{"id":1624,"date":"2019-11-18T16:18:22","date_gmt":"2019-11-18T13:18:22","guid":{"rendered":"http:\/\/www.expertpsy.ro\/wordpress\/?page_id=1624"},"modified":"2019-11-18T16:22:15","modified_gmt":"2019-11-18T13:22:15","slug":"aspecte-informative-legate-de-evaluarea-si-interventia-in-stresul-posttraumatic","status":"publish","type":"page","link":"https:\/\/www.expertpsy.ro\/wordpress\/index.php\/accidente-de-circulatie-sau-de-munca\/aspecte-informative-legate-de-evaluarea-si-interventia-in-stresul-posttraumatic\/","title":{"rendered":"Aspecte informative legate de evaluarea \u0219i interventia in stresul posttraumatic"},"content":{"rendered":"\n<ul class=\"wp-block-list\"><li><strong>Erna CONSTANTIN, psiholog clinician, psihoterapeut <\/strong><\/li><li><strong>Armand VELEANOVICI, PhD, psiholog clinician, psihoterapeut <\/strong><\/li><\/ul>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignright size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.expertpsy.ro\/wordpress\/wp-content\/uploads\/2019\/11\/stres-posttraumatic-ptsd.jpg\" alt=\"\" class=\"wp-image-1627\" width=\"215\" height=\"130\" srcset=\"https:\/\/www.expertpsy.ro\/wordpress\/wp-content\/uploads\/2019\/11\/stres-posttraumatic-ptsd.jpg 531w, https:\/\/www.expertpsy.ro\/wordpress\/wp-content\/uploads\/2019\/11\/stres-posttraumatic-ptsd-300x181.jpg 300w\" sizes=\"auto, (max-width: 215px) 100vw, 215px\" \/><\/figure><\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>Evaluarea \u0219i interven\u021bia psihologic\u0103 \u00een cazurile de stres posttraumatic reprezint\u0103 procese de risc inalt \u00eentruc\u00e2t rezultatele acestor demersuri atrag dup\u0103 sine consecin\u021be \u00een planul func\u021bion\u0103rii individului, dar \u0219i in deciziile instan\u021bei de judecat\u0103, atunci c\u00e2nd exista un proces pe rol \u00een care sunt implicate victime ale eventimentelor traumatice.<\/em><\/strong> <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Acestea sunt motive suficient de importante pentru care este necesar ca\nspecialistul care realizeaz\u0103 evaluarea \u0219i interven\u021bia psihologic\u0103 s\u0103 aib\u0103\npreg\u0103tire temeinic\u0103 \u00een psihotraumatologie.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u00cen cele ce urmeaz\u0103 vom puncta acele aspecte care sus\u021bin aceast\u0103 idee: care sunt simptomele specifice Tulbur\u0103rii de stres posttraumatic (PTSD), diferen\u021bierea PTSD de alte tulbur\u0103ri asociate traumei \u0219i factorilor de stres, indicatori privind rezilien\u021ba \u0219i evaluarea capacit\u0103\u021bii de recuperare dupa evenimentul traumatic \u0219i importan\u021ba factorilor psihoindividuali. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Simptomele specifice Tulbur\u0103rii de\nstres posttraumatic (PTSD)<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Conform DSM-5 (Manualul de Diagnostic \u0219i Clasificare Statistic\u0103 a\nTulbur\u0103rilor Mintale) principalele criterii care se aplic\u0103 adul\u021bilor,\nadolescen\u021bilor \u0219i copiilor cu v\u00e2rste mai mari de 6 ani sunt urm\u0103toarele:<\/p>\n\n\n\n<ol class=\"wp-block-list\"><li>Expunerea la\no situa\u021bie concret\u0103 sau la amenin\u021barea cu moartea, v\u0103t\u0103marea sever\u0103 sau\nviolen\u021ba sexual\u0103: in mod direct, ca martor, in