Lecture 8: Trauma/ PTSD

Question 1

Defenition trauma

Answer 1

1. A deeply disturbing or distressing experience
2. Physical injury

Question 2

How is PTSD diagnosed?

Answer 2

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)

Question 3

What is the lifetime prevalence of trauma?

Answer 3

An estimated 50 - 80%

Question 4

Is there a gender difference in exposure to trauma?

Answer 4

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

Question 5

What are the biological consequences of exposure to trauma?

Answer 5

Two systems

1. SAM
   - Within seconds
   - Stimulates the adrenal glands to produce adrenaline to fight/ flight
2. 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

Question 6

What is the role of appraisal when experiencing a traumatic event?

Answer 6

Appraisal of the threat determines the course of action

Question 7

Explain the freeze response and its consequences

Answer 7

= 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

Question 8

Provide examples of acute stress reactions

Answer 8

• Recurrent images
• Urge to avoid reminders
• Heightened emotional state
• Numbness
• Watchfullness
• Irritability
• Anger

Question 9

Difference PTSD and normal stress reaction

Answer 9

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%!)

Question 10

What are the 4 PTSD symptom trajectories?

From biggest to smallest group

Answer 10

1. Resiliance
2. Recovery
3. Chronic (early detection possible, start high)
4. Delayed

Most studies were conducted in injury patients

Trajectories are quite stable throughout different populations

Question 11

Traumatic exposure can also lead to…

Answer 11

• Depression
• Anxiety
• Substance use
• Suicidality

Comorbidity is also common

Question 12

What are the different levels of risk factors for PTSD?

Answer 12

1. Pretrauma
2. Peritrauma
3. Posttrauma

Question 13

What are pretrauma risk factors?

7 items

Answer 13

• Genetic vulnerability
• Female sex
• Low age
• Intellegence
• Low SES
• Prior trauma
• Prior psychotic symptoms

Question 14

What are peritrauma risk factors?

5 items

Answer 14

• Perceived threat
• Negative interpretation of event
• Fysiological arousal
• Anger or shame
• Dissociation during event

Question 15

What are postrauma risk factors?

Answer 15

• Social support
• Coping
• Negative interpretation of consequences of the event
• New life events

Question 16

What is important to understand in order to be able to prevent PTSD?

Answer 16

Intersectionality
“What is someones context when experiencing trauma?”

Question 17

How does PTSD offer unique possibilities for prevention?

3 items

Answer 17

• Distinct stressor, clear onset point
• Early symptoms (mostly) develop within days of the trauma

Question 18

Provide an example for failed Universal preventive intervention for PTSD

Answer 18

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

Question 19

What was found in the dismantling studie of the Clinical incident stress debriefing?

Answer 19

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

Question 20

Provide an example for a currently used Universal prevention strategy for PTSD

And what does it contain (4) and provide (5)?

Answer 20

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

Question 21

Provide an example of a selective prevention strategy for PTSD

Answer 21

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

Question 22

Results Screen and Treat NL? And future directions?

Answer 22

= 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

Question 23

Pharmacological treatments?

2 items

Answer 23

• Opiate use can work beneficial
• Hydrocortisone reduced risk of development PTSD

BUT insufficient evidence, side effects, acceptability, impairments, etc.

Question 24

(Early) treatment for PTSD?

Answer 24

• Trauma-focused pyschotherapy (TF)
• CBT
• Eye movement desensitization and reprocessing (EMDR)

Both focus on the event and exposure

Question 25

What is the Strenghts project?

Answer 25

Scaling up psychological interventions with Syrian refugees