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current topics 2 > L5: post traumatic stress > Flashcards

L5: post traumatic stress Flashcards

1
Q

what constitues a trauma(tic event)? according to DSM (1)

A

dsm: a traumatic event involves “exposure to actual or threatened death, serious injury, or sexual violence”

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2
Q

how can you assess exposure to trauma? (1)

A

with the LEC 5 (life events checklist)

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3
Q

what are the characteristics of a traumatic event? (5)

A
  • can happen to one individual or many at a time (collective memory)
  • be apparent or remain hidden to others
  • be (somewhat) anticipated or unexpected
  • happen at a very young, very old age or any thing in between
  • single time vs prolonged/repeated/chronic
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4
Q

what are the 4 symptom clusters of PTSD?

A
  • avoidance
  • change in affect & cognitions
  • instrucive re experiencing
  • hyperarousal & reactivity
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5
Q

what is meant with the intrusive re experiencing symptoms? (5)

A
  1. recurrent, involuntary, and intrsuvie distressing memories of trauma
  2. recurrent trauma-related nightmares
  3. dissociative trauma related reactions (flashbacks)
  4. intense or prolonged psych distress at exposure to trauma related cues
  5. marked physio reactions to trauma related cues
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6
Q

what is meant with the negative alterations in cognition & mood symptom cluster of ptsd? (7)

A
  1. inability to remember an important aspect of the trauma
  2. negative beliefs or expectations about oneself/others/the world
  3. distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individiual to blame themselves or others
  4. negative emotional state (fear, horror, guilt, shame etc)
  5. diminished interest or participation in significant activities
  6. feelings of detachment or estrangement from others
  7. inability to experience positive emotions
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7
Q

what is meant with the hypoerarousal & reactivity symptom cluster of ptsd? (6)

A
  1. irritable behaviour & angry outbursts (w little or no provocation) in form of verbal or physical aggression
  2. reckless of self destruttive behaviour
  3. hypervigilance
  4. exagggerated startle response
  5. problems w concentration
  6. sleep disturbance
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8
Q

when do u get a ptsd diagnosis? (4)

A
  • specific symptom constellation is met from each symptom cluster
  • symptoms present min 1m (also if delayed onset after trauma)
  • interfere sig w daily functioning & well being
    note: some initial reactivity/symptoms after a traumatic event is normal
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9
Q

what is the prevalence of trauma? (2)

A
  • lifetime trauma exposure: about 80% in the netherlands
  • mean nr of traumatic events experienced: 3.2
  • most common type: lots of transportation accident amongst men, lots of sexual violence amongst women
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10
Q

what is the prevalence of current PTSD? (4)

A
  • 1.3%
  • more common in females (2.2% than males .4%)
  • more common in non western migration background (3.6%) than dutch (.9%)
  • more common in younger ppl
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11
Q

what is the prevalence of lifetime ptsd? (4)

A
  • 11.1%
  • more in females then males (15% vs 7%)
  • more in non western (20%) migrations & western migrations (17%) than dutch (9%)
  • more in young ppl
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12
Q

what are the risk factors of PTSD? (3)

A
  • being a woman
  • being younger
  • being from non western migration
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13
Q

what are the differences in PTSD in women vs men? (6)

A

stressors: male more overall exposure, female more often exposed at young age & higher impact trauma
appraisal: female higher perception of danger & loss of control
psych response: female more anxiety, distress, dissocaition
bio response: female more hpa axis dysregulation, oxytocine, cortisol, male more hypoersarousal
mental health: female more ptsd & other mental disroders, male more aggression & hypervigiolance
social support: female larger effect, moire tend & beriend
copin
-> women more ptsd cause more sexual violence

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14
Q

what is the impact of PTSD? (4)

A
  • increased morbidity (through cardiovascuar disease, dementia, diabetes)
  • increased mortality (all causes: suicide, accidental/violence, disease etc)
  • high (mental) health care use
  • work & productivity loss
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15
Q

why is it important to research what PTSD interventions are effective? (3)

A
  • available treatments not effective in 1/3 of patients
  • only about 40% of patients eventually get adequate treatment
  • average treatment delay is 4.5y
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16
Q

what are the treatment guidelines for ptsd in the netherlands? (6)

A
  1. first choice trauma treatment: emdr or prolonged exposure therapy
  2. other trauma treatment
    along the way:
    can intensify treatment, use meds, or use alternative treatments
17
Q

what are the effective interventions for PTSD? (5)