cazul unei persoane apropiate\n(prieten sau membru al familiei), expunerea repetat\u0103 sau de o intensitate\nextrem\u0103 la detalii care \u021bin de evenimentul traumatic ( Ex. cazul membrilor din\nechipele de descarcerare sau poli\u021bi\u0219ti care sunt expu\u0219i in mod repetat\ndetaliilor privind abuzurile asupra copiilor)<\/li><li>Prezen\u021ba\nsimptomelor intruzive (nedorite \u0219i nepl\u0103cute) asociate cu evenimentul\ntraumatic, dup\u0103 ce acesta a avut loc: amintiri nepl\u0103cute, intruzive \u0219i\nnedorite, co\u0219maruri ce au leg\u0103tur\u0103 cu evenimentul traumatic, flashbackuri \u00een\ncare persoana simte sau ac\u021bioneaz\u0103 ca \u0219i cum evenimentul traumatic s-ar repeta,\ndisconfort psihic intens \u0219i reac\u021bii fiziologice \u00een cazul expunerii la stimulii\ncare pot aminti de evenimentul traumatic<\/li><li>Evitarea\nstimulilor sau situa\u021biilor care amintesc de evenimentul traumatic (oameni,\nlocuri, conversa\u021bii, situa\u021bii, obiecte)<\/li><li>Alter\u0103ri ale\ncogni\u021biei \u0219i dispozi\u021biei asociate cu evenimentul traumatic: <\/li><li>perturb\u0103ri\nale memoriei sau incapacitatea de amintire a unor aspecte ce \u021bin de evenimentul\ntraumatic (ceea ce poate ridica dificult\u0103\u021bi la evaluarea PTSD \u00een cazul \u00een care\nnu exist\u0103 preg\u0103tire de specialitate),<\/li><li>&nbsp;convingeri \u0219i a\u0219tept\u0103ri negative despre sine\n\u0219i lume: ,,Lumea este \u00een totalitate periculoas\u0103\u201d, fric\u0103, furie, groaz\u0103, sentiment de vinov\u0103\u021bie,\nru\u0219ine, <\/li><li>sc\u0103derea\nmarcat\u0103 a interesului pentru activit\u0103\u021bile importante, sentimente de deta\u0219are \u0219i\n\u00eenstr\u0103inare de al\u021bii, incapacitate persistent\u0103 de a resim\u021bi emo\u021bii pozitive\n(bucurie, satisfac\u021bie, iubire), ceea ce poate duce la confundarea PTSD cu\ndepresia \u0219i anxietatea ca tulbur\u0103ri de sine st\u0103t\u0103toare \u0219i nu ca simptome. <\/li><li>Comportament\niritabil, hiervigilen\u021b\u0103, comportament autodistructiv, r\u0103s\u0103uns exagerat de\ntres\u0103rire , probleme de concentrare, tulbur\u0103ri ale somnului<\/li><li>Durata\nperturb\u0103rii trebuie s\u0103 fie mai mare de o lun\u0103<\/li><li>Perturbarea\ncauzeaz\u0103 disconfort sau deficit clinic in plan social, profesional \u0219i personal<\/li><li>Perturbarea\nnu poate fi atribuit\u0103 efectelor fiziologice induse de o substan\u021b\u0103 (drog sau\nmedicament) sau altei afec\u021biuni medicale.<\/li><\/ol>\n\n\n\n<p class=\"wp-block-paragraph\">\u00cen cazul copiilor cu v\u00e2rsta sub 6\nani, amintirile spontane \u0219i intruzive pot s\u0103 nu par\u0103 neap\u0103rat nepl\u0103cute \u0219i pot\nfi exprimate ca retr\u0103ire prin joc. De asemenea, \u00een cazul co\u0219marurilor, poate fi\nimposibil de afirmat cu certitudine c\u0103 respectivul con\u021binut \u00eenfrico\u0219\u0103tor al\nviselor este asociat cu evenimentul traumatic. De aceea, preg\u0103tirea de\nspecialitate \u00een psihotraumatologie&nbsp; a\nevaluatorului este util\u0103 \u0219i \u00een acest sens, f\u0103c\u00e2ndu-se apel \u0219i la aspecte ce \u021bin\nde psihologia v\u00e2rstelor \u0219i la aspectele psihoindividuale ale persoanei,\nsurprinse prin tehnici de lucru suplimentare \u0219i de specialitate.