Lecture 8: Trauma/ PTSD Flashcards
Defenition trauma
- A deeply disturbing or distressing experience
- Physical injury
How is PTSD diagnosed?
Using the DSM-5:
- Criterion A: The person experienced a traumatic event, which involves exposore to actual or threatened death, serious injury or sexual violence”
Exposure can be either direct (self, important other) or indirect (witnessing, repeated controntation to details)
What is the lifetime prevalence of trauma?
An estimated 50 - 80%
Is there a gender difference in exposure to trauma?
No, but there is a difference in exposure to the type of trauma
M>F:
- Physical voilence
- Accidents
- Disasters
- Combat
- Rescue
F>M:
- Sexual violence
- Life-threatning illness
- Loss of a child
What are the biological consequences of exposure to trauma?
Two systems
- SAM
- Within seconds
- Stimulates the adrenal glands to produce adrenaline to fight/ flight - HPA
- After minutes
- Stimulates the production of cortisol to supress immune system and prolong the stress response
- Sufficient cortisol levels provide negative feedback to decrease cortisol production and restore balance
What is the role of appraisal when experiencing a traumatic event?
Appraisal of the threat determines the course of action
Explain the freeze response and its consequences
= part of dissociative reactions (dissociation)
- Disrupts normal integrated functions of consiousness, memory, identity and perception
- Causes fragmentation or disconnection of the emotional content and memory of the trauma
This leads to absence or decreased awareness of emotion
= risk factor for posttrauma psychopathology
= a continuus construct
Provide examples of acute stress reactions
- Recurrent images
- Urge to avoid reminders
- Heightened emotional state
- Numbness
- Watchfullness
- Irritability
- Anger
Difference PTSD and normal stress reaction
The acute stress reactions usually decrease after one month (80% of people), in people with PTSD (20% of people) these acute stress reactions remain present even after 1 month and do not decline.
Probability of PTSD after PTE = 14%
Lifetime prevalence = 7-8% (M: 8,5%, F: 20%!)
What are the 4 PTSD symptom trajectories?
From biggest to smallest group
- Resiliance
- Recovery
- Chronic (early detection possible, start high)
- Delayed
Most studies were conducted in injury patients
Trajectories are quite stable throughout different populations
Traumatic exposure can also lead to…
- Depression
- Anxiety
- Substance use
- Suicidality
Comorbidity is also common
What are the different levels of risk factors for PTSD?
- Pretrauma
- Peritrauma
- Posttrauma
What are pretrauma risk factors?
7 items
- Genetic vulnerability
- Female sex
- Low age
- Intellegence
- Low SES
- Prior trauma
- Prior psychotic symptoms
What are peritrauma risk factors?
5 items
- Perceived threat
- Negative interpretation of event
- Fysiological arousal
- Anger or shame
- Dissociation during event
What are postrauma risk factors?
- Social support
- Coping
- Negative interpretation of consequences of the event
- New life events
What is important to understand in order to be able to prevent PTSD?
Intersectionality
“What is someones context when experiencing trauma?”
How does PTSD offer unique possibilities for prevention?
3 items
- Distinct stressor, clear onset point
- Early symptoms (mostly) develop within days of the trauma
Provide an example for failed Universal preventive intervention for PTSD
Clinical incident stress debriefing: aimed to reduce stress (short term) and prevent PTSD (long-term)
- Was not effective! and even harmfull in case of high arousal symptoms
What was found in the dismantling studie of the Clinical incident stress debriefing?
They analyzed the effect of educational and emotional debriefing seperately and found that emotional debriefing impedes recovery in highly aroused trauma survivors
So.. prevention with psychological debriefing is ineffective and potentially harmful
Provide an example for a currently used Universal prevention strategy for PTSD
And what does it contain (4) and provide (5)?
The Psychological First Aid protocol (PFA) by the WHO:
Includes:
- Psycho-education
- Material and practical support
- Emphasis on distraction, relaxation, rest
- Involvement of social network
Provides:
- Sense of safety
- Calming
- Sense of self and community efficacy
- Connectedness
- Hope
Provide an example of a selective prevention strategy for PTSD
Screen & treat
Step 1: Screening for PTSD
- Known risk factors
- Early symptoms
Step 2: Early intervention
- (brief) psychotherapy within 1st month
- Self-guided E-health
Results Screen and Treat NL? And future directions?
= Online preventive intervention
- Easy to implement
- Low response rate and use of self-help app
- Insufficient awareness about importance of sreening
- Potentially cost-effective (if higher response rate)
Future directions:
- co-creation with users to better suit their needs and increase uptake
Pharmacological treatments?
2 items
- Opiate use can work beneficial
- Hydrocortisone reduced risk of development PTSD
BUT insufficient evidence, side effects, acceptability, impairments, etc.
(Early) treatment for PTSD?
- Trauma-focused pyschotherapy (TF)
- CBT
- Eye movement desensitization and reprocessing (EMDR)
Both focus on the event and exposure
