LMHC Crisis and Trauma Counseling 3 — Questions and Answers
Question 1: The PTSD diagnostic criterion requiring 'alterations in cognition and mood' (Criterion D in DSM-5) includes which of the following symptoms?
- Hypervigilance and exaggerated startle response
- Intrusive memories and nightmares
- Persistent negative beliefs about oneself or the world (Correct answer)
- Avoidance of trauma-related stimuli
Correct answer: Persistent negative beliefs about oneself or the world
Criterion D includes persistent negative beliefs, distorted blame, negative emotional states, diminished interest in activities, and feelings of detachment.
DSM-5 Criterion D for PTSD covers negative alterations in cognition and mood, including: persistent negative beliefs about self or world; persistent negative emotional states; distorted blame of self or others; diminished interest in significant activities; feelings of detachment from others; and inability to experience positive emotions. This criterion was expanded in DSM-5 from DSM-IV to better capture the full psychological impact of trauma.
Question 2: In EMDR therapy, bilateral stimulation is used primarily during which phase?
- History taking
- Desensitization (Correct answer)
- Closure
- Treatment planning
Correct answer: Desensitization
Bilateral stimulation (eye movements, tapping, or sounds) is applied during the desensitization phase while the client focuses on traumatic memories and negative cognitions.
EMDR (Eye Movement Desensitization and Reprocessing), developed by Francine Shapiro, has eight phases. Bilateral stimulation is the central technique applied during Phase 4 (Desensitization), where the client holds the traumatic image, negative cognition, and body sensation in mind while engaging in sets of bilateral stimulation. This is believed to facilitate adaptive information processing and reduce emotional distress associated with traumatic memories.
Question 3: A counselor working with a veteran experiencing PTSD notices that the client becomes emotionally dysregulated when discussing combat experiences. The MOST trauma-informed response is to:
- Encourage the client to push through the distress to achieve catharsis
- Slow down, use grounding techniques, and re-establish a sense of safety before continuing (Correct answer)
- End the session immediately and refer the client to a psychiatrist
- Reassure the client that their reactions are not normal and need to be controlled
Correct answer: Slow down, use grounding techniques, and re-establish a sense of safety before continuing
Trauma-informed practice requires monitoring the client's window of tolerance and using grounding and stabilization when they become dysregulated.
Dan Siegel's concept of the 'window of tolerance' describes the optimal zone of arousal where clients can process trauma effectively. When clients go outside this window (hyperarousal or hypoarousal), trauma processing is counterproductive. Trauma-informed counselors recognize these states, slow down, and use grounding techniques to return the client to their window of tolerance before continuing.
Question 4: Which of the following is NOT a core component of Prolonged Exposure (PE) therapy for PTSD?
- In vivo exposure to avoided trauma-related situations
- Imaginal exposure to the traumatic memory
- EMDR bilateral stimulation (Correct answer)
- Psychoeducation about PTSD and the rationale for treatment
Correct answer: EMDR bilateral stimulation
Prolonged Exposure uses in vivo exposure, imaginal exposure, and psychoeducation — but does NOT include EMDR bilateral stimulation, which is a separate treatment.
Prolonged Exposure (PE), developed by Edna Foa, is a first-line, evidence-based treatment for PTSD. Its core components are: psychoeducation, breathing retraining, in vivo exposure, and imaginal exposure. EMDR bilateral stimulation is not part of PE. Both PE and EMDR are evidence-based PTSD treatments but are distinct theoretical frameworks.
Question 5: A school counselor discovers a student has been making statements suggesting suicidal ideation. After assessing risk, the counselor determines the student is at moderate risk. What is the MOST appropriate next step?
- Send the student back to class with a check-in scheduled for next week
- Contact parents/guardians immediately, collaborate on a safety plan, and consider a higher level of care (Correct answer)
- Wait until the student requests help to take action
- Notify only the school principal and document the conversation
Correct answer: Contact parents/guardians immediately, collaborate on a safety plan, and consider a higher level of care
Moderate suicide risk requires immediate contact with parents/guardians, collaborative safety planning, and consideration of whether a higher level of care is needed.
Suicide risk assessment should guide the level and urgency of response. For moderate risk, best practice involves: notifying parents or guardians, collaborating on a safety plan that includes lethal means restriction and contact information; consulting with clinical supervisors; and evaluating whether inpatient or intensive outpatient services are needed. Documentation throughout is essential, as are clear follow-up plans.
Question 6: Complex trauma (c-PTSD) differs from single-incident PTSD primarily in that it:
- Is less severe and easier to treat
- Results from prolonged, repeated interpersonal trauma and includes affect dysregulation, identity disturbance, and relational difficulties (Correct answer)
- Only affects children and not adults
- Does not involve intrusive symptoms such as flashbacks
Correct answer: Results from prolonged, repeated interpersonal trauma and includes affect dysregulation, identity disturbance, and relational difficulties
Complex PTSD arises from chronic, repeated interpersonal trauma and is characterized by additional features beyond standard PTSD, including affect dysregulation and disturbances in self-concept.
Complex PTSD (ICD-11) captures the sequelae of chronic, repeated trauma — particularly interpersonal trauma such as childhood abuse, domestic violence, or prolonged captivity. In addition to PTSD symptoms, individuals experience disturbances in self-organization including affect dysregulation, negative self-concept, and relationship difficulties. Treatment typically requires longer-term, phase-based approaches that prioritize stabilization before trauma processing.
LMHC Crisis and Trauma Counseling 3
The PTSD diagnostic criterion requiring 'alterations in cognition and mood' (Criterion D in DSM-5) includes which of the following symptoms?