Quantum Units Education®

Introduction

1. Experts believe that there needs to be an increase in the provision of psychotherapy and counseling for survivors of sexual violence and complex trauma, as existing services don't always incorporate full exploration of the dynamics involved in complex trauma.

Part 1: Understanding Trauma and Complex Trauma

2. In contrast to a single traumatic event, the repeated betrayal of trust, in which abuse masquerades as protection or affection, gives rise to a range of symptoms such as dissociation, alterations in sense of self, and:

Complex Trauma Symptoms

3. Each of the following is an accurate statement about complex trauma EXCEPT:

Section 2: Understanding Trauma Symptoms-The Alarm System

4. When the body's alarm system is tripped and goes on red alert, the parasympathetic nervous system mobilizes high level energy necessary for flight or flight, while the sympathetic nervous system slows down the heart and metabolic rate which results in the freeze response.

Role of the Freeze Response

5. In most cases of complex trauma, especially when it occurs in childhood, the general response is to run away from the threat.

Post-Traumatic Stress Symptoms-Avoidance

6. Some major post-traumatic stress reactions occur largely due to avoidance or lack of __________________,  which impedes emotional processing and prevents feelings from becoming fully integrated.

Section 3: Skills to Manage Complex Trauma Symptoms

7. Which of the following is NOT a likely bodily sensation that occurs with dissociation?

Clinical Dissociation

8. The type of dissociation that is associated with with severe childhood trauma and complex trauma in which distinct ego-states emerge to contain the traumatic experience is:

Box 3.2 Dissociative Disorders

9. According to the DSM-V, generalized dissociative disorder is characterized by an inability to recall autobiographical information or life events.

Associated Disorders

10. Severe and chronic dissociation can lead to a range of associated disorders, most notably

Section 4: Understanding the Role of Attachment-The Function of Attachment

11. Early attachment bonds facilitate the regulation of emotions, and help the infant to learn that unbearable states can be managed.

Attachment Styles

12. The five primary attachment styles include each of the following EXCEPT:

Traumatic Bonding

13. In order for traumatic bonding to occur, there has to be an imbalance of power in a relationship and the abuse must be constant and consistent.

Part 2-Section 5: Safe Trauma Therapy-Assessment

14. Generally speaking, survivors of complex trauma tend to benefit more from a warm, genuinely engaged, human relationship than a distant or clinical one which is driven by standardized protocols and assessments.

The Role of Psychoeducation

15. Psychoeducation is an important part of recovery, as ___________________ can help to stabilize trauma reactions in order to acquire the necessary skills to have more choice over emotional and behavioral responses.

Create a Safe Therapeutic Setting

16. With trauma survivors, practitioners need to be aware of personal space and create an optimal space which is not intrusive or invasive, and not too distanced.

Duration of Therapy

17. While survivors will vary in terms of length of therapeutic interventions, most benefit from a minimum of _______ of psychological support.

Section 6: Therapeutic Challenges-Challenges in the Therapeutic Process

18. Which of the following is NOT a correct statement about empathy in the therapeutic process with survivors?

Core Challenges to Counselors

19. At times, professionals may feel anger, rage, and terror when hearing of brutality and dehumanization, and if these responses are not regulated, the professional may develop burnout and symptoms of vicarious traumaitization.

Section 7: Building and Maintaining the Therapeutic Relationship-The Role of the Therapeutic Relationship

20. In order to counteract damaged early relationships, counselors must provide a reparative, _________________ relationship in which they present what was missing in childhood.

Barriers to Building the Therapeutic Relationship

21. The biggest obstacles in building the therapeutic relationship are fear of vulnerability, fear of disclosure, and fear of becoming defenseless.

The Role of Attachement Style in the Therapeutic Relationship

22. The attachment style most associated with complex trauma is the:

Core Challenges in Maintaining the Therapeutic Relationship-Submission and Compliance

23. Submissive and compliant survivors tend to be overly-charming or tend to shift the focus of attention away from themselves onto the counselor in an attempt to be the "perfect client".

Section 8: THe Process of Recovery-Regaining Control

24. Research has found that control and __________________ are the two most positive factors in recovery from trauma.

25. During the process of recovery, each of the following is recommended EXCEPT:

Change is Difficult

26. Sometimes survivors experience an obstacle known as besmirchment, where they believe they are damaged goods and that they do not deserve a better life.

Part 3: Section 9: Establishing Safety and Control-Regulating Emotions

27. Exercise and grounding techniques can be especially beneficial to help survivors reconnect to their bodies.

The Role of Reflection

28. When helping clients learn to reflect, they should be encouraged to be in the present, acknowledge and accept feelings, and to notice _______________ without judgment.

Section 10: Skills to Improve Daily Life-Sleep and Rest

29. Sleep is essential for survivors because it rests the body, aids the processing of emotional experiences, and is critical in the formation of storage and consolidation of memories.

Physical Exercise

30. Strenuous physical exercise might not suit all survivors as increased heart rate, respiration, and sweating can mimic the arousal of sexual abuse.

