Dr.

Sara Thompson

Complex Trauma

This course provides students with a broad overview of the complexities of

complex trauma and complex PTSD (C-PTSD). Speci c topics include the theories
of trauma, assessment of complex trauma, psychopathology, trauma informed
interventions, as well as trauma resolution and growth after trauma. Additionally,
the course examines ethical consideration and cultural sensitivity to provide a
trauma informed and culturally appropriate treatment. 

Pre-requisite: None

Course Information

Unit 1 - Overview of Complex Trauma and C-PTSD

Unit 2 - Cultural Competency and Ethics

Unit 3 – Theories of Trauma

Unit 4 - Assessing for Complex Trauma/C-PTSD

Unit 5 - Psychopathology of C-PTSD

Unit 6 – Trauma Informed Interventions

Unit 7- Trauma Resolution

Unit 8 - Resilience and Growth After Trauma

Final Knowledge Check

Course Survey
Lesson 1 of 11

Course Information
Dr. Sara Thompson

Course Outcomes
Upon successful completion of the course, students will be able to:

Explain the etiology of complex trauma.

Apply ACA Code of Ethics to diverse case scenarios.

Critique the theories of trauma.

Correctly assess, diagnose and develop trauma informed interventions.

Examine trauma resolution, resilience and growth to inform clinical practice.

Resources
American Counseling Association. (2014). ACA code of ethics.
https://www.counseling.org/resources/aca-code-of-ethics.pdf

The National Child Traumatic Stress Network. What is complex trauma? A resource guide for youth
and those who care about them. https://health.uconn.edu/adoption-
assistance/wpcontent/uploads/sites/68/2018/04/what_is_complex_trauma_for_youth.pdf

Whealin, J.M., & Slone, L. (2013). Complex trauma. https://www.mirecc.va.gov/cih-

visn2/Documents/Provider_Education_Handouts/Complex_PTSD_Version_3.pdf  
**Additional electronic resources will be provided within each unit. 

 The information within this course is sensitive, and it may trigger feelings, thoughts and
reactions for you. Please be sure to take the time to re ect upon those experiences and it
is okay, rather you are  encouraged to step away from the course for a while. 

C O NT I NU E
Lesson 2 of 11

Unit 1 - Overview of Complex Trauma and C-PTSD

Dr. Sara Thompson

Objectives
In this unit, students will:

Explain complex trauma and C-PTSD.

Identify the events that can lead to C-PTSD.

Examine the criteria for a diagnosis of PTSD as outlined in the DSM-5.

 Upon completion of the ACE questionnaire, analyze your results and re ect how your
results might in uence your work as a counselor. 

Overview of Complex Trauma and C-PTSD

Complex trauma is de ned as exposure to multiple forms of trauma or abuse the di culties
that arise from those experiences when adapting to or surviving those traumatic experiences.
The trauma may begin during childhood in the form of abuse or neglect (adverse childhood
experiences ACEs) that are in ected by another person to include family members. In
addition, complex trauma includes chronic toxic stress, such as living in a violent home and
is compounded with other forms of violence as well as oppression experienced by some
populations. Symptoms of PTSD may develop, and complex PTSD (C-PTSD) may result from
the chronic and multiple forms of trauma experienced. C-PTSD is generally associated with
sexual, physical and psychological abuses, chronic intimate partner violence, bullying, human
tra cking, and being held a prisoner.

A person who has experienced recurrent abuse and/or victimization may also experience
di culties with:

Self-perception: shame, guilt, feelings of hopelessness or helplessness, or stigma

Emotional Regulation: anger, sadness or suicidal ideation

Relationships: distrust, isolation, or search for a rescuer 

YOUTUBE

What Is C-PTSD? (Complex Post Traumatic Stress Disorder)

 What Is C-PTSD? (Complex Post Traumatic Stress
Disorder)
Complex PTSD is di erent from PTSD. With PTSD, there's typically one
traumatic incident that an individual is dealing with; however, Complex PTSD
is a diagn...
VIEW ON YOUTUBE 

DSM - 5 Criteria for Diagnosing PTSD in Adults, Adolescents

and Youth (older than 6 years)

Criterion A
–
Criterion A (one required): The person was exposed to: death, threatened death, actual or
threatened serious injury, or actual or threatened sexual violence, in the following way(s):

Direct exposure

Witnessing the trauma

Learning that a relative or close friend was exposed to a trauma

 Indirect exposure to aversive details of the trauma, usually in the course of professional
duties (e.g., rst responders, medics)

Criterion B
–
Criterion B (one required): The traumatic event is persistently re-experienced, in the following
way(s):

Unwanted upsetting memories

Nightmares

Flashbacks

Emotional distress after exposure to traumatic reminders

Physical reactivity after exposure to traumatic reminders

Criterion C
–
Criterion C (one required): Avoidance of trauma-related stimuli after the trauma, in the
following way(s):

Trauma-related thoughts or feelings

Trauma-related reminders

Criterion D
–
Criterion D (two required): Negative thoughts or feelings that began or worsened after the
trauma, in the following way(s):

Inability to recall key features of the trauma

 Overly negative thoughts and assumptions about oneself or the world

Exaggerated blame of self or others for causing the trauma

Negative a ect

Decreased interest in activities

Feeling isolated

Di culty experiencing positive a ect

Criterion E
–
Criterion E (two required): Trauma-related arousal and reactivity that began or worsened after
the trauma, in the following way(s):

Irritability or aggression

Risky or destructive behavior

Hypervigilance

Heightened startle reaction

Di culty concentrating

Di culty sleeping

Criterion F
–
Criterion F (required): Symptoms last for more than 1 month.

Criterion G
–
Criterion G (required): Symptoms create distress or functional impairment (e.g., social,
occupational).

Criterion H
–
Criterion H (required): Symptoms are not due to medication, substance use, or other illness.

