Exam 2 Flashcards
1
Q
Episodic depression
A
Last 2-9 months if untreated (episodes will remit within one year)
2
Q
In what % of episodes do not remit for 2= years
A
10-20%
3
Q
What percentage of people who experience a major depressive episode will experince 1+ recurrences
A
40-50%
4
Q
People who experince recurrent depression are not entirely
A
Symptom- free between episodes
5
Q
What increases with # of last episodes, presence of comorbidities
A
Probability of recurrence
6
Q
Depression is common
A
Lifetime prevalence of unipolar major depression ~17%
- fail to detect depression in 50% of patients
- twice as common in women
- three times as common among people in poverty
7
Q
What can play an important role symptom expression and description
A
Cultural factors
8
Q
Disparity
A
Observed in most countries around the world
- starts in adolescence and continues until age 65
9
Q
Depression age of onset
A
Early 20s
10
Q
Functional consequences of depression
A
1) leading cause of disability worldwide
2) even subsyndromal depression symptoms associated with significant impairment
3) long-term effects of MDD in adolescence often felt at least through young adulthood
11
Q
Bipolar disorder
A
Severity and duration of mania is hallmark (bipolar 1 vs bipolar 2)
- can be diagnosed with bipolar disorder without ever having an episode of depression
-mixed episodes are common (high risk for suicide)
12
Q
Prevalence rates of bipolar
A
1% in US
- .6% worldwide
0”4-0.2% for bipolar 2
-4% for cyclothymia
13
Q
Bipolar disorder
A
Average age onset of 20’s
-no gender differences in rates of bipolar disorders
- high rate of misdiagnosis
14
Q
Consequences of bipolar disorder
A
Considered a severe and persistent mental illness
- episodic and recurrent
- 6th leading cause of disability worldwide
-high rates of suicide
15
Q
Genetic factors (MDD)
A
35% in twin studies
16
Q
Genetic factors (bipolar)
A
60-85% in twin studies
17
Q
Genetic models
A
Predict risk and age of onset to a degree, but not frequency, severity, or duration of episodes
18
Q
Monoamine hypotheis
A
Early focus on serotonin and norepinephrine especially on low absolute levels of serotonin
19
Q
Depression and Neurotransmission
A
Focus on complex interactions between neurotransmitters and with other hormonal and neurophysiological patterns and biological rhythms
- relative balance of serotonin to other neurotransmitters
- role of dopamine, particularly in anhedonic symptoms
20
Q
Depression and brain function
A
Earl neurological finding: injury to the left anterior prefrontal cortex often followed by depression
21
Q
Depression and the neuroendocrine system
A
Hypothyroidism
- inflammation
- over activity of stress reposne system
22
Q
What percentage of blood plasma cortisol evaluation occurred in outpatients with depression
A
20-40%
23
Q
What percentage of blood plasma cortisol elevation occurred in hospitalized patients with severe depression
A
60-80%
24
Q
What percentage of people with dexamethasone either fail to entirely suppress cortisol or failed to sustain its suppression
A
45%
25
Depression and Life stress
Early adversity associated with long term vulnerability
- chronic stress
- interpersonal relationships and interpersonal stress
* high levels of familial expressed emotion predict relapse
* depression strongly associated with martial conflict
* lack of social support increase risk
26
Perinatal depression
1/7 women experience perinatal depression
- men also at risk
-hormone change can play a role
Major challenge: distinguishing postpartum depression from “baby blues”
27
Depression and psychological factors
Personality variables
* strong evidence for negative affectivity
* tendency to experience frequent and intense negative affect
* also predicts onset of anxiety, which is highly comorbid
28
Depression and psychological factors
Behavioral theories
- lewinsohn: absence of response- contingent positive reinforcement and/ or high rate of negative experinces, low levels of activity/ behavioral engagement-> vicious cycle
- seligman: learned helplessness
Cognitive theories: negative thought patterns, beliefs cause depression
29
Beck’s theory of depression
* negative views of beliefs about self, world, future (depressogenic schemas)
* life experinces thought to play critical role in formation, activation of these belief
*automatic cognitive biases: tendency to process information in negative ways
