Fight, Flight or Freeze – I’m
fighting! The application of
EMDR in a group based
violence reduction
treatment programme
Dr Rachel Worthington
Alpha Hospitals, Bury and University of Central Lancashire (UCLan)
Content
Theories of Violence and Aggression
•
Effects of Trauma
•
Trauma and Aggression
•
Current Treatment Approaches
•
The future – EMDR and Aggression
•
Aggression - Definition
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According to Siever (2008) “Aggression may be classified in a
number of ways, for example, by the target of aggression
(e.g., self-directed or other-directed), mode of aggression
(e.g., physical or verbal, direct or indirect), or cause of
aggression (e.g., medical). The most widely utilized and
perhaps most heuristically valuable classification of
aggression is that of premeditated versus impulsive
aggression” (pp429).
Theories of Aggression – the
early years…
Initial theories of aggression focussed less on
violence and more on theories of anti-social
behaviour
•
Also focused more on the nature of aggression
rather than the individual motive
•
Focussed on proactive and reactive definitions
•
Frustration-aggression theories(Gustafson, 1989)
•
Social Learning (Baron et al.,2006)
•
Current Theories of
Aggression
General Aggression Model (GAM)
•
This asserts that aggression may be attributed to two main factors:
•
the current situation and person factors, influencing human aggression
(Baron et al., 2006)
1)
Situational and individual differences can cause interpersonal
aggression
2)
Situation factors include - frustrations, insults from environment and
other people, discomfort, and other environmental problems (heat,
cold, etc)
•
Individual factors include - irritability traits, physical arousal, affective
states, cognitive appraisals, beliefs about other‘s intentions, and
developmental skills related to aggression
•
Information Processing
Huesmann (1998) developed the ‘Unified model of Information
Processing’
•
This attended to the role of:
•
Scripts
-
Cognitive processing as a simultaneous process
-
Parallel processing
-
Placed all of the above within the context of emotion
-
Advantages of the GAM
Takes into account ‘mixed-motive’ aggression
•
Recognises the way in which aggression can adapt
•
Addresses information processing models of
aggression
•
Includes focus on peace research and positive
psychology
•
Recognises the importance of focussing on client
strength for change
•
Aggression and Information
Processing
According to Huesmann (1988), the conditions ‘‘most conducive to the learning of
aggression seem to be those in which the child has many opportunities to observe
aggression, in which the child is reinforced for his or her own aggression, and in
which the child is the object of aggression’’ (p. 14).
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Linder et al(2010) suggest that the processing of social information occurs in an
automatic, unconscious and implicit manner.
Todorov and Bargh (2002) suggested that individuals who are exposed to aggression
related stimuli develop hostile attributions which influence their social information
processing. Furthermore, Linder et al. (2010) suggest that this processing is out of a
person’s conscious control and can result in biases in information processing which
result in an individual producing hostile attributions.
Furthermore, Zelli et al(1995) found that aggressive individuals only made
unconscious hostile attributions when asked to give automatic and spontaneous
responses as opposed to controlled responses.
Therefore, it would seem that when a person is exposed to trauma, aggression
inputs and hostile attributions may develop at a less conscious level and hence, this
may have implications for treatment
Information Processing
and Trauma
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●
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In terms of trauma experiences, there is evidence that those who have
been exposed to traumatic experiences remain in a hyper-aroused state,
overly attending to environmental stimulus, that they experienced reduced
levels of trust and their experience of negative emotions is intensified
(Solomon and Heide, 2005)
In addition, it has also been noted that in those exposed to trauma,
rehearsal may take the form of both nightmares and flashbacks of the
experience (Duke et al., 2008) as well as fear which Jarymowicz and Bar-Tal
(2006, p. 367) suggest could lead the individual to store both conscious and
unconscious memories which can lead to ‘‘pre-emptive aggression’’.
