Lecture 4 - Trauma

Question 1

How many people develop PTSD after experiencing trauma?

Answer 1

Around 25-30%

Question 2

What are intrusions?

Answer 2

Recurrent/involuntary/intrusive memories, re-living it (flashbacks), nightmares, experiencing distress when confronted w/ reminders

Question 3

What is avoidance?

Answer 3

Avoiding circumstances resembling/associated w/ stressor, trauma-related thoughts/feelings

Question 4

What is hyperarousal?

Answer 4

Difficulty falling/staying asleep, irritability/outbursts, diff concentrating, exaggerated startle response

Question 5

What is alteration in mood beliefs?

Answer 5

Inability to recall key features of event, change to beliefs

Question 6

What does complex trauma involve?

Answer 6

Difficulties with:
1. Relationships: forming/maintaining close relationships
2. Emotion regulation: experiencing strong emotions, feeling emotionally numb
3. Self-concept: beliefs about self as worthless, shame/guilt

Question 7

What is NICE recommended treatment for PTSD?

Answer 7

Trauma-focused CBT intervention to adults w/ diagnosis or clinically important symptoms

Cognitive processing therapy, cognitive therapy for PTSD, narrative exposure therapy, prolonged exposure therapy

8-12 sessions, include psychoeducation about reactions to trauma, elaboration/processing of trauma memories

Involve processing trauma-related emotions (guilt/shame/loss/anger), help overcome avoidance

Question 8

What is involved in stabilisation?

Answer 8

Psychoeducation: body’s threat response, memory processing, window of tolerance

Grounding: strategies to keep you in present moment/connect w/ surroundings

Breathing: soothing rhythm breathing, square breathing

Mindfulness: guided practice vs mindfulness in daily life

Trigger discrimination: strategy for managing re-experiencing by breaking associations

Question 9

What are the steps of the defense cascade?

Answer 9

(increasing arousal)
1. Freeze
2. Flight
3. Fight
4. Fright
(decreasing arousal)
5. Flag
6. Faint
(dissociation increasing entire time)

Question 10

What is the linen closet metaphor?

Answer 10

Treatment involves slowly taking things out of cupboard, examining them carefully, folding them neatly, putting them back in the right place

Question 11

What are the goals of trauma-focused CBT? (TF CBT)

Answer 11

Elaborate/integrate trauma memory, evaluate appraisals relating to trauma, work on coping strategies

Question 12

How does TF CBT work?

Answer 12

Updating trauma memories: identify ‘hotspots’ in memory + explore what was worst thing about this? What did it mean?

Working on coping strategies: identify strategies being used + effectiveness, try out new ones usually in behavioural experiment

Reclaiming life: What activities have stopped? What would achievable first step be?

Question 13

What are the steps of Narrative Exposure Therapy? (NET)

Answer 13

1. Normalisation and psychoeducation
2. Laying lifeline (eg. flowers represent positive events, stones as negative events)
3. Narrating lifeline w/ attention to traumatic events + going through in slow-motion
4. Reading narrative

Question 14

How does NET work?

Answer 14

Therapeutic elements of NET: chronological reconstruction of memories, prolonged exposure to ‘hotspots’, linking of physiological/sensory/cognitive/emotional responses, revisiting positive life experiences

Evidence: Schaal et al. (2009) compared w/ Interpersonal Psychotherapy, only 25% participants fulfilled PTSD criteria in 6 month follow up (71% in IPT)

Question 15

What is trauma-informed care?

Answer 15

Creating services that aim to reduce harm + promote healing

Raise awareness, prevent re-traumatisation

Apply trauma lens to policies/procedures, minimise barriers to access, be aware of imbalance of power, use of language

Gentle approach, consistency, active listening, empathetic responding, respect, etc.

Question 16

What are the key principles of trauma informed practice?

Answer 16

Safety, Trust, Choice, Collaboration, Empowerment, Cultural Consideration