MUNGADZE TRAUMA AND TRAUMA /ADDICTIONS PROGRAMProgram Narrative
Jerry Mungadze PhD
Philosophy of TreatmentWe believe that treatment of trauma related disorders should include the following components; crisis stabilization, elimination of acute symptoms, processing of traumatic memories, cognitive restructuring of the cognitive distortions from trauma, managing behaviors and teaching healthy coping skills.
We also believe that trauma related symptoms are rooted in the disruptions of normal brain functioning due to stress and trauma. It is therefore our belief to take into account these disruptions in our treatment focus. (Ratey 2001), (Howard, 2006), (Schore 1994), Van der Kolk, BA, Burbridge, J.A. and Suzuki J. (1997).
Exposure Therapy As Treatment Frame WorkOur treatment frame work shown below is an eclectic combination of evidence based treatment interventions under exposure therapies as backed by the Journal of Traumatic Stress, Volume 16, number 2, (April 2003): “…targeting the mechanisms thought to underlie persistent, pathological anxiety, exposure therapy comprises a set of techniques designed to help patients confront their feared objects, situations, memories, and images…”.
The use of exposure therapy, (Hembree, et al, 2003) is designed to help patients process their traumatic memories and learn mastery over the reactions from the trauma.
Treatment Components Our treatment targets the problem areas for the trauma treatment as sighted in trauma research literature. The five different components comprise the majority of the treatment focus for trauma related disorders.
I Affect and Behavior Dysregulation
II. Trauma Resolution
III. Dissociation
IV. Cognitive Disturbance
V. Functional Ability
Treatment Progress MeasuresIn order to monitor the progress or lack of it in our patients, we have a 30 item symptom evaluation tool administered to the patients upon admission and at intervals determined by the treatment team to determine a treatment focus or discharge of the patient.
Our Structured Group Therapies 1. Cognitive Restructuring Group (Mungadze, 1994)
In this group patients learn to dispute their cognitive distortions underlying their feelings, thoughts, and behaviors they experience due to trauma, in order to learn how to regulate those feelings, thoughts, and behaviors. These feelings, thoughts, and behaviors include:
Irrational Fears
Self defeating Beliefs
Over generalizations
Cognitive distortions
Acting out Behaviors
2. Behavior Management: (Foa, et al, 1991)
In this group patients learn how to control out of control behavior and increase their ability to function.
This is a cognitive group, intended to increase frontal cortex activation.
Patients are given homework and assignments targeting specific behaviors. Specific measures of progress will be implemented.
3. Expressive Art Therapy: (Schiraldi, 1997, 2000, Ratey 2001; Kolb, 1987)
In this group patients are allowed to express their feelings, thoughts and behaviors using symbolic language which is their Neuro-Language. The therapists helps his patient put a cognitive meaning to what has been expressed. And then the patients are helped learn how to manage these feelings, thoughts, and behaviors through expressive art therapy.
4. Patient Education: (Richard Cytowic, 1996)
In this group patients are given information about the recovery process to help them in and out of the hospital. This information includes the following:
Information about their illness, Skills to live with their illness, How to manage their everyday life, and How to manage their treatment.
5. Family of Origin: (Bessel Van der Volk, 1996)
As the name suggests most of the patients have issues that go back to their family of origin. Which they need to deal with in therapy, and for some in a safe environment. This groups gives patients and opportunity to do so. The following topics discussed in this group are: The role of Genes and influencing behavior, The role of family influence in behavior formation, and Boundary Setting.
6. Life Skills: (Pinker, 1994; Deacon, 1997)
Trauma often affect people’s ability to live productive lives. It is not unusual for trauma survivors to lose a lot of very basic life skills such as:
Communication
Self expression
Relational skills
Social skills
Abilities needed to sustain gainful employment.
7. Recreational Therapy:Recreational therapy is essential in this program for very good reasons. Trauma patients need ways to manage stress, and we know that taking good physical care of their bodies is beneficial in helping heal mental stress and trauma. The majority of the activities in recreational therapy are designed to achieve these goals.
Four Level Inpatient Program Trauma related problems pose a challenge for the treatment community because the trauma patient presents a complex clinical picture. The issue of co-morbidity and dual diagnosis is a real one in the trauma field requiring treatment to be just as sophisticated as the clinical picture.