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>\u00cen evaluarea \u0219i interven\u021bia psihologic\u0103 se \u021bine cont \u0219i de aspecte legate de:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>factorii pretraumatici <\/strong>\u2013 \u00eenainte de evenimentul traumatic : de temperament, factori de mediu (statut socio-econimic, nivel de educa\u021bie, decese in familie, disfunc\u021bii \u00een rela\u021biile dintre membrii familiei, nivel sc\u0103zut de inteligen\u021b\u0103, statutul de minoritate etnic\u0103), factori genetici \u0219i fiziologici care includ \u0219i v\u00e2rsta la care a avut loc traumatizarea.<\/li><li><strong>factori peritraumatici<\/strong> \u2013 \u00een timpul evenimentului traumatic: cu c\u00e2t magnitudinea traumei este mai mare cu at\u00e2t riscul de PTSD este mai mare \u0219i aici un factor important \u00eel reprezint\u0103 percep\u021bia persoanei cu privire la evenimentul traumatic, percep\u021bie care poate fi influen\u021bat\u0103 de factorii pretraumatici men\u021biona\u021bi anterior. De asemenea, poate ap\u0103rea \u0219i disocierea care are loc \u00een timpul traumei \u0219i care poate persista o perioad\u0103 nedeterminat\u0103 de timp dup\u0103 eveniment, \u00een cazul \u00een care persoana nu o con\u0219tientizeaz\u0103 \u2013 ceea ce poate ridica din nou dificult\u0103\u021bi de evaluare \u00een lipsa preg\u0103tirii de specialitate. <\/li><li><strong>factori posttraumatici<\/strong> \u2013 dupa evenimentul traumatic: de temperament (aprecieri negative, strategii de adaptare inadecvate \u0219i dezvoltarea tulbur\u0103rii acute de stres), factori de mediu (expunerea la elemente ce provoac\u0103 rememor\u0103ri ale evenimentului traumatic). Aceste elemente, de asemenea, pot fi con\u0219tientizate sau nu de individ, iar strategiile de adaptare pot fi considerate adecvate, \u00een cazul \u00een care nu se face o evaluare de fine\u021be a detaliilor. <\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Instrumentele de evaluare clinic\u0103,\ninterviul clinic structurat \u0219i scalele specifice \u00een caz de trauma, validate \u0219tiin\u021bific\n&nbsp;sunt utile de cele mai multe ori. Pe\nl\u00e2nga utilizarea corespunz\u0103toare a acestora, aceste instrumente sunt &nbsp;completate de preg\u0103tirea de specialitate. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">De ce este necesar\u0103 preg\u0103tirea de\nspecialitate \u00een psihotraumatologie? Pe l\u00e2ng\u0103 interviul clinic structurat, scalele\nde autoevaluare PTSD pot surprinde aspecte esen\u021biale. \u00cens\u0103, lu\u00e2nd in\nconsiderare aspectele ce \u021bin de percep\u021bia traumei: sunt cazuri \u00een care, de\nexemplu, violen\u021ba fizic\u0103 este o normalitate \u00een anumite medii disfunc\u021bionale.\n\u00censa, aceast\u0103 normalizare poate fi doar o strategie de adaptare la mediu.