Lecture 2: Chapter 7: Trauma-related disorders (202-212) Flashcards
What are the 6 types of trauma- and stressor related disorders?
- PTSD
- Acute stress disorder (ASD)
- Adjustment disorder
- Reactive attachment disorder
- Disinhibited social engagement disorder
- Other/unspecified TSR disorder
What is the period of time an acute stress disorder develops?
From 3 days until a month after trauma.
After that it’s PTSD
What is complex PTSD?
Symptoms of PTSD that fit with prolonged traumatic experiences in childhood. It’s not in the DSM
What are 2 issues with a diagnosis with ASD?
- Acute stress disorder diagnosis might medicalize/stigmatize what is actually a natural response
- The diagnosis isn’t predictive of who will develop PTSD
What is the role of dissociation in a traumatic event and how does it relate to PTSD?
Dissociation can protect during the traumatic event, but it is a predictor of future PTSD
What is the most common cause of PTSD in men and in women?
Men: military trauma
Women: rape
What is the definition of trauma according to DSM 5 and what are the 4 aspects? How does it differ from DSM 4?
DSM 5: exposure to actual or threatened death, serious injury or sexual violence
1. Directly experiencing
2. Witnessing in person
3. Learning: close family member/friend
4. Repeated/extreme exposure
DSM 4: This shut out people that acted during the event and dissociated (fear, helplessness, horror etc.)
What are the 3 possible outcomes after psychotrauma?
- Posttraumatic growth
- No problems or quick recovery
- PTSD, other mental health problems
What percentage of people experiences some kind of trauma during their lifetime? What amount of people experience a severe trauma?
80 %
2/3 experience a severe trauma
What is the diathesis-stress model? Describe the elaborate version.
Heriditary predispositions + early experiences
–> Diathesis (strengths/vulnerabilities)
+ support/stress –> complaints/symptoms
What is a good predictor of PTSD according to Brewin’s study? (3)
Lack of social support (r=0,40), life stress (r=0,32), trauma severity (r=0,23)
What are the 4 symptom clusters of PTSD?
- Intrusively reexperiencing the traumatic event
- Avoidance of stimuli associated with the event
- Signs of negative mood and thought
- Signs of increased arousal/reactivity
What is a useful aspect of ASD diagnosis?
It may identify who needs more support after a trauma. Treating ASD may prevent development of PTSD
Give examples of common comorbid disorders of PTSD
Major depressive disorder, substance use disorder, conduct disorder, personality disorder
What could be an explanation why women are almost 2 times as likely as men to develop PTSD?
Women face different life circumstances (sexual abuse)
What can you say about the comorbidity of PTSD with other disorders?
Most people who develop PTSD have a history of other psychological disorders
2/3 of PTSD’ers have history of anxiety disorders
What are things that overlap in PTSD and anxiety disorders? (3)
- Childhood trauma exposure
- Genetic risk
- Great amygdala activation, diminished mPFC in response to threat
How is Mowrer’s two-factor model of conditioning applied to PTSD?
Initial fear in PTSD is assumed to arise from classical conditioning (fear the neighborhood one was raped)
Operant conditioning contributes to maintaining this avoidance behavior (reinforcement of avoidance by reduction of fear that you’re not in that scary neighborhood)
Why are traumas caused by humans (instead of nature) more likely to cause PTSD?
Because these events are more distressing since they challenge ideas about humans as benevolent
Which brain regions are dysregulated in PTSD?
Amygdala (more active), prefrontal cortex (less active), hippocampus (less active)
What is the consequence of diminished activity in the hippocampus in PTSD?
Influences cognitive tasks and emotion regulation
It predicts the development of PTSD
What is a biological predisposition concerning brain structure for PTSD?
Smaller hippocampus: difficulties placing memories in context –> people with PTSD can experience fear when they have any reminder of their trauma, even outside of context
What is dissociation in PTSD?
Avoiding confronting memories of trauma
Which coping mechanism is more likely to lead to PTSD?
