynamic therapist will assist the patient
in recognizing the defense mechanisms being used, what they are being used for (to avoid painful
feelings in the unconscious mind stemming from a traumatic experience) and connecting with and
appropriately releasing those feelings and thoughts that were previously being avoided.

vGroup Therapy
•Because isolation is such a powerful effect of trauma, the ability of groups to provide support
and reconnections for members is particularly important for trauma treatment.. The appeal of group
interventions for trauma survivors rests, to a large extent, on the clear relevance of joining with
others in therapeutic work when coping with victimization consequences such as isolation,
alienation, and diminished feelings. Bonding with similar others in a supportive environment can be
a critical step toward regaining trust

vHypnotherapy
•The aim of hypnotherapy is to unlock stored emotion so that the trauma can be revisited and
explored from a different perspective.
•Work with the unconscious mind so that negative beliefs which were built up during the trauma can
be explored and alleviated
•Hypnosis and other techniques that ply upon a person’s suggestibility must be used with great
caution
•

VIDEOS I
•Liz Mullinar - Treating the core problem of childhood trauma
•https://www.youtube.com/watch?v=svX3fEdVTLQ
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•Healing Trauma, Healing Humanity: Rolf Carriere
•https://www.youtube.com/watch?v=CcXqcQecRXo
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•The paradox of trauma-informed care | Vicky Kelly
•https://www.youtube.com/watch?v=jFdn9479U3s
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VIDEOS II
•Trauma, Brain & Relationship: Helping Children Heal
•https://www.youtube.com/watch?v=jYyEEMlMMb0
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•Through Our Eyes: Children, Violence, and Trauma
•https://www.youtube.com/watch?v=z8vZxDa2KPM
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•Neurobiology of Trauma - Dr. David Lisak
•https://www.youtube.com/watch?v=py0mVt2Z7nc
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Recommendations & Suggested readings



Recommendations & Suggested readings II



Recommendations & Suggested readings III



References & Literature I.
•Source from: Stanford Report, Jan., 2004, by Lisa Trei - Psychologists offer proof of brain’s
ability to suppress memories - http://news.stanford.edu/news/2004/january14/memory-114.html
•source from:  http://www.guidetopsychology.com/repressn.htm written by Raymond Lloyd Richmond,
Ph.D
•http://www.victorianweb.org/science/freud/repression.html written by David B. Stevenson, 1996,
Brown University
•Renee Fredrickson, Ph.D, 1992– Repressed memories-A Journey to recovery from sexual abuse-A
dawning reality- 25-30 p. ISBN 0-671-76716-X
•http://www.caic.org.au/fms-sra/rmt.htm written by Jan Groenveld
•http://faculty.washington.edu/eloftus/Articles/lof93.htm written by Elizabeth Loftus
•Trauma statistics:
http://www.bercelifoundation.org/s/1340/aff_2_interior.aspx?sid=1340&gid=1&pgid=391
•Sources - Trauma Releasing Exercises Pamphlet - Dr. David Berceli, Ph.D
http://www.bercelifoundation.org/s/1340/aff_2_interior.aspx?sid=1340&gid=1&pgid=403
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References & Literature II.
•Source of the article: http://www.ncbi.nlm.nih.gov/pm c/articles/PMC3181836/ J. Douglas BremnerMD
- 2006 Dec. 8 Traumatic stress: effects on the brain
•Source: http://www.fenichel.com/repression.shtml - written by Michael Fenichel, Ph.D. -
Repression: Anxiety Filter for the Ego
•http://www.rachelsvineyard.org/Downloads/Canada%20Conference%2008/TextOfBrainPP.pdf - written by
-Theresa Burke, Ph.D. - How Trauma Impacts the Brain
•Source: http://www.trauma-pages.com/a/vanderk.php Approaches to the Treatment of PTSD - Bessel A.
van der Kolk, M.D.
Onno van der Hart, Ph.D.
Jennifer Burbridge, M.A.
•2004, Group interventions for treatment of psychological trauma, p. 25-27. -By Kathleen Hubbs
Ulman,
Ph.D-http://www.agpa.org/docs/default-source/practice-resources/group-interventions-for-treatment-o
f-trauma-in-adults.pdf?sfvrsn=2
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