Certified Clinical Trauma Specialist: Trauma and Addiction (2021) by Luci Rhoton | Aug 12, 2021 | 0 comments Welcome to your Certified Clinical Trauma Specialist: Trauma and Addiction (2021) Username Email Phone (no dashes) What is a behavioral salutogenic attribute? Alcohol and drugs Intimacy/empathy Meaning/purpose Cultural identity What is indicative of a substance use disorder rather than addiction? Cannot stop behavior by act of will Current use of alcohol/drugs causes clinically significant impairment Dissociative experiences Self-administered analgesia When the balance system (ANS) is dysregulated, it responds with ___________ Intentionality Growth and learning Survival strategies Vagal brakes Changes in the hormones and biochemistry of the body lead to _____ changes in behavior, emotions, and thinking Abnormal Problematic Predictable Volitional Which of the following is NOT an increased risk for people with 4 ACEs? Kidney Disease Scoliosis Loss of vision Cancer What can happen when there is a large increase in noradrenalin? Fear, withdrawal, flight Depression, sadness Anxiety, increased energy, mania Anger, aggression, and hostility In Arizona, what percentage of children ages 12 to 17 have experienced two or more ACEs? 15.6% 30.5% 44.4% 57.8% What was found in the brain scan of cocaine abusers? Increase in white matter integrity Reduction of dopamine D2 receptors Increase in grey matter density Reduction of brain’s basal ganglia How can an individual motivate trauma clients? Utilize long term goals Decrease distress tolerance Focus on the year rather than the week Address avoidance with curiosity How can a therapist capacity build with a client? Recognize that most problematic behavior should be addressed by healing pathology Understand that developmental history cannot be deconstructed Define reality by pathology and impairment Acknowledge connections and potential in individuals, families, and communities Which of the following is NOT how the human body reacts to threat, toxic stress, or adversity? Muscles tighten throughout the body Hypothalamus activates the adrenal glands Liver produces extra insulin resulting in low levels of glucose in the blood Stress hormones affect the respiratory and cardiovascular systems Which of the following is NOT a hippocampal function Connects separate brain regions as part of active integration Serializes and/or sequences time within a context Enhances executive functioning and cognitive flexibility Modifies and governs hypothalamus function What is the limbic system responsible for? Learning, memory, and coping with stress Involuntary physiologic processes (e.g., heart rate, blood pressure, etc.) Delivering oxygen and nutrients to cells Movement and muscle contraction How can a clinician show cultural humility and competence? Expect people of color to educate them Avoid making client’s culture and worldview a priority Maintain a commitment to continually grow and change over time Change the subject away from perspectives, beliefs, and values Why was treatment unsuccessful for Jaime? Overuse of trauma treatment in substance abuse facility Shame based punitive approach Individual support only rather than therapeutic groups Free movement in an unlocked facility Which of the following is NOT an attribute of pathogenesis? Paternalistic Capacity building Curative Disease-centric What does the amygdala do? It is involved in coordinating movement and balance It sends and receives hormones in the body It supports hallucinations/delusions It relays information from the brain to the body Which of the following statements is false regarding trauma? Trauma is any experience that overwhelms one’s nervous system and ability to cope Trauma is a standardized experience among all individuals meaning what one person perceives as traumatic is also traumatic to others Trauma is the body’s reaction to Sympathetic System dominance that has occurred continuously/repeatedly creating changes in the CNS Unresolved trauma leads to a “Frozen residue of energy” that needs to be discharged from the body Which of the following is NOT a core feature in resilience? Intentional applications of personal strengths Appreciation of life except when faced with stressors Exploring new possibilities Relating to others, reconnecting or creating new connections Which of the following questions asks about the degree of recovery? If you were to break recovery into 7 or 8 steps, what do you think they would be? How much improvement would you need to make to feel some real difference? What would be required on your/family part to shorten the time required for recovery? How long did it take to get this problem to this stage? What does oxytocin enable? Attachment, trust, connection Self-worth, positive self-image Euphoria, decreased anxiety Motivation, learning, goal setting Which of the following statements about the vagus nerve is false? It is the 9th cranial nerve extending from the medulla oblongata to the pharynx It provides the nervous system with critical information It connects several major organs such as lungs, heart, stomach, and intestines It regulates heart rate variability What happens when the body moves into sympathetic dominance? Diaphragm muscles relax Inhibited insulin production Maintaining baseline blood pressure Minimal or no muscle tension Which of the following statements is false about the salutogenic approach? Salutogenesis is necessary when acuity is not centered in one part Salutogenesis considers individuals as multiple systemic beings Salutogenesis is designed for dealing with