Module 2 revision Flashcards
How many people report a traumatic event occuring in their lifetime?
Over ⅔ of people
What is the most common trauma for men and women?
Military trauma is most common for men, rape is most common for women
What is the duration of symptoms needed for PTSD?
1 month - years
What are some struggles people with PTSD often have?
- relationship/martial dissatisfaction,
- divorce
- unemployment
- suicidal thoughts and self-injury,
- physical illnesses
Which gender is more likely to have PTSD and what factor seems to be contributing to this?
Women are 1.5-2x more likely to develop PTSD than men
arguably due to higher likelihood of being sexually assaulted, equal rates of PTSD after sexual abuse is controlled for
What cultural symptom is similar to PTSD?
Ataque de nervios (Puerto Rico)
Why is C-PTSD not in the DSM?
C-PTSD is not considered to be distinct enough from PTSD in the DSM
What are the two steps in Mowrer’s 2-stage model of PTSD?
- PTSD symptoms arise from classical conditioning, but people with PTSD often have elevated tendencies to develop and sustain conditioned fears, due to the severity of the original distressing event
- Operant conditioning maintains the negative association - eg. the intrusive/avoidant symptoms reinforce the distress initially experienced
What does Mowrer’s model help explain about the nature of PTSD?
Mowrer’s 2-stage model also explains how and why these symptoms of PTSD actively maintain the disorder and disrupt/interfere with the fear being reduced/eliminated
What are two features in the brain that are often found in people with PTSD?
- greater amygdala activation
- lower activity in medial prefrontal cortex
What 3 factors influence the chance of developing PTSD?
- duration / repeated exposure
- type of trauma
- severity of trauma
eg. PTSD is higher after seeing war casualties than just being in a warzone,
rates of PTSD are double in soldiers with two tours of Afghanistan compared to those who only had one tour
Why is human based trauma often worse for PTSD than natural disasters?
Distressing events caused by humans are more likely to cause PTSD than natural disasters probably because of the interpersonal effects it has on people’s rates of trustworthiness / targeted nature of the trauma to oneself
What nucleus and neurotransmitter is associated with PTSD?
Nucleus = L— C——–
What does it explain?
locus coeruleus and norepinephrine
it may explain hyperreactivity to threat-related stimuli
What’s up with hippocampi in people with PTSD and what does it help explain?
- diminished activity and often also lower grey matter in hippocampus in cognitive/ ER tasks
- explains diminished ability to distinguish autobiographical memories in space, time and context
What does a diminished smaller hippocampus help explain?
hippocampal changes might increase the risk that a person will experience fear even in safe contexts
What coping strategies may increase risk of PTSD?
- avoidant thinking about event
- dissociating during/immediately after event
What are 2 protective factors against PTSD?
- Strong social support
- Good cognitive (intellectual) ability to ‘make sense’ of distressing events, eg. rationalise and regulate emotions
What are 4 risk factors in PTSD?
- Lack of social support
- Lack of ability to make sense of event
- Tendency to dissociate during/after event / avoid thinking about event
- Comorbid disorders
- What SSRIs work well for PTSD?
- What doesn’t work well?
- paroxetine (Paxil) and sertraline (Zoloft)
- not benzodiazepines
What psych treatment is more effective than medication or other therapies?
- prolonged exposure therapy
What 3 things does prolonged exposure therapy apart from exposure include?
- psychoeducation
- breathing exercises
- challenging thinking patterns about the fear
What 3 things is prolonged exposure therapy trying to achieve?
- overgeneralized fear response
- beliefs of not being able to get through it/confront it
- negative self-beliefs from trauma, eg. reducing self-blame
What other therapies are often used?
1.VR training - exposure, less good
2. Cognitive Processing Therapy (CPT) to reduce self-blame, guilt and dissociation
3. EMDR therapy - to reprocess memories
What is used when patients are unable to go back to trauma in therapy?
imagined exposure
What are the outcomes for internet based CBT?
internet based CBT is shown to relief immediate acute symptoms of PTSD in short term, but not for long term outcomes
What’s the differences in perception and SNS between anxiety and fear?
- Anxiety is an apprehension over an anticipated problem
- moderate arousal from SNS
- leads to moderate physiological changes in body, eg. tension - Fear is a reaction to immediate danger
- high arousal from SNS
- leads to high physiological changes in body, eg. sweat, fight/flight system activated
What is the benefit to moderate anxiety in tests?
Small degrees of anxiety enhances lab performance tasks (Yerkes & Dodson, 1908)
Has an inverse U-shaped curve when plotted against performance
What are 3 examples of stress questionnaires?
- General Health Questionnaire, 38 languages to detect distress in clinical setting
- Kessler Psychological Distress Scale (10, 6 items) to identity significant levels of psych stress for adults
- Distress Questionnaire-5 (5 questions) based on DSM-5 - better validity than Kessler
What Fight or flight response activities occur in the sympathetic nervous system?
sweating, shaking, heart racing, pupils dilating and improved hearing
cortisol release
unnecessary functions are delayed to conserve and redirect energy to the threat
What are the 3 stages of the General Adaptation Syndrome?
- Alarm - encountering a stressor, body releases adrenaline and cortisol in reaction to threat
- Resistance - respiration and heart rate return to normal, glucose, other hormones high
- Exhaustration - after chronic/prolonged stress body’s defences break down
Causes increased risk to infection/disease
What are moderate health risks to stress?
Headaches, loss of appetite, increased blood pressure, sleep issues, sexual dysfunction, chest pain
What are some severe health risks to stress?
