Complex trauma in children and adults

COMPLEX TRAUMA 7 COMPLEX TRAUMA Complex trauma Student name: Student ID Author’s Note Introduction 3 An overview of Stress inoculation training (SIT) 3 An overview of Prolonged Exposure Therapy (PET) 4 A comparison between the two modes of therapy 5 Conclusion 9 Reference 10 Introduction Complex trauma can be diagnosed in adults and even children who are subjected to continuous traumatic events such as cases of neglect, abuse and even violence. The essay for the same reason aims to understand the importance of Stress

Running head: COMPLEX TRAUMA
Complex trauma
Student name:
Student ID
Author’s Note

COMPLEX TRAUMA
2
Table of Contents
Introduction......................................................................................................................................3
An overview of Stress inoculation training (SIT)............................................................................3
An overview of Prolonged Exposure Therapy (PET)......................................................................4
A comparison between the two modes of therapy...........................................................................5
Conclusion.......................................................................................................................................9
Reference.......................................................................................................................................10

COMPLEX TRAUMA
3
Introduction
Complex trauma can be diagnosed in adults and even children who are subjected to
continuous traumatic events such as cases of neglect, abuse and even violence. Trauma turns out
to be complex if the traumatic experience occurs early in life and most importantly caused by the
carer. The exposure to trauma can be termed as one of the important factors that makes things
complex for the patient. It becomes important to note the fact; it may take more than few years to
recognise symptoms of complex trauma. The essay for the same reason aims to understand the
importance of Stress inoculation training (SIT) and Prolonged Exposure Therapy (PET), in
training patients with Post-traumatic stress disorder (PTSD). The essay identifies modus
operandi of both the treatment models and evaluating efficacy of the same through the course
An overview of Stress inoculation training (SIT)
SIT is often termed as a mode of cognitive behavioural therapy (CBT) best suited for
complex stress (Lee et al., 2016). CBT is a form of cognitive therapy that can help the person to
recognize and change the series of incorrect thoughts that influence their thought process. The
modus operandi for SIT is similar to that of a vaccination process. As pointed out by Botella,
Serrano, Baños and Garcia-Palacios (2015), stress inoculation training prepares the body to
defend against the PTSD related anxiety and fear, or even the possible cues that trigger the
associated symptoms. As supported by Brockhurst et al. (2015), exposure to milder form of
stress boosts the confidence of the person ensuring effective response in case of trauma. The
mentioned mode of psychotherapy, operates within the timeline of 90 minutes’ duration with 9 to
12 times, involving a therapist

COMPLEX TRAUMA
4
The main intervention undertaken in SIT is development of the coping skills. As opined
by Kaczkurkin and Foa (2015), if the patient is subjected to complex trauma they are seen to
receive SIT; the therapist becomes aware of the possible triggers that can cue trauma related
anxiety and fear. Additionally, the patient learns a variety of coping skills for managing anxiety.
Firstly, deep breathing from diaphragm; coupled with muscle relaxation techniques. Secondly,
the events of role playing is important, as it works on analysing the situation from different
perspective and finding possible solutions (Lee et al., 2016). Thirdly, it is important to think and
change the negative behaviours. Once the skill is identified, it becomes important to note the
person should recognise the triggers and work on controlling the same.
An overview of Prolonged Exposure Therapy (PET)
Over the course of time, people with complex trauma may develop fear in response to the
traumatic experience. These reminders can be within the environment such as sound, smell, or
even simple thoughts connected with traumatic incidents. As pointed out by Lambert and
Alhassoon (2015), the triggers can give rise to immense level of stress that the person may want
to avoid. The goal of exposure therapy is to reduce the fear and level of anxiety, linked with the
triggers and is usually done by series of confrontation. By dealing with the level of anxiety and
fear, one can conclusively state that fear would reduce on its own as the extent of the reminders
would no longer be fearful. The exposure therapy is usually accompanied with learning of
several relaxation techniques for managing the level of anxiety (Foa et al., 2018). The
continuous exposure to stress and relating events can work on providing a clear idea about the
factors triggering anxiety related behaviour in an individual. The constant exposure to stress can
be termed as one of the leading ways to enhance the coping facilities of the person.

