Lecture 18 - PTSD Flashcards
What category in DSM-III; DSM-5?
- III: anxiety
- 5: trauma & stress related
Criteria in DSM-5
A - exposure to actual or threatened death, serious injury/violence or threat to self or others through direct experience, witnessing or learning B - Intrusive Symptoms C – Avoidance D – Mood/Cognitive alteration E - Increased arousal and reactivity F - at least 2 months G - causes functional impairment
- Often have remission after 3 months; if remission after 6 months = chronic
- Delayed onset PTSD: ~5% of cases
Prevalence
between 3-8%
But lifetime trauma exposure is 75% !
PTSD symptoms are normal following trauma exposure; but usually don’t meet criteria for PTSD
Women:Men –> 2:1
Common comorbidity: anxiety, substance abuse, depression
Leading Causes of PTSD
o War o Sexual assault o Violent crime o Motor vehicle accident o Childhood abuse
Risk factors
o Interpersonal vs. non-interpersonal stressors (interpersonal more; stressors that occur when other people are involved…ex: divorce)
o Severity of trauma (ex: amount of combat exposure)
o Female
o Family history of psychopathology, parental PTSD
o Personal psychopathology (already have another issue)
o Lower IQ (for combat-related PTSD)
o Childhood abuse
o Poor social support
Behavioural Treatment
o Prolonged Imaginative Exposure:
- Breathing retraining & relaxation training
- Repeated exposure to the traumatic memory (ex: go with client in detail through the situation)
- Repeated in vivo exposure to situations avoided because of trauma-related fear (not always possible, but if they have PTSD from a car accident can slowly get them into a car)
- *BUT, very hard (50% attrition rate)
Cognitive Processing Therapy
Aims to fix:
Two types of cognitive-distortions (self, or related to the world)
1) The sufferer is incompetent
• Others would have prevented the trauma
• Other who are not weak would not experience PTSD symptoms
2) The world is dangerous
Individuals with chronic PTSD reported more self-blame and negative thoughts about the self and the world than traumatized individuals without PTSD
Appraisal of the Sequelae of the Trauma
Appraisal:
- Initial PTSD symptoms
- People’s reaction in the aftermath of the trauma
- Consequences of the trauma on other life domains
- Produce negative emotions
- lead to dysfunctional coping (avoidance and numbing)
Cognitive therapy
o Script, Impact statement
o Identify dysfunctional thoughts, beliefs and behaviours
EMDR; Eye Movement Desensitization and Reprocessing
- While performing saccadic movement of the eyes:
- Accessing traumatic images and memories, generating alternative cognitive appraisals of these images and memories
-Meta-analysis - No more effective than other exposure therapy
- Eye movement not essential for the therapeutic effect
- Accessing traumatic images and memories, generating alternative cognitive appraisals of these images and memories
- But, some positive studies recently published
Still controversial**
Effective treatments
o Prolonged exposure
o Cognitive processing therapy
o Combination of these
o Effective but difficult
Pharmacotherapy
SSRIs, MAO inhibitors, Neuroleptics (ex: valproate), propranolol
Effect of Mindfulness Therapy
STUDY: take veterans with PTSD and gave them mindfulness techniques
Results: there was a greater decrease in symptoms for the participants given mindfulness techniques compared to those given present-centered group therapy; but moderate effect size
** One of the strategies that can be used as an extra tool to diminish symptoms is mindfulness**
Biological mechanism
o Hippocampus (smaller in PTSD people; twin study; both twins had smaller hippocampus, but twin who went to war had PTSD)
o Amygdala
o Prefrontal cortex
STUDY: Imaging during Trauma Recall
Increased blood flow: • Posterior cingulate • Anterior prefrontal cortex, motor cortex Decreased blood flow: • Right hippocampus • Visual association cortex • Anterior cingulate
