PTSD in Partners: A Treatment Approach with Eye Movement (Accelerated Resolution Therapy) Presented at IACSAS in Dalla on May 1,2,3 2014 by Dr. alexis Polles

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PTSD in Partners:
A Treatment Approach
with Eye Movements
(Accelerated Resolution Therapy)
Dallas, May 1,2,3, 2014
Presented by Alexis Polles, MD, PLLC
www.RecoveryThatLasts.com
agpolles@recoverythatlasts.com
601-255-5485

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Disclosures
 None
 No relevant financial issues
 If medications are mentioned the generic name will be used
and non-FDA approved uses will be stated

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OUTLINE
I. Trauma and its sequelae
II. Trauma in partners of sexual compulsives/addicts
(focus on women)
III. Treatment options
IV. Use of special approaches in the treatment of trauma
 Eye Movements
V. Conclusion

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Definition of Trauma
The diagnostic manual used by mental health providers
(DSM-5) defines trauma an event that involves actual
or threatened death or serious injury or sexual
violation.
The Merriam-Webster Dictionary defines it as
a)an injury to living tissue caused by an extrinsic agent
b)a disordered psychic or behavioral state resulting from
severe mental or emotional stress or physical injury or
c)an emotional upset
DSM-IV requirement that “The person’s response to the event must involve intense fear,
helplessness or horror” has been eliminated in DSM-5.

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Trauma
• May include events that are not beyond the scope of normal
human experience, as long as the event has had a trauma-like
impact on the person.
• DSM-5 moved it from an Anxiety Disorder to Trauma- and
Stress-or-Related Disorders
• What makes an event traumatic:
– The severity of the event
– The proximity of the experience
– The personal impact of the event
– The after-event impact

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Potential Victims Of A Traumatic Stressor
1 Primary
Victims
Those individuals most directly affected by the
event, e.g., the persons whose houses are
blown down in a hurricane.
2 Secondary
Victims
Those individuals who in some way observe the
consequences of the traumatic event on the
primary victims, e.g., bystanders, rescuers, and
emergency response personnel. (Partners/kids)
3 Tertiary
Victims
Those individuals who are indirectly affected by
the traumatic event as a result of later exposure
to the scene of the trauma or to the primary or
secondary victims of the trauma.

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Trauma Spectrum
Trauma - + + + +
Consequences - -/+ + + +++
Impairment > 30d - - + ++
Re-experience, arousal
and avoidant
symptoms
+ ++
Co-occurring
syndromes
+

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Types of PTS/PTSD
Simple PTS/D
 The response to one or more traumatic events that
are NOT linked in any way (e.g., one rape, one car
accident, one sudden loss).
Complex PTS/D
 The response to a combination of specific traumatic
events that ARE linked to each other in some way or
occur repeatedly over time

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Natural vs. Human Made
 Prolonged stressors, deliberately inflicted by people, are far
harder to bear than accidents or natural disasters.
If this was done deliberately, in the context of an ongoing
relationship, the problems are increased.
The worst situation is when the injury is caused deliberately
in a relationship with a person on whom the victim is
dependent –
most extreme is parent-child; spouse or partner
infidelities/betrayals are high on the list

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Symptom Clusters
(Four in DSM-5)
• Re-experiencing (nightmares, intrusive images)
• Avoidance
• Persistent Negative Alterations in Cognitions and Mood
(includes numbing, distorted self-blame, estrangement,
inability to remember key aspects of the event)
• Arousal (includes fight and flight)
Subtypes include kids < 6 and dissociative

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Trauma is an experience that
overwhelms our capacity to
have a sense of control over
ourselves and our immediate
environment, to maintain
connection with others and
to make meaning of our
experience.
In Summary:

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Effects of Trauma
on Brain Function
Amygdala
Sorts for immediate danger
(significance)
Pre-frontal Cortex
(Integration and Planning)
Hippocampus
Stores longterm memory
(cognitive map)

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Fear Response

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16
Trauma Response
Visual
Cortex
Amygdala

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Hypothalamus-Anterior Pituitary-Adrenal Cortex Axis
 Cortisol (stress hormone)
elevates blood sugar and
increases metabolism
 Body is then able to sustain
prolonged activity
 But immune system activity
is decreased
 High cortisol levels damage
hippocampus
 Learning and memory suffer
as a result

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Tend and Befriend
(Taylor, Lewis, Gruenwald, Gurung, Klein, & Updegraff, 2000; 2002)
 Women developed
other stress responses
 To protect the child
 To galvanize resources
 Mediated by oxytocin

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Partner Trauma Is
Financial
Social
Psychological
Emotional
Spiritual
Sexual
Modified from APSATS Multidimensional Trauma Model Training

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Therapeutic Options
Psychosocial
PharmacologicalComplementary

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Healing is Possible
Evidence Supported Treatments
 Narrative (oral, written, past tense, imaginal)
 Cognitive Therapy, Cognitive Processing Therapy (TfCPT)
 Exposure Therapy
 Stress Inoculation Training (SIT)
 Psychoeducation
 Eye Movement Desensitization and Reprocessing
 DBT Strategies
 Mindfulness Based Strategies
 Complementary and Integrative Modalities (Yoga, Meditation, Acupuncture)
 Pharmacotherapy (alpha 2 ligands, SSRI, SNRI) Avoid Ambien for sleep.
Consider B-blockers, and morphine in field or acute injury.

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How It Works
Access relevant memory
Stimulate brain with bilateral stimulation
Move through channels of association
until memory successfully resolved in
EMDR or Image Replacement with ART

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Courtesy
Dr. Uri Bergman

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NEURAL NETWORKS
Courtesy
Dr. Uri Bergman

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Yes, this is part of healing!

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The Conclusion
The trauma reactions of partners of
sexual addicts who have been terrorized
and repetitively assaulted are not due to
the person’s “underlying issues,” they
are the issue.

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Core Principles of Partner Trauma
 Almost all the behaviors are coping strategies.
 Reactions are not character flaws.
 Reactions are affected by supports and circumstances.
 Behaviors may be effective or ineffective.
 Responses will change if safety is established, though all triggers
may not be eliminated.
 There can be reconnection that is healthier and more deeply
satisfying with God, ones self, and others, including the
perpetrator.

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Alexis Polles, MD, PLLC
agpolles@recoverythatlasts.com
601-255-5485
www.RecoveryThatLasts.com