#104- 3105 31 St., Vernon BC. V1T 5H9
tel 250-542-0660

#230-1855 Kirshner Road, Kelowna BC V1Y 4N7
tel 250-762-0078

Dr. Gordon Davidson, R. Psych.

Dr. Ralph Maddess, R. Psych.

Introduction

Symptoms of PTSD

Program

Treatment modalities

    -exposure therapy

    -EMDR (Eye Movement Desensitization Reprogramming)

    -cognitive therapy

    -hypnosis 

    -relaxation therapy and biofeedback

    -group education

    -couple/family education/consultation

    -pain program

    -vocational/career consultation

    -Graduated Return to Work programs (GRTW)

Public awareness of Post-traumatic Stress Disorder (PTSD) grew after the Vietnam War when a flood of combat-wearied veterans began exhibiting many psychological symptoms upon returning from war. The experience of 9/11 piqued societal interest further in PTSD, and more recently the military actions in Iraq and Afghanistan have brought this issue into sharper focus.

In addition, PTSD has become more prominent in terms of the aftermath of workplace traumas such as accidents, assaults, robberies, or murders, the psychological aftermath of motor vehicle accidents, the impact of domestic violence, historical trauma of child physical and sexual abuse, and the long lasting effects of native residential schools.

Symptoms of PTSD

Common to trauma is a cluster of symptoms such as re-living experiences, which includes dreaming of the traumatic incident or incidents, daytime flashbacks of the incidents, and highly stressful responses to reminders of the incident, all of which can be quite distressing. These experiences can intrude on social, family, and occupational function.

Another cluster of symptoms in the area of PTSD includes what is known as numbing experiences. The numbing spectrum of experiences includes emotional distance to those who are close to you, which can cause significant interpersonal and relationship issues, lack of interest in things that used to motivate you, or a sense of dissociation or unreality in more extreme cases.

Avoidance behaviors are the third cluster of symptoms. Avoidance in PTSD can be seen as the development of minor phobias to the site of, or reminders of, the incident. For example, those injured in a vehicle might have a strong fear reaction to being in or around vehicles. As in any phobia, the fear can be amplified by avoidance of the stimuli. For example, those who have been victimized in the community may be fearful of being in public and can develop agoraphobia (fear of crowds).

The fourth set of responses within PTSD is what is known as hyper-arousal. Hyper-arousal experiences include phenomena such as an exaggerated startle response to any stimuli that may or may not be related to the incident, including movement or sounds. Insomnia, irritability and anger can be present, and are partly a result of post incident central nervous system over-stimulation and the aftermath of adrenaline surges. Hyperarousal also can cause cognitive deficits such as problems with concentration/attention, short term memory, decision making, multitasking, and thinking speed. These symptoms can mimic ADHD or mild to moderate concussion, but are temporary. These symptoms are caused in part by the surge of cortisol, another stress hormone.

PTSD can also be accompanied by addiction issues, depression, panic, or dissociation.

The incidence of PTSD

Several factors can determine whether PTSD develops and are also influential in the degree of  recovery experienced. These factors include additional complexities such as anger, guilt or grief related to the incident, a prior history of trauma, or a history of psychological conditions. Another complicating factor is whether the incident was accidental or deliberate victimization. The degree, length and frequency of trauma experiences impact both the degree of traumatization and recovery.

One of the aspects of PTSD recovery is that many sufferers tend to feel misunderstood and have a strong need to relate to others who are going through, or who have gone through, similar experiences. It tends to be very difficult to find a supportive environment where people can extend mutual support to each other. This program is designed in part to address the need of mutual support by development of a therapeutic community.

The program is designed with a strong educational component so as to assist each participant in understanding his or her experiences.

Treatments are tailored to the individual in terms of type of involvement and degree of intensity.

This approach addresses the coping strategy of avoidance by gradually exposing people to thoughts of the incident, or place of the incident. Initially the exposure in through visualization. If the individual needs to manage dealing with that environment again, as in the case of the need to return to work, driving a vehicle, or dealing with the public, real life exposure is implemented when there is sufficient comfort through visualization. Goals are always set very small initially so desensitization can occur.

2. EMDR (eye movement desensitization retraining)

Another exposure-based therapy is EMDR, which has been shown to be roughly as successful as graduated exposure in the scientific literature. This also involves a desensitization process through visualization, with a gradual increase in the ability of the individual to remember the incident while diminishing the emotional response.

