L5: post traumatic stress Flashcards
what constitues a trauma(tic event)? according to DSM (1)
dsm: a traumatic event involves “exposure to actual or threatened death, serious injury, or sexual violence”
how can you assess exposure to trauma? (1)
with the LEC 5 (life events checklist)
what are the characteristics of a traumatic event? (5)
- 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
what are the 4 symptom clusters of PTSD?
- avoidance
- change in affect & cognitions
- instrucive re experiencing
- hyperarousal & reactivity
what is meant with the intrusive re experiencing symptoms? (5)
- recurrent, involuntary, and intrsuvie distressing memories of trauma
- recurrent trauma-related nightmares
- dissociative trauma related reactions (flashbacks)
- intense or prolonged psych distress at exposure to trauma related cues
- marked physio reactions to trauma related cues
what is meant with the negative alterations in cognition & mood symptom cluster of ptsd? (7)
- inability to remember an important aspect of the trauma
- negative beliefs or expectations about oneself/others/the world
- distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individiual to blame themselves or others
- negative emotional state (fear, horror, guilt, shame etc)
- diminished interest or participation in significant activities
- feelings of detachment or estrangement from others
- inability to experience positive emotions
what is meant with the hypoerarousal & reactivity symptom cluster of ptsd? (6)
- irritable behaviour & angry outbursts (w little or no provocation) in form of verbal or physical aggression
- reckless of self destruttive behaviour
- hypervigilance
- exagggerated startle response
- problems w concentration
- sleep disturbance
when do u get a ptsd diagnosis? (4)
- 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
what is the prevalence of trauma? (2)
- 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
what is the prevalence of current PTSD? (4)
- 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
what is the prevalence of lifetime ptsd? (4)
- 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
what are the risk factors of PTSD? (3)
- being a woman
- being younger
- being from non western migration
what are the differences in PTSD in women vs men? (6)
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
what is the impact of PTSD? (4)
- increased morbidity (through cardiovascuar disease, dementia, diabetes)
- increased mortality (all causes: suicide, accidental/violence, disease etc)
- high (mental) health care use
- work & productivity loss
why is it important to research what PTSD interventions are effective? (3)
- available treatments not effective in 1/3 of patients
- only about 40% of patients eventually get adequate treatment
- average treatment delay is 4.5y
what are the treatment guidelines for ptsd in the netherlands? (6)
- first choice trauma treatment: emdr or prolonged exposure therapy
- other trauma treatment
along the way:
can intensify treatment, use meds, or use alternative treatments
what are the effective interventions for PTSD? (5)
- trauma focused CBT
- narrative exposure therapy
- prolonged exposure therapy or EMDR
- imaginery rescripting
what is narrative exposure therapy? (3)
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
what is prolonged exposure therapy or EMDR? (5)
- 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
what is intensified prolonged exposure therapy? (1)
PE but delivered more intensively, so more sessions in shorter time
what is STAIR + PE? (2)
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)
what are the pros & cons for prolonged exposure therapy & EMDR (2)
- 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
which PTSD patients are / are not indicated for treatment? (6)
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
how do we improve treatment outcomes in PTSD? (2)
- innovate treatments & use new ones: guide dogs, VRET, somatic approaches, boxing, mdma… (but might hurt instead!)