Ex: tending to minimize positive events
- descriptive theory
- causal theory
30
Abramson’s Helplessness/ Hopelessness theories of depression
*pressimistic attributional style: negative life events attributed to internal, stable, and global causes
Ex: this bad thing happened because I’m fundamentally a bad person
*hope is an important ingredient in treatment/ recovery
31
Psychosocial factors in bipolar disorder
Similar to unipolar depression: negative live events, negative affectivity, negative conditions, expressed emotion, and lack of social support
*predictors of mania
- reward sensitivity: high responsivity to rewards, strong attachment to and pursuit of goals, life events that involve attaining goals
- disruption of sleep, circadian rhythms, social rhythms
32
Issues with etiological models
- cause vs effect
- effect sizes
- specificity
33
Medications for depression
75% prescribed antidepressants
34
Citalopram (celexa) *depression*
33% achieved full symptom relief
35
Treatments for depression
1. Interpersonal psychotherapy
2. Cognitive therapy
3. Mindfulness- based cognitive therapy
4. Behavioral activation
36
Cognitive therapy for MDD
1. Efficacious as medication for severe depression
2. More efficacious than medication in the long-term for reducing relapse risk
3. Medication can potentially be quicker
4. Increase odds of recovery over either alone by 10-20%
37
Bipolar disorder *lithium*
Naturally occurring salt
- up to 80% experince least some relief
- aversive and potentially medically serious side effects
- high rate of discontinuation
38
Bipolar disorder *medications*
Mood stabilizers
- recommended if people are not able or not willing to use lithium
- may be combined with lithium
- six medications on average
39
Psychological treatment of bipolar disorder
Psychotherapy for BD: cognitive therapy, family-focused treatment, interpersonal and social rhythms therapy
40
Strong evidence that psychological treatments can
1. Promote consistent medication use
2. Reduce relapse and hospitalizations
3. Reduce acute symptoms of depression and mania
4. Improve quality of life, social, and occupational functioning
41
Mediators
We don’t understand enough about how and why our treatments work
42
Moderators
We don’t know nearly enough about who will benefit most from which treatments
43
Self-harm
Umbrella term for self-injuries behavior
*fuzzy boundaries (some would include disordered eating behaviors)
44
Suicidal ideation
Thoughts of wishes to die, ranging from comparatively passive ideation to images of ending one’s life to concrete planning
45
Suicide attempt
Deliberate, self-inflicted harm at least partly intended to en one’s life (regardless of likely or actual medical lethality)
* people are often ambivalent about taking their own lives)
46
Suicide
Death resulting from a suicide attempt
47
No suicidal self-injury
Deliberate, direct destruction of body tissue without any intent to die
48
Where do self-injurious thoughts and behaviors appear as symptoms
In the DSM
* diagnostic categories for the behaviors themselves don’t exist
49
Multiple proposed diagnostic entities
1) suicidal behavior disorder
2) non-suicidal self-injury disorder
3) suicidal crisis syndrome
4) suicidal affective disturbance
50
Epidemiology of suicidality
12th Leading cause of death in the US
- 2nd leading cause of death for ages 20-34
- someone in the US dies from suicide every 11 minutes
- >50% of Americans have been affected by suicide in some way
- suicide rate in the US has risen in the 21st century
- suicide rates are almost certainly underestimated
51
Worldwide epidemiology of suicidality
9% report suicidal ideation at least once in their lives; 2.5% have made at least one suicide attempt
52
Demographics of suicide
Men tend to use more lethal means
-50% of all suicides are by firearms
>50% of firearm deaths are suicides
53
Other demographics at higher risk for suicide
1) age 45+ (rates increasing more rapidly for adolescents)
2) LGBTQ+
3) veterans
4) people living in rural areas
5) people who are divorced or widowed
54
Risk factors for suicide
Clear evidence of associations w genetic and biological factors, but associations are very weak and likely multiple meditated
55
Environmental and sociocultural factors ( suicide)
1) stressful life events
2) economic recessions
3) cuktural norms
4) availability of firearms