Two speci cations:

1. Dissociative Speci cation. In addition to meeting criteria for diagnosis, an individual

experiences high levels of either of the following in reaction to trauma-related stimuli:

Depersonalization. Experience of being an outside observer of or detached from

oneself (e.g., feeling as if "this is not happening to me" or one were in a dream).

Derealization. Experience of unreality, distance, or distortion (e.g., "things are not

real").

2. Delayed Speci cation. Full diagnostic criteria are not met until at least six months after
the trauma(s), although onset of symptoms may occur immediately.

DSM - 5 Criteria for Diagnosing PTSD in Youth (Under the age

of 6 years) 

Exposure to actual or threatened death, serious injury, or sexual violation

–

direct experience 

witnessing the events as they occurred to others, especially primary caregivers (Note:

Does not include events witnessed only in electronic media, television, movies, or
pictures.)
 learning that the traumatic events occurred to a parent or caregiving gure

The presence of one or more of the following:

–

spontaneous or cued recurrent, involuntary, and intrusive distressing memories of the

traumatic events (Note: Spontaneous and intrusive memories may not necessarily appear
distressing and may be expressed as play reenactment.)

recurrent distressing dreams related to the content and/or feeling of the traumatic
events (Note: It may not be possible to ascertain that the frightening content is related to
the traumatic event.)

reactions as if the traumatic events are recurring; the most extreme being a complete loss
of awareness of present surroundings. (Note: Such trauma-speci c reenactment may
occur in play.)

intense or prolonged psychological distress at exposure to internal or external cues

marked physiological reactions to reminders of the traumatic events

One of the following related to traumatic events:

–

persistent avoidance of activities, places, or physical reminders

people, conversations, or interpersonal situations that arouse recollections

diminished interest or participation in signi cant activities such as play

socially withdrawn behavior

persistent reduction in expression of positive emotions

Two or more of the following:

–
 irritable, angry, or aggressive behavior, including extreme temper tantrums

hypervigilance

exaggerated startle response

problems with concentration

di culty falling or staying asleep or restless sleep

Additional symptoms for consideration:

–
The child experiences signi cant distress or impairment in relationships with
parents/guardians, siblings, and caregivers or di culties in school that are not attributed to
another medical condition. 

YOUTUBE

Complex Trauma in Children | Counselor Toolbox Episode …

 Complex Trauma in Children | Counselor Toolbox
Episode 116
A direct link to the CEU course is
https://www.allceus.com/member/cart/index/product/id/158/c/Subscribe to
the podcast at https://allceus.com/CounselorToolbo...
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Readings and Resources

Complex Trauma: What is it and how does it a ect people?

Fact Sheet I – Trauma and Complex Trauma: An Overview

Trauma and Stress-Related Disorders in DSM-5

YOUTUBE

Trauma and Complex Trauma Disorder - Prof Jayashri Kul…

 Trauma and Complex Trauma Disorder - Prof Jayashri
Kulkarni
Prof Jayashri Kulkarni, Professor of Psychiatry and Director of Monash Alfred
Psychiatry Research Centre discusses the epidemic of antenatal domestic
violenc...
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ACE Questionnaire 
Click on the link to take the ACE questionnaire, analyze your results and re ect how your
results might in uence your work as a counselor.

 After reviewing this unit and the readings and resources provided, please move on to
Scenario One.
 Complex Trauma Scenario
In this scenario you will navigate through a complex trauma
case. 

CONTINUE

Scene 1 Slide 1
Continue Next Slide
 Susan, age 16 is experiencing sadness
and her mother is concerned about her
performance in school. The intake form
indicates Susan was raped last year and
is being bullied at school. Is this C-
PTSD?

There is not enough information to determine if

1
this is C-PTSD.

2 Yes, this is a case of C-PTSD. 

Scene 1 Slide 2
0 Scene 1 Slide 3
1 Scene 1 Slide 3
 What are follow up questions to ask
Susan and/or her guardian include? 

Have you ever been hit or yelled at by another

1
person?

Have you experienced other traumas, such as the

2
loss of a family member or pet?

Have you ever been hit or yelled at by another

person? How often? Have you experienced other
3
traumas, such as the loss of a family member or
pet?

Scene 1 Slide 3
0 Scene 1 Slide 3
1 Next Slide
2 End of Scenario
 Scenario End
In the next section you will learn about being culturally
sensitive and we will also cover the ethical considerations for
working with an individual who has C-PTSD.  

START OVER


Scene 1 Slide 4
Continue End of Scenario

C O NT I NU E
Lesson 3 of 11

Unit 2 - Cultural Competency and Ethics

Dr. Sara Thompson

Objectives 
In the unit, students will:

Compare the di erences between cultural competency and cultural sensitivity. 

 Demonstrate cultural competency and sensitivity with diverse populations. 

Examine the ACA Code of Ethics.

Recommend ethical action to case vignettes.

Cultural Competency and Ethics

In order to provide trauma informed treatment and/or support to individuals who have
experienced multiple traumas it is necessary to develop culturally competency and an ethical
foundation.

Cultural Competence
 Being culturally competent
means that you have taken
the time to learn about the
culture, values, traditions,
What is Cultural Competency?
worldview and practices of
another person - this is an
active action, whereby you
operate effectively in

The difference between

cultural competence and
cultural sensitivity is being
sensitive to other cultures
What is Cultural Sensitivity?
is not dependent upon an
action, such as immersing
yourself in an culturally
diverse experience. 

1.  Engage in experiential
opportunities, such as
festivals
Application of Cultural
Competence
Competence 
2. Ask questions

3. Read about the culture

4 Learn the language or at

Ethics
There are many ethical considerations to be mindful of when working with a person who has
experienced trauma and/or is diagnosed with C-PTSD. Additionally, the ethical treatment
must also be culturally sensitive. The ACA Code of Ethics is one of several Code of Ethics that
you might refer to, others are the NASW or APA Code of Ethics. Regardless of the
organization, there is an expectation of privacy and con dentiality. Covering the entire ACA
Code of Ethics would be a course on its own, thus within this unit we will focus on 5 key
ethical considerations for working with a client who has experienced trauma, privacy,

con dentiality, avoiding harm, boundaries and diversity. 