Furthermore, Siever (2008) found that exposure to repeated acts of
aggression can leave individuals with a neurobiological susceptibility to
aggression as a result of an imbalance between the prefrontal cortex and
the amygdala. The authors argued that this affects the ‘‘top down’’
circuitry and reduces the person’s ability to modulate aggression
Trauma and Aggression
●
Therefore, this would seem to suggest that exposure to
aggression and trauma can result in both conscious,
unconscious and neurobiological changes which could
increase a person’s potential to use pre-emptive aggression
as a means of managing fear as well as a reduced capacity for
modulating aggression
Links between trauma and
aggression
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There is a growing body of research into the prevalence and
impact of prior psychologically traumatic experiences on
psychological functioning, impulsive externalizing and violent
behaviour (Ford et al., 2007). Within forensic samples rates
can be as high as 90%
More aggressive individuals report higher rates than nonaggressive individuals (Sarchiapone, Carli, Cuomo, Marchetti,
& Roy, 2009).
Experiencing childhood abuse has also been associated with
increased risk of later child abuse perpetration (Milner et al.,
2010), often using similar forms of abusive behaviour on their
victims that they were exposed to as children (e.g. Felson &
Lane, 2009).
Trauma and Aggression cont
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Studies also find exposure to childhood trauma is related to
subsequent perpetration of intimate partner violence
(Merrill, Hervig, & Milner, 1996; Reitzel-Jaffe & Wolfe, 2001;
Schumacher,Feldbau-Kohn, Slep, & Heyman, 2001),
homicidal ideation, person offenses, and problem behaviours
(Clark, Reiland, Thorne & Cropsey, 2014)
physically and/or sexually violent behaviours in adulthood
(Jakupcak & Tull, 2005).
It is related to violence in populations with psychosis (Sarkar
et al., 2005; Spidel et al., 2010).
It is also related to instability of employment (Sansone et al.,
2012) and relationships (Colman & Widom, 2004).
Trauma and Dual Aggression
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Substance use may also lead to greater trauma exposure, for
example Afful, Strickland, Cottler, and Bierut (2010) found
higher rates of interpersonal violence, in particular rape or
sexual assault in women (58% vs. 33%) in treatment vs.
community samples.
The common pathway theory suggests that both trauma and
drug use are symptoms of the same underlying factors, such
as a low distress tolerance and a tendency to use avoidant
coping to manage negative emotional states, such as
dissociation or risk-taking—phenomena common to
substance abuse and reactions to trauma (e.g., Najavits &
Walsh, 2012; Otto, Safren, & Pollack, 2004). These
explanations could also be used to explain the relationship
between trauma and violence (Clark et al., 2014).
Trauma and PTSD
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Exposure to interpersonal violence is more likely than nonviolent trauma to precipitate PTSD with such individuals
reporting problems with attention and emotion regulation
(van der Kolk, Roth, Pelcovitz, Sunday, & Spinazzola, 2005)
too much and too little autonomic activity (Corrigan, Fisher,
& Nutt, 2011), and either too little or too much arousal is
known to have a negative impact cognition (DePierro,
D’Andrea, & Pole, 2013).
Trauma and Cognitive
Changes
●
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Models of anxiety and PTSD suggest that conditioning may be
central to understanding an individual’s response to trauma
cues.
Mower’s two-factor model of anxiety has been applied to
PTSD and suggests that classical conditioning explains the
initial fear response to the trauma cue, whereas operant
conditioning explains the continuation of this fear response in
terms of a reinforcing reduction in negative affect.
Trauma and PTS
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Research suggests that individuals who are exposed to
potentially traumatic childhood experiences (e.g. family
violence or natural disasters) are vulnerable to symptoms of
post-traumatic stress (PTS).
●
PTS manifests in three broad clusters of symptoms:
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avoidance
-
re-experiencing
-
hypervigilance .