the whole person Salutogenesis asks the question, “what is wrong with you?” Which template is NOT created by a child’s nervous system looking for stimulus? Regulation patterns Physical patterns Emotional patterns Cognitive patterns Which of the following is NOT an indication of an integrated brain? Attunement to others Ability to isolate Sequential memory Logic and reason Which of the following is NOT an attribute of an optimal living environment? Goals that inspire the individual or whole family Self-awareness used to monitor behavior Connecting with the spiritual, or universal Series of tasks rather than a purpose What happens when cortisol is released in limbic shift? Reduced ability to create sequential memory Increased fear, anxiety, phobias, hallucinations, depression, agitation Reduced healthy sleep patterns Increased access to the impulse control center Which of the following statements regarding yoga is false? Yoga offers a sensory-motor approach in conjunction with trauma therapy Trauma is stored in the body and more primitive brain Integrative movement leads to cycles of shame and hopelessness Yoga can help with the shutdown response What are the two categories of ACEs? Discrimination and household dysfunction Abuse or neglect and socioeconomic status Distress and deviance Abuse or neglect and household dysfunction What is an action-oriented behavior related to adaptation? Compulsiveness Addiction Suicidality Impulsivity What happens when there is increased potentiated reactivity? Pausing before reacting Shorter space between stimulus and response Weighing consequences before acting Consistent self-control What is the nature of parasympathetic system? Adherence to values and ethics Impulsive Poor ability to evaluate rewards Immediate gratification Which of the following statements is false about using the SUD’s scale? 10 indicates no distress, no anxiety/depression, no disturbance It is a tool for clients to measure their own level of distress Breath techniques can be used at any notice of increase on SUDs scale It is helpful for clients to begin practicing tools/techniques when they are on the lower end of the SUDs scale According to the American Medical Association in 1957, what is “primary”? The illness does not go away, heal spontaneously, or remit The illness will result in death if left untreated The illness exists in and of itself The illness gets worse over time How many drug overdose deaths occurred in the United States in the 12 months ending in May 2020? 53,000 68,000 79,000 81,000 What fraction of individuals with 7+ ACEs have heart disease? 1 in 14 1 in 30 1 in 7 1 in 6 What is a salutogenic assumption? Avoid getting worse Humans are inherently flawed Reactive to treat disease Humans are naturally healthy What is the bottom-up method from Bessel Van der Kolk? Allowing the body to have experiences that deeply and viscerally contradict the helplessness, rage, and collapse that result from the trauma Talking, connecting with others, learning, cognitive processing Medications to shut down inappropriate alarm reactions, other therapies, changes the way the brain organizes information Changes in thinking that will positively affect emotions and then the body Which of the following is NOT associated with SUD and PTSD? Increased physical health problems Poorer social functioning Lower rates of suicide attempts More legal problems What is an example of a process addiction? Caffeine Hallucinogens Stimulants Exercise Which of the following statements is false about the reptilian brain? It is indistinctive, automatic It aids in the functioning of the heart, lungs, intestines, throat/larynx via the pharyngeal nerve It is the oldest, primitive part of the brain It is everything individuals have in common with a lizard What assessment can be used for trauma history and treatment planning? Trauma Recovery Scale Graphic Timeline PCL-5 Session Rating Scale (SRS) Which statement about memory is true? Attention is always focused on everything in the environment Memory is built on the foundation of relevance Energy competition in the brain is high in parasympathetic dominant states Memory is always reliable What is a intrusion symptom of PTSD? Withdrawal and isolation Maladaptive behaviors such as drug/alcohol use Flashbacks or dissociative experiences Avoidance of people, places, and things that are reminders of trauma Which of the following is NOT a way that an individual could be invited to engage in the social dominance game? If the individual perceives status, power, or role is respected If the individual perceives attention is being forced If the individual perceives a restriction of movement and action If the individual perceives that someone is trying to exert control Which of the following is NOT a way to stimulate the vagus nerve? Loud singing, chanting, or humming Yoga poses (such as twists) Inhaling longer than exhaling Cold water immersion Which of the following statements is false regarding epigenetics and addiction? Chemical signatures can be temporary or permanent Genes are turned on and off due to environmental factors There are no genes for mental health conditions Genes can cause addiction Which of the following is NOT relational-developmental trauma? Emotional neglect Unstable environment Natural disaster Attachment trauma How is muscle tension affected when an individual is more deeply drawn into the dominance game? Less tension is experienced Tension continually fluctuates regardless of the dominance game There is no change in tension More tension is experienced What happens when the relational social engagement system is suppressed? Stable friendships and family relationships Poor quality attachment Understanding of social cues Altruistic behaviors What is the difference between impulsive and instrumental aggression? Impulsive aggression is used to maintain control whereas instrumental aggression is a failure to self-manage Impulsive aggression is not planned whereas instrumental aggression is intended to achieve a larger goal There is no difference between impulsive and instrumental aggression Impulsive aggression is predatory aggression whereas instrumental aggression is affective aggression In 2008, what was the prevalence of PTSD in SUD clients in comparison to the general population? 