Crisis, Trauma, and PTSD Final

Question 1

Reasons why it is important to understand the technical diagnosis of PTSD

Answer 1

Misdiagnosis is common

Misunderstandings are common

Great reason not to focus on other issues

Serious but treatable when it is present

Typically, NOT present alone

Question 2

Diagnostic Criterion A

Answer 2

Exposure (exposed to death, threatened death, actually or threatened serious injury, or actual or threatened sexual violence as follows.

Question 3

Diagnostic Criterion B

Answer 3

Intrusive Symptoms

Question 4

Diagnostic Criterion C

Answer 4

Persistent effortful avoidance of distressing trauma-related stimuli after the event

Question 5

Diagnostic Criterion D

Answer 5

Negative alterations in congitions and mood that began or worsened after the traumatic event

Question 6

Diagnostic Criterion E

Answer 6

Trauma-related alteration in arousal and reactivity that began or worsened after the traumatic event

Question 7

Conceptualization of PTSD

Answer 7

Might need to be reconceptualized as a spectrum disorder in which several distinct pathological posttraumatic phenotypes are distinguished symptomatically and psycho-biologically

Optimal treatment for one phenotype might not necessarily be the best treatment for another

Question 8

Acute stress and PTSD

Answer 8

•	No mandatory symptoms from any cluster
•	Nine (or more) of the following (with onset or exacerbation after the traumatic event)
o	Intrusion (4)
o	Negative mood (1)
o	Dissociative (2)
o	Avoidance (2)
o	Arousal (5)

Question 9

Risk factors for PTSD

Answer 9

• Being female
• Being poor
• Less education
• Bad childhood; adverse childhood experiences (ACE)
• Previous psychological problems
• Strength or severity of the trauma

Question 10

Characteristics of the trauma (NOT in a vacuum)

Answer 10

Greater perceived life threat
Feeling helpless
Unpredictable, uncontrollable events

Question 11

After the trauma

Answer 11

• Degree of social support

- Degree of life stress

Question 12

PTSD Profile

Answer 12

• No one clinical picture, but it is not like it is shown on television or movies
• Should NOT stereotype

Question 13

“Hallmarks” of PTSD

Answer 13

oNightmares
oPoor sleep
oAnger
oNumbness or sadness
oAvoidance of groups

Question 14

BKTS C1 Loss of self

Answer 14

Difficult to engage in intimate relationships
•Hard to trust yourself or anyone else
o Learning to trust = goal (trust self – determination and self)
•Shame
o Objective or misguided – difficulty to confront and address

Question 15

BKTS C1 Numbing

Answer 15

•Limited repertoire of emotions
o Not always in head/soul, but physiological
o Can’t engage in other emotions in frontal cortex
 Physically unable
•A sense of being disconnected
•For many, only able to feel intense emotions, so avoid certain triggers

Question 16

BKTS C1 Reorganization of Perception

Answer 16

•Trauma is superimposed on everything
o Leads to difficulty discerning what is going on
•Loose “mental flexibility” and access to imagination
o Loss of future orientation – hope
•Pulled back into the past

Question 17

BKTS C1 Stuck in Trauma

Answer 17

•Questions where to belong
o Those who know (get it, lived it) and those who don’t
o Results in social alienation
o Event becomes source of pain and sole source of meaning (identity)
o Ironically, the ‘brotherhood’ is both a source of connection and a source of social disconnect from other social support
•Fundamentally recognizes the way the mind and brain manages perceptions
•How we think and what we think about as well as our very capacity to think
•In the midst of sharing, unless addressed, the body remains hyper-vigilant
o The body has to learn danger is in the past, I’m in the present

Question 18

BKTS C2 Inescapable Shock & Learned Helplessness

Answer 18

• Opportunity to escape does not mean freedom
• Secrete stress hormones long after the trauma has passed
• Seek refuge, even in the familiar, even when it is not safe
• Experiencing pain or adversity repeatedly, without finding a way to escape it, will eventually lead to giving up on how to avoid it.
• When someone believes they have no power over anything that happens to them, they continuously act, think, and feel as if they don’t
• This is not a trait anyone is born with; therefore, it is learned over time, through conditioning

Question 19

BKTS C2 Addicted to trauma

Answer 19

•Attractors – attracted to things that cause pain
•Re-experiencing the trauma
o Exposure can offer relief from the anxiety – sense of release
•Experiencing trauma and pain makes us feel intense emotions and later, when trying to get away from bad or painful stimuli, our body reacts as though it excites us, despite it being harmful
•When replacing scary or painful behaviors with better ones, it may be better to do something that may still scare someone, but is relatively normal and exciting, like sky diving, marathon running, rock climbing, etc.
•Strong emotions can block pain, like veterans in combat not requesting morphine

Question 20

BKTS C2 Adaptation or Disease

Answer 20

•Brain disease model overlooks 4 fundamental units
o Our capacity to destroy one another is matched by our capacity to heal one another. Restoring relationships and community is central to restoring wellbeing.
o Language gives us the power to change ourselves and others by communicating our experiences, helping us to define what we know, and finding a common sense of meaning
o We have the ability to regulate our own physiology, including some of the so-called involuntary functions of the body and brain, through such basic activities as breathing, moving, and touching
o We can change social conditions to create environments in which children and adults can feel safe and where they can thrive

Question 21

BKTS C3 Analogy: understanding a car’s engine by studying gasoline

Answer 21

•PET scans and fMRI allowed us to watch the brain as it processed memories, sensations and emotions and begin to map the circuits of mind and consciousness. The earlier technology of measuring brain chemicals like serotonin or norepinephrine had enabled scientists to look at what fueled neural activity, which is like trying to understand the car’s engine by studying the gasoline. Neuroimaging lets us see inside the engine.