COMPLEX TRAUMA
5
A comparison between the two modes of therapy
Both SIT and PET stress the importance of exposing the patient to stressful situations.
However, the former works on developing necessary skills before coping with the fear and stress.
On the other hand, PET exposes the person to milder form of stress and allows the person to
gradually develop their coping skills. It is probably for the same reason that PET is often a
reluctant mode of treatment for the psychologists due to high dropout rates.
SIT was deemed to be superior to PET both in short and long term outcomes in managing
complex trauma. The differential efficacy has not been shown in case of previous study and is of
high importance. However, the apparent superiority of SIT over PET in complex trauma needs to
be accepted with immense care. SIT resulted in lowering of the level of anxiety and stress,
coupled with depression among the patients. Parcesepe, Martin, Pollock and Garcia-Moreno
(2015), reported the reduction in level of stress and depression among the cancer patients and
education of stress coping mechanism is seen to bring about better reactions under stressful
scenarios. Charney, Hellberg, Bui and Simon (2018), were found to report positive effect in
regards to group education of SIT in reducing stress on the research participants. The research
participants were seen to exhibit low level of stress and anxiety. Research based study carried out
by Blankenship (2017), showed that SIT leads to reduce depressive thoughts. Thus, it can be
conclusively stated; implementation of psychological intervention’ coupled with stress
management programs can reduce the level of anxiety and depression; in events of complex
stress. Acierno et al. (2017), reported that group psychotherapy can be termed as one of the most
suitable interventions deemed effective in promoting recovery of breast cancer patients (Kashani,
Kashani, Moghimian & Shakour, 2015). In similar regards, reports found the fact,
implementation of group psychotherapy helps in reducing aggression and even anxiety.

COMPLEX TRAUMA
6
Ability of an individual to cope with stress is increased through the modes of SIT. As
stated by Meichenbaum (2017), encouraging individuals to apply SIT in activities of daily life
results in obtaining positive feedback by reducing the avoidance of stressful situations. The mode
of operation of the mentioned model of intervention is based on the fact that an individual has
full control over the environment thereby reducing the level of anxiety. However, Lee et al.
(2016), argued the fact that constant and continuous exposure to stressful situations can be
termed threatening for the patient. Patients are often seen to exhibit high level of reluctance in
case of exposing themselves to predisposed triggers of anxiety. Techniques pertaining to SIT is
seen to reduce collateral consequence of mental pressure imposed as per the situation. SIT helps
an individual to recognise the possible illogical thoughts on one hand and to obstacle their issues
by making use of creative and problem solving strategies. As stated by Brockhurst et al. (2015),
when people solve their problems by making use of compatible methods, their level of self-
confidence is likely to rise. The rise in level of self-confidence is often coupled with decrease in
fear with problems. All the factors mentioned above, help in increasing tenacity and improving
the quality of life. It becomes important to note the fact; cognitive vulnerability of an individual
has an implication with stressful life. It is for the same reason, people are inclined to practice
negative understanding in near future, regards to event of self-valuation. The changes in relation
of self-valuation may result in disappointment, in reaching the pre-determined objectives
(Kaczkurkin & Foa, 2015).
The efficacy of PET can be well explained through the theory of emotional processing
that anxiety related issues reflects structures that contains unrealistic associations among the
physiological, behavioural and even cognitive elements. Lambert & Alhassoon (2015), suggested
the fact that exposure to stimuli of fear allows activation of fear structure and presentation of