In our Programs, we understand this reality and have designed them to meet the different levels of care of the trauma patient and the dual diagnosis of addictions. The four level treatment program covers;
Level I: Crisis Stabilization. This level covers acute symptoms and self destructive behaviors that often bring trauma patients to treatment. This also includes medication administration, and adjustment. For those patients with substance abuse problems they will go through detoxification during this time.
This level takes anywhere from 3-7 days of treatment.
Level II: Affect and Behavior Regulation. Most of the problems with self destructive and out of control behaviors, and aggression take more than 3-5 days to resolve. Therefore, in our program, we focus on dealing with these issues during the second week.
Level III: Conflict Resolution and Cognitive Restructuring. It is documented in research that trauma patients do better when they address in treatment the reasons behind their acute symptoms that bring them into treatment and also learn to change their cognitive distortions that often have lead to the crises that results in a hospital stay. This level takes an additional 5-7 days bringing the length of stay for this stage to three weeks.
Level IV: Building Functional Ability and Relapse Prevention. For those patients whose acuity is still very high, they need to learn how to stabilize themselves. Therefore they must learn new coping skills and trauma resolution. They also need to learn to manage their symptoms on an outpatient basis and learn how to prevent relapse.
ReferencesAffect regulation and the repair of the self. Schore, Alan, New York: W.W. Norton and Co, 2003.
Affect dysregulation and disorders of the self. Schore, Alan, New York: W.W. Norton and Co, 2003.
A Users Guide To The Brain. John J Ratey, M.D., First Vintage Books, New York, 2001
The Owners Manual For The Brain. Pierce J. Howard, PhD, Bard Press, Austin, Texas, 2006
Pierre Janet on Post Traumatic Stress . Journal of Traumatic Stress, 2, 365-378, Van der Kolk, B.A, Burbridge, J.A., and Suzuki J. (1997).
Journal of Traumatic Stress, published for the International Society for Traumatic Stress Studies Volume 16, number 2, April 2003.
Beyond the manual: The insider’s guide to prolonged exposure therapy for PTSD. Hembree, E.A., Rauch, S.A.M., & Foa, E.B. (2003). Cognitive and Behavioral Practice, 10, 22-30.
The Owner’s Manual For The Brain. Pierce J. Howard, PhD, Bard Press, Austin, Texas, 2006
Dissociation in aging Holocaust survivors: Yehuda, R., (Bronx Veterans Affairs Medical Center), Elkin, A., Binder-Brynes, K., Kahana, B., Southwick, S.M., Schmeidler, J., & Giller, E.L. American Journal of Psychiatry (1996)
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The BASK model of dissociation. Dissociation, 1, 4-23, Braun, 1988;
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Dissociative Reactions in persons with post traumatic stress disorder. (in press) In P.F. Dell, & J. O’Neil (Eds.) Ginzburg, K, Butler, L.D., Saltzman, K., & Koopman, C.
Hidden Scars. Scientific American, pp.14, 20, Mukerjee, M. October 1995.
Dissociative disorders. Cardena, E., Lewis-Fernandez, R., Beahr, D., Pakianathan, I., & Spiegel, D. 1996.
The Post Traumatic Stress Disorder Resource book”. Glen R. Schiraldi, PhD, Stress management faculties at the U.S. Pentagon, and the University of Maryland, McGraw Hill, 1997.
The Use of hypnosis with dissociative disorders. Psychiatric Medicine, 10(4), 31-46. Kluft, R.P. 1992.
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A retrospective analysis of shame, dissociation, and adult victimization in survivors of childhood sexual abuse. Journal of Counseling Psychology, 46, 335-341, Kessler, B.L., & Bieschke, K.J. 1999.
The Mosaic Mind: Empowering the tormented selves of child abuse survivors. New York: Norton, Goulding, R.A., & Schwartz, R.C., 1995.
Stopping the dividedness: Dealing with chronic dissociation in later stages of therapy. Presented at the CHSDD conference. Mungadze, Jerry, J., 1994.
Foa, Rothbaum, Riggs and Murdock 1991.
The Neurological Side of Neuropsychology. Richard Cytowic, M.D. Bradford Books, MIT Press, Cambridge, Mass., 1996.
The language Instinct. Stephen Pinker. HarperCollins, New York, 1994.
The Symbolic Species. Terrance Deacon. W.W. Norton, New York, 1997.