Trauma – Biological changes
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Heide and Solomon (2006) also proposed that trauma
experienced in childhood through neglect and/or abuse leads
to ‘‘biological changes involving the nervous and endocrine
systems’’ (p. 221). They further argue that these changes
impact upon ‘‘physiological, emotional, cognitive and social
function, including the ability to regulate, affect, relate to
other people, and develop empathy’’ (p. 221). However, it is
important to note that at all victims of trauma may
experience negative biological responses and aggression,
therefore, consideration should be given to the potential of
genetic predisposition to trauma, the type of trauma and the
role of individual differences
Nature of Trauma
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-
-
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Emerging evidence suggests that the nature of the trauma
may explain the diverse symptomology. It is hypothesised
that the separate clusters of symptoms of post-traumatic
distress arise from two distinct dimensions of
harm–life threat = Life threat is predicted to lead to
symptoms of anxiety, hyper-arousal, hostility, anger and
aggression
social betrayal = lead to symptoms of dissociation, emotional
numbness, depression and constricted or abusive
relationships.
Both = post-traumatic stress disorder where individuals may
show symptoms from all clusters.
Types of Trauma
Therefore, in order to consider the complexities of
the nature and degree of trauma Solomon and
Heide (1999) suggested that trauma could be
differentiated into three types, the most
extreme being type III which is regarded as
‘‘severe abuse and/or neglect particularly during
early childhood’’ (p. 221) and ‘‘trauma
characterised by multiple traumatic experiences
that typically begin at an early age may be
perceived as life threatening’’ (p. 221).
Trauma and logical thinking
Heide and Solomon (2005) argue that type III trauma survivors
have difficulties engaging in logical thinking and decision
making because their responses are more automatically
driven. Furthermore, they argue that long term childhood
maltreatment can result in chronic physiological ‘‘hyperarousal’’ and ‘‘survival mode’’ which when exposed to
triggers associated with trauma can result in a ‘‘fight or
flight’’ response. In addition, they argue that in an attempt to
dampen this arousal, trauma survivors may seek to dissociate
from their experiences by using alcohol and drugs which may
‘‘impair judgement and reduce inhibition, making violent
acting out even more likely’’ (p. 222).
GAM and trauma
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Following the model of GAM, the ‘‘inputs’’ that a person may bring as a
consequence of childhood were also explored by Schore (2003) who
suggested that childhood traumatic stress interferes with the development
of neural circuits in the brain which connect emotional, psychological and
social development.
Heide and Solomon (2006, p. 223) suggest that stress associated with child
abuse and neglect ‘‘compromises right brain development’’ resulting in
specific impairments of the orbitofrontal cortex which is involved in social
adjustment and the control of mood, drive and responsibility and
regulating emotions (Rolls, 1999).
Heide and Solomon (2006) also suggest that as a result of these changes
situations in which a person who has been exposed to trauma is required
to engage in relationships with others may also be impaired
Trauma and Criminality
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Best et al. (2002) also found that abnormal
development of the neural circuits in the brain
and the orbitofrontal cortex was associated with
reduced inhibition of rage and is associated with
‘‘sociopathy”
Blake et al. (1995) to concluded that severe
physical abuse may interact with neurological
brain dysfunction and contribute to violent
behaviour
Implications of Trauma on
Interventions
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Berkowitz (1993) postulated that aversive and unpleasant
experiences directly activate aggression-related motor
programs, without the need for actively mindful cognitive
processing. In terms of cognitions, in the case of trauma, both
the ability to recall memories and the ability to generate
cognitions associated with aggression may be impaired.
Parnell (2007) suggested that psychological trauma is
believed to cause disassociation of hemispheric processing.
That is, the left hemisphere (which is responsible for verbal
and motor control, the manipulation of words and symbols,
and the sequential processing of information) is locked out
thus leaving the encoding of memory as implicit memory in
the right hemisphere.
Continued....