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Mai mult dec\u00e2t at\u00e2t, specialistul\npoate identifica ce este real \u0219i ce este imaginat (de exemplu amintiri\nfabricate din povestiri ale unor persoane impactante, legate de un eveniment\ntraumatic \u0219i care pot induce stres, c\u0103p\u0103t\u00e2nd valoare de adev\u0103r) \u0219i de asemenea,\npoate sesiza blocarea amintirilor sau fazele traumatiz\u0103rii (apud Fischer \u015fi Riedesser, 1998, p.89-90): <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u00b7 Faza expozitorie peri-traumatic\u0103 \u2013 r\u0103spunsul normal este format din\n\u0163ipete, team\u0103, doliu, \u015fi reac\u0163ie de m\u00e2nie. Starea patologic\u0103 a experien\u0163ei este\ndesemnat\u0103 ca inundare cu impresii cople\u015fitoare. Persoana afectat\u0103 este cuprins\u0103\nde o reac\u0163ie nemijlocit\u0103 \u015fi se afl\u0103 adesea \u00eenc\u0103 mult timp dup\u0103 aceea \u00eentr-o\nstare de panic\u0103, respectiv, epuizare, care ia fiin\u0163\u0103 din reac\u0163iile emo\u0163ionale\ncare escaladeaz\u0103<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Faza (respectiv starea) de negare. Cei afecta\u0163i se ap\u0103r\u0103 \u00eempotriva amintirilor din situa\u0163ia traumatic\u0103. Varianta patologic\u0103: comportament extrem de evitare, eventual sus\u0163inut de folosirea de droguri \u015fi medicamente pentru a nu fi obligat s\u0103 tr\u0103iasc\u0103 durerea sufleteasc\u0103.<\/li><li>&nbsp;Faza (respectiv starea) de invazie a g\u00e2ndurilor sau imaginilor mnezice. Varianta patologic\u0103: tr\u0103iri cu g\u00e2nduri \u015fi imagini mnezice ale traumei care se impun. <\/li><li>Faza (respectiv starea) de perlaborare. Aici cei afecta\u0163i se confrunt\u0103 cu evenimentele traumatice \u015fi cu reac\u0163ia lor personal\u0103.<\/li><li>&nbsp;Concluzie relativ\u0103 (completion). Un criteriu este capacitatea de a-\u015fi putea reaminti situa\u0163ia traumatic\u0103 \u00een cele mai importante p\u0103r\u0163i ale sale, f\u0103r\u0103 a se g\u00e2ndi compulsiv la acestea.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">O variabil\u0103 important\u0103 este \u0219i timpul scurs de la\nmomentul evenimentului traumatic \u0219i p\u00e2n\u0103 la procesul de evaluare \u0219i interven\u021bie\npsihologic\u0103. Fazele descrise se concretizeaz\u0103 \u00een: faza de \u0219oc, negare, ac\u021biune,\ndesc\u0103rcare, ceea ce poate influe\u021ba rezultatul evalu\u0103rii psihologice, dac\u0103 nu se\nacord\u0103 aten\u021bie de specialitate \u00een acest sens.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">De asemenea, evaluarea \u0219i interven\u021bia psihologic\u0103 de\nspecialitate \u00een psihotraumatologie tine cont \u0219i de urm\u0103toarele variabile:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Eveniment \u2013 impact,\npredictibilitatea lui, durata, importan\u021ba<\/li><li>Situa\u021bia, contextul \u2013 unde era\nsituat\u0103 persoana \u00een timpul evenimentului, care au fost aspectele cu impact\npersonal, ce leg\u0103tur\u0103 a fost \u00eentre persoana \u0219i contextul respectiv<\/li><li>Detalii \u2013 elementele din\ncontext<\/li><li>Timpul \u2013 timpul petrecut in\ncontextul traumatic.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Lu\u00e2nd \u00een considerare toate aceste aspecte, PTSD nu\npoate fi confundat cu: tulbur\u0103rile de adaptare, alte tulbur\u0103ri \u0219i afec\u021biuni\nposttraumatice, tulburarea acut\u0103 de stress, tulbur\u0103rile anxioase \u0219i depressive,\ntulburarea obsesiv-compulsiv\u0103, tulbur\u0103rile de personalitate, tulbur\u0103rile\ndisociative \u0219i conversive, tulbur\u0103rile psihotice \u0219i implica\u021biile traumatismelor\ncerebrale. