LPC Trauma-Informed Care and PTSD Treatment 1 — Questions and Answers
Question 1: According to SAMHSA's trauma-informed care framework, which of the following is NOT one of the six key principles?
- Safety
- Trustworthiness and transparency
- Empowerment
- Mandatory reporting (Correct answer)
Correct answer: Mandatory reporting
SAMHSA's six key principles are: Safety; Trustworthiness and transparency; Peer support; Collaboration and mutuality; Empowerment; and Cultural, historical, and gender issues. Mandatory reporting is a legal requirement, not a TIC principle.
SAMHSA's trauma-informed approach is built on six principles: (1) Safety — physical and psychological safety; (2) Trustworthiness and transparency — clear goals and consistent boundaries; (3) Peer support — integrating peer support specialists; (4) Collaboration and mutuality — shared power; (5) Empowerment, voice, and choice — strengths-based, resilience-promoting; (6) Cultural, historical, and gender issues — recognizing how cultural background shapes trauma responses.
Question 2: Prolonged Exposure (PE) therapy for PTSD involves which two core components?
- Cognitive restructuring and relaxation training
- In vivo exposure to avoided situations and imaginal exposure to the trauma memory (Correct answer)
- EMDR and trauma narrative writing
- Mindfulness meditation and emotion regulation skills
Correct answer: In vivo exposure to avoided situations and imaginal exposure to the trauma memory
PE includes imaginal exposure (revisiting the trauma memory in imagination) and in vivo exposure (confronting avoided situations, places, or activities).
Developed by Edna Foa, Prolonged Exposure is an evidence-based treatment for PTSD. Imaginal exposure involves repeatedly recounting the trauma memory in detail to reduce the fear associated with it through habituation and cognitive processing. In vivo exposure involves gradually confronting avoided situations that are objectively safe but trigger trauma reminders. Both components are supported by a solid evidence base.
Question 3: Complex PTSD (C-PTSD) differs from PTSD primarily by the addition of which features?
- Hallucinations and delusions related to the traumatic event
- Disturbances in self-organization including affect dysregulation, negative self-concept, and relational difficulties (Correct answer)
- Conversion symptoms and somatic complaints
- Amnesia for the traumatic event and depersonalization only
Correct answer: Disturbances in self-organization including affect dysregulation, negative self-concept, and relational difficulties
C-PTSD (recognized in ICD-11) adds disturbances in self-organization: affect dysregulation, persistent negative self-perception, and persistent difficulties in sustaining relationships.
C-PTSD was included in ICD-11 to capture sequelae of chronic, repeated trauma (e.g., prolonged childhood abuse, domestic violence, captivity). In addition to PTSD's core symptoms (reexperiencing, avoidance, hyperarousal), C-PTSD includes disturbances in self-organization: (1) affect dysregulation (persistent difficulties managing emotions); (2) negative self-concept (shame, guilt, self-loathing); (3) disturbances in relationships (difficulty with closeness and trust).
Question 4: Eye Movement Desensitization and Reprocessing (EMDR) therapy uses bilateral stimulation to facilitate which process?
- Deep muscle relaxation and parasympathetic activation
- Adaptive processing of traumatic memories that had become 'stuck' in the nervous system (Correct answer)
- Systematic desensitization through progressive exposure
- Cognitive restructuring of dysfunctional trauma-related beliefs
Correct answer: Adaptive processing of traumatic memories that had become 'stuck' in the nervous system
EMDR, developed by Francine Shapiro, uses bilateral stimulation (eye movements, taps, or tones) to facilitate adaptive information processing of traumatic memories.
EMDR is based on Shapiro's Adaptive Information Processing (AIP) model, which proposes that psychological distress results from inadequately processed memories that remain stored in maladaptive forms. Bilateral stimulation (most commonly tracking the therapist's moving finger) during trauma memory activation is theorized to facilitate information processing similar to what occurs during REM sleep, enabling integration of the memory into adaptive memory networks. EMDR is designated as a first-line PTSD treatment by major clinical guidelines.
Question 5: The Window of Tolerance, developed by Siegel, refers to the zone in which:
- A client can withstand the most intense level of trauma processing
- Arousal is optimal for information processing — neither hypo- nor hyperaroused (Correct answer)
- Exposure therapy is contraindicated due to the client's fragile state
- A client's traumatic memories are fully conscious and accessible
Correct answer: Arousal is optimal for information processing — neither hypo- nor hyperaroused
The Window of Tolerance describes the optimal arousal zone for therapeutic work — clients in this zone can process difficult material without becoming overwhelmed or shutting down.
Dan Siegel's Window of Tolerance is a concept used in trauma therapy to describe the zone of arousal in which a client can engage with difficult material while maintaining the integrative functioning needed for processing. Above the window (hyperarousal) clients are flooded and overwhelmed; below the window (hypoarousal) they are shut down and dissociated. Trauma-informed therapists help clients build skills to stay within, and expand, their window.
Question 6: Which ACE (Adverse Childhood Experience) Study finding has had the greatest public health implication?
- ACEs are rare and affect fewer than 5% of the population
- ACEs have a dose-response relationship with negative health and mental health outcomes across the lifespan (Correct answer)
- ACEs primarily affect cognitive development and have minimal impact on physical health
- ACEs are fully reversible with brief psychotherapy in childhood
Correct answer: ACEs have a dose-response relationship with negative health and mental health outcomes across the lifespan
The ACE Study found a dose-response relationship — the more ACEs a person experienced, the higher their risk for a wide range of negative health, mental health, and social outcomes.
The landmark ACE Study (Felitti et al., 1998) examined 10 categories of adverse childhood experiences in over 17,000 adults. Key findings: ACEs are common (>60% had at least one), they cluster together, and there is a clear dose-response relationship between ACE score and outcomes including depression, substance use, heart disease, cancer, and premature death. The study transformed public health understanding of trauma as a root cause of health disparities.
LPC Trauma-Informed Care and PTSD Treatment 1
According to SAMHSA's trauma-informed care framework, which of the following is NOT one of the six key principles?