CTRI EXAM QUESTIONS WITH 100%
VERIFIED ANSWERS
What is the most significant public health problem in the US according to the
CDC? - ANSWER Childhood Trauma
How many people affected by Childhood Trauma? - ANSWER 1 million
children suffer physical and sexual abuse each year
1 in 10 children exposed to intrafamilial violence
Adverse Childhood Experiences - ANSWER ACEs
Mechanisms by Which ACES influence health and wellbeing (pyramid) -
ANSWER -disrupted neurodevelopment
-social, emotional, cognitive impairment
-adaption of health-risk behaviors
-disease disability and social problems
-early death
Impact of Trauma on Emotional/Behavioral Stress - ANSWER -History of
trauma increases likelihood of substance abuse; mental illness - and vice versa
-Substance abuse and MI decrease a person's ability to mitigate the effects of
trauma and prevent future trauma
-interpersonal trauma increases likelihood of future trauma
Characteristics of ACEs - ANSWER -come in groups
-produce behaviors that if sustained, created illness and disease = as a coping
strategy (smoking)
-Cumulative ACEs increase clinical complexity of individual case (# of lifetime
mental health diagnoses increases)
Clinical Complexity - ANSWER ACEs --> complex, multiple problems
-treatment of presenting problems may not be the best path to significant change
-multiple disciplinary approaches may be most effective
Page 1 of 24
,Factors that increase difficulty of trauma recovery - ANSWER -repeated or
prolonged trauma
-closer the perp is to the victim emotionally (capacity of victim to trust in the
future)
-intentional action vs. accidents
Why does childhood experience matter so much? - ANSWER -child cannot
escape the problem (especially under 5 y/o)
-don't have good affect-regulation skills yet
-no control over when and how often
-abused children extremely in tune to minute changes in a persons emotional
state
Betrayal Trauma - ANSWER when the abuser is a primary attachment figure
-particularly difficult for later intimate relationships ---entangles emotional
closeness and care with fear, shame and rage [sexually abusive, nice dad and
very physically abusive mom]
-very basic sense of self as bad, disgusting and worthless
Hyperarousal vs. Hypoarousal - ANSWER Very aware of surroundings (PTSD
-like)
vs.
Feeling numb
It is common to flip flop
-often attempt to shut off negative feelings, which would require shutting off
positive ones too (feeling numb)
Regulation of Emotions - ANSWER Frequent episodes of intense dysregulation
in childhood lead to harsh difficulties regulating emotions later.
-If a child is scared and a parent screams at the child - escalates these feelings.
Child learns that when you get emotional - things get worse.
-Example: VERY angry about being "disrespected" for being 15 minutes late to
an appointment
Triggering - ANSWER -Memory and emotion are both associative.
-Disrespect - reminds us of previous times when we were disrespected
Page 2 of 24
, -Emotions associated with previous incidents may greatly magnified the current
incident
90/10 Reaction - ANSWER Emotions associated with previous incidents may
greatly magnified the current incident
Child Abuse & Emotion - ANSWER Parents unable to regulate their own
emotions
Triggering in medical settings - ANSWER various things can reenact abuse
-lack of predictability, feeling disrespected, etc
Change of Attitude in Trauma Informed Care - ANSWER From What's wrong
with you?
to
What's happened to you?
Three R's of Trauma Informed Care - ANSWER -REALIZES the widespread
impact of trauma and understands potential paths for healing
-RECOGNIZES the signs/symptoms of trauma
-RESPONDS by fully integrating knowledge about trauma into polices,
procedures
Three Pillars of Trauma Informed Care - ANSWER -SAFETY: What happened
to you?
CONNECTION: forming healing relationships
-MANAGEMENT OF EMOTIONS-affect regulation and coping skills
Key Elements of Trauma Care - ANSWER -Encourages autonomy, agency and
self-efficacy
-Emphasize that trauma responses are a NORMAL response to an
ABNORMAL situation
-once you understand a person's history, their behavior may make sense.
