Beyond the Obvious

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29 Νοε 2013 (πριν από 3 χρόνια και 11 μήνες)

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RESPONDING TO TIP TRAUMA
VICTIMS

Beyond the Obvious

PRESENTATION
AGENDA


Differentiate between stress, crisis, trauma


Understand sources of trauma and how trauma
(including TIP) affects individuals


individually


Develop strategies for identifying and
interviewing victims of trauma



What are some beliefs pertaining to the
effects of trafficking in persons on victims?


How are victims effected by their kidnapping,
brainwashing, and imprisonment?


How do our beliefs effect the way we approach
and intervene with trauma victims?


What are some bias’ pertaining to TIP
victims?




Before we begin…

THE
SCIENCE

OF TRAUMA

There is science we need to
understand and apply to
discover the truth…can reduce
the fear and prejudice

THE DIFFERENCE BETWEEN STRESS, CRISIS, AND
TRAUMA


A
stressor

is:


An event that can cause a person physical or
emotional tension


Short term or chronic


Followed by physical and emotional effects
which are alleviated when the stressor is
removed


Examples?



Filing you income taxes


Late for a meeting


Receiving a call on
a
complaint


What type of crimes might you consider stressful on
the victim?


THE DIFFERENCE BETWEEN STRESS, CRISIS, AND
TRAUMA


A crisis is:


A threat to homeostasis (Caplan, 1964)


A temporary disruption of coping and problem solving
skills


but not necessarily a life threatening experience


Resolved when the crisis event passes and normal
functioning returns


Examples?


A traffic accident in which you break a leg


When will the cast come off, how are you going to get to work, how
will you walk?


You child has an epileptic fit in front of you for the 1
st

time


You fail a tax audit


What type of crimes might you consider a crisis for the victim?


THE DIFFERENCE BETWEEN STRESS, CRISIS, AND
TRAUMA


Trauma is:


More extreme versions of stressful events, they
are perceived as: life threatening and evoke fear,
helplessness and even horror


Have physical and emotional responses that last
long after the event is over


Memory of the traumatic event lingers on


Fear and psychological arousal continues and
the body may never fully recover


Life changing…

THE DIFFERENCE BETWEEN STRESS, CRISIS, AND
TRAUMA


Examples of trauma?


You kill an intruder in your home


You find your child dead


You are told you have cancer


What type of crimes might you consider
traumatic
on the victim?


Child abuse


Suicide (friend, co
-
worker, relative)


Attempted homicide (victim, friend, co
-
worker,
relative)


Homicide (friend, co
-
worker, relative, witness)


Sexual assault


TIP



VICTIMIZATION PROCESS


Life Experiences Before The Assault


Common Experiences During The
Assault


Common Experiences After The Assault


PRE
-
TRAUMA
EXPERIENCES



Gender Socialization


Lack Of Sufficient Boundaries


Lack Of Self
-
Parenting


Utopian Approach To The World Vs.
Environmental or Situational Awareness


Looking to Others to Keep Them Safe


EXPERIENCES DURING
TRAUMATIC
ASSAULT


Physical resistance


Verbal resistance


Surprise or confusion


“Frozen fright”


Disassociation


Tend or befriend



POST
-
ASSAULT EXPERIENCES


Acute Trauma (Stage 1)


Disorganization
-
Nightmares
-
Flashbacks


Reliving Event or Re
-
Enacting Experience


Shock
-
Disbelief
-
Loss of Control
-
Guilt
-
Shame


Suppressed or Intensified Emotion


Fear
-
Hyper
-
vigilance or Calm and Denial


Irritability and Angry Outbursts


Depression
-
Suicidal Ideations
-
Self
-
Destructive


Physical Pain or Fatigue


POST
-
ASSAULT EXPERIENCES


Outward Adjustment (Stage 2)


Effort to Deny or Minimize the Impact of the Sexual Assault


Rationalize the Reasons it Happened


Avoid Reminders of the Sexual Assault


Depression, Anxiety and Fear Remain


Fewer Episodes of Reliving the Incident


Return to Crisis


Increased Ability to Express Emotions about Incident


Develops Coping Skills

POST
-
ASSAULT EXPERIENCES


Integration (Stage 3)