 PR I VA C Y C O N F I DE N T I A L I T Y AV O I DI N G H A R M B O UN DA R I E S D

Counselors must respect their client's privacy, otherwise trust will not be developed and that
will impact treatment. Information that a client shares with their counselor is considered
private and that is also protected under HIPPA. 

PR I VA C Y C O N F I DE N T I A L I T Y AV O I DI N G H A R M B O UN DA R I E S D

What a client shares with you should never be discussed with family members or friends, and in
fact, what a client shares during a counseling session should only be shared when the client
provides written consent. There are limitations to con dentiality, such as when the counselor
believes that their client might harm themselves or another person, a court order, known or
suspected child or elder abuse, and when a client discloses a contagious life threatening illness
and a third party may be at risk.

PR I VA C Y C O N F I DE N T I A L I T Y AV O I DI N G H A R M B O UN DA R I E S D

A mental health professional may not cause further harm to their client. This includes never
engaging in a sexual or romantic relationship with a current or former client (prohibited for a
period of 5 years since the last counseling session) or their family member. A counselor must
also consider dual relationships so that the client is not harmed. Additionally, when working
with a client who has experienced traumas, knowing all the details is unnecessary, pushing the
client to disclose too fast will most likely result in mistrust and the client not returning or
seeking other professional support. 
 PR I VA C Y C O N F I DE N T I A L I T Y AV O I DI N G H A R M B O UN DA R I E S D

Boundary setting from the rst professional contact will strengthen the counseling relationship.
For a person who has experienced multiple traumas, they have obscure or rigid boundaries, this
can be a teachable moment that is integrated into the therapy sessions. 
 PR I VA C Y C O N F I DE N T I A L I T Y AV O I DI N G H A R M B O UN DA R I E S D

A mental health professional must respect the di erences between and within di erent
cultures, and recognize that each culture might have a di erent interpretation of the counseling
relationship, privacy and con dentiality. Additionally, there are di erences in the disclosure of
information that should be examined. 
Readings and Resources 
American Counseling Association. (2014). ACA code of ethics.
https://www.counseling.org/resources/aca-code-of-ethics.pdf

Barnett, J. E., & Bivings N. D. (n.d.). Culturally Sensitive Treatment and Ethical Practice.
https://www.apadivisions.org/division-31/publications/articles/maryland/barnett-ethical.pdf 

Knowledge Check 
 After reviewing this unit and the readings and resources provided, please move on to
 Scenario Two. 
 Ethical Scenario
In this scenario you will navigate through an ethical dilemma. 

CONTINUE

Scene 1 Slide 1
Continue Next Slide
 Brad, age 15, shares that his uncle
touched him. Brad does not provide any
further information and refuses to talk
for rest of the session.  Is this a situation
where con dentiality should be broken?

Right now it is not clear if con dentiality should be

1
broken. 

Yes, without question, con dentiality should be

2
broken. 

Scene 1 Slide 2
0 Scene 1 Slide 3
1 Next Slide
 Brad's counselor, Jack empathizes with
Brad and asks, "Brad, I know this is
di cult, will you point to where your
uncle touched you?" Brad, points to his
groin. Should con dentiality be broken?  

Yes, this is a situation when the counselor must

1
break con dentiality.

No, what Brad shared should be kept con dential,

2
otherwise he might not share further in session. 

Scene 1 Slide 3
0 Scene 1 Slide 4
1 Scene 1 Slide 4
 Scenario End
This was just one possible ethical consideration that could
present when working with a client who has experienced
traumas. In the next unit we examine the theories of trauma. 

START OVER


Scene 1 Slide 4
Continue End of Scenario

C O NT I NU E
Lesson 4 of 11

Unit 3 – Theories of Trauma

Dr. Sara Thompson

Objectives 
In this unit, students will: 

Distinguish a traumatic event from a crisis. 

Compare and contrast major theories of trauma.

Examine 21st century theories of trauma.

Theories of Trauma
Traumatic events include and are not limited to child abuse or neglect; domestic or intimate
partner violence; death of a family member, friend, pet or loved one; experiencing an assault;
war; human tra cking; and catastrophic natural events (e.g., tornadoes, earthquakes,
hurricanes, etc.); terrorism; serious illness; parental abandonment. Unlike trauma that causes
a person to feel overwhelmed, afraid, or broken due to an event that left the person
powerless, a crisis is considered an imbalance in an individual that results from an event,
such as as house re or car accident. 

The rst two units provided you with a comprehensive overview of what complex trauma is as
well as the cultural and ethical considerations for working with a client who has experiences
traumas. In the next section we will examine biological, bioecological, developmental,
behaviorism, cognitive, and integrated emotion processing theories of trauma.

Biological Theory
–
The biological theory of trauma focuses on the interactions between environmental and
personal factors to explain chronic stress, psychological distress, and individual vulnerabilities.
In addition, genetic factors, such as neurotransmitters (norepinephrine, dopamine and
serotonin), neurohormones (i.e., vasopressin and oxytocin), and brain structures are all
considered to in uence the symptoms of trauma and PTSD.

Bioecological Theory
–
This theory considers the individual's entire environment when understanding reaction to
trauma and the development of PTSD. Included in the environment are the interactions
between the individual and their family, community, workplace, social space, community,
culture and the resources available. 

Developmental Theory
–
The developmental theory of trauma is based upon attachment, developmental tasks and
neuroplasticity of the brain. With repeated exposure to traumatic events, the brain continues to
reactivate the arousal part of the brain (amygdala), creating a state of hyperarousal in adults.

Behavioral Theory
–
After a traumatic event, the body often reacts in ight, ght or freeze. The more times a
person has experienced trauma, such as childhood sexual abuse or intimate partner violence,
the body reacts through classical conditioning; thus, whatever helped the person through the
experience is what is often triggered when fear returns. 