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Parnell (2007) proposed that fear blocks the hippocampus so
that information will not go into explicit memory. Moreover,
some argue (Parnell, 2007) that early abusive experiences are
stored in the right hemisphere of the brain which is separate
from the language centre of the left brain causing synaptic
pruning in the orbital frontal cortex resulting in hyper arousal,
the misreading of external cues and difficulty with selfsoothing or calming.
This results in trauma freezing the integrative processes with
the memory and the memory remaining as implicit stored in
the limbic system which is responsible for fleeing, fighting,
feeding and reproduction
Trauma, Memory and arousal
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Heide and Solomon (2004) also argued that episodic
memories of traumatic experiences ‘‘may be stored in the
right limbic system indefinitely’’ (p. 226) because of the
restricted ability to process information into the left cerebral
cortex where it would be filed away for retrieval when
required. The authors proposed that as a result memories of
the trauma (including thoughts, feelings, body sensations,
sounds and smells) are not processed into semantic
memories but instead result in heightened arousal, emotional
looping, anxiety and an inability to learn from experiences.
The Bridge..
Trauma, arousal and processing
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Rauch et al. (2000) suggest that this inability to process episodic
memories to the left cerebral cortex results in the emotions
associated with the trauma being stored in the amygdala and the
right limbic system.
Rauch et al. (2000) propose that as a result when any stimulus is
triggered which is associated with the trauma this results in an
exaggerated response from the amygdala and responses are
generated by the limbic system.
Heide and Solomon (2004) suggest that as a result the person
responds in an emotional rather than a rational way. Therefore, this
would seem to suggest that focusing on the rational cognitive
aspects of aggression alone would not take into account the
inability of the individual to process information into the left
cerebral cortex
Trauma, recall and language
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In the case of trauma, early abusive experiences are stored in the
right hemisphere of the brain which is separate from the language
centre of the left brain causing synaptic pruning in the orbital
frontal cortex resulting in hyper arousal, the misreading of external
cues and difficulty with self-soothing or calming.
Teicher et al. (2004) also noted how the trauma may impact on the
capacity of the corpus callosum resulting in reduced neural activity
between the logical and reasoned left side of the brain with the
emotional right side of the brain.
There is some evidence that the ability of the individual to recall
the function of aggression in the context of both the emotional
right hemisphere with the logical and reasoned linguistic left
hemisphere may be compromised
One brain or two?
How many brains do you have - one or two? Actually, this is quite easy to
answer...you have only one brain. However, the cerebral hemispheres are
divided right down the middle into a right hemisphere and a left
hemisphere. Each hemisphere appears to be specialized for some
behaviours. The hemispheres communicate with each other through a
thick band of 200-250 million nerve fibers called the corpus callosum. (A
smaller band of nerve fibers called the anterior commissure also connects
parts of the cerebral hemispheres.)
The Brain
So what does this mean?
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Information Processing influences aggression
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Information Processing is also influenced by trauma
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Trauma experiences impact on brain development
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Trauma experiences impact on general cognitive functioning
So how do we treat this all together?