This approach involves the development of mental coping strategies in dealing with the fears and emotional triggers related to the incident.

Hypnosis is also utilized as a method for dealing with the aftermath of trauma. The hypnotic state is fundamentally a highly focused, special state of awareness based in the stability of comfort. The participant in that state can activate imagery and more effectively decrease trauma related responses and re-associate positive feelings, for example, to driving after a motor vehicle accident.

Progressive relaxation and biofeedback are utilized in dealing with hyper-arousal, irritability and anxiety. Biofeedback is an advanced method of stress reduction, which targets reduction of activity in the sympathetic nervous system.

6. Psychological –Education program

Those who are ready for group format are involved in education groups. Social support through group processes is a very important part of the program. Members will learn from the struggles and successes of others, and be able to pass on some of their own success stories. Topics include:

1. signs and symptoms of PTSD
2. biology and neuropsychology of PTSD
3. risk factors (eg. previous mental health, personality, severity/duration of trauma)
4. recovery factors-(social and workplace support, education, physical health (exercise, relaxation skills, nutrition etc), environmental stress, length of recovery,
5. treatment options (cognitive behavioural therapy, EMDR, biofeedback, hypnosis, couples/family therapy)
6. pros and cons of medications

PTSD often causes significant relationship strain, particularly if emotional numbing and irritability are present for the sufferer. A group education program will be provided for those family members who are available. Topics will include those in the participant education program, but also will focus on family and marriage issues related to recovering from PTSD. 

Consultation and counselling, tailored to the needs of each couple, will also be provided as necessary in the development of coping strategies related to the recovery from PTSD. Topics might include support strategies, communication and conflict resolution skills.

Some individuals with PTSD who have been injured experience ongoing pain. The pain can be a reminder of the incident and can amplify anxiety. The stress and anxiety of PTSD can also produce muscle tightness and nerve excitation which can amplify the experience of pain. Pain consultation can assist the development of strategies to assist in these areas.

9. Vocational/career Consulting

For those who cannot return to previous employment due to physical injury or PTSD related limitations, consultations may be provided to examine aptitudes, interests and abilities integral to the choice of new occupations.

10. Graduated Return to Work programs (GRTW)

Program staff can assist in the development of GRTWs for those who are returning to work. A well planned gradual return is crucial in making a successful return to work.

OTHER PROGRAMS

Critical Incident Stress Debriefing (CISD)

Group or individual debriefing are offered as way to provide support and education soon after a traumatic incident.

Psychological Assessments as often requested by lawyers, ICBC, or insurance companies to determine an individual’s level of trauma and recovery status.

Participants will be present in the community for two weeks and will access educational programs and individual consultations.

This program is five full days per week.

This less intensive program is for people who require services as infrequent as weekly or biweekly.

Dr. Davidson has an extensive background in working with trauma with a special emphasis on workplace incidents, including accidents, robberies and violence. He has conducted many critical incident debriefing sessions. He has conducted hundreds of PTSD assessments for workplace injuries, motor vehicle accidents, personal injury and native residential school. He has testified in court as an expert witness. He has developed innovative strategies in the use of biofeedback in exposure therapy. He teaches on PTSD for the Okanagan School of Massage and has taught psychology, social work and education at Okanagan University College, now UBC Okanagan. He taught individual , family and group therapy. Published in the area of conflict resolution and organizational stress management, Dr. Davidson has presented his research at national and international conferences. In his consultation with organizations, he has assisted organizations in dealing with organizational stress and trauma. He holds a MA in Applied Behavioral Science and a doctorate in Counselling Psychology.

Dr. Maddess has 35 years of experience in working with hypnosis and other forms of psychotherapy. He has worked extensively with victims of severe historical trauma including sexual abuse, military combat service (Veteran Affairs Canada) since 1985. he holds a Master of Science degree in experimental and applied psychophysiology (now called biofeedback) and a Ph.D. in neuropsychology. In addition to a private clinical practice he is a part time term professor at Okanagan College in Vernon. He has consulted at the Labyrinth Centre for Dissociation in Victoria.

Other staff

A psychiatrist may be available for consultation on medication reviews if necessary.

A massage therapist will be available for participants if required.

Costs

Costs may be covered under extended health programs for registered psychologists. WorkSafe BC, ICBC, private lawyers, Criminal Injuries Compensation program or Native Residential healing fund sources may cover program costs.

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