COMPLEX TRAUMA
7
correct information unable to coexist with the pathological terms of fear. Foa et al. (2018) stated
the fact that exposure therapy helps in forming a structure containing realistic association
between physiological, behavioural and even cognitive elements. The mentioned process can be
termed relevant in case of complex trauma. PET based techniques provides participants with
scope to learn to control their responses while being confronted to stress related stimuli. The
treatment program for complex trauma using PET was further explored by Parcesepe, Martin,
Pollock and Garcia-Moreno (2015), involving imaginal exposure to experience laced with
trauma. The aim of the mentioned intervention was to evoke the possible stressful event.
Exposure may involve real life scenarios.
Despite the series of encouraging findings, PET is still underutilised in regards to clinical
settings. Blankenship (2017), found the fact, a small sample of psychologists are seen to make
use of exposure therapies as patients are apprehensive about the continuous exposure to stress.
However, Charney, Hellberg, Bui and Simon (2018), claimed that one of the prime reasons for
not making use of exposure therapy can be termed as lack of adequate training and even
experience with complex stress. However, even the trained psychologists have experienced poor
patient cooperation during the implementation of exposure therapy. The possible barriers to the
exposure therapy can be worsening in symptoms or simple desire to drop out. Research based
study conducted by Watkins, Sprang and Rothbaum (2018), stated the fact exposure therapy is
seen to have concerning dissemination among clinicians. The rates of dropout in regards to
exposure therapies was 20.5%; which is similar to the dropout rates of other forms of therapies
such as SIT and even CBT, for treating events related to complex trauma (Acierno et al. 2017).
Furthermore, PET was often linked with exacerbation. Watkins, Sprang and Rothbaum (2016),
worked on exploring the relation between exacerbation and PET. The results showed that a

COMPLEX TRAUMA
8
limited number of patients; roughly 11 percent were shown to exhibit symptoms of exacerbation;
on temporary basis (Nacasch, Rachamim and Foa, 2015). Simultaneously, such related
exacerbation was not linked with dropout from treatment.
The avoidance of traumatic experience can be termed as a central diagnostic feature
linked with complex trauma. Thus, any possible need to confront the trauma within the domain
of SIT can represent significant challenges for the patients. In similar regards, it can be stated
few patients are able to think about their trauma; however, they are emotionally not attached to
the experience. The prevalence of limited emotional engagement can act as a potential barrier to
bring about reduction in anxiety leading in poor mental health outcomes. Thus, potential
negative effect in PET can be brought about by patient’s inability to imagine; which is not
evident in case of SIT. Finally, Lancaster, Teeters, Gros and Back (2016), mentioned the fact
psychotherapy for complex trauma failed to meet the criteria for treatment. There remains no
doubt that the findings were highly encouraging, relating to the fact; inoculation therapies are
suitable based on scientific evidences. However, there still remains room for improvement for
providing the expected mode of treatment to the patients suffering from complex trauma.
Thus, based on the above statements, it can be conclusively stated both the modes of therapy
are seen to have effective results and are subjected to the patient requirements. The prime topic
remains in the fact that teaching of relaxation techniques helps an individual to gain peace
through formation of anti-tension signs for obtaining better self-control (Nacasch, Rachamim and
Foa, 2015). Additionally, the mentioned modes of treatments enhance the possibility of positive
information within the human memory. This additionally facilitates access of an individual to the
possible options linked with anti-risk thoughts. Reduction of stress and associated signs and
symptoms; can work on improving the sleeping condition of patient. The ubiquitous presence of

COMPLEX TRAUMA
9
stress in daily lives cannot be ignored. The limited ability in coping with daily stress is managed
through the mentioned mode of treatments. The evidence based finding support the fact that
exposure therapy is not only efficacious approach in treatment mental health issues related to
complex trauma; but also more tolerable, as perceived by the clinicians (Watkins, Sprang and
Rothbaum, 2018).
Conclusion
On the basis of the above finding, it can be conclusively stated it is important to
understand the cause of anxiety trigger and managing the same. The mode of therapy is suitable
as per the needs of the patient and experience of the psychologist. The efficacy of the exposure
therapy or even stress inoculation therapy is highly subjective as per the patient preference and
coping ability of the patient. However, it can be concluded, slow and continuous exposure to
stress under controlled environmental conditions provides suitable results