5) past history of suicide attempt, non suicidal self-injury
56
Psychological factors (suicide)
1) psychological disorders not only depression
2) psychache
3) hopelessness strong predictor of ideation, but not of attempts
57
What is a strong predictor of suicide attempts
Suicidal ideation
58
Ideation to Action
Suicide attempts aren’t always preceded by deliberate ideation and most people who ideate about suicide will not go on to attempt
59
The interpersonal theory of suicide (Joiner)
Thwarted belonging: I am alone
Perceived burden: I am a burden
Capability for suicide
Perdue d and capability: lethal ( suicide attempts)
Thwarted and perceived: Desire for suicide
60
Aftermath of suicide
Loss of a loved one through suicide is often associated with symptoms of depression, social withdrawal, anger, and perceived stigma from others
61
Suicides by close others and highly publicized suicides is associated with
Heightened risk of suicide
62
Challenges in studying suicide
1) low base of completed suicide
2) reluctance to disclose
3) suicides and suicide attempts often undercounted in official records
4) studying people who are no longer alive
5) at the end of thr day our ability to predict who will attempt suicide or when they will attempt is poor
- people with many risk factors may never attempt; others with few risk
- suicidologists disagree about how important prediction is a goal
63
Treating suicidality
* importance of routine suicide assessment
* direct (cognitive therapy) vs indirect (targeting depression treatments)
* may include psychological, pharmacological, and non-pharmacological biological approaches
*before vs after attempts
- addressing medical concerns after attempts
- those who receive therapy after an attempt have a lower risk of future attempts
64
Suicidality and Hospitalization
* suicidality most common reason for psychiatric hospitalization
* may be voluntary or involuntary
* most hospitalizations are quite short
* can potentially offer an important respite, opportunity for stabilization
* can also be very stressful, disruptive, undermine autonomy
* ongoing risk during and following hospitalization
- period immediately after discharge is very high risk
- follow up and ongoing access to care is essential- but many people don’t received systematic follow-up
65
Stepped Care Model
1) in patient hospitalization
2) partial hospitalization or intensive outpatient program
3) outpatient care
4) brief intervention and follow up
5) crisis support and follow up
66
When were formal suicide prevention program was founded and where
1955 in Los Angeles
67
Public health: preventing suicide
Suicide hotlines and other crisis services
*targeted education directed to healthcare providers, first responders and teachers may be more effective
68
Prevention strategy with the strongest evidence
Is universal means restriction (reducing access to firearms, suicide deterrent nets on bridges)
* when deterrents are installed at hotspot bridges there’s often some corresponding increase in suicides at other nearby bridges, but the net effect is still a decrease in total suicides
69
Important knowledge
People who are prevented from attempting suicide or whose attempts do not result in death won’t necessarily attempt again in the future
70
Epidemiology of NSSI
Not an altogether uncommon behavior
* lifetime prevalence of up to 18% internationally
* only a small proportion will engage in repeated NSSI
Most prevalent in adolescents and young adulthood
* substantially lower prevalence in adulthood but still 4-5%
* women slightly higher risk than men
* LGBTQ+ people at higher risk
71
Risk factors
*Psychologists disorders
* negative affectivity and related traits
* life stress
* difficulties with emotion regulation and tolerating distress
72
Toward a functional model of NSSI
Barriers
- many reasons for people not to self-harm such as
* stigma, social norms
* self-preservation motives
* fear of pain
Functions
-reguakte distressing emotions
* pain-offset model
- gravity self-punishment motives
- communicate distress to others
73
Consequences of NSSI
Result in unintended serious harm or even death
Associated with : suicide risk, life stress, depression
Highly stigmatized
- report negative attitudes, feeling ashamed
- may contribute to a vicious cycle
74
Treatment of NSSI
Dialectical Behavior Therapy