Historical treatment
approaches – Anger
Management
Novaco (1994) developed Anger Management techniques
•
Regarded Anger as an emotional state that leads to aggression
and developed a 3 stage approach to the treatment of aggression
•
Phase 1 – Cognitive Preparation
•
Phase 2 – Skills Acquisition
•
Phase 3 – Application Training
•
BUT – only attended to the emotion of anger
•
Current Approaches to the
Treatment of Aggression
Attend to the SORC – that is directly establish the function of the
behaviour(s) as part of the intervention
•
Attend to the role of physiology – ‘stress’
•
Identify the role of scripts and cognitive biases
•
Directly address the role of emotion management rather than anger
per se
•
Utilise methods to induce the emotion experienced and rehearse new
ways of managing the emotion
•
Explore the negative reinforcers and maintaining factors for aggression
so that these can be explored, challenged and replaced by more prosocial aspects
•
Attends to relapse prevention
•
Current Aggression
Interventions continued
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According to Ireland et al. (2009) treatment aimed to reduce
aggression expression should focus on the four areas
identified in the Unified Model of Information processing
proposed by Huesmann (1998). Specifically, this noted:
1. social scripts;
2. normative beliefs;
3. emotions and the impact of these on processing; and
4. perception errors
Aggression interventions
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Aggression Replacement Training
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Controlling Anger and Learning to Manage it (CALM)
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Cognitive Self-Change programme (CSCP) now Self Change
Programme
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Healthy Relationships Programme (HRP)
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Integrated Domestic Abuse Programme
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Community Domestic Violence Programme
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Chromis
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Life Minus Violence (LMV)
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Violence Reduction Programme (VRP)
Examples of Treatment
Approaches in practice – LMV
The LMV treatment modules form part of an intensive high-dosage
psychological treatment programme. The LMV programme is cognitive
behavioural in basis and uses a range of techniques to convey learning
points including: The modules include;
(1)
Motivation;
(2)
Stress and coping;
(3)
How I got here (development of aggression)
(4)
Emotional regulation
(5)
Information processing and aggression
(6)
Consequences
(7)
Empathy, emotional intelligence and theory of mind
(8)
Interpersonal skills
(9)
Working towards the future – Relapse prevention
Constraints of current
approaches
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Do not account for emotional memories
Do not account for the impact of trauma on brain
development
Do not account for the impact of trauma on cognitive
functioning
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Are highly cognitive
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Are verbal/language based
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Underestimates the ‘state’ of the client
Problems…. Stories of
delivering standard groups
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High drop out
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Poor uptake
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Arousal in sessions
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Lack of recall (from one session to another)
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Lack of recall regarding violent behaviours
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Dissociation
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Accusatory/Unsupportive
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Everything took twice as long!
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Lack of resources for dealing with Life History
Problems – patient
experiences
“I was terrified going to the group, I didn’t want to go to it but
felt I had no choice. I dreaded every session and most of us
missed quite a few. For those of us that stayed it did get better
but there are days when I would have done anything not to be
there”
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Secondary trauma
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Time for a change……
Something has to change..
THE FUTURE?
Neurosequential Model of
Therapeutics (NMT)
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takes account of the developmental stage of the brain.
the brain develops hierarchically with four anatomically
distinct but interconnected regions:
1)
brainstem,
2)
diencephalon,
3)
limbic system,
4)
cortex.
●
The brainstem is the least complex and develops first, then it
develops in increasing level of complexity through to the
cortex
Application of NMT to adult
brains
●
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therapeutic techniques to be timed to be more effectively in
harmony with brain development
therapeutic interventions should also match the order of
brain development. This is for interventions aimed at the
cortex level to be maximised by improvements feeding it to it
from the lower parts of the brain. This is because Perry
(2008) stated “the organisation of higher parts of the brain
depends upon input from the lower parts of the brain”
(p242).
Order of treatment using
NMT
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In relation to the brain stem, patterned repetitive activity is
recognised to shape and influence the brain stem and
diencephalon (Perry and Hambrick, 2008)
positive patterned repetitive actions include positive
interactions with trustworthy peers/ caregivers. Other
examples that offer the brain patterned neural activation
necessary for reactivation include, sensory motor activities
such as music, movement, yoga (breathing), balancing,
drumming and therapeutic m)assage (Perry & Hambrick,
2008
Eye Movement Desensitization
and Reprocessing (EMDR)
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EMDR seeks to activate client’s information processing
systems by focusing on a target related to a trauma in an
attempt to stimulate the memory network where the trauma
is stored. Once this is done, alternating eye movements or
bilateral stimuli (BLS) is added in order to stimulate
accelerated information processing.
According to Parnell (2007) EMDR transforms psychological
memory to objective memory, that is, ‘‘memory that feels
emotionally charged, alive and self referential into functional
and devoid of emotional charge memory’’ (p. 7).
