Coping With Trauma

A highly comprehensive, readable summary of current professional knowl edge for helping individuals who are struggling to cope with the direc t effects of trauma. Mental health professionals who work with people with a history of trauma will find it to be a useful digest of curren t knowledge that they can share with their patients.

Preface

xv

The Plan of This Book

xvi

Acknowledgments

xix

Part I: Foundations

Trauma

3

(14)

Trauma Happens

4

(1)

Types of Trauma

5

(2)

Varieties of Man-Made Trauma

7

(6)

Severity of Trauma

13

(1)

The Eye of the Beholder

14

(1)

Not All Symptoms Come From Trauma

15

(1)

Not All Trauma Leads to Symptoms

16

(1)

Development

17

(18)

Derailed Development

18

(3)

Complex Effects and Vicious Circles

21

(1)

Rerailed Development

22

(1)

Before the Cradle

23

(1)

Trauma and the Nervous System

23

(12)

Part II: Effects of Trauma

Attachment

35

(14)

The Foundation of Development

36

(1)

The Secure Base

37

(1)

The Strange Situation

38

(1)

Secure Attachment

39

(1)

Insecure Attachment

39

(2)

Disorganized Attachment

41

(1)

Reciprocity and Vicious Circles

42

(1)

Attachment Beyond Infancy

43

(1)

Disruption of Attachment by Trauma

44

(2)

Attachment and Regulation of Arousal

46

(1)

Restoring Security

47

(2)

Emotion

49

(24)

Anxiety, Fear, and Panic

51

(2)

Anger and Aggression

53

(6)

Shame and Guilt

59

(2)

Depression

61

(3)

Temperament and Personality

64

(2)

Establishing Emotional Control

66

(7)

Consciousness

73

(16)

Escaping the Inescapable

73

(2)

Shades of Consciousness

75

(2)

Self-Consciousness

77

(1)

Unconscious, Conscious, and Subconscious

78

(3)

Dissociation as a Blessing and a Curse

81

(4)

The Process of Dissociation

85

(2)

Back to Reality

87

(2)

Memory

89

(38)

Intrusive Memories

89

(5)

Memory or Fantasy?

94

(2)

The Pendulum Swings

96

(4)

How Accurate Is Autobiographical Memory?

100

(3)

Reasons for Traumatic Memories to Be Clouded

103

(4)

Amnesia

107

(3)

Memory Versus Fantasy: A Current Perspective

110

(9)

Remembering in Therapy

119

(8)

Self

127

(22)

Aspects of the Self

128

(2)

Self-Continuity

130

(5)

Self-Concept

135

(3)

Self-Destructiveness

138

(5)

Restoring Self-Esteem

143

(6)

Relationships

149

(20)

Repetition of Trauma in Relationships

150

(1)

Relationship Models

151

(3)

Traumatic Bonding

154

(4)

Problematic Models

158

(4)

Problematic Patterns

162

(1)

Developing New Models

163

(2)

Self-Dependence

165

(4)

Part III: Trauma-Related Psychiatric Disorders

Posttraumatic Stress Disorder

169

(22)

A Brief History

170

(1)

Prevalence

171

(1)

Hyperarousal

172

(1)

Reexperiencing

173

(5)

Avoidance and Numbing

178

(2)

Variations in Course

180

(1)

Complex PTSD

181

(2)

What Causes PTSD?

183

(5)

Treatment

188

(3)

Dissociative Disorders

191

(24)

The Spectrum of Dissociation

192

(1)

Depersonalization Disorder

193

(2)

Dissociative Amnesia and Fugue

195

(1)

Dissociative Identity Disorder

195

(11)

Responsibility for Dissociative Behavior

206

(2)

Achieving Continuity and Integration

208

(7)

Other Disorders

215

(20)

Anxiety Disorders

216

(2)

Depressive Disorders

218

(1)

Substance Abuse

219

(1)

Somatization Disorder

220

(2)

Sexual Dysfunction

222

(3)

Eating Disorders

225

(2)

Borderline Personality Disorder

227

(3)

The Perils of Labeling

230

(5)

Part IV: Treatment

Treatment Approaches

235

(32)

Safety First

236

(1)

Individual Psychotherapy

237

(9)

Cognitive-Behavior Therapy

246

(3)

Group Psychotherapy

249

(2)

Family Intervention

251

(5)

Medication

256

(6)

Hospital Treatment

262

(3)

Continuum of Care

265

(2)

Self-Regulation

267

(32)

Simple but Difficult

268

(2)

Positive Emotions

270

(9)

Methods of Self-Regulation

279

(17)

Putting It All Together

296

(3)

Conclusions

299

(12)

Trauma Happens

299

(1)

Trauma Is One Factor Among Many

300

(1)

Understand Your Brain and Be Gentle on Your Mind

301

(1)

Safety Rests on a Secure Base

302

(1)

Emotions Are Adaptive

302

(1)

Dissociation Is a Blessing and a Curse

303

(1)

Your Autobiography Is a Continual Construction

303

(1)

Your Self-Concept Is a Compass

304

(1)

Outdated Relationship Models Can Be Put on Unemployment

305

(1)

Avoid Retraumatization

305

(1)

Dissociation Diminishes With Self-Expansion

306

(1)

Focus on Trauma Should Not Obscure Other Problems

307

(1)

The Goal of Treatment Is to Improve the Quality of Life

307

(1)

Care for Yourself and Your Nervous System

308

(1)

Beyond Fight or Flight

308

(3)

Appendix: The Biology of Trauma

311

(12)

Gene Doings

312

(1)

The Biochemical Brain

313

(2)

The Triune Brain

315

(4)

The Neurophysiology of the Fight-or-Flight Response

319

(1)

Concluding Biological Reflections

320

(3)

Notes

323

(16)

References

339

(36)

Index

375

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