* originally develoed by Marsha Linehan as a treatment for people who were chronically suicidal and self-harming
* stringer evidence for efficacy in adolescence than in adulthood
75
Fear and Anxiety
- alert and orient us to acute, potential, or sustained threats
- motivate and organize our response to threat
* “loosely coupled” behavioral (fight, flight, freeze), physiological (increased heart rate, sweating), cognitive responses
- communication of danger to conspecifics
- helped us to survive
76
Specific phobia
Fear of objects or situations that is out of proportion to any real danger
77
Social anxiety disorder
Fear of unfamiliar people or social scrutiny
78
Panic disorder
Anxiety about recurrent panic attacks
79
Agoraphobia
Anxiety about being in places where escaping or getting help would be difficult if anxiety symptoms occurred
80
Generalized anxiety disorder
Uncontrollable worry
81
Agoraphobia (part 2)
- marked fear of being in public spaces, particularly crowded spaces
- often comorbid with and may frequently arise as a consequence of panic attacks
- fear of fear hypothesis: Expectations of catastrophic consequences of having a panic attack in a crowded public place
82
Panic attack and panic disorder shared features
- clinically significant distress or impairment
- excessive mess
* people with anxiety disorders often regard their own anxiety as disproportionate
- avoidance
* can be overt or more subtle
* inhibits problem solving, learning
* if im avoiding this, it must be too scary to face
- no universal, objective demarcating line
*how much anxiety is appropriate amount of anxiety?
* how to distinguish between problematic avoidance vs important safety precautions or leaving an unhealthy situation
83
Epidemiology
12 month prevalence: 18%
Lifetime prevalence: 29%
Social anxiety disorder > generalized anxiety disorder (more common than others)
More common in women than men
84
Comorbid it’s
80% of those with an anxiety disorder meet criteria for another anxiety disorder
75% of those with an anxiety disorder meet criteria for another type of psychological disorder
* disorders commonly comorbid with anxiety include depression, substance use, and personality disorders
85
Conditioned learning of fears (Mowrer)
Classical conditioning
1) UCS (dog bite)
2) Linked by contiguous pairings
3) CS (dog)
4) CR: Conditioned fear of dogs
Operant conditioning
1) strong fear response acts as a stimulus or drive
2) overt avoidance response
86
Extensions of Mowrer’s Model
- coincident panic attack (associative learning)
- prior learning
- social and vicarious learning
* social learning can also inoculate against fear
- individual differences ( some people may be more susceptible to acquiring fears than others/ and or to be more resistant to fear extinction)
87
Genetics
Twin studies consistent with heritability, with estimates ranging from 20-50% for the various anxiety disorders
- non shared environmental factors seem to play a role in anxiety disorders
- genetic effects highly complex, polygenic
88
Neurobiological
Fear circuit
- amygdala, hippocampus, and medial prefrontal cortex
89
Neurotransmission
- multiple NT implicated: GABA, serotonin, norepinephrine
- corticotropin releasing factor- neuropeptide that regulates the HPA axis
90
Personality
Negative affectivity
- recall that this is also a major risk factor for depression, among other mental health conditions
91
Temperament: behavioral inhibition in early childhood
- shy, subdued, wary of novel stimuli
- particularly related to social anxiety
92
Cognition
- perceived unpredictability of, lack of control over one’s environment
- beliefs about the future ( bad things will happen-> motivation to avert worst-case catastrophe)
- childhood trauma and adversity, some forms of parenting can foster these beliefs and information processing strategies
- adverse life events may be unpredictable, uncontrollable
93
Cognitive biases
Information processing (bias towards interpreting neutral information as threatening), overestimation of likelihood of danger, and recall of fear-relevant stimuli
94
Social anxiety disorder
Evolutionary context: very important for humans to maintain social ties
Learning: many people with social anxiety disorder recall traumatic social experiences, bullying
- avoidance of social situations can interfere with development of social skills
- engagement in safety behaviors ( not making eye contact)