Cognitive Theory
–
This theory focuses on thoughts, speci cally the person who has experienced multiple traumas
often believe their "self" is incompetent and that world is a threatening place. The latter makes
a lot of sense, after all the person has experienced chronic multiple traumas.   

Integrated Emotion Processing Theory

–
This theory integrates social/learning, behavioral and cognitive theories, concluding that it is
not unusual for a person who has experienced traumas to have emotional responses to events
and triggers long after the trauma has been experienced. 
Readings and Resources 
Guy-Evans. OP. (2020). Bronfenbrenner's ecological systems theory.
https://www.simplypsychology.org/Bronfenbrenner.html

Mambrol, N. (2017). Sigmund Freud and the trauma theory.

https://literariness.org/2017/06/21/sigmund-freud-and-the-trauma-
theory/#:~:text=Trauma%20theory%20emerged%20in%20the%201960s%20from%20several
,and%20genocide,%20especially%20in%20regard%20to%20the%20Holocaust.

Portland Psychotherapy. (2021). An overview of emotional processing theory.

https://portlandpsychotherapytraining.com/2011/11/07/an-overview-of-emotional-
processing-theory/

 Once you have reviewed the theories of trauma and the readings, please move on to the
Self Re ection assignment below. 

Self Re ection
In this unit you were introduced to six (6) current theories of trauma and one is not better
than the other. Quite often, mental health professionals and professionals who work directly
with individuals who have experienced complex trauma, such as domestic violence or sexual
assault advocates, will develop a professional philosophy that integrates at least two theories.
For this assignment, please review and re ect upon the theories covered in this unit, and
journal about the theory/theories that align with your approach to treating or supporting a
person who has experienced multiple or chronic traumas. As you journal, consider why you
selected that theory/theories as an explanation to trauma. 
C O NT I NU E
Lesson 5 of 11

Unit 4 - Assessing for Complex Trauma/C-PTSD

Dr. Sara Thompson
Objectives
Examine current trauma and PTSD assessments. 

Apply a speci c assessment to assess a client and interpret the results.

Evaluate ethical considerations when assessing a client for trauma and/or PTSD.

Overview
In the rst three units you examined complex trauma and C-PTSD, to include the DSM-5
criteria for PTSD, evaluated ethical and cultural considerations to e ectively work with a client
who has experienced trauma, and analyzed theories of trauma to help you understand the
etiology of trauma as well as related symptoms and recommend speci c treatment. 

In this unit, you will be introduced to assessment tools used to assess the severity of trauma
and screen for PTSD symptoms. These assessments provide useful information to direct
treatment, however and this is exceptionally important, the assessment results are only one
piece of information and a comprehensive client assessment will also include interviews with
the client (and their family if applicable and consent is provided) and other providers
(consent must be provided). Furthermore, to ethically administer an assessment tool,
counselors must be familiar with the assessment instrument, otherwise there is the potential
of harming the client. After the assessment is administered, there should be additional time
set aside to ensure the client is safe and grounded, as there is the possibility for the client to
be triggered while responding to the questions/statements. Below you will nd several
di erent trauma and PTSD assessments, and you are encouraged to examine each, noting
that the CAPS-5 (either past week or past month/worst month) are considered to be the gold
standard assessment for PTSD. 
Readings and Resources 
Center for Substance Abuse Treatment (US). Substance Abuse and Mental Health Services
Administration (US). (2014). (Treatment Improvement Protocol (TIP) Series, No. 57.) Chapter
4, Screening and Assessment.  https://www.ncbi.nlm.nih.gov/books/NBK207188/

The National Child Traumatic Stress Network. (2021). Trauma screening.

https://www.nctsn.org/treatments-and-practices/screening-and-assessments/trauma-
screening

Trauma Screens

Trauma History Screen.pdf

747 KB

Trauma History Questionnaire.pdf

674.9 KB

PCL-5 (PTSD)

Using the PTSD Checklist for DSM-5 (PCL-5).pdf

902.6 KB
 PTSD Checklist for DSM 5 (PCL-5) Past Week.PDF
1.9 MB

PTSD Checklist for DSM 5 (PCL-5) Past Month.PDF

806.1 KB

CAPS-5 (Considered the gold standard for PTSD assessment)

Clinician Administered PTSD Scale for DSM 5 (CAPS-5) Past Week

Version.pdf
2.2 MB

Clinician Administered PTSD Scale for DSM 5 (CAPS-5) Past

Month Worst Month.pdf
1.5 MB

Knowledge Check 
For this activity you will watch one of the videos below and then choose at least one of the
assessments above to apply to the case. It is suggested that you take notes as you watch the
video, and it may be helpful to watch the video more than once. After you have completed the
assessment of your choice, you will then interpret the results and make a recommendation
for treatment. 

YOUTUBE

Conducting a Quick Screen for Trauma - Child Interview

Conducting a Quick Screen for Trauma - Child

Interview
These videos are meant for educational purposes, and the scenarios are
played by actors, and developed by CAMH sta .For more information on
trauma and child...
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YOUTUBE

Inside the Nepalese Human Tra cking Industry

 Inside the Nepalese Human Tra cking Industry

Inside the Nepalese Human Traf cking Industry

Content Warning: Human Tra cking is the world's second-largest criminal
activity and it rakes in close to $32 billion dollars annually. And, in South
Asia,...
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YOUTUBE

You Have A Voice: Paige's Story | Sexual Assault Awarene…

You Have A Voice: Paige's Story | Sexual Assault
Awareness Month (SAAM)
April is Sexual Assault Awareness Month. It's important to have conversations
with teens about consent to prepare them for the potential dangers of teen
dati...
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C O NT I NU E
Lesson 6 of 11

Unit 5 - Psychopathology of C-PTSD

Dr. Sara Thompson

Objectives
Distinguish psychopathological symptoms of C-PTSD, complex trauma and trauma. 

Explain changes to the brain that occur with traumas.

Summarize trauma psychopathology and make recommendations for treatment. 