EMDR – effects on physiology
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Research investigating the neurological effects of eye
movements has assisted with this. For example, it has been
demonstrated that saccadic eye movements create changes
in brain activation that enhance memory processing
(Christman et al., 2003, 2004, 2006).
There is also evidence that eye movements produce
physiological de-arousal (Sondergaard and Elofsson, 2008).
Schubert et al. (2010) suggest that EMDR may be particularly
suitable for patients who cannot tolerate the high-stress
associated with standard therapies such as exposure
therapies which expose the client to stimulus which triggers
emotions
Benefits of EMDR
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Greenwald (2002) proposed that EMDR has the benefit of being adapted
for clients who may not be comfortable providing in depth memories of
trauma and/or for those who may have difficulty articulating in depth
details of trauma, and for those who may become frustrated and impatient
in being asked to provide in depth details.
Farkas et al. (2010) also agree that EMDR has the advantage because
homework is not required and because the client is not required to
verbalise insight into their experiences nor is there an expectation of any
level of cognitive functioning (Seubert, 2005).
Hence, there would seem to be evidence that EMDR may be able to assist
clients to reduce the associated effects of trauma and that this may have
benefits over other interventions because of the way in which the client is
not required to disclose in depth verbal accounts of the trauma, nor are
they required to complete homework.
Group Treatment using
EMDR
Cochrane review (Bisson & Andrew; 2009) found the following
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Individual TFCBT, EMDR, stress management and group TFCBT
are effective in the treatment of PTSD.
Other non-trauma focused psychological treatments did not
reduce PTSD symptoms as significantly.
There was some evidence that individual TFCBT and EMDR
are superior to stress management in the treatment of PTSD
at between 2 and 5 months following treatment
TFCBT (both individual and group), EMDR and stress
management were more effective than other therapies
Features of effective groups
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Group therapy is a well-proven form of treatment for
traumatized children and adolescents (Cemalovic, 1997;
Kristal-Andersson, 2000; Meichenbaum, 1994; Samec, 2001).
Key features that build a therapeutic, safe, and respectful
environment. These features include:
- group membership determined by shared type of trauma
- disclosure and validation of the traumatic experience;
- normalization of trauma-related responses
- validation of behaviours required for survival during the time
of the trauma
- challenge to the idea that the non-traumatized therapist
cannot be helpful through the presence of fellow survivors in
the group
Group EMDR?
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Current literature provides consistent evidence that group
therapy, is associated with favourable outcomes across a
number of symptoms. PTSD and depression are the most
commonly targeted, but efficacy has also been demonstrated
for a range other symptoms, including global distress,
dissociation, self-esteem, and fear.
However, as was noted in the Cochrane Review, EMDR was
also noted to be an effective treatment for PTSD.
How EMDR can be used in a group setting and whether this
as a treatment maintains efficacy in the treatment of PTSD
when used in a group.
Group EMDR for trauma
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The EMDR-Integrative group Treatment protocol (EMDRIGTP) was developed by members of AMAMECRISIS due to
the extensive need for mental health services after Hurricane
Pauline on the western coast of Mexico in 1997.
Combines the Standard EMDR Treatment Phases 1 through 8
(Shapiro, 1995, 2001) with a Group Therapy model (Artigas,
Jarero, Mauer, López Cano, & Alcalá, 1999; Jarero, Artigas,
Mauer, López Cano, & Alcalá, 2000).
Benefits - offers more extensive reach than individual EMDR
applications and that the treatment may produce a more
effective outcome than expected from traditional group
therapy (Jarero et al., 2008).
EMDR-IGTP has also been found suitable for group work with
adults (Jarero, & Artigas, 2010).
Benefits of group EMDR
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Jarero, & Artigas (2010) argue that the advantages of this
protocol are that unlike other group based PTSD
interventions clients in the EMDR group are not required to
verbalise information about the trauma.