95
Social anxiety disorder
Cognitive factors
- unrealistic beliefs about consequences
- negative self -evaluation
- heightened self-awareness
- attention to and interpretation of possible social threat cues
- upward social comparison
96
Panic: neurobiology
- early theorizing focused heavily on locus coeruleus= major source of norepinephrine
- panic circuit
- hippocampus presumably plays an important role in the conditioning of the emotional response
97
Panic: anxiety sensitivity
Anxiety sensitivity: tendency to focus on bodily sensations, have difficulty interpreting bodily sensations, and interpret of bodily sensations as potentially harmful
98
Generalized anxiety
Problem orientation: tendency to view challenges as threats
- attempts to control worries can backfire
Functional models
1) simultaneous believe that worrying is useful and harmful + uncontrollable
2) worrying suppresses physiological arousal
3) worry distracts from/ avoids more unpleasant emotions and thoughtS
4) contrast avoidance model: worry produces sustained, modest negative affect and so protects from dramatic shifts in emotion
99
Behavioral component (treatment): Exposure
Involves facing the situation or object that triggers fear/ anxiety
- can take various forms like imaginable or in vivo
- habitual model: do it till you’re bored
- inhibitory model: learning to feel safe
- should include as many features of the trigger as possible
- reduce or eliminate use of safety behaviors like reassurance-seeking
100
Cognitive components
- increase belief in ability to cope with the anxiety trigger: ability and willingness to tolerate/ accept uncertainty, anxious sensations
- challenge unhelpful beliefs
- post-exposure debriefing to facilitate new learning
- increase mindfulness
101
Relaxation and other skills
- diaphragmatic breathing
102
Medications
Benzodiazepines
- can produce fast-acting relief
- effects are shirt lived
- induce physical, psychological dependence
- produce various unpleasant side effects
- dangerous in combination with other drugs
103
Anxiety disorders are
1) highly comorbid with each other
2) share many common etiologcial factors
3) can be treated with a unified protocol
104
Obsessions
Persistent and recurrent intrusive thoughts, images, or impulses experiences as disturbing, inappropriate, or uncontrollable
- people who have such obsessions often try to actively resist, suppress, or neutralize them
105
Compulsions
Repetitive behaviors or rituals that a person feels driven to perform, often according to very specific or rigid rules
-people can simultaneously feel compelled to perform compulsions and regard those compulsions as excessive
106
Excoriation
Compulsive skin-picking
107
Trichotillomania
Compulsive hair-pulling
108
Compulsive and related disorders
1) obsessive compulsive disorder
2) body dysmorphic disorder
3) compulsive hoarding
109
OCD
Previously classified as an anxiety disorder
110
BDD
Previously classified as a somatoform disorder
111
Body dysmorphic disorder
Most people have some aspect of their body that they dislike
- spend 3-8 hours/day thinking about their body-related concerns
112
Epidemiology of OCD
Lifetime prevalence: 2-3%
- equally common in women and men
- common onset is childhood
- may have both obsessions and compulsions
- co-occurs with anxiety disorders, etc
113
Epidemiology of BDD
1-2% common
- equal in women and men
- age of onset is adolescence
- associated with stress and diminished quality of life
114
BDD and plastic surgery
1/5 will undergo plastic surgery and visit dermatologist
115
Epidemiology of hoarding
Compulsive hoarding as a symptom occurs in 3-6% of adults
- people conceal
- early signs begin in childhood
- high rates of unemployment and social alienation
- can be dangerous: fire risk
116
Biological factors in OCD
Moderate heritability
-basic idea: impulses most people keep under control with little effort
- difficulty inhibiting prepotent actions
- experince fear in response to obsessions
- heightened neurological response to making errors
Neurotransmission: serotonin, glutamate, GABA, dopamine all potentially implicated- but exact roles remain unclear
117
Behavioral processes in OCD
Conditioned learning (mowrer’s model of fear learning)
- coincidences -> superstitions
- habits are hard to change
118
Cognitive processes in ocd
