Certified Clinical Trauma Specialist: Trauma and Addiction (2021)

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What is the nature of parasympathetic system?

Adherence to values and ethics

Impulsive

Poor ability to evaluate rewards

Immediate gratification

Which template is NOT created by a child’s nervous system looking for stimulus?

Regulation patterns

Physical patterns

Emotional patterns

Cognitive patterns

What can happen when there is a large increase in noradrenalin?

Fear, withdrawal, flight

Depression, sadness

Anxiety, increased energy, mania

Anger, aggression, and hostility

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 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

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 relational-developmental trauma?

Emotional neglect

Unstable environment

Natural disaster

Attachment trauma

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

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

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

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

What behavior emerges when there is hypoarousal?

Hypervigilance

Disembodiment

Hostility

Defensiveness

Which of the following is NOT an attribute of pathogenesis?

Paternalistic

Capacity building

Curative

Disease-centric

What is a salutogenic assumption?

Avoid getting worse

Humans are inherently flawed

Reactive to treat disease

Humans are naturally healthy

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

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

What does oxytocin enable?

Attachment, trust, connection

Self-worth, positive self-image

Euphoria, decreased anxiety

Motivation, learning, goal setting

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 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

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 do pathogenic approaches address?

Whole person

Lifestyle

Deficits

Prevention

Which of the following is NOT an increased risk for people with 4 ACEs?

Kidney Disease

Scoliosis

Loss of vision

Cancer

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 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 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%

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

Which of the following is NOT a phase of adaptation?

Hemostasis Phase

Inflammatory Phase

Pulmonary Phase

Maturation Phase

What assessment can be used for trauma history and treatment planning?

Trauma Recovery Scale

Graphic Timeline

PCL-5

Session Rating Scale (SRS)

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 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

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

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

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

What is an example of a process addiction?

Caffeine

Hallucinogens

Stimulants

Exercise

Changes in the hormones and biochemistry of the body lead to _____ changes in behavior, emotions, and thinking

Abnormal

Problematic

Predictable

Volitional

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

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 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

In 2010, what percentage of people had 1 ACE?

9.5%

24%

26%

41%

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

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

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

What happens when there is increased potentiated reactivity?

Pausing before reacting

Shorter space between stimulus and response

Weighing consequences before acting

Consistent self-control

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?

Which of the following is NOT an indication of an integrated brain?

Attunement to others

Ability to isolate

Sequential memory

Logic and reason

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 is NOT one of the four R’s from SAMHSA?

Resist re-traumatization

Realize

Recognize

Reactivate

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

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 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 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

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

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

What fraction of individuals with 7+ ACEs have heart disease?

1 in 14

1 in 30

1 in 7

1 in 6

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

When the balance system (ANS) is dysregulated, it responds with ___________

Intentionality

Growth and learning

Survival strategies

Vagal brakes

Which of the following does NOT occur when the ACC is repeatedly activated?

Attentional competition

Attribution errors

Increased impulse control

Collapsed categories

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

What is an action-oriented behavior related to adaptation?

Compulsiveness

Addiction

Suicidality

Impulsivity

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

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

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 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 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

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

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 is a common medication to treat alcohol use disorder?

Buprenorphine

Naloxone

Disulfiram

Methadone

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 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 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

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 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

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 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?

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

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

What happens when the relational social engagement system is suppressed?

Stable friendships and family relationships

Poor quality attachment

Understanding of social cues

Altruistic behaviors

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 percent of participants engaging in AA would remain completely abstinent one year later?

35%

42%

56%

65%

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 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

Which of the following is NOT provided by the integrated brain?

Impulse control

Reward evaluation

Evaluation and planning

Erratic thinking/behavior

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 is a behavioral salutogenic attribute?

Alcohol and drugs

Intimacy/empathy

Meaning/purpose

Cultural identity

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?)

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

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

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 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

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

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

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

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

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

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