COMPLEX TRAUMA
10
Reference
Acierno, R., Knapp, R., Tuerk, P., Gilmore, A. K., Lejuez, C., Ruggiero, K., ... & Foa, E. B.
(2017). A non-inferiority trial of Prolonged Exposure for posttraumatic stress disorder: In
person versus home-based telehealth. Behaviour research and therapy, 89, 57-65.
Blankenship, D. M. (2017). Five efficacious treatments for posttraumatic stress disorder: An
empirical review. Journal of Mental Health Counseling, 39(4), 275-288.
Botella, C., Serrano, B., Baños, R. M., & Garcia-Palacios, A. (2015). Virtual reality exposure-
based therapy for the treatment of post-traumatic stress disorder: a review of its efficacy,
the adequacy of the treatment protocol, and its acceptability. Neuropsychiatric disease
and treatment, 11, 2533.
Brockhurst, J., Cheleuitte-Nieves, C., Buckmaster, C. L., Schatzberg, A. F., & Lyons, D. M.
(2015). Stress inoculation modeled in mice. Translational psychiatry, 5(3), e537.
Charney, M. E., Hellberg, S. N., Bui, E., & Simon, N. M. (2018). Evidenced-based treatment of
posttraumatic stress disorder: an updated review of validated psychotherapeutic and
pharmacological approaches. Harvard review of psychiatry, 26(3), 99-115.
Foa, E. B., McLean, C. P., Zang, Y., Rosenfield, D., Yadin, E., Yarvis, J. S., ... & Fina, B. A.
(2018). Effect of prolonged exposure therapy delivered over 2 weeks vs 8 weeks vs
present-centered therapy on PTSD symptom severity in military personnel: A randomized
clinical trial. Jama, 319(4), 354-364.
Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: an
update on the empirical evidence. Dialogues in clinical neuroscience, 17(3), 337.

COMPLEX TRAUMA
11
Kashani, F., Kashani, P., Moghimian, M., & Shakour, M. (2015). Effect of stress inoculation
training on the levels of stress, anxiety, and depression in cancer patients. Iranian journal
of nursing and midwifery research, 20(3), 359.
Lambert, J. E., & Alhassoon, O. M. (2015). Trauma-focused therapy for refugees: Meta-analytic
findings. Journal of counseling psychology, 62(1), 28.
Lancaster, C., Teeters, J., Gros, D., & Back, S. (2016). Posttraumatic stress disorder: Overview
of evidence-based assessment and treatment. Journal of clinical medicine, 5(11), 105.
Lee, A. G., Nechvatal, J. M., Shen, B., Buckmaster, C. L., Levy, M. J., Chin, F. T., ... & Lyons,
D. M. (2016). Striatal dopamine D2/3 receptor regulation by stress inoculation in squirrel
monkeys. Neurobiology of stress, 3, 68-73.
Lee, D. J., Schnitzlein, C. W., Wolf, J. P., Vythilingam, M., Rasmusson, A. M., & Hoge, C. W.
(2016). Psychotherapy versus pharmacotherapy for posttraumatic stress disorder:
Systemic review and meta‐analyses to determine first‐line treatments. Depression and
anxiety, 33(9), 792-806.
Meichenbaum, D. (2017). Stress inoculation training: A preventative and treatment approach.
In The Evolution of Cognitive Behavior Therapy (pp. 117-140). Routledge.
Nacasch, N., Rachamim, L., & Foa, E. B. (2015). Prolonged exposure treatment. In Future
directions in post-traumatic stress disorder (pp. 245-251). Springer, Boston, MA.
Parcesepe, A. M., Martin, S. L., Pollock, M. D., & Garcia-Moreno, C. (2015). The effectiveness
of mental health interventions for adult female survivors of sexual assault: A systematic
review. Aggression and violent behavior, 25, 15-25.

COMPLEX TRAUMA
12
Watkins, L. E., Sprang, K. R., & Rothbaum, B. (2018). Treating PTSD: a review of evidence-
based psychotherapy interventions. Frontiers in Behavioral Neuroscience, 12, 258.