Attentional and perceptual biases: disproportionate attention toward obsession-related stimuli; difficulty blocking out negative information
- thought action fusion (Rachmaninov): thoughts are morally equivalent to actions -> guilt, self-blame, self-recrimination, shame, as well as efforts to neutralize the thoughts and to seek reassurance
- endorse beliefs that thoughts can and should be controlled
- high standards of conduct and morality; responsibility-> heightened efforts to avert harms
- lack of confidence in effectiveness of preventative (harm-avoiding) actions
119
Yedasentience
Internally generated feeling that you’ve done enough
- associated with goal completion
- facilitates termination of action and thinking related to that goal
120
Etiology of BDD
Environments that focus on apperance
- strong belief in the importance of apperance, valuing apperance
- biased attention to physical attractiveness features, words, perceived flaws
- attentions to details
121
Etiology of hoarding
High rates of drama
- cognitive factors
* difficulty with organization
- common beliefs about self
Self: unlovable and unworthy
Others: can’t be trusted
Possession: irreplaceable, important
122
Exposure and response prevention
Exposure to situations that elicit obsessions
Prevention of engagement in compulsive behavior
50-70% show improvement
- limited access to therapy
123
Biological treatments
Medication: SSRI and SNRI
- higher doses and more time than for depression
- relapse common if medication are discontinued
- little known about hoarding disorder
- 50-60% of those with OCD experince improvement from SSRI
Deep brain stimulation for OCD
- indicated for those who don’t experience relief from pharmacological interventions
- 50% of those treated with DBS attain significant relief within a couple months
124
Mental health disparities
Risk is even higher for people with multiple minioritzed identities-> intersectionality
125
Social/ structural determinants of health
1) education
2) healthcare
3) physical environment/ neighborhood
4) economic security
5) social environment
126
Distal stress factors
1) gender-related discrimination
2) gender-related rejection
3) gender-related victimization
4) non-affirmation of gender identity
127
Proximal stress factors
1) internalized transphobia
2) negtajve expectations
3) concealment
128
Resilience factors
1) community connectedness
2) pride
129
Extensions
Diamond and alley: it’s not just stress- it’s also insufficient social safety
Social safety: reliable social connection, inclusion, protection
Social safety imperiled by queerphobia
Lack of social safety-> chronic threat-vigilance
Virginia brooks: minority stress and socioeconomic factirs (restricted access to economic opportunities)
130
Stress generation and adaptation
The set of psychological and physiological processes that allow us to respond to actual, potential, or perceived threats, challenges, and demands
131
Types of stress
Acute vs chronic
- major life events vs daily hassles
- chronic persistent vs chronic intermittent
132
Timing of stressors
Childhood seems to be a particularly important sensitive period
* greater biological, psychological plasticity
* less control, autonomy
* less time in which to have developed coping skills
Loss of a spouse at age 30 vs age 90
Casual compounding (loss of job-> loss of stable housing)
133
Measure stress
Self- report (questionnaires and interviews)
* exposure to stressors
* perceived stress
Stress physiology
* activity of the autonomic nervous system
* hormonal assays (cortisol)
134
Stress response system
1) pupils dilate
2) muscle tense
3) increased sweating
4) lungs dilate
5) heart rate accelerated
6) suppression of non-essential bodily functions (digestion)
135
Psychological (chronic stress)
1) negative affect
2) positive affect
3) executive function
4) beliefs about self, others, and world
136
Behavioral (chronic stress)
1) sleep
2) substance use
3) social withdrawal
4) diet
5) physical activity
137
Biological (chronic stress)
1) brain structure, function
2) systematic inflammation
3) immune suppression
4) metabolic function
138
Subjective stress vs stress exposure
Ratings are a strong predictor of poor betaken than stress exposure, even if the exposure is weighted by stress or severity
* subjective stress ratings index a combination of stress exposure and health-relevant individual and contextual differences in vulnerability to stress
