mh 5 Flashcards
4 main areas of difficulty after facing trauma
- intrusions
- Avoidance
- hyperarousal
- alteration in mood/ beliefs
what % of people experience traumatic event go on to develop PTSD
25-30%
intrusions following trauma
- recurrent, involuntary intrusive memories
- re-living traumatic experience in the here
- distressing dreams
- Experiencing distress when reminded of trauma
Avoidance following trauma
avoid:
- circumstances resembling or associated with the stressor
- trauma related thoughts and feelings
hyperarousal following traumatic event
difficulty falling or staying asleep
- irritability or outbursts of anger
- difficulty concentration
- hyper vigilance
- Exaggerated startle response
Alteration in moods / belief following trauma
- inability to recall key features of event
- change to beleifs and expectations about oneself, the world and others
- Persistent trauma-related emotions (horror, fear etc)
Complex trauma, extra difficulty
repeated trauma, often across key developmental stages.
difficulties with
- relationships (form + maintain)
- Emotional regulation (Strong emotions, emotionally numb)
- Self Concept (worthless, shame + guilt)
NICE guidelines for PTSD
- for adults experiencing PTSD or symptoms longer than 1 month after traumatic event
CBT interventions include:
- cognitive processing theory
- cognitive therapy for PTSD
- narrative exposure therapy
- prolonged exposure therapy
EMDR (eye movement desensitisation reprocessing) for non-combat related trauma only.
8-12 sessions. (only accurate for 1 trauma).
- include psychoeducation and strategies for flashbacks etc
- elaboration and processing of trauma memories
- provide help to overcome avoidance
should acknowledge alcohol and drug abuse
first stage of trauma therapy is usually
stabilisation.
get to a nice stable place with new coping strategies.
- psychoeducation
- Grounding (to reality, present moment e.g. 54321 technique)
- Breathing (soothe threat)
- Mindfulness
- Trigger discrimination (help break association between trigger and memory
Defence cascade (psychoeducation example)
increasing dissociation 1-6
increasing arousal as go thru stages 4 is peak. then decrease arousal.
- Freeze (brief)
- flight (for most)
- Fight
- Fright
- Flag
- Faint (hard to hear…extreme)
linen closet metaphpr
expl what Treatment for PTSD involves
idea that we all have that messy cupboard to chuck things in.
Same with traumatic memories, shoved in, can pop out. keeping door closed is hard.
Taking them out, rearranging them, folding them. They won’t now pop out. can still access them.
Trauma focused CBT key goals
- Elaborate and integrate traumatic memory
- Evaluate appraisals relating to the trauma memory
- work on coping strategies that may be unhelpful
updating trauma memories
identify hotspot in trauma memory.
rate how they feel, pick out worst points. ask what the worst parts are. (not always what u think it would be).
update memory, maybe with the defense cascade.
coping strategies
thought supression experiment often used. e.g. not think ab green rabbit.
mindful way of responding to thoughts
Narrative Exposure therapy (NET)
procedure
very specific process each week.
1. normalisation and psychoeducation at start.
2. laying out the lifeline. start at birth, lay down items to show hapy and traumatic memories along a rope.
3. Talk thru in very great detail. helps to link into context.
4. Read narrative. at start of session and as a final session.
theraputic elements of NET
Chronological reconstruction of memories across lifespan
-prolonged exposure to hotspots
- linking the experience to context
-revisit positive life events to adjust assumptions
Evidence for NET
compared NET to interpersonal psychotherapy for Rwandan genocide orphans
6 mnth follow up, 25% NET had PTSD symptoms
but 71% IPT
The goals of a trauma-informed approach
To raise awareness among staff about the wide impact of trauma.
* To prevent re-traumatisation of clients.
* To prevent vicarious trauma by supporting staff regularly working with trauma
Key principles of trauma informed practice
(from GOV.UK
- Safety.
- Trust.
- Choice.
- Collaboration.
- Empowerment.
- Cultural consideration.
Trauma informed care relates to
creating services that aim to
reduce
harm and promote healing.
