lecture 4 : PTSD

Question 1

Lecture Themes

Answer 1

1. Stress on the Body
2. Posttraumatic Stress Disorder(PTSD)
3. Biopsychosocial (PTSD) Etiology
4. Biopsychosocial (PTSD) Presentation
5. Biopsychosocial (PTSD) Treatment

Question 3

Stress: HPA Axis

Answer 3

1. Hypothalamus:it releases hormons
2. which hits the pitaitary glands so it release ACTH hormone)
3. that gets to the adrenal glans which releses the cortosal(stress hormone) and epinephirine and norepinephrine
4. this when u have the flight or fight instic (sympathetic nervous system)

Question 4

Effects of Severe Stress

Answer 4

• Extreme or prolonged stress > extensive physical and psychological problems

Increse your Reactivity in sympathetic nervous system (becomes more responsive to stimuli)

decrese Efficacy of immune syste
- in cases of real denger your immune system efficency will decrese because your body needs more attention in other areas but when denger appears for a long time and contisiosly this will become something never ending

Question 5

Effects of Severe Stress

Answer 5

• Lowered efficacy
• Depletion of adaptive resources
• Wear and tear on biological system
• Severe personality and physical
  deterioration
• Death

Question 6

Predisposing Factors: External

Answer 6

• Nature of stressor (stressor)
  -ex: an accident, to u, to other people
• Life changes due to crisis(crisis)
  ex: is my job? my life? my family? on the line
• Social support(resources)
  ex:therapy

Question 7

Predisposing Factors : Internal

Answer 7

• Perception of stressor(stressor)
  ex: less control more stress
• Experience of crises(crisis)
  ex: can i give meaning to what happened to me ?
• Stress tolerence (biological,psychological)(resource)

ex: can i talk myself throught this?

Question 8

PTSD: Traumatic Event

Post Traumatic Stress Disorder

Answer 8

Exposure to event that threatened death, serious injury, sexual violence through:

• Direct experience
• Witness others’ experience
• Learning it happened to close friends/family (must be violent/accidental)
• Repeated/extreme exposure to aversive details of event (e.g., EMTs, cops)

ex: a soldier who expirenced war

Question 9

PTSD Symptoms

Answer 9

• Intrusion
   Nightmares, flashbacks
• Avoidance
   Avoid things associated with trauma
• Negative cognitions & mood
   Detachment
   Shame, anger
   Distorted blame self/others
• Arousal & reactivity
   Insomnia
   Difficulty concentrating
   Hypervigilance
   Heightened startle response(ex;someone comes behind them and they jump)

Question 10

Prevalence

Answer 10

• Lifetime: 1 in 10
• 1 month: 1 in 25

Question 11

Most common triggering events:

Answer 11

• combat
• assault (sexual, physical)
• natural disaster
• torture

Question 12

Gender Differences

Answer 12

Men exposed to more traumatic events

But Women are 2x as likely to have PTSD then Men

Question 13

why?-

Answer 13

• because womens event are more traumatic
• but it is not just the event (when control)

Question 14

PTSD: Events

Answer 14

• the degree of how much something is traumatic in PTSD have a lot to do with human intention
• assult vs accident

Question 15

Most common cause of PTSD in women

Answer 15

• Sexual Assault
• Ex. 39% of Canadian women report being sexually assaulted since age 16

Question 16

Sexual Assault Consequences:

Answer 16

• Serious psychological problems depends
• Past coping skills
• Current level of psychological functioning

Some research: disclose assault >
more positive and fewer negative reactions

Question 17

PTSD is more common in soldies that:

Answer 17

• Soldiers involved in abusive violence
• Soldiers involved in graves registration
• Prisoners of war

Question 18

Biopsychosocial (PTSD) Etiology

Biopsychosocial (PTSD)
Etiology

Answer 18

• Diathesis-stress model:

PTSD is a combination of genetic and
environmental factors

Question 19

Etiology of PTSD: Bio

Answer 19

Genes

Genetics account for ~33% of variance in PTSD symptom severity

5-HTTLPR gene (serotin transpoter gene) - seratonin regulates emotion

Correlations of PTSD:
 MZ: r = 0.28-0.41
 DZ: r = 0.11-0.24

Question 20

Etiology of PTSD: Bio

Neurobiological Factors

Answer 20

• Disruption of the limbic system(emotions are regulated here)
• Disruption of the NE, 5-HT, & opioid systems- less able to tolarate pain
• Higher cortisol in women (Cortasol is a stress hormone)

Question 21

Etiology: Psycho

Answer 21

• Threat-related psychological processes
  -people that are more attuned with the possibility of threat
• **+ Neuroticism **
• Negative attributions/Maladaptive Appraisal
  Ex. “The world is a bad place”
• Cognitive ability (IQ)(higher IQ seems to be protective)

Question 22

Etiology: Social

Answer 22

• Previous experience of trauma
• Severity of current trauma

*** Early experience with uncontrollable or unpredictable events ** (e.g., family stability)

• Part of a minority group
• Social support(protective)
• Current life stress
• Education(protective)
• Combat

Question 23

specific combat social Etiology of PTSD

Answer 23

• Acceptability of war goals (protective)
• ex: society sees what im doing as a good thing, im protecting my country
• Identification with combat unit (protective)
• Returning to an un-accepting social environment (more vulnerable)

Question 24

Presentation: Bio

Answer 24

• **Women are more likely **than men to meet PTSD criteria
• Men are more likely to experience traumatic events
• male and female participants differ in terms of the type of traumatic experience(but this dosnt explain differences)
• Because when we control the traumatic event(same traumatic event), women still show more PTSD

Question 25

# Presentation: Bio Neurobiological Factors

Answer 25

* **Fear learning** -Higher activation in the Amygdala ~ threat perception increses ~ physiological responding (cause or vulnerability?) -Medial prefrontal cortex ~difficulty extinguishing fear **Memory & Learning** -Hippocampus cell death/reduced size (risk factor or consequence?) **Stress response** -Limbic system hyperactivity -higher Stress hormones (e.g., cortisol) -Physiological damage of sustained stress hormones

Question 26

**Presentation: Psycho**

Answer 26

* **Persistent reexperience** -Nightmares, flashbacks * **Avoidance and emotional numbing** -Avoid things associated with trauma -Restricted range of affect * **Increased arousal** -Insomnia -Difficulty concentrating

Question 27

**Presentation: Social**

Answer 27

* **Avoidance and emotional numbing**  Avoid things associated with trauma  Detachment from others  Restricted range of affect (socially)

Question 28

Treatment: Bio

Answer 28

* **Beta blockers?** (e.g., propranolol) -Prophylactic * **SSRIs** -Alleviate depression, intrusive thoughts, avoidance

Question 29

May have unwanted consequences

Answer 29

* Suppression of natural warning signs * Future reliance on medication

Question 30

Treatment: Psycho

Answer 30

* **Cognitive-behavioural therapy (CBT)** -**Exposure-based therapy**  Visualization (imaginal exposure)  Systematic desensitization Increase positive coping skills -Critical Incident Stress Debriefing?? ( single debriefing session could be harmful! ) - it does not reduce PTSD ex: 9/11 debrifing

Question 31

**Prevention**

Answer 31

* **Stress-inoculation training** -Advanced preparation before combat (soldiers) -Now trying with people facing stressful events (e.g., major surgery, relationship ending)

Question 32

Treatment: Social

Answer 32

* **Disclosing trauma** (e.g.,sexual assault) * Prevention: social support