Question 22

BKTS C3 Speechless Horror

Answer 22

• Lose ability to talk a lot about feelings/situation
• Can’t relay what happened to them
• Without functioning, you cannot put your thoughts into words (Broca’s area)

Question 23

BKTS C3 Shifting to One Side of the Brain

Answer 23

•Lost left (logical) side of brain
•Unable to rationalize
o Blame others
•Normal: both sides work together seamlessly to give us a cohesive experience
•Left communicates through speech
o Explains experience and order
•Impacts capacity to organize and translate feelings and perceptions into words
•Right communicates through non-verbal
o Memories of sounds, touch, smell
o Experiences pass trauma in present

Question 24

BKTS C3 Stuck in Fight or Flight

Answer 24

• Stay in this after event
• Retriggers through memories
• Mind has forgotten but body still remembers and acts on it
• Normal: temporary then leaves
• Trauma: longer to go back, maybe never until the issue is resolved
• Body continues to “keep score”

Question 25

BKTS C4 Organized to survive

Answer 25

•Agency – being able to actively engage in fight or flights
o Without freedom to act, body’s threat response system remains activated long after threat has passed
 Secretion of stress hormones
 Firing of brain’s electrical circuits

Question 26

Reptilian “Instinctive” Brain

Answer 26

oBrain region: brain stem and hypothalamus
oResponsible for: fight, flight, hunger, and other instincts. Life sustaining functions.
oHappy when: safe from danger

Question 27

Mammalian “feeling” brain

Answer 27

oBrain region: limbic system (includes amygdala, fear center/please center)
oResponsible for: (positive) emotions, learning, emotional memory and spirituality
oHappy when: feels trust, social bonds

Question 28

Human “rational” brain

Answer 28

oBrain region: neocortex
oResponsible for: sensory perception, spatial reasoning, generation of motor commands, conscious thought, intellectual memory, logic, and abstract thinking
oHappy when: learning, anticipating future reward, connected to higher purpose, in flow

Question 29

BKTS C4 Mirroring each Other: Interpersonal Neurobiology

Answer 29

• Neuroscientists discovered mirror neurons – frontal lobe neurons that are when performing certain actions or when observing another doing so – in the brain of animals and humans that are active during observational learning
• PET scans of different brain areas show that humans have a mirror neuron system that supports empathy and imitation

Question 30

Identifying Danger: The Cook and the Smoke Detector

Answer 30

• Trauma increases the risk of “faulty” smoke detector

Question 31

Controlling the Stress Response: The Watchtower

Answer 31

•Top-down regulation
o Strengthen watchtower to override sensation
 Meditation, yoga (strengthen awareness)
•Bottom-up regulation
o Regulate body – not thoughts
o Deep breathing, etc.
 Simple movements

Question 32

The Rider and the Horse

Answer 32

• Reason is the charioteer
• The horses are emotions
o One good, one bad
• The good horse naturally pulls towards rational goals
• The unruly, bad horse must be battled
• Without emotions, reason gets nowhere
• Pressure from deeper regions in the brain that drive our perceptions and attention, rather than not understanding

Question 33

Dissociation

Answer 33

•Dissociation is a normal response to trauma
o Survivors inhabit their head and lose contact with their body
•Frequent detachment from bodily experiences results in loss of reality, and uncertainty about whether the experience actually happened
•Dissociation is a form of emotional anesthetic to aid survival
•Three types of dissociation is associated with trauma order which aid survival
o Primary dissociation occurs in the face of overwhelming trauma preventing the individual from integrating what is happening to the extent that experience remains fragmented
o Secondary or peritraumatic association is activated during trauma when there is no escape and represents a psychological flight when a physical flight is not possible.
 Accompanied by after body experiences ad sense of leaving the body
o Tertiary dissociation is associated with severe childhood abuse and complex trauma, in which distinct ego states emerged to contain traumatic experiences, which can result in dissociative identity disorder

Question 34

Viktor Frankl Quote

Answer 34

“Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”

Question 35

Eric Gentry’s Treating Trauma pyramid

Answer 35

•Therapeutic Relationship – develop and maintain
o Emotional bond + completion of tasks + mutual goals + positive expectancy
•Relaxation – reciprocal inhibition (exposure + relaxation)
o Parasympathetic dominance
•Narrative – sharing with safe other chronology of “micro-events” of traumatic experience

Question 36

Vagus Nerve

Answer 36

• Relax the bum (butt)
• Deep breaths
• Relaxation tension of pelvic floor muscles switches from sympathetic to parasympathetic dominance
• Psoas, sphincter, and Kegels (anterior and posterior)
• Regaining of neocortical functioning in 20-30 seconds
• Relieves pressure on vagus nerve
• Impossible to experience stress – comfortable in one’s own skin