139
Pathways linking stress to disease
1) direct biological: inflammation
2) indirect behavioral: poor nutrition
3) indirect psychological: motivation
* health problems are significant stressors*
140
Factors associated with resilience
Access to resources
- psychological: self-esteem
- interpersonal: social supoort
- financial, systemic: health insurance
141
DSM criteria A for PTSD
1) exposure to actual or threatened violent death, serious injury, or sexual violence
2) direct Experience, witnessing (in-person), learning about trauma experience by a close other, experiencing repeated or extreme exposure to details of trauma (first responders)
142
Traumatic stress spectrum
Having some post-traumatic stress symptoms ( nightmares and hyper vigilance) is very common in the immediate wake of a traumatic experience
- not same as PTSD
143
PTSD in the DSM
Introduced in 1980: inclusion was initially opposed by some in part because PTSD has an explicit, external cause (the trauma)
- not limited to soldiers and veterans
144
DSM-5 Criteria
A: exposure to trauma
B: one of more intrusion symptoms (flashbacks or nightmares)
C: persistent avoidance (behavioral, cognitive, emotional)
D: changes in cognition and mood
E: marked alteration in arousal and reactivity
F: duration is less than a month
145
Epidemiology of Trauma and PTSD
1) report at least one criterion A trauma in their lifetime
2) symptom develop within 6 months of the trauma
3) symptoms can be highly chronic
- not everyone develops PTSD: lifetime prevalence is 7-9
146
Epidemiology of PTSD
1) comorbid with other conditions
2) higher prevalence in women than men
3) sociocultural factors can shape risk (poverty and exposure to violence)
4) associated with significant functional impairment across multiple life domains
147
Acute stress disorder
1) symptoms similar to PTSD
2) covers 1 month gap between trauma exposure and ability to quality for PTSD diagnosis
3) only diagnosed immediately following the trauma
148
Complex PTSD
Judith Herman: argues that prolonged exposure to serial traumatization wit limited opportunities to escape can give rise to a syndrome related to, but distinct from OTSD
- focus on difficulties with emotion regulation, negative self-concept, interpersonal difficulties
149
Trauma experience can produce
1) atypical memory trace (past is present)
2) allostatic load
3) alter beliefs about self, other people, the world
4) interfere with various aspects of living
150
Stuck point in 5 dimensions
Safety: I can’t protect myself
Trust: Otehr people shouldn’t trust me
Power/Control: I must control everything that happens to me
Esteem: I deserve to have bad things happen to me
Intimacy: I am unlovable because of the trauma
151
More direct exposure to trauma
Causes higher risk of trauma
152
Adverse Childhood Experiences
Increase lifetime risk for a host of psychological and physical health problems
* dose-response relationship
153
Overlapping risk factors with anxiety
1) genetic risk
2) neural circuitry
3) cognitive factors (selective attention)
4) personality factors (negative affectivity)
5) two-factor model of conditioning
6) avodinave
154
Reduced hippocampal volume
Both a risk factor for PTSD and a consequence of traumatic stress exposure
155
Trauma- focused psychotherapy
1) first-line treatment
2) various forms
* prolonged exposure and cognitive processing therapy
3) Key element: Exposure
4) effective, but many people don’t get access to evidence-based treatment
156
Misconceptions about TF psychotherapy
Can be held by both service users and service providers
Ex: TF psychotherpay not suitable for complex/ multiple trauma
Ex: most people with trauma are too fragile for TF psychotherapy
Ex: exposure therapy is harmful because it can increase distress
157
Prevention
1) reducing incidence of trauma exposure
2) enhancing psychological preparedness for those at high-risk
3) disrupting memory consolidation
158
Trauma- informed care
Reflects growing recognition of the role of trauma
Key idea: shift the focus from what’s wrong with you to what happened to you
159
Moral injury
1) not classified as mental disorder
2) begins with an event witnessed, perpetrated or learnt about that goes against be beliefs
3) result of direct or indirect threat to core mental beliefs
4) strongly associated with emotions that developed such as guilt and shame