Overview
In this unit we will investigate the psychopathology of C-PTSD, speci cally focusing on
abnormal thoughts, behavior and experiences.  Understanding the psychopathology of C-
PTSD and complex trauma creates the foundation for which treatment is provided.
Psychopathological signs or symptoms of C-PTSD and/or complex trauma include and are not
limited to change in mood, suicidal ideation, excessive worry, withdrawal from family and
activities that once brought pleasure, changes in eating or sleep patterns, inability to
concentrate, ashbacks, irritability, distressed and di culty coping with daily activities. 

 In Unit 1 the DSM-5 criteria for PTSD was provided, and it may be helpful to review the
criteria before moving along in the unit. 

Psychopathology
Individuals respond to trauma uniquely, there is no de nitive response, nor is there a time
limit to how long traumatic symptoms remain. Children who are abused and/or neglected
often exhibit behavioral issues (e.g., aggression and disruptive behaviors), and the symptoms
as well as longevity become more serious as the number of adverse childhood experiences
increases. Children who have experienced complex traumas are more likely to experience
psychopathology as an adult, such as mood, anxiety, feeding and eating, substance use and/or
disruptive disorders. 

Adults who have experienced multiple and/or chronic trauma (e.g., domestic/intimate partner
violence, war, human tra cking) may be diagnosed with PTSD, mood, anxiety, and/or
substance use disorders. In fact, alcohol or drugs (illicit and prescription) may be used to help
cope with anxiety, depression, ashbacks and general sense of distress; however, the
substance use often exacerbates the symptoms, leading to a cycle that can be dangerous. 

Brain imaging research has found individuals who have been diagnosed with PTSD have an
underactive amygdala (responsible for emotions and memory) and a hyperactive prefrontal
cortex which is responsible for regulating behavior, abstract thinking and thought analysis. 

Please watch this video Brain Imaging Shows Damage Caused by PTSD that examines the changes
that occur within the brain after trauma.

YOUTUBE

Brain imaging shows damage caused by PTSD

Brain imaging shows damage caused by PTSD

PTSD doctors are now able to see actual changes to the brain caused by
trauma. Dr. Ruth Lanius, a Western University professor and pyschiatrist who
is the di...
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 Image sourced from Las Cruces Sun-New article Science reveals severe childhood
trauma can alter developing brain, creates lifetime risk.

PET Scan

The brain scan on the right is of an abused child. The circles represent the temporal lobes
 that in a healthy non-abused brain are responsible for transferring short term memories to
long-term memories and the interpretation of smells and sounds.
 Retrieved from https://wholehealthathome.com/ptsd-past-wont-let-go/

Brain Scan

Overstimulated amygdala : An almond-shaped mass, the amygdala is responsible for

survival-related threat identi cation, plus memories and emotional regulation. After trauma,
the amygdala may remain highly alert and activated, looking for and perceiving threat
everywhere.

Underactive hippocampus: An increase in the stress hormone glucocorticoid negatively

a ects the hippocampus. This interruption keeps both the body and mind stimulated in
reactive mode ( ght, ight or freeze) as neither element receives the message that the threat
passed.

Ine ective variability: The constant elevation of stress hormones interferes with the
body’s ability to regulate itself. When the sympathetic nervous system remains highly
activated it can  lead to fatigue of the entire body.

Readings and Resources

Howard, S. , & Crandall, M. W. (2007). Post traumatic stress disorder: What happens in the
brain? https://www.afom.org.au/images/research/V.93-3-
Post%20Traumatic%20Stress%20Disorder.%20Sethanne%20Howard%20and%20Mark%20Cr
andalll.pdf

Newton, P. The anatomy of posttraumatic stress disorder.

https://www.psychologytoday.com/us/blog/mouse-man/200901/the-anatomy-
posttraumatic-stress-disorder

Reynolds, J. L. (2020). This is what your brain looks like with PTSD.
https://www.msn.com/en-us/health/medical/this-is-what-your-brain-looks-like-with-
ptsd/ar-BB14TFsA

Knowledge Check
For this knowledge check you will watch the video below Counseling Diagnostic Assessment
Vignette #27 - Symptoms of Posttraumatic Stress Disorder and then document the
psychopathological symptoms you noticed while watching and listening to the hypothetical
client. 

YOUTUBE

Counseling Diagnostic Assessment Vignette #27 - Sympto…

Counseling Diagnostic Assessment Vignette #27 -
Symptoms of Posttraumatic Stress Disorder
This counseling diagnostic assessment vignette demonstrates an interview
with a client (played by an actress) who exhibits symptoms of posttraumatic
stress d...
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C O NT I NU E
Lesson 7 of 11

Unit 6 – Trauma Informed Interventions

Dr. Sara Thompson
Objectives
Examine current trauma treatment modalities.

Evaluate ethical and cultural considerations when providing therapeutic interventions. 

Apply trauma focused interventions to case vignettes. 

Overview
There are several e cacious interventions that are trauma focused, and within this unit we
will explore cognitive behavioral (CBT), exposure, cognitive processing (CPT), eye movement
desensitization and reprocessing (EMDR) and narrative therapies. These ve therapies have
shown positive results with individuals who have experienced complex trauma, and whilst it
is possible to use one of these therapy models, many times, a mental health professional will
use more than one therapy style, taking an integrative approach. A mental health professional
must be knowledgeable and trained in the therapy being provided and the treatment approach
must take the client's needs, worldview, culture and ethnicity into consideration. Below you
will nd a trauma informed case video and descriptions of each of the 5 interventions. 

