ICL 7.0: Trauma Flashcards
what are the 3 main trauma and stressor related disorders?
- acute stress disorder
- PTSD
- adjustment disorder
what are the 2 types of stressors?
- traumatic
you can experience it yourself or witness it happen to someone else or you hear about it happening to someone very close in your life; this would all count towards a traumatic stressor
- non-traumatic
a traumatic stressor is required for the diagnosis of PTSD or acute stress disorder –> life threatening, serious injury, sexual violence, combat zone, car accident, shooting, *repeated exposure to media that depicts any of these etc.
non-traumatic stressors are associated with adjustment disorder –> divorce, loss of job, marital crisis
what type of stressor is associated with PTSD, acute stress disorder and adjustment disorder?
traumatic stressor = PTSD and acute stress disorder
non-traumatic = adjustment disorder
however, people’s reports of symptoms from non-traumatic stressors can be very similar to traumatic stressors
so severe adjustment disorders can work like PTSD but they’re qualified as different because of the nature of the stressor
what is the triple vulnerability model of PTSD etiology?
generalized biological and psychological vulnerability that exist in a person feed into a person’s experience of trauma
the experience of trauma generates a “true alarm” which is an intent stress response
with PTSD, these true alarms lead to a learned alarm which are strong mixed emotions associated with it
with a learned alarm, what’s triggered is fear and anger which leads to anxious apprehension that’s focused on re-experienced emotions because this emotional learning keeps getting triggered (negative emotional states = fear, rage, and grief)
when there’s reoccurrence and maintenance of these fear and anger states it leads to an avoidance or numbing of emotional response like a dissociative state, drugs, alcohol, avoidance of places/people that remind them of the event etc.
this avoidance/numbing can be moderated by social support and their ability to cope but the weaker the social support and cope, the higher the probability they’re going to end up with PTSD
is PTSD heritable?
heritability accounts for 30%–40% of the variance in risk for PTSD (twin studies)
so there’s clearly a familial link
what genetic factors are associated with PTSD?
no genes have yet been reported that appear to have large main effects across the expected several replications in association with PTSD
genes encoding the dopamine receptor and the serotonin transporter have repeatedly shown an effect across studies but have not been uniformly replicated
little is known about the genetic mechanisms of PTSD, including the potential genetic role of the glutamatergic, GABA-ergic, and endocannabinoid systems
how does PTSD develop and how long does it last?
symptoms usually begin within 3 months of the trauma
there may be a delay of months, or years, before full criteria are met
complete recovery occurs within 3 months in about 50% of adults who have met diagnostic criteria
what is the DSM5 criteria for PTSD?
- a history of exposure to a traumatic event*
- symptoms from each of four symptom clusters* (TRAP)
(a) intrusive recollections; at least 1/5 symptom (intrusive memories are the most common)
(b) avoidance symptoms; at least 1 symptom
(c) negative alterations in cognition and mood; at least 2 symptoms
(d) marked alterations in arousal and reactivity-at least 2 symptoms - duration of symptoms of at least 1 month
- functional impairment or distress
- specifiers-delayed expression – dissociative symptoms
what’s the DSM5 criteria for acute stress disorder?
- exposure to a traumatic event
- presence of at least 9* symptoms from any of five categories:
(a) intrusion
(b) negative mood
(c) dissociative
(d) avoidance
(e) arousal
- duration is 3 days to 1 month
- distress or Impairment
- not attributable to the effects of a substance, another medical condition, and is not better explained by brief psychotic disorder
what are the various types of treatments you can do for PTSD?
- psychotherapies
- cognitive behavior therapies
ex. prolonged exposure**, trauma focused CBT, cognitive processing therapy - psychodynamic therapy
- group, family therapy
- EMDR = eye movement desensitization and reprocessing
what is trauma focused CBT?
they use cognitive behavioral therapy and then also include exposure too
treatment for PTSD
what is cognitive processing therapy?
cognitive behavioral therapy approach that also includes a kind of exposure and also some specific work working on how we process certain thoughts and emotions
used to treat PTSD
which medications are used to treat PTSD?
SSRIs –> specifically, sertraline and paroxetine are FDA approved
other SSRIs are prescribed but technically they’re not FDA approved
they may reduce depression, intrusive and avoidant symptoms, anger, explosive outbursts, hyperarousal symptoms, and numbing
which medications are used to treat PTSD nightmares?
- praszosin (alpha-adrenergic blocker)
- clonidine (stimulates alpha-2 receptors)
- olanzapine, quetiapine
* benzodiazepines are NOT effective
what is the basis behind prolonged exposure therapy?
the emotional processing theory
the idea is that fear memories are stored as fear structures = stimuli + meaning + response
people can access the fear structure through imagination, virtual or in-vivo experiences
the idea is that you can change this by helping people to cognitively reframe the fear and also use behavioral processing with habituation/repeated exposure to the fear which can lead to reappraisal and a sense of mastery of the fear
this is helping people restructure their underlying beliefs by helping them reframe cognitively what happened and by also rexperiencing the traumatic event over and over in a safe situation that leads the brain to reprogram itself and not generate such a strong reaction when exposed to fear triggers
one way to do this is virtual reality exposure therapy!