Acceptance and Understanding Assault


Reorganization of Life



Severity Of Response Does Not Reflect Brutality
Of Attack


Stranger Vs. Non
-
stranger


Re
-
victimized Victims


SPECIAL ISSUES AFFECTING VICTIMIZATION


COMMON VICTIM BEHAVIORS


May try to normalize trauma


May have difficulty understanding the context of
the assault


May have difficulty fully realizing and/or
appreciating danger posed by offender


May attempt to “forgive” the offender


May believe their higher power will protect them


exclusively



May feel overwhelming guilt and may try to ease
their conscience and may blame themselves



SPECIAL ISSUES AFFECTING VICTIMIZATION


COMMON VICTIM BEHAVIORS


May be trying to protect others


physically,
psychologically


May feel pressure from the rapist or others


May actually feel safer maintaining the
relationship


May have some emotional/physical attachment
w/offender


May still be under the influence or manipulation
and control of the offender


May be worried about collateral misconduct


perceived or real



WE
CANNOT

TRULY UNDERSTAND
BEHAVIOR WITHOUT
UNDERSTANDING THE EXPERIENCES
OF THE PERSON OR CONTEXT IN
WHICH THE BEHAVIOR OCCURS

UNDERSTANDING MEMORY & TRAUMA

WHAT IS MEMORY?


a: the power or process of reproducing or
recalling what has been learned and retained
especially through associative mechanisms


b: the store of things learned and retained from
an

activity or experience as
evidenced by modification of structure or
behavior or by recall and recognition


Webster



Sense

Process

Act


External


Internal


Perceive


Store


Survive


Mating

Cortical


Abstract thought


Concrete thought


Affiliation

Limbic


Attachment


Sexual behavior


Emotional reactivity

Midbrain


Motor regulation


“Arousal”


Appetite/Satiety

Brainstem


Sleep


Blood pressure


Heart rate


Body temperature

Goldstein, 1995

MEMORY


“We tell ourselves stories in order to live” Joan
Didion


What we can’t recall, we invent


Memory is designed to filter the world and discard what
we deem irrelevant


We tend to hone in on the details of the event


called
weapon focus


we recall the grisly details of the
weapon pointed at us, but we may not remember the
robbers face or the other people in the store


If our brains were perfect video cameras we would be
paralyzed by information overload



Funes
, the
Memorious


MEMORY ENCODING


Whenever we encode an experience (and we all
do) we filter it through our own awareness.


If we only remembered the literal words or all the
details, we might miss the meaning


If I tell you “I’m really tired today because the
baby was up all night”
-

what might you
remember about what I told you?


An inference would normally be that the baby
cried all night


People have unfounded confidence in our
memories


We continually confabulate and we don’t even
know it

MEMORY AND RECALL


No one is a human video recorder


When we recall an event


that recall
becomes our most recent memory


Like a photograph


when we take a
photograph and look at it we most often do
not recall most of the details in the original
memory


What impact does this information have
on how and when we interview?

MEMORY AND RECALL


When we recall we are reconstructing what we think
we remember


When we don’t know something we try to figure it out


If we can’t figure it out we have choices


Say “I don’t know”


Confabulate


Fill in the blanks


What if that memory is less


than flattering?

TO CONFUSE THE ISSUE…


The initial formation of long
-
term memory
requires a chemical called brain
-
derived
neurotrophic factor


while subsequent recall
depends on a transcription factor called Zif268


These processes are related, but
fundamentally different and so researchers
conclude that repeated remembering does not
create a duplicate of the original memories

CONFABULATION


When the brain strives to re
-
create an event, it
often grafts details of other memories into it


The common wisdom was that once a memory
was consolidated into long
-
term memory


it was
stable


Many experts now believe that a memory may
return to it’s embryonic state when it’s activated


When a consolidated memory is reactivated
through retrieval, it may become particularly
susceptible to disruption

Reconsolidation

Recall

Memory formation

WE CREATE MEMORIES


EVEN AS THEY CREATE
US…

Robust

Fallible

Malleable

Potent

Slippery

Inventive

BRAINS ARE ELASTIC


Memories change


Patterns change


House breaking a dog…


So what??