Children & Youth Involved in "Trauma informed Care" programs demonstrate -
ANSWER Reduced: behavior/emotional problems, trauma symptoms and
substance abuse problems
Page 3 of 24
VERIFIED ANSWERS
What is the most significant public health problem in the US according to the
CDC? - ANSWER Childhood Trauma
How many people affected by Childhood Trauma? - ANSWER 1 million
children suffer physical and sexual abuse each year
1 in 10 children exposed to intrafamilial violence
Adverse Childhood Experiences - ANSWER ACEs
Mechanisms by Which ACES influence health and wellbeing (pyramid) -
ANSWER -disrupted neurodevelopment
-social, emotional, cognitive impairment
-adaption of health-risk behaviors
-disease disability and social problems
-early death
Impact of Trauma on Emotional/Behavioral Stress - ANSWER -History of
trauma increases likelihood of substance abuse; mental illness - and vice versa
-Substance abuse and MI decrease a person's ability to mitigate the effects of
trauma and prevent future trauma
-interpersonal trauma increases likelihood of future trauma
Characteristics of ACEs - ANSWER -come in groups
-produce behaviors that if sustained, created illness and disease = as a coping
strategy (smoking)
-Cumulative ACEs increase clinical complexity of individual case (# of lifetime
mental health diagnoses increases)
Clinical Complexity - ANSWER ACEs --> complex, multiple problems
-treatment of presenting problems may not be the best path to significant change
-multiple disciplinary approaches may be most effective
Page 1 of 24
,Factors that increase difficulty of trauma recovery - ANSWER -repeated or
prolonged trauma
-closer the perp is to the victim emotionally (capacity of victim to trust in the
future)
-intentional action vs. accidents
Why does childhood experience matter so much? - ANSWER -child cannot
escape the problem (especially under 5 y/o)
-don't have good affect-regulation skills yet
-no control over when and how often
-abused children extremely in tune to minute changes in a persons emotional
state
Betrayal Trauma - ANSWER when the abuser is a primary attachment figure
-particularly difficult for later intimate relationships ---entangles emotional
closeness and care with fear, shame and rage [sexually abusive, nice dad and
very physically abusive mom]
-very basic sense of self as bad, disgusting and worthless
Hyperarousal vs. Hypoarousal - ANSWER Very aware of surroundings (PTSD
-like)
vs.
Feeling numb
It is common to flip flop
-often attempt to shut off negative feelings, which would require shutting off
positive ones too (feeling numb)
Regulation of Emotions - ANSWER Frequent episodes of intense dysregulation
in childhood lead to harsh difficulties regulating emotions later.
-If a child is scared and a parent screams at the child - escalates these feelings.
Child learns that when you get emotional - things get worse.
-Example: VERY angry about being "disrespected" for being 15 minutes late to
an appointment
Triggering - ANSWER -Memory and emotion are both associative.
-Disrespect - reminds us of previous times when we were disrespected
Page 2 of 24
, -Emotions associated with previous incidents may greatly magnified the current
incident
90/10 Reaction - ANSWER Emotions associated with previous incidents may
greatly magnified the current incident
Child Abuse & Emotion - ANSWER Parents unable to regulate their own
emotions
Triggering in medical settings - ANSWER various things can reenact abuse
-lack of predictability, feeling disrespected, etc
Change of Attitude in Trauma Informed Care - ANSWER From What's wrong
with you?
to
What's happened to you?
Three R's of Trauma Informed Care - ANSWER -REALIZES the widespread
impact of trauma and understands potential paths for healing
-RECOGNIZES the signs/symptoms of trauma
-RESPONDS by fully integrating knowledge about trauma into polices,
procedures
Three Pillars of Trauma Informed Care - ANSWER -SAFETY: What happened
to you?
CONNECTION: forming healing relationships
-MANAGEMENT OF EMOTIONS-affect regulation and coping skills
Key Elements of Trauma Care - ANSWER -Encourages autonomy, agency and
self-efficacy
-Emphasize that trauma responses are a NORMAL response to an
ABNORMAL situation
-once you understand a person's history, their behavior may make sense.
Children & Youth Involved in "Trauma informed Care" programs demonstrate -
ANSWER Reduced: behavior/emotional problems, trauma symptoms and
substance abuse problems
Page 3 of 24
