Posted on: June 8, 2020 | Julie Rael, LCSW, CCO Valley Behavioral Health Trauma refers to a distressing event or series of events that can result in adverse long-term effects on an individual’s overall functioning and well-being. The Month of June is observed as Post Traumatic Stress Disorder (PTSD) Awareness Month. During this time, I also want to highlight the issue of psychological trauma and how it is critical that behavioral health providers continue to gain more knowledge about how to help those suffering from trauma, as this is a complex issue and an area of great need. In last week’s blog, I talked about how trauma is common to the human experience but having endured traumatic events in the past does not always result in the development of PTSD. Conversely, unresolved trauma can negatively impact an individual’s mental health and possibly lead to the development of a substance use disorder. The focus of addressing trauma in behavioral health treatment is commonly referred to as trauma-informed care. Over the years, the behavioral health field has increased its focus on providing trauma-informed care as clinicians have gained a greater understanding of how trauma, behavioral health, and substance use difficulties are all interconnected. Trauma-informed clinicians can correlate the impact of trauma on their patient’s depression and anxiety symptoms, phobias, panic responses, and use of alcohol and other substances. If you are new to working in behavioral health, it is essential to learn how trauma impacts patients and become familiar with common symptoms and behaviors exhibited by them, as many new to this work may misinterpret these and interact with these patients in a manner that can contribute to further trauma. These symptoms and behaviors include feelings of anxiety, memory loss, being overwhelmed, agitation, irritability, anger, aggression, and rigidity. They have been observed in engaging in repetitive behaviors or thoughts, misusing alcohol or other substances, being disconnected or “being on autopilot”, having confusion, dissociation (not being present in the moment), lacking an emotional response or separation of emotions (numbing), demonstrating chaotic responses, impulsive behaviors, emotional or aggressive outbursts, They can experience intense or inappropriate relationships, difficulty with communicating and maintaining personal boundaries and understanding social norms. There are several important factors to consider in working with patients with trauma. The first is many individuals don’t recognize the correlation of their trauma with their behavioral health concerns, or they avoid discussing these concerns due to the immense discomfort that recalling the trauma causes. These individuals often misuse alcohol and other substances to decrease the uncomfortable physiological sensations and numb the psychological pain associated with distressing memories. The second is that individuals with trauma histories need to feel physically and psychologically safe before they can start addressing these concerns. Many of these individuals struggle with trusting others as they have often suffered trauma at the hand of those they should have been able to trust but were abused by parents, family members, or those in authority positions when they were children, and or were in an abusive relationship as an adult. It is essential to build and maintain the trust of your patients by creating a safe environment and discussing appropriate clinical boundaries at the beginning of treatment and reviewing these boundaries periodically through the course of treatment to uphold a safe environment. Your patients need to know why you are asking for information, your treatment recommendations, and your reasoning for these. They also need to know that they are in control of their treatment and they direct its course. They have a choice to take a break, choose not to explore an issue, provide the therapist feedback, and or ask for a different therapist. The third area of need is that victims of trauma may have also suffered neglect as children, have neglected health care needs, and often have developed chronic health conditions. The study of Adverse Childhood Experiences (ACEs) by Kaiser Permanente has looked at this issue in extensive detail. At Valley Behavioral Health, we continue to strive to help our patients obtain treatment from a primary care physician or medical specialist, and we begin the discussion with them on how trauma and its associated symptoms and behaviors can exacerbate their health concerns. Treatment planning and therapy focus on helping the patient rebuild a sense of control and empowerment. We also help them implement protective factors and coping skills that can help increase their resiliency. Resiliency is an important factor in reducing the impact of stressors on their physiological and physical health. Our peer support program focuses on helping our patients successfully navigate treatment, as these peer specialists have successfully done so. The peer specialists facilitate an environment and activities that support our patients in building healthy social connections with others who are also working to improve their mental health. The treatment team considers how social determinants of health impact our patients and we implement interventions to reduce the impact of these stressors with our case management services. Finally, we look at our patient’s environment and how they can further nurture their wellbeing by implementing self-care practices that include mindfulness, exercise, and an awareness of how nutrition allows for them to further care for their mind and body. All the components discussed above are essential to our patient’s treatment, along with the use of evidence-based treatments that include therapy and medication. We use the following evidence-based individual and group therapy treatments at Valley Behavioral and our Highland Springs clinics: Cognitive Behavioral Therapy (CBT), Cognitive Processing Therapy (CPT), Prolonged Exposure and Eye Movement Desensitization and Reprocessing (EMDR), Dialectical Behavioral Therapy (DBT), Trauma Recovery and Empowerment Model (TREM) and Seeking Safety. If you or a loved one has experienced concerns with trauma, please don’t delay in contacting us. We are here for you and are looking forward to meeting with you to discuss your concerns, provide an evaluation and individualized treatment plan. References CDC-Kaiser Adverse Childhood Experiences Study www.cdc.gov/violenceprevention/acestudy/ Julie Rael, LCSW, CCO Valley Behavioral HealthMs. Rael earned her Bachelor’s degree in psychology and her Master’s degree in social work with a substance use treatment certificate at the University of Utah. She began working at Valley in 2005 and is a licensed clinical social worker. Prior to obtaining her Master’s degree, she worked as a case manager in a homeless shelter connecting individuals to occupational and housing resources and as a social service worker teaching vocational and psycho-educational skills to youth, refugees, and adults with mental health and substance use difficulties. Ms. Rael enjoyed seeing the participants gain more skills and the confidence to move on to employment and further education. After completing her Master’s degree, she worked as a therapist providing individual and group psychotherapy with individuals with substance use and mental health difficulties. After obtaining her LCSW license, she transitioned to a team lead position that provided intense community treatment and outreach services for individuals needing more than traditional outpatient services. Ms. Rael went on to manage and further develop programing for two behavioral health clinics with multidisciplinary treatment teams. She has worked as Field Instructor training and supervising MSW interns for the University of Utah’s Social Work department for the past six years. Ms. Rael was promoted to a Director of Adult Mental Health services in 2017, and then began providing oversight of Valley’s Forensics clinic in 2018. She has also served as a board member and volunteer for a local non-profit that provides individuals the training and support needed to obtain meaningful employment after incarceration and recovery from substance use difficulties. Ms. Rael believes that evidenced-based treatments, collaboration with health care providers, and connecting individuals to recovery support programs are essential factors in obtaining effective treatment outcomes. She is passionate about working alongside individuals to discover their unique strengths, grow and continue to progress in becoming their personal best. In the role of Chief Clinical Officer, Ms. Rael will be working collaboratively with clinical and medical leadership to improve clinical processes, program development and identify those interventions which will best predict clinical success for each of the conditions that we treat. She will be a coach to all Adult and Children’s Clinical Directors and will serve on the Valley Academy team to ensure all Valley Staff feel properly trained and well prepared to bring Valley Behavioral Health’s systems of care to the forefront of our industry.