13x higher 13x lower 17x higher 17x lower Which of the following is NOT a salutogenic asset-focused counselor characteristic? Skilled in delivering information lengthily Awareness of one’s own beliefs, preferences, needs and biases Experienced in strengthening personal reliance to stressors Ability to give a believable and reasonable rationale for information Which of the following is NOT a phase of adaptation? Hemostasis Phase Inflammatory Phase Pulmonary Phase Maturation Phase Which of the following does NOT belong to Picker’s Eight Principles of Patient Centered Care? Compliance with the clinician’s opinion Involvement of family and friends Coordination and integration of care Physical comfort Which of the following statements is false regarding ibogaine? Ibogaine has been classified as a pharmaceutical substance and is restricted to license medical practitioners in the U.S. Ibogaine is used most frequently in other countries for detoxification from opioids Ibogaine is an alkaloid that comes from a shrub called the iboga in West Africa Ibogaine administered to animals reduces naloxone Which of the following is NOT provided by the integrated brain? Impulse control Reward evaluation Evaluation and planning Erratic thinking/behavior In 2010, what percentage of people had 1 ACE? 9.5% 24% 26% 41% What is the neocortex involved with? Abstract representation, social behavior, decision making Converting short-term memory to long-term memory Relaying all senses except for smell Autonomic arousal, sensory information, body processing Which of the following does NOT indicate that a client is ready to begin exposure work? Ability to distinguish being safe from feeling safe Clinician is needed to help client regulate from abreaction Informed consent for resolution of trauma memories Ability to self-regulate while confronting perceived threats and imaginal exposure Which of the following does NOT occur when the ACC is repeatedly activated? Attentional competition Attribution errors Increased impulse control Collapsed categories A trauma informed lens ___________ Looks at the person and the behavior as a problem Encourages authoritarian control through power and force Validates the humanity of the individual Marginalizes and criticizes the individual What can happen when there is reduced serotonin in the body? An interruption in sequential memory Loneliness, stress, alienation A reduction in ability to reality check Low self-esteem, hopelessness, panic attacks Which of the following is NOT a step to interoception? Learn to calm, relax, and reduce arousal in the limbic system Detect what in the environment is activating the limbic shift Practice detecting and reducing limbic shifts at higher thresholds Recognize when a limbic shift is occurring What behavior emerges when there is hypoarousal? Hypervigilance Disembodiment Hostility Defensiveness What percentage of U.S. adults indicate they have a family member/close friend who is addicted to drugs or has been in the past? 37% 46% 53% 62% Which of the following is NOT a question that one should ask themselves to promote personal growth? How are you making sure you are growing past your upsets, failures, and/or disappointments? What is your plan to grow tomorrow, and then the next day and the next day? What have you done today “on purpose with a plan” to improve your character, talents, skills, and relationships? What did you do wrong today and how will you make sure it does not happen again in the future? Which of the following is NOT a criterion for intermittent explosive disorder? Age is under 6 years old Magnitude of aggressiveness is grossly out of proportion to stressor Aggressive outbursts are impulsive, or anger based Verbal of physical aggression occurring 2x weekly for 3 months What percent of participants engaging in AA would remain completely abstinent one year later? 35% 42% 56% 65% Which of the following is NOT included in Stage 1: Preparation and Relationship Building? Avoid sharing personal weaknesses and biases Review pacing differences Discuss how transitions are approached in treatment Create as many success visuals as possible What has Medicated Assisted Treatment (MAT) been shown to do? Decrease retention in treatment Increase criminal activity among people with substance use Contribute to lowering a person’s risk of contracting HIV or hepatitis C Impairs birth outcomes among women who have substance use disorders and are pregnant Which of the following is NOT a principle of a trauma sensitive organization? Trustworthiness and transparency Dependence on binaries Collaboration and mutuality Peer support and mutual self-help What emerges when categories collapse? Thinking on a spectrum/gradient Moving toward relationship and connection Difficulty in activating the ACC Developing a belief that one must choose between polarities What