Full Video: Trauma Informed Care Role Plays with Dr. Lauri…
 C O GN I T I V E C O GN I T I V E E Y E MO V E ME N T NA
PR O L O N GE D
B E H AV I O R A L PR O C E SSI N G DE SE N SI T I Z AT I O N E
E X PO SUR E
T H E R A PY ... T H E R A PY ... ... TH

CBT is a highly e ective treatment intervention for trauma/PTSD as well as other DSM-5
diagnoses. The focus of CBT is on thoughts, feelings and behaviors. The premise is changing
thoughts, feelings and behaviors that cause di culty in functioning. 
 C O GN I T I V E C O GN I T I V E E Y E MO V E ME N T NA
PR O L O N GE D
B E H AV I O R A L PR O C E SSI N G DE SE N SI T I Z AT I O N E
E X PO SUR E
T H E R A PY ... T H E R A PY ... ... TH

Prolonged exposure therapy is a type of CBT that encourages individuals to gradually approach
trauma memories, situations and feelings. Care must be taken to not push the client too fast,
doing so may cause the client to shutdown. 

C O GN I T I V E C O GN I T I V E E Y E MO V E ME N T NA
PR O L O N GE D
B E H AV I O R A L PR O C E SSI N G DE SE N SI T I Z AT I O N E
E X PO SUR E
T H E R A PY ... T H E R A PY ... ... TH

CPT is a form of CBT as well. CPT teaches clients to modify and challenge unhelpful thoughts
and beliefs associated with a trauma. It is similar to restructuring. 
 C O GN I T I V E C O GN I T I V E E Y E MO V E ME N T NA
PR O L O N GE D
B E H AV I O R A L PR O C E SSI N G DE SE N SI T I Z AT I O N E
E X PO SUR E
T H E R A PY ... T H E R A PY ... ... TH

EMDR is a type of intervention that absolutely requires the administrator to be su ciently

trained in using EMDR. EMDR is a structured therapy whereby the client focuses on a traumatic
memory while moving their eyes. The result is a reduction in the vividness and recall of the
emotions associated with the trauma. 
 C O GN I T I V E C O GN I T I V E E Y E MO V E ME N T NA
PR O L O N GE D
B E H AV I O R A L PR O C E SSI N G DE SE N SI T I Z AT I O N E
E X PO SUR E
T H E R A PY ... T H E R A PY ... ... TH

Narrative exposure therapy is an e ective intervention that can be used with individuals and in a
group setting and is especially useful with individuals who have experienced complex trauma.
NET encourages clients to develop a chronological narrative of their life, that includes
traumatic events as well as positive and happy experiences.  Think of NET as an
autobiographical story. The story can be written or shared through voice (out loud or in our
mind).
YOUTUBE

Taking a Trauma-Informed View and Recognizing Sympto…

 Taking a Trauma-Informed View and Recognizing
Symptoms
Trauma-informed care means assuming that every patient could have
experienced a trauma. Medical providers can learn to identify diverse signs of
trauma in pa...
VIEW ON YOUTUBE 

Readings and Resources 

APA. (2021). PTSD treatments. https://www.apa.org/ptsd-guideline/treatments

Brinen, A. (2018). Trauma Treatment: Evidence-Based Approaches versus Intuituve

Approaches. https://beckinstitute.org/trauma-treatment/

Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health
Services. Substance Abuse and Mental Health Services Administration. 2014. Chapter 6:
 Trauma-speci c services.  https://www.ncbi.nlm.nih.gov/books/NBK207184/

The National Child Traumatic Stress Network. (2021). Interventions.

https://www.nctsn.org/treatments-and-practices/trauma-treatments/interventions

Knowledge Check

After watching the video above, you will select at least one of the interventions addressed
within this course to apply to one of the cases described in the video. Please re ect upon why
you chose that intervention(s) and document the ethical and cultural considerations you
found relevant to the case you selected. 
C O NT I NU E
Lesson 8 of 11

Unit 7- Trauma Resolution

Dr. Sara Thompson
Objectives
Explain somatic experiencing and its usefulness for treating trauma. 

Examine somatic experiencing techniques.

Take part in somatic experiencing exercises.  

Overview
This unit covers trauma resolution interventions used widely in treating PTSD. By resolving
the trauma, the individual will be able to lead a life that brings peace, freedom and
transformation. Trauma resolution resembles many of the trauma informed interventions
covered in Unit 6, a key di erence is trauma resolution continues to occur long after
traditional therapy ends as a way to live a healthy life. For example, a person with complex
trauma may begin practicing meditation daily to focus on the present while bringing into
awareness sensations, thoughts and feelings associated with the traumatic events.
Additionally, trauma resolution encourages the individual to develop their sense of purpose
past the traumas experienced. We examined CBT in the last unit and it might be helpful to
refer back to that therapy style, and now we will take a closer look at somatic experiencing
that resets the nervous system as a way to resolve the trauma.
 Somatic Experiencing

Somatic Practices to Relieve Stress and Self-Soothe | Dr. Peter A. Levine & Dr.
Jeffrey Rutstein

Somatic Practices to Relieve Stress and Self-Soothe | Dr. Peter A.…

 Step 1

What is Somatic Experiencing?

What is SOMATIC EXPERIENCING in Trauma Therapy? | Kati Morton

What is SOMATIC EXPERIENCING in Trauma Therapy? | Kati Mor…

Somatic experiencing is often used to help reset the nervous system that is on
overload in response to traumatic events. As you recall, the brain changes due to
trauma and with the overload, the body in response will go into one of three states,
ght, ight or freeze. Somatic experiencing gives the individual time to focus on
sensations such as shaking or crying as a healing process. The video above further
explains the use of somatic experiencing in trauma therapy. 

Here is a eBook that describes somatic experiencing, with emphasis on the brain and
nervous system that you might want to save for reference.

Somatic Experiencing 
 Step 2

Somatic Experiencing Exercises

Please read and then practice each of the 5 steps below for your own somatic
experiencing exercise. 

1. Notice your present physical comfort - Sit in a chair with your feet grounded to the
oor, move your feet on the oor, sliding them back and forth, noticing how the chair
supports you. Look around your surroundings to nd things that feel resourceful and
then notice your overall comfort level. 

