CP: Lecture 7 Trauma Related Disorders Flashcards
6 trauma related disorders
post traumatic stress disorder
acute stress disorder
adjustment disorder
reactive attachment disorder
disinhibited social engagement disorder
other/unspecified TSR disorder
welke 2 worden in NL vergoed
ptsd en asd
verschil timeframe asd en ptsd
asd = symptoms between 3 days and 1 month after trauma
ptsd = symptoms after one month after trauma
asd criticism
medicalizing normal reactions to trauma.
hoeveel mensen met asd developen ptsd
50%
DSM 3 trauma definition A
event outside usual human experience
DSM 4 trauma definition
actual or threatened death, serious injury, physical integrity. fear, helplessness and horror
DSM 5 definition trauma
exposure to actual or threatened death, serious injury or sexual violence
1. directly experiencing
2. witnessing inperson
3. learning: close family member or friend
4. repeated/extreme exposure to aversive details (not through movies or pictures unless work related)
3 possible outcomes of psychotrauma
post traumatic growth
no problems/quick recovery
mental health problems (bv ASD/PTSD)
criticism DSM 3 definition of trauma
unsual human experience: may be true on individual level, but natuurrampen, covid, WWII -> not true on a group level, rather common than rare.
DSM 4 criticism
moet gelijk fear, helplessness or horror zijn -> dit is niet eerlijk tov. mensen die pas jaren na ptsd ontwikkelen. spreekt ook psychological dissociation tegen.
prevalence trauma =
80%
prevalence ptsd =
7%
PTSD in ICD
kijkt minder naar de etiology, en meer naar alleen symptomen
positive association between, post traumatic stress and…
post traumatic growth.
want meer problemen=meer opportunities?
predictors of PTSD
meeste:
trauma
lack of social support
life stress
low iq
childhood abuse
dus wat voor soort predictors hebben de meeste impact
things that happen during or after the trauma, dit is fijn! want daar kunnen we dan interventies op aanpassen.
welk gender meer ptsd
females
other predictors of trauma
peritraumatic emotions
peritraumatic dissociation
percieved support
prior trauma
prior adjustment
family history of psychopathology
peritraumatic emotions =
negative emotions felt at the time of or in the hours and days following a traumatic event
ptsd a criteria=
Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
- Directly experiencing the traumatic event(s).
- Witnessing, in person, the event(s) as it occurred to others.
- Learning that the traumatic event(s) occurred to a close family member or
close friend. In cases of actual or threatened death of a family member or
friend, the event(s) must have been violent or accidental. - Experiencing repeated or extreme exposure to aversive details of the
traumatic event(s) (e.g., first responders collecting human remains; police
officers repeatedly exposed to details of child abuse).
ptsd b criteria=
reexperiencing at least 1:
intrusions
dreams
(dissociative) flashbacks
emotional distress upon cues
physiological reactions upon cues
ptsd c criteria
avoidance
avoidance of internal cues (memories/flashbacks/feelings)
avoidance of external cues (places/situations/people)
ptsd d criteria
negative changes in mood and cognition, at least 2:
dissociative amnesia
negative convictions and expectations
excessive conditions about cause or guilt
persistent negative mood
loss of interest
estrangement
inability to experience positive feelings
ptsd criteria e
arousal and reactivity, at least 2:
irritation/anger outburst
self-destructive/reckless behaviour
hypervigilance
exaggerated startle
concentration problems
sleeping problems
hoelang moet ptsd duren
1 maand!
wat is een flashback
not just a memory, but more a reexperience of the whole situation.
cognitive model ptsd (check samenvatting)
trauma type/coping <-> cognitive processing during trauma
leidt tot
trauma memory <-> negative appraisal
leidt tot
current threat (intrustions, arousal, emotions)
leidt tot
strategies intended to control threat
en gaat weer terug naar negative appraisal.
voorbeeld idiosyncratic appraisal over trauma
nowhere is safe for me, i deseve bad things, i cannot cope with stress, i attract disaster etc
ptsd paradox
the feeling of current threat: how are people afraid of something that happened in the past?
2 types of processing
data-driven processing: sensory details of an event, quickly
conceptual processing: think carefully about it, integrate it in memory
which type of processing bij ptsd
vaak data driven meer kans: want dan isolated trauma memories that come back, no clear timeline.
wat gebeurt er bij de andere vorm van processing
conceptual processing: echt er over nadenken, het een plekje geven in autobiografisch memory, this happened to me back then, not here and now. minder kans op ptsd want je weet dat er geen current threat is.
single session debriefing
early intervention, makkelijk bij ptsd want duidelijk startpunt.
maar… dit werkt niet goed, juist averechts.
treatment of ptsd
- first choice treatment:
imaginal/prelonged exposure
cognitive therapy
emdr
trauma focused congitive behaviour therapy
brief electric psychotherapy for ptsd
narrative exposure therapy
writing therapy
imaginal rescripting
- try other first choice
- intensified care (pharmacotherapy, clinical treatment)
- alternative/complementary treatment
prolonged exposure
expose ppl to traumatic stimuli, anxiety decreases
learning theory of prolonged exposure
CS-US association stays intact, but new CS-no US association is learned that competes with original CS-US association
want… er is wel relapse, dus CS-US verdwijnt niet helemaal
other theories of prolonged exposure
memory: trauma becomes contextualized (conceptual processing) into autobiographical memory
cognitive: new insights
cognitive therapy
- Directly identify and challenge
dysfunctional/irrational cognitions - Often combined with exposure into (TF-)CB
working memory theory model of emdr
long term memory (stable) -> working memory (liable, limited capacity) -> competing tasks (reduces vividness of emotionally traumatic memory) -> modified memory reconsolidation into long term memory
dus… verschillen in werking tussen exposure en emdr
exposure: learning new CS- no US association
emdr: trauma imagery is directly modified!
imagery rescriping
veranderen van ending in hoofd
disturbing reconsolidation
reactivation of hotspot memories, emotional reexperiencing via retrieval -> administer betablocker -> minder noradrenergic receptors -> amygdala does not strenghten memory trace -> reconsolidation (a weaker memory is installed)
wat zou fijn zijn aan deze nieuwe interventie distrubing reconsolidation
intensive, maar wel hopeful: want past de CS-US associatie aan! dit zou dus minder relapse betekenen, large effect, minder sessions. but… suitable for which problems? how to reactivate? is new learning neccessary?