is a common medication to treat alcohol use disorder? Buprenorphine Naloxone Disulfiram Methadone What can one do to build their inner resources daily? Rewiring the brain by focusing on pathology Connecting to nature Asking questions like, “what’s wrong with you?” Practicing compassion and kindness except for in annoying circumstances What can determine how genes are turned on/off or whether some are expressed at all? Early experiences Number of genes transferred from parent to offspring Presence of neurotransmitters Development of synapses What occurs when executive functioning can take place? Balancing and regulating emotions Reducing threat through aggression Altering body tension and muscle readiness to act Avoiding threat through flight What is implicit memory? Information one consciously works to remember An example would be recalling animals that live in the sea The memory of everyday events Body and tactile memory Which of the following is NOT one of the four R’s from SAMHSA? Resist re-traumatization Realize Recognize Reactivate What is meaningfulness according to Antonovsky’s work? The quality of having great value or significance The extent to which you might perceive both internal and external stimuli as being understandable in a rational way The degree to which we might feel that there are resources at our disposal The extent to which we feel that our lives have emotional meaning How long does it take for a single dose of the fiery cocktail to metabolize? Seconds Minutes Hours It metabolizes immediately Which of the following is NOT expected in sympathetic dominance? Reduced ability to express resilience and self-regulation strategies Increased volatile, reactive behaviors Reduction in recognizing social cues Increase in expressing verbally and modulating emotion How can an individual avoid activating someone’s “sore spots”? By never relying on assumptions By always laying on additional demands By directly asking what happened By judging behavior, thinking, and emotions Which of the following is a salutogenic definition of addiction? Addiction is not a moral failure or ethical relapse but rather a response to human suffering Addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry Alcoholism is a chronic, progressive, and potentially fatal disease Addiction is a chronic disorder with biological, psychological, social and environmental factors influencing development and maintenance What can sensory integration rooms be used for? Provide symptom tracking, instant access to support, connection with communities, daily meditations, mindfulness tools, etc. Create dynamic, 3-D stimulus environments and allows for the recording of behavioral and physiological responses providing clinical assessment options Help clients identify emotions, understand why they are feeling this way, and learn how to calm themselves without the use of substances Reduce or eliminate the geographic distance causing spatial barriers for patients to receive care and treatment Which of the following questions about symptoms asks about duration? When has it stopped immediately? When does the problem occur? What have you discovered that increases how much it happens? Is there anywhere the problem does not occur? How can a clinician support the recovery of people with histories of adversity? Share vivid, descriptive examples of failure Focus on behavior and emotion rather than environment Start trying to intervene with “the Hulk” Discuss real stumbling blocks and how people deal with them What is an example of tolerable stress? Presence of buffering, caring adult Temporary, mild elevation in stress hormones Disrupted development of brain and immune system Lifelong consequences for poor health outcomes What do pathogenic approaches address? Whole person Lifestyle Deficits Prevention 1. What is a somatic resource for the traumatic reaction of muscular hypervigilance? Lengthening the spine Grounding with the feet Slowing the pace Placing the hand over heart How does binary thinking make healing and dealing effectively with trauma more complicated? Binary thinking allows for being relational rather than being ego driven Binary thinking is problem focused and deficits based Binary thinking promotes intentional living rather than reactivity Binary thinking follows the salutogenic model Which of the following does NOT occur when the hot system is activated? A reduction in language ability Internal conditioned dialogues are suppressed Perceptions shift to worrisome fantasies Moral reasoning lessens or disappears Which of the following is NOT included in the format to give information? Disregard sharing how each activity connects within the overviewed material Summarize by embedding them in a success story Overview/orient Ask for their feedback (e.g., As you move through this situation, what do you expect you will experience?) Which of the following is NOT a reason why COVID-19 may have been traumatizing for some individuals? Decreased social engagement and attunement Increase in unpredictability Decrease in chaotic and aggressive environments Increase in inconsistent environments Which of the following is NOT included in Stage 2: Psychoeducation and Self-regulation? Normalize perceptions of self, significant relationships, and the world view Increase understanding around causes, symptoms, and treatment of traumatic stress to provide comprehensive psychoeducation to clients Create a common language to enhance relational connection Move discussion away from physiology and towards emotions and psychological states Time is Up! Time's up