A
  • trauma focused CBT
  • narrative exposure therapy
  • prolonged exposure therapy or EMDR
  • imaginery rescripting
18
Q

what is narrative exposure therapy? (3)

A

exposure therapy w a twist: the patient might imagine themselves being protected by a dragon, or the therapist or someone else, in the traumatic memory
go through it in timeline order, not by most distressing first

19
Q

what is prolonged exposure therapy or EMDR? (5)

A
  • patient goes through most traumatic event first & then w decreasing in distress throught the others repeatedly
  • assess their avoidance behaviour
  • do exposure exercises
  • listen to recording of sessions in different contexts
  • w emdr we also “distract” w stimulation
20
Q

what is intensified prolonged exposure therapy? (1)

A

PE but delivered more intensively, so more sessions in shorter time

21
Q

what is STAIR + PE? (2)

A

Skills training in affective & interpersonal regulation followed by prolonged exposure therapy
STAIR: teach emotion regulation & interpersonal skills, addressing disturbances in self organization (typical in CPTSD, like emotion regulation & relationship issues)

22
Q

what are the pros & cons for prolonged exposure therapy & EMDR (2)

A
  • emdr doesnt address the illogical cognitions (like i cant handle this) so risk of relapse, especially if another traumatic event happens
  • but prolonged exposure can be more intimidating & harder
23
Q

which PTSD patients are / are not indicated for treatment? (6)

A

exposure therapy can be very stressful! but works & is safe
- also for childhood abuse related PTSD
- and for complex PTSD
- and for ptsd w dissociative symptoms

24
Q

how do we improve treatment outcomes in PTSD? (2)

A
  • innovate treatments & use new ones: guide dogs, VRET, somatic approaches, boxing, mdma… (but might hurt instead!)
25
Q

what are future directions for PTSD treatment? (4)

A
  • prevention! so ppl dont dev ptsd after trauma
    research:
  • focus on what we already know from effective interventions for PTSD (inensive treatment, enhancing effective elements, potential treatment amplifiers?)
  • focus on those who dev complaints/do not respond to current treatmen( risk factors, risk algorithms)
  • focus on access to treatment
26
Q

what are barriers for seeking help in ppl w ptsd/trauma? (10)

A
  • didnt think they needed help
  • sought informal support instead
  • avoidance
  • no confidence in help
  • lack of knowledge
  • shame
  • money
  • feeling too scared
  • bad previous experience
  • feel you dont deserve help
27
Q

what was the research question of the C PTSD paper?

A

does complex PTSD predict of moderate treatment outcomes of 3 variants of exposure therapy (Prolonged exposure, intensified exposure, skills training in affective and interpersonal regulation followed by PE)
investigates whether CPTSSD patients experience worse treatment outcomes or respond better to certain therapies, specifically STAIR + PE

28
Q

what is C PTSD? (5)

A

complex PTSD
characterized by disturbances in self organization (DSO), such as emotion regullation difficulties, interpersonal issues, and negative self concept (added to core PTSD symptoms)

29
Q

what were the results of the C PTSD study? (3)

A
  • contrary to expectations, C PTSD did not predict worse treatment outcomes and it did not moderate the treatment effects
  • no sig difference between effects of STAIR + PE, and other forms of PE
  • all treatments (PE, IPE, STAIR + PE) were effective in reducing PTSD in both CPTSD & non CPTSD patients
30
Q

what were the conclusions of the C PTSD study? (3)

A
  • tho CPTSD patients have more severe symptoms and comorbidities, they respond to exposure therapies similarly to patients with non-CPTSD
  • trauma-focused treatments should not be withheld from CPTSD patients, as they benefit from these therapies as much as those with simpler PTSD.
  • CPTSD does not represent a distinct disorder with a unique treatment response, at least in the context of exposure therapies.
31
Q

what was the aim of the PE study? (1)

A

determine whether PE therapy, including its variations (standard, intensified, and preceded by STAIR) reduces the presence of comorbid psych disroders in patients w childhood abuse related PTSD

32
Q

what were the findings of the PE study?(3)

A
  • reduced comorbid disorders in all 3 PE variants: depressive, anxiety, SUD, personality disorder
  • no change in these comorbid disorders: OCD, psychotic, EDs
  • long term effects in comorbid depressive disorders
33
Q

what are the clinical implilcations of the PE study?

A

provides evidence that PE is effective for treating PTSD as well as its comorbidities, so can be used in complex profiles (but not for OCD, psychosis)

current topics 2 (6 decks)

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