Unlike group CBT approaches, group EMDR therapy can be
completed on subsequent days without the need for
homework (such as periods of exposure or diary monitoring
etc).
Jarero, & Artigas (2010) propose that the group protocol
taught easily to both new and experienced EMDR
practitioners unlike TFCBT which may require a very
experienced practitioner.
Factors required for group
EMDR (Jarero & Artigas,
2010)
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Trust
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Open and Supportive therapists
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Coping plans for each group member
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Stress Management
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Thought Stopping
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Relaxation
Aggression treatment – the future
and considerations
●
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Consistent with theories of aggression, not all children who
experience child abuse and/or neglect go on to engage in violence
or aggression. Therefore, this would seem to suggest that factors in
addition to brain development may contribute to aggression and
thus EMDR should not be considered in isolation.
It could be argued that EMDR could be used as an additional
strategy for the management of emotions, arousal reduction and
increased inter-hemispheric activity to assist in logical decision
making and the reduction of limbically driven responses for clients
who present with aggression.
The use of EMDR could assist to reduce the overall length of
treatment in relation to aggression because of the speed at which
information is reprocessed in EMDR
Implications for practice
Considering the potential of using reprocessing therapy such as EMDR
as a method of addressing information processing in relation to
aggression could have several implications. For example:
●
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Interventions designed to modify behaviour in relation to aggression could
consider whether an assessment of trauma would be beneficial.
It is worth exploring whether clients who have experienced trauma and
who are engaging in interventions to reduce aggression may benefit from
receiving EMDR. This may be used as an additional strategy for reducing
arousal and increasing hemispheric activity in order to reduce limbically
driven activity.
This may also have implications when designing aggression interventions
for clients who have experienced trauma with reduced cognitive and verbal
abilities.
Whilst EMDR could be incorporated into treatment interventions for
aggression this should be placed within the context of wider treatment
provisions which attend to all of the factors associated with aggression.
Personality, Trauma and the
Future
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Livesley (2013) – Integrative
Treatment Approaches
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Moves away from singular models
●
Therapies needs based
The Future – Trauma
Informed Group Aggression
Treatment Programme
Dr Rachel Worthington
Alpha Hospitals and University of Central Lancashire
Dr Fiona Wilks-Riley
Alpha Hospitals and University of Central Lancashire
Professor Niki Graham-Kevan
University of Central Lancashire
Pre- Group
Pre-group
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Stabilisation and Safe place
Identification of out of group caretaker
Functional Assessment – human needs fulfilment
Therapy room construction – grounding stimuli
Strength based goal setting
The Group - outline
Enhancing Safety in the group –
bringing safety objects, expanding
their sense of self and identity,
connection, grounding techniques
The group - outline
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Self control
Relaxation, Meditation, Mindfulness
Pre-session physical activity - saccadic
Emotion identification and regulation – attentional control and
bio-feedback
Group Outline continued
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Triggers and breaks– identification
Positive Identity Development
Cognitive and Emotional Processing
Life/Trauma Narrative
Aggression Narratives
Reading me, reading others
Conflict Resolution
Future Narratives
Pilot Study
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30 sessions (high need group)
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Shorter version for lower need group
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6 months
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Twice a week
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Closed group
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2 therapists (team of 3)
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Prison/Hospital sample
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Male and female
Results
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Effects of treatment will be measured using both
psychometric and incident data
Comparisons will be made for degree of trauma history as
well as aggression risk history to better inform the principles
of risk-need-responsivity
●
Quality of therapist delivery will be measured
●
Qualitative Analyses will explore client experiences
Conclusions
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Trauma and Aggression are intrinsically linked
Current interventions do not adequately take into account
the role of trauma and the effects this has on information
processing
There is a need for group based trauma informed aggression
interventions
This will be the first group based aggression treatment
programme to address the role of trauma
Outcome data will be published once obtained
Questions?
rachel.worthington@alphahospitals.co.uk