2. Containment with safe touch - Take your right hand and place it just below your
left armpit, holding the side of your chest. Place your left hand on your right bicep (or
shoulder or elbow).Take a few minutes to notice the feeling under your hands (e.g.
does your body feel warm, is the fabric of your shirt smooth or scratchy, can you feel
your heartbeat)? Do you experience a sense of containment from your hands and
arms? Is it pleasant? Notice how the rest of your body experiences this soothing and
containing touch.

3. Recall Kindness - Recall a time when someone was kind to you, recalling all you
can about the words, gestures, or actions that the person used to soothe you. Try to
imagine that you are back at that time, focusing on the sensory aspects. Recall the
emotion from that time and identify how you feel at this moment. 

4. Focus on emotional and nervous system regulation - Notice your current overall
experience. Recall a time in the last 24 hours that you felt more like yourself. Notice
how that recall a ects your body and senses. Now recall another time when you felt
like yourself within the past few weeks. As you think about that take notice of your
body and sense. 

5. Use the Voo Sound- For this exercise you might want to nd a quiet place as you
will be making some noise! Think of the sound a foghorn makes, imitate that sound
trying to feel that sound and vibrations down to your pelvic oor if possible. As you
make the foghorn/voo sound try to make the pitch as low as possible. Feel free to
repeat this a few times, noticing the overall experience for you. 
 Summary

Although somatic experiencing that focuses on nervous system regulation for trauma
therapy, these techniques can be used when in times when a person needs more
grounding or is experiencing grief.  

Readings and Resources

Lyn-Lake Psychotherapy & Wellness. (2020). Somatic experiencing: A body-centered
approach to treating PTSD. https://therapy-mn.com/somatic-experiencing-
ptsd/#:~:text=Somatic%20Experiencing%20is%20a%20body-
centered%20approach%20to%20treating,expands%20to%20include%20the%20natural%20b
odily%20%28somatic%29%20responses.

Mandic, Tijana. (2019). The PTSD workbook.

https://www.betweensessionsresources.com/uploads/4/4/6/6/44661643/ptsd_pdf_version.
pdf

C O NT I NU E
Lesson 9 of 11

Unit 8 - Resilience and Growth After Trauma

Dr. Sara Thompson

“In the context of exposure to signi cant adversity, resilience is both the capacity
of individuals to navigate their way to the psychological, social, cultural, and
physical resources that sustain their well-being, and their capacity individually
and collectively to negotiate for these resources to be provided in culturally
meaningful ways.”
                                                                                      Dr. Michael Unger

Objectives
 De ne resilience as related to traumatic experiences. 

Analyze the factors that contribute to resilience. 

Examine factors that might a ect an individual's ability to experience resiliency or

regrowth after trauma.

Determine ethical and cultural considerations that may potentially a ect resilience or
regrowth after trauma. 

Overview
Resilience is an individual's ability to overcome adversity and continue normal development
and living, as well as healthy wellbeing. Resilience is a personal attribute and must come from
the individual themselves. It is important to keep in mind that normal development and
living, and healthy wellbeing should be determined by the individual, thus they are culturally
sensitive and may mean di erent things to each person. There are many factors that directly
in uence resilience and those are categorized by general, cultural, community, relationship,
and physical ecological factors. We will now examine each of these groupings in more detail. 

Having a positive
outlook

Self-awareness
General Factors
Having aspirations and
goals

A sense of humor

1 of 5
 Religious or spiritual
beliefs

Identi ed life
Cultural Factors
philosophy

Cultural identi cation 

Culturally grounded

2 of 5

Employment
opportunities

Sense of safety and

Community Factors
security 

Access to education,
school and learning

3 of 5

Parenting that meets a

child's needs
 Appropriate parental
Relationship Factors
monitoring

Social competence 

Peer group acceptance

4 of 5

Access to a healthy
environment

Diversity
Physical Ecological Factors 
Access to recreational
activities (e.g., bike
paths, trails, beach,
l k )

5 of 5

YOUTUBE

Transforming Trauma Into Resilience and Strength | Byanc…

 Transforming Trauma Into Resilience and Strength |
Byanca Nimijean | TEDxYYC
Over the last nine years my life has been consumed by the justice system.
Police, investigators, meetings with a crown prosecutor, and testimonies. My
journe...
VIEW ON YOUTUBE 

Growth After Trauma

Growth after trauma, also referred to as post-traumatic growth (PTG) is a process that
requires time, strength, energy and even struggle. PTG refers to when a person in general has
a di cult time bouncing back experiences a traumatic event that challenges their core values
or beliefs, endures psychological challenges (e.g., PTSD symptoms) and in the end is able to
nd a sense of personal growth. Generally, if a person is resilient they will not experience
PTG as they have the ability to bounce back and do not need to nd a new belief or value
system.

To understand PTG, here are a few examples of post-traumatic growth:

Survivors of terrorist attacks become friendlier and accepting of others.

A child who lost a parent at a young age becomes more grateful and appreciative for what
they have than others their age. 

Survivors of sexual assault volunteer their time as a sexual assault advocate. 

Tedeschi and Calhoun developed the Post-Traumatic Growth Inventory (PTGI) that examines
the following ve areas:
 1. Appreciation of Life

2. New possibilities in life

3. Relationship with others

4. Spiritual change

5. Personal strength 

Below you will nd the PTGI. Please take the time to complete the inventory, re ect upon
your responses, and consider how your experiences might in uence your work with clients
who have experienced complex-trauma.