Our standards for memory are too
high…especially when it comes to trauma…and
emotions

EMOTIONS ARE AT THE CENTER OF DECISION
MAKING… (
DAMASIO
, 2008)


Brain injury patients (stroke, tumors, accident)
whose frontal cortex,
somatosensory

cortex, or
amygdala

was damaged


Prior to the injury they were successful in their
relationships, jobs, and marriages


Following the damage they could still speak perfectly
well, deal with the logic of a problem, and could learn
new things


but…


Their marriages fell apart, they’re careers were
reduced to odd jobs and disability checks


Their emotions were compromised, they were
flattened compared to what they used to be an what
we expect of people


Patients’ inability to be emotional were getting in the
way of their reasoning and decision making

ADDING TRAUMA INTO THE MIX


The prime “directive” of the
brain is survival


The brain is “over
-
determined”
to sense, process, store,
perceive, and mobilize in
response to the threat
(Goldstein, 1995)


All areas of the brain are
recruited and orchestrated for
optimal survival tasks


Cognition, emotional, social,
behavioral, and physiological
residue of trauma may impact
an individual for years


even
a lifetime (Perry, 1999)

TRAUMA CHANGES THE BRAIN & MEMORY


Trauma response


including rape


is bimodal


Hypermnesia


abnormally vivid


Hyper
-
reactivity to stimuli and traumatic
reexperiencing

coexist with psychic numbing
(Horowitz, 1978)


Avoidance


Amnesia and
anhedonia

-

inability to enjoy pleasure
(DMS
-
R IV)


In many people who have undergone severe stress
the post
-
traumatic response fades over time, while
persists in others (von
der

Kolk
, 1994)


Trauma interferes with declarative memory (van
der

Kolk
, 1991)

BRAIN’S RESPONSE TO THREAT


In order for any experience to be remembered,
traumatic or not, it must 1
st

be “sensed” (Perry, 1999)


The 1
st

“stop” of this sensory input is the lower parts of
the brain (brainstem and midbrain) (Perry, 1999)


Incoming information is “matched” against previously
stored information


if associated with previous threat


an alarm response begins (Aston
-
Jones , 1986)


The fear response will involve a tremendous
mobilization and activation of systems


terror involves
cortical, limbic, midbrain, and brainstem (Gorman,
Liebowitz
,
Fyer
, & Stein, 1989)

USE
-
DEPENDENT MEMORIES


Violence


Stress


Grief


Fear


Joy


Riding a bike


Typing


Dancing


Playing piano


Learning
Names


Phone #’s


Language

Cognitive

Motor
Vestibular

State

Emotional
-

Affect

STATES BECOME TRAITS

Sense

of Time

Extended

Future

Days

Hours

Hours

Minutes

Minutes

Seconds

Loss

of
Sense of
Time

Primary

Secondary

Brain

Areas

Neocortex

Subcortex

Subcortex

Limbic

Limbic

Midbrain

Midbrain

Brainstem

Brainstem

Autonomic

Cognition

Abstract

Concrete

“Emotional”

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Dr. Bruce Perry

ALTERED REACTIVITY FROM CHRONIC THREAT

Terror

Fear

Alarm

Vigilance

Calm

Vulnerable

Normal

Resilient

Dr. Bruce Perry

STATE MEMORY


3 YR OLD WITNESS OF A
MURDER

DISSOCIATION & FRAGMENTED MEMORIES


Trauma overwhelms peoples coping skills


memory
is a coping skill


Traumatic amnesia is a well documented
phenomenon (
Kolk

&
Fisler
, 1995)


Traumatic amnesia lasts for hours, weeks, or years


Dissociation during the trauma (
peritraumatic

dissociation) is known to cause memory gaps


Victimization, helplessness, and betrayal increases
the likelihood of
peritraumatic

dissociation


Dissociation refers to a compartmentalization of
experience that is stored in memory as isolated
fragments (
Nemiah
. 1998)


Sensory perceptions


Affective states


Behavioral reenactments

WHAT DOES THIS MEAN?