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Evaluarea corect\u0103 influen\u021beaz\u0103\ndemersul psihoterapeutic \u00een vederea stabilirii strategiilor optime de\ninterven\u021bie psihologic\u0103, astfel \u00eenc\u00e2t persoana s\u0103 ating\u0103 o func\u021bionare optim\u0103,\nprin raportare la punctele sale forte. Astfel, se pot lua \u00een calcul scale\nconstruite pe baza unor publica\u021bii referitoare la tr\u0103s\u0103turile persoanelor\nreziliente, evaluarea relizien\u021bei \u0219colare, profesionale, familiale, rezilien\u021ba\n\u00een fa\u021ba suicidului \u0219i mecanismele de coping \u0219i adaptare&nbsp; ale individului. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Bibliografie:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>American Psychiatric Association, <em>DSM-5,<\/em> 2013 <\/li><li>Fischer, G., Riedesser, P<em>., Tratat de psihotraumatologie<\/em>, traducere, Ed. Trei, Bucure\u015fti, 2007<\/li><li>Ionescu, \u0218., <em>Tratat de rezilien\u021b\u0103 asistat\u0103<\/em>, Ed. Trei, Bucure\u0219ti, 2013<\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Erna CONSTANTIN, psiholog clinician, psihoterapeut Armand VELEANOVICI, PhD, psiholog clinician, psihoterapeut Evaluarea \u0219i interven\u021bia psihologic\u0103 \u00een cazurile de stres posttraumatic reprezint\u0103 procese de risc inalt \u00eentruc\u00e2t rezultatele acestor demersuri atrag dup\u0103 sine consecin\u021be \u00een planul func\u021bion\u0103rii individului, dar \u0219i in deciziile instan\u021bei de judecat\u0103, atunci c\u00e2nd exista un proces pe rol \u00een care sunt implicate &hellip; <a href=\"https:\/\/www.expertpsy.ro\/wordpress\/index.php\/accidente-de-circulatie-sau-de-munca\/aspecte-informative-legate-de-evaluarea-si-interventia-in-stresul-posttraumatic\/\" class=\"more-link\">Continu\u0103 lectura <span class=\"screen-reader-text\">Aspecte informative legate de evaluarea \u0219i interventia in stresul posttraumatic<\/span> <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":1629,"parent":1310,"menu_order":2,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1624","page","type-page","status-publish","has-post-thumbnail","hentry"],"_links":{"self":[{"href":"https:\/\/www.expertpsy.ro\/wordpress\/index.php\/wp-json\/wp\/v2\/pages\/1624","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.expertpsy.ro\/wordpress\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.expertpsy.ro\/wordpress\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.expertpsy.ro\/wordpress\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.expertpsy.ro\/wordpress\/index.php\/wp-json\/wp\/v2\/comments?post=1624"}],"version-history":[{"count":2,"href":"https:\/\/www.expertpsy.ro\/wordpress\/index.php\/wp-json\/wp\/v2\/pages\/1624\/revisions"}],"predecessor-version":[{"id":1630,"href":"https:\/\/www.expertpsy.ro\/wordpress\/index.php\/wp-json\/wp\/v2\/pages\/1624\/revisions\/1630"}],"up":[{"embeddable":true,"href":"https:\/\/www.expertpsy.ro\/wordpress\/index.php\/wp-json\/wp\/v2\/pages\/1310"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.expertpsy.ro\/wordpress\/index.php\/wp-json\/wp\/v2\/media\/1629"}],"wp:attachment":[{"href":"https:\/\/www.expertpsy.ro\/wordpress\/index.php\/wp-json\/wp\/v2\/media?parent=1624"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}