Section 11: Managing Sensations, Feelings, and Grounding Skills

31. Hypo-arousal is associated with experiencing too much and being plagued by flashbacks, panic attacks, intrusive memories, thoughts and feelings, and often unexplained sensations or pain.

Loss of Control Over Feelings and Thoughts

32. It may be helpful to have clients identify triggers to trauma reactions by grading them on a scale of 1-4, with 1 being triggers they will always wish to avoid and 4 being those that are the least difficult to manage.

Grounding Techniques

33. The most effective way for survivors to ground themselves is to:

Section 12: Managing Flashbacks, Nightmares, Panic Attacks, and Dissociation-Internal Dialogue

34. To reduce the power of flashbacks, clients should be taught to use internal self-talk that is in the present tense such as, "He is coming to get me" rather than past tense, as they are able to have more  control over what is  going on in the present.

Panic Attacks

35. A good way to manage panic attacks is to mimic the sensations of the panic attack in a safe setting in order to show that the sensations are not life threatening and can be controlled.

Section 13: Managing Negative Thoughts and Beliefs-Common Biases in Thinking

36. Each of the following is an accurate statement about common biases in thinking that support negative beliefs EXCEPT:

Section 14: Managing Fragmented Memories-The Danger of Overprocessing

37. Memory recall is the best, and often times only validation of abuse, but clients should be made aware that they may not be able to restore full memory.

Pacing Memory Work

38. Before starting memory work, you need to assess your clients __________________ to ensure that they will be able to regulate these feelings.

Section 15: Managing Shame, Guilt, and Self Blame-The Function of Shame

39. Shame is a necessary survival trait as it alerts us to the fact that something is wrong about an experience or behavior, and acts as a prompt to seek help.

Helpful Therapeutic Strategies

40. To reduce shame and allow survivors to develop a more empathic view of themselves, they need to develop self-compassion which will enable the recognition that what happened to them was abuse.

Section 16: Managing Self-Harm

41. Addictive behaviors such as over-eating, gambling, or shopping excessively are considered passive self-harm activities since they don't cause direct self-injury.

Suicidal Ideation

42. Self-injury and self-harm can be used to manage suicidal thoughts and suicide attempts, although the motivation may be _________________ rather than death.

Setting and Managing Healthy Personal Boundaries-Collapsed or Rigid Boundaries

43. An example of a collapsed boundary is when a survivor avoids intimacy by being unable or unwilling to communicate, picking fights, working too much, or otherwise being unavailable.

Four Stages of Assertiveness

44. Which of the following is NOT one of the four stags of assertiveness that clients need to work through?

Section 18: Managing Relationships

45. Complex trauma and childhood sexual abuse can make it extremely hard to trust others or get close to them, which creates a paradox in which the survivor yearns for closeness and yet is compelled to avoid it.

Trust

46. The repeated betrayal in complex trauma leads to a basis lack of trust in self and others, so it is helpful for the clinician to review the client's level of trust throughout the course of the relationship as this is rarely static and will fluctuate.

Section 19: Managing Sexuality

47. The quality of a survivor's sexual relationship will be enhanced if he or she can communicate sexual _________________ without shame or fear of rejection.

Emotional Reactions

48. Sexual intimacy may trigger the same bodily sensations as during the abuse which may propel the survivors back to the abuse experience.

Conclusion

49. Ground rules that are necessary for a healthy sexual relationship include each of the following EXCEPT:

Section 18: Managing Loss and Mourning-Grief

50. Grief that has been prolonged over many years and is usually accompanied by chronic clinical depression, persistent sadness, and a deep sense of hopelessness is known as daunting grief.

Reclaiming Losses

51. It may be helpful to have clients make a list of losses in order to identify those things that were missing in childhood and work toward reclaiming them.

Section 21: Restoring Reality and Trust in Self

52. In order for clients to restore trust in themselves rather than being influenced by others, and to rebuild their self-esteem and make positive choices, they need to develop their own:

Restoring Self-Reliance

53. Self-reliance, which is also referred to as self-sufficiency, occurs when survivors are confident that they can protect themselves from others.

Section 22: Relapse Prevention and Maintaining Self-Care

54. If there are any self-care strategies that clients have not been able to maintain, the clinician may suggest that they try some alternative ones or recommend that they adapt those that they have tried to better suit their needs.

Maintaining Relationships and Friendships

55. When clients are able to maintain relationships and friendships, they will find that they feel more connected to themselves, which will help them to maintain their self-care in making positive choices.

56. Clients need to realize that __________ are an opportunity to measure progress in how they are able to use all of the skills they have learned throughout their recovery.

Section 23: Maintaining Post-Traumatic Growth

57. Survivors report seeing post-traumatic growth in six significant areas including personal strength, greater appreciation of life, getting closer to others, self-understanding, spiritual development, and:

Part 5-Section 24 Practitioner Self-Care

58. Sometimes a practitioner can be so affected by the suffering and pain of others that compassion is eroded and replaced by feelings of powerlessness and helplessness.

Secondary Traumatic Stress

59. Secondary traumatic stress is characterized by symptoms which closely mirror those of:

60. To ensure self-care on all dimensions, counselors should focus on seeking contentment in the areas of work, body, mind, emotion, creativity, and spirituality.