When anyone (including you) are under
threat


the
cortex

is shut down


Time to come back to normal state is days,
weeks, months, and years…


Intervention is state dependent


When people want to avoid talking


for
whatever reason


they use words that
conceal rather than reveal “what they can
tolerate in the moment”


Just because we are ready for every detail


doesn’t mean the victim is ready or able to
fully disclose

THE BRAIN RESPONDS TO THREAT


Preparing the human for survival


Freezing


the instantaneous assessment of
danger (some people do not leave this state,
unable to fight or run away)


Flight


escaping the danger


Fight


trying to defeat, remove or contain the
fear


Tend or befriend


the person may survive by a
strategy that does not use either of the other
approaches but uses interpersonal skills in an
attempt to reduce the threat

TRAUMATIC RESPONSES CAN ALTER…


Physiology


Heart rate, respirations, dilated pupils, dry
mouth, knot in the stomach


Affective (mood and emotion) responses


Fear, helplessness, horror


Cognitive (thought) processing


Memory


fragmented, out of sequence


Time distortion


Increased confabulation


Trauma memory and recall

EFFECTS OF NEUROTRANSMITTERS &
TRAUMA


Trauma is not only a psychological event but also a
physiological event as well…


During stress, crisis, and trauma, the human body
generally produces higher levels of neurotransmitters
such as


Norepinephrine


Cortisol (stress hormones)


Dopamine


Serotonin


Massive quantities


Interaction with alcohol and other drugs unknown


May alter memory, reaction, judgment, response


High levels received during event may be undetectable



WORKING WITH TRAUMA VICTIMS


Memories of personal trauma are particularly durable and
accurate (so don’t worry if you don’t get everything in the
ER)


The content of traumatic memory is usually vivid, detailed
and more accurate than that of ordinary day
-
to
-
day
memories


Traumatic events are first organized in memory on a
perceptual or sensory level


This often depends on the way trauma was first received


Visual images, smells, pain, taste, body positions, sounds


For some people recalling sensations in the only way to
describe the traumatic event initially


The narrative emerges over time as the individual tries to
explain what has happened (Schacter, 1996)

WORKING WITH A TRAUMA VICTIM


While some victims may be able to verbalize and recount
what happened, many experience difficulties in:


Concentration


Sequencing of events, and


Memory disturbances


Retelling of experiences may contain internal
inconsistencies


Victim may often re
-
live the event and re
-
experience all of
the emotional, physiological effects


The victim may not even be able to recall experiencing any
pain, or location of the pain due to stress induced analgesia


This analgesic effect is caused by the activation of the brains
opiate system following a trauma (Bolles, 1980)

THE IMPACT


The assault experience is remembered in
fragments but infused with intense emotion
and recollections of sensations such as tastes,
smells, and sounds.


Some victims may become haunted by feelings and
senses they know are related to the trauma, but
have difficulty identifying the source of the feeling
or sensation


Appropriate Open
-
Ended Questions:


What did you do next?


Help me understand?


Tell me what you were thinking at that point?


Tell me what you were feeling when he did that?


Tell me more about that?


This type of questioning will provide the victim an
opportunity to talk about thoughts, feelings, and
experiences during the assault


This will help us understand better the reality of
the situation and overcome most, if not all,
challenges to credibility

CONDUCTING A BETTER VICTIM INTERVIEW


Begins with a realistic understanding of our role


Law enforcement must focus on developing at
least three hypothesis and prove or disprove
each one to attempt to remain unbiased


We must use an awareness of societal
stereotypes regarding victimization to overcome
challenges to the victim’s credibility


Engage in finding new and better ways to
understand the victims experiences


including
initial interviews


Difference between interview and interrogation

COGNITIVE INTERVIEW
TECHNIQUES


Cognitive interview


Free flow narrative


Third person/object


Backwards


Questions


What they remember the most


What is most important aspect of what
happened to them

VICTIM’S
EXPERIENCE/PERSPECTIVE


Continue to ask questions until you
can experience the incident yourself


feelings


Explore smell


tastes


sounds


feelings


The truth is in the details!


THEREFORE…


Sensitivity and empathy are the keys to a
successful victim interview


Be patient


Be thorough


Go beyond “He said, She said”


Build a case in depth


Don’t stop asking questions until you can in
some ways experience what the victim has
experienced


Give the victim time to process and work through
the trauma


Provide the victim with a materials to “journal”
their experience

QUESTIONS & ANSWERS


Invite questions from the audience


For further information


contact:


Russell W. Strand

Chief, Family Advocacy Law Enforcement Training Division

US Army MP School, 401 MANSCEN Loop, Suite 1721,

Ft. Leonard Wood, MO 65401

Email:

russell.strand@us.army.mil

Phone: (573)563
-
8061