When people are avoiding –> dissociation
What are protective factors that may help a person cope with severe traumas more adaptively? (2)
- Strong social support
- High cognitive/intellectual ability
What are the 2 antidepressants used in treatment of PTSD? How do they work? What is the downside of using this for treatment?
Paroxetine (Paxil) and sertraline (Zoloft)
They are selective serotonin reuptake inhibitors
Many patients relapse after medication stops
What is the best supported and most effective approach to treating PTSD?
Exposure treatment (prolonged) provides more relief than medication or other types of therapy (relaxation or supportive psychotherapy)
What is prolonged exposure therapy for PTSD? (3) And what is the goal?
- Breathing/relaxing exercises
- Techniques to challenge negative beliefs about trauma
- Facing the worst memories of the trauma (through exposure hierarchy (least to worst))
Goal = extinction of fear response, less self blame and to let the client believe they can deal with their anxiety
When do therapists use imaginal exposure?
When it isn’t feasible/safe to return to the scene of the trauma
Why is exposure therapy hard for the therapist as well?
It requires intense focus on traumatizing events. More than a third of clients will drop out of treatments focused on disccussing their trauma
What is cognitive processing therapy (CPT) in PTSD?
Developed to help victims of rape/abuse to dispute tendencies of self-blame
It’s effective in reducing guilt and dissociation
What are 5 aspects of reexperiencing the trauma in PTSD?
- Intrusions
- Bad dreams/nightmares
- (Dissociative) flashbacks
- Emotional distress upon cues
- Physiological reactions upon cues
What is the difference between avoidance of internal and external cues?
Internal = memories, thoughts, feelings
External = places, people, situations
About the cognitive model of PTSD: what does it try to explain?
It tries to explain why the current threat exists
What is persistent PTSD in the cognitive model of PTSD?
Factors that directly maintain the sense of current threat
- Current threat
- Strategies intended to control threat and symptoms
- Prevents change in negative appraisal of trauma and the nature of the trauma memory
- Triggers of nature of trauma memory lead to current threat
What is the current threat in the cognitive model of PTSD and what are 3 aspects of it?
Current threat = people experience threat from something that happened in the past. It leads to strategies intended to control threat, which prevents it from getting better
1. Intrusions
2. Arousal symptoms
3. Strong emotions
What are the 5 steps in the guidelines of Dutch psychological PTSD treatment?
- Diagnosis
- First choice treatment
- Try other first choice treatment
- Intensified care (clinical treatment, pharmacotherapy)
- Alternative/complementary treatments
On what theory is the prolonged exposure treatment based?
Conditioning: extinction of fearful conditioned response
How does cognitive therapy for PTSD work?
Directly identifying and challenging dysfunctional/irrational cognitions
What does EMDR stand for and what is it?
Eye Movement Desensitization and Processing
Patient recalls a trauma-related scene while reviewing and challenging negative thoughts about that scene. The clients need to visually track the therapist’s fingers. This focuses attention on something other than the traumatic memory due to limited working memory capacity
This reduces the vividness and intensity of memories
On what idea is teaching emotion regulation skills as treatment for PTSD based?
Repeated exposure to trauma can interfere with learning to cope with emotions
What are 5 treatments for PTSD?
- Exposure treatment (prolonged)
- Cognitive therapy –> less negative emotions
- Emotion regulation skills teaching
- Internet based CBT –> short term relief
- EMDR
How do you treat ASD? (2)
- Short-term exposure treatment to prevent development of PTSD
- Critical incident stress debriefing (CISD)
What is critical incident stress debriefing (CISD)?
Treatment of trauma victims within 72 hours of the traumatic event to prevent development of PTSD
What is the difference between EMDR and imagery rescripting?
EMDR = trauma imagery directly modifying through distracting task
Imagery rescripting = trauma imagery directly modified through new script
How does disturbing reconsolidation work?
- Reactivation of hotspot memories
- Retrieval: emotional reexperiencing
- Administering betablocker to prevent amygdala from strengthening memory trace
- Reconsolidation of weaker less vivid memory trace