Post-Traumatic-Growth-Inventory.pdf
108.3 KB

YOUTUBE

What is Post-Traumatic Growth? with Sonja Lyubomirsky

 What is Post-Traumatic Growth? with Sonja
Lyubomirsky
VIEW ON YOUTUBE 

Readings and Resources 

Chowdhury, M. R. (2021). What is post-traumatic growth? (+Inventory & scale).
https://positivepsychology.com/post-traumatic-
growth/#:~:text=At%20its%20most%20basic%20form%2C%20PTG%20is%20marked,and%2
0opportunities%204%20Personal%20strength%205%20Spiritual%20enhancement

Collier, L. (2016). Growth after trauma. APA, 47(10), 48.

https://www.apa.org/monitor/2016/11/growth-
trauma#:~:text=Growth%20after%20trauma.%20Post-
traumatic%20growth%20%28PTG%29%20is%20a,following%20adversity%20can%20often%
20see%20positive%20growth%20afterward

Mary, A., Dayan, J., Leone, G., Postel, C., Fraisse, F., Malle, C., Vallee, T., Klein-Peschanski, C.,
Viader, F., de la Sayett, V., Peschanski, D., Eusteche, F., & Gagnepain, P. (2020). Resilience
after trauma: The role of memory suppression. Science, 367(6479). DOI:
10.1126/science.aay8477 

Trauma Recovery. (2013). What is Resiliency. https://trauma-recovery.ca/resiliency/what-is-

resiliency/

PTSD Workbook
Below is a workbook by Dr. Mandic that can be shared with clients or used for your own
journey after experiencing trauma. The workbook focuses on resiliency after experiencing
trauma, and the author recommends going through the workbook slowly, being mindful that
completing the exercises may bring forth memories of traumatic experiences. 

The PTSD Workbook.pdf

7 MB

Knowledge Check
 Resilience and PTG Scenario
In this scenario you will navigate through a complex trauma
case to identify resilience and/or PTG.  

CONTINUE

Scene 1 Slide 1
Continue Next Slide
 Elisa experienced the death of her
spouse, the murder of a son, and a
foreclosure. Elisa has a strong support
system, is future focused and an active
church member. Is this resilience or
PTG?

Elisa has experienced multiple traumas and stress,

1
is adapting well and is resilient. 

Elisa has experienced multiple traumas and stress,

2
and has experienced PTG.

There is not enough information to discern if Elisa

3 is resilient or has gone through post-traumatic
growth.

Scene 1 Slide 2
0 Next Slide
1 Next Slide
2 Next Slide
 Elisa has accepted the losses she has
experienced, is taking care of herself and
just got a part-time position at a local
school. Is this resilience or PTG?

1 Elisa is showing signs of resilience. 

Elisa is showing signs of post-traumatic growth

2
rather than resilience. 

Scene 1 Slide 3
0 End of Scenario
1 Scene 1 Slide 1
 Scenario End
Add text here to let learners know your scenario is over. View
this tutorial to learn how to create branching scenarios.

START OVER


Scene 1 Slide 4
Continue End of Scenario

C O NT I NU E
Lesson 10 of 11

Final Knowledge Check

Dr. Sara Thompson
Question

01/18

Complex trauma can result from 

Bullying

War

Domestic/Intimate partner violence

Human Tra cking

All of the above

Question

02/18

The ________________ is the gold standard assessment for PTSD

PTGI

DSM-5

CAPS-5

PCL-5
Question

03/18

Complex trauma is exposure to ___________ forms of trauma or abuse the

di culties that arise from those experiences when adapting to or surviving
those traumatic experiences.

Type your answer here

Question

04/18

Cultural competence means that you have taken the time to learn about the
culture, values, traditions, _______________ and practices of another
person.

Type your answer here

Question

05/18

Limits to con dentiality are when the counselor believes that their client might
harm themselves or another person, a court order, known or suspected
____________________ abuse, and when a client discloses a
contagious life threatening illness and a third party may be at risk.

Type your answer here

Question

06/18

After a traumatic event, the body often reacts in ight, ght or freeze. The more
times a person has experienced trauma, such as childhood sexual abuse or
intimate partner violence, the body reacts through classical conditioning; thus,
whatever helped the person through the experience is what is often triggered
when fear returns, this is the _____________________ theory of
trauma.

Type your answer here

Question

07/18

The _____________________________theory believes it is not

unusual for a person who has experienced traumas to have emotional responses
to events and triggers long after the trauma has been experienced.

Type your answer here

Question

08/18

After the assessment is administered, there should be additional time set aside
to ensure the client is safe and grounded, as there is the possibility for the client
to be triggered while responding to the questions/statements.

True

False
Question

09/18

A person who experiences recurrent abuse or victimization may experience

Guilt

Shame

Isolation

Anger

All of the above

Question

10/18

Psychopathological signs or symptoms of C-PTSD and/or complex trauma

include and are not limited to 

Type your answer here

Question

11/18

________________________ is a highly e ective treatment

intervention for trauma/PTSD as well as other DSM-5 diagnoses. The focus of
this intervention is on thoughts, feelings and behaviors. The premise is
changing thoughts, feelings and behaviors that cause di culty in functioning. 

Type your answer here

Question

12/18

Brain imaging research has found individuals who have been diagnosed with
PTSD have an ______________________amygdala (responsible for
emotions and memory) and a hyperactive prefrontal cortex which is responsible
for regulating behavior, abstract thinking and thought analysis. 

Overactive 

Underactive 
Question

13/18

________________ experiencing resets the nervous system as a way to

resolve the trauma.

Type your answer here

Question

14/18

________________________ is a structured therapy whereby the

client focuses on a traumatic memory while moving their eyes. The result is a
reduction in the vividness and recall of the emotions associated with the
trauma. 

Type your answer here

Question

15/18

Trauma _____________________continues to occur long after

traditional therapy ends as a way to live a healthy life.

Type your answer here

Question

16/18

________________________ is an individual's ability to overcome

adversity and continue normal development and living, as well as healthy
wellbeing and it is a personal attribute that must come from the individual
themselves. 

Type your answer here

Question

17/18

There are many factors that directly in uence resilience and those are
categorized by general, cultural, community, relationship, and physical
ecological factors.

General

Community

Cultural

Relationship

Physical ecological

All of the above 

Question

18/18

_____________________ refers to when a person in general has a

di cult time bouncing back experiences a traumatic event that challenges their
core values or beliefs, endures psychological challenges (e.g., PTSD symptoms)
and in the end is able to nd a sense of personal growth. 

Post traumatic growth 

Resilience 
Lesson 11 of 11

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