Cardiovascular disease, IBS, diabetes and mental health issues
How does task complexity mediate levels of stress and performance?
Simple tasks - higher levels of stress arousal are needed for optimal performance
Complex tasks - lower levels of stress arousal are needed for optimal performance due to more cognitive resources being utilised
How does type of motor task mediate arousal and performance
- Some sports are better for low levels of arousal that use precision movements, eg. golf
- Sports that use gross motor skills often require higher levels of arousal, eg. football
What is the pre-task stress evaluation of the situation in the challenge or threat model?
this is a cognitive evaluation of the task happens early stress can be viewed as a threat or a challenge
What happens if person perceives stressor as threat and/or challenge?
- If perceived as a threat - the person may feel overwhelmed and have impaired performance, low resources, high demands
- If perceived as a challenge, it is energising and enhances performance, high resources, low demands
What is the process of the threat challenge model?
- Pre-task Stress appraisal (challenge or threat)
- Stress reactivity - physiological responses efficient/inefficient responses from SNS
- Performance - better or worse
- Post-task stress appraisal - coping mechanisms for stress, leading to more or less stress
What does the Stress Buffering Model posit?
There is a relationship between our resources (eg. social support) + psychological distress + our stressors
How do resources influence the relationship between our distress and our stressors?
Higher levels of resources can reduce relationship between distress and stressors and has effect on distress independent of stressors
What is the biological origin of psychological stress?
Limbic system + cerebral cortex
Emotions, cognitions, coping mechanisms, appraisals, arousal and motivations
What is the biological origin of physiological stress?
Autonomic NS and HPA axis -
Metabolism, immune system, cardiovascular activity, digestion and reproduction
What is the biological origin of behavioural stress?
Sympathetic NS
Aggression, running away, freezing, reflexing, facial expressions
What’s the difference between primary and secondary appraisals?
- Primary appraisal - how we evaluate an event/interaction that affects us
- Secondary appraisals - evaluating contextual factors to guide our responses
What 2 things does cognitive appraisal consist of?
How does it create a cognitive cycle?
- A stress pre-task evaluation
- A stress post task evaluation
the post task evaluation, whether good or bad, creates a cycle that influences the next pre-task evaluation and our behaviour and attitudes
When and why does a stress response occur?
- When appraisal perceive threats, stress reactions occur, in pre-task appraisal (modulating our stress) or in post-task appraisal (after outcome we can feel stressed)
- When we perceive it outside our coping ability
What type of coping styles are linked with lower psychological stress?
Problem focused coping styles
What are the 5 different coping styles in PROBLEM FOCUSED stress?
- Active coping - active steps to remove the stressor from our lives
- Planning - thinking about how to cope, strategies, steps, with the stressor when we encounter it
- Suppression of competing activities - focusing on the stressor and putting away other projects
- Restraint coping - waiting until appropriate opportunity and not acting prematurely
- Seeking social support for instrumental reasons - advice, assistance / info
What type of coping styles are linked with higher psychological stress?
Emotion-Focused coping
What are the 5 different coping styles in EMOTION FOCUSED stress?
- Seeking social support for emotional reasons
- Positive reinterpretation
- Acceptance
- Denial
- Turning to religion
What is the main difference in gender with coping styles?
Women score higher than men on EMOTIONAL and AVOIDANT coping styles and lower on RATIONAL and DETACHMENT coping styles
Men have more EMOTIONAL INHIBITION than women
What are the 3 input stress triggers?
- Inputs - stressful events, chronic social and environmental stress, home and work, poverty, social isolation
- Internal - physiological stressors in metabolic syndrome, circadian rhythms
- Memory - major life events / trauma, grief, loss, divorce, abuse, dislocation
What are the 3 output stress responses?
- Behaviour
- Cognition
- Physiology
What is the Holmes-Rahe Social Readjustment Rating Scale?
What do the scores indicate?
A scale of 43 life events that require change and adaptation, eg. death, divorce, jail, fired from job
- Rating experience with life events
<150 = low amounts of life change and lower susceptibility to stress induced health issues
150-299 points - estimated 50% chance of health breakdown in next 2 years
Over 300 points - estimated 80% chance of health breakdown in next 2 years
What is trauma?
Maladaptive reactions following exposure to a traumatic incident that is emotional disturbing or life threatening
What is lifetime prevalence of PTSD?
12% lifetime prevalence, women 2x likely to develop PTSD, 1.7% women and 1.3% of men had lifetime prevalence of PTSD
OUTLINE the four types of trauma
- Acute trauma - one single distressing event
- Chronic trauma - repeated exposure, eg. ongoing abuse, war zones
- Complex trauma - multiple and varied events, often childhood and interpersonal trauma
- Secondary (vicarious) - hearing/witnessing an event, common in healthcare first-responders/therapists
What do you need to have Emotional adjustment disorder (DSM-5)?
- Event is seen as distressing but is not traumatic
- Clinically significant symptoms where the reaction of the event is out of proportion to the severity of the stressor OR
Significant impairment in an area of functioning
Reaction to event occurs within 3 months, and then lasts no longer than 6 months
Not meeting a representative of normal bereavement, eg. grief/loss
What specifiers are added to emotional adjustment disorder?
Specifiers (additional info + disorder) - eg. adjustment disorder + depression, anxiety, conduct disturbance and emotional regulation
What do you need to have acute stress disorder?
- Three days - 1 month
- Significant distress and impaired functioning
Intrusive symptoms, eg. nightmares, dissociation, flashbacks, psycho/physio reactions to cues to the event
Negative mood - inability to experience positive emotions
Dissociative symptoms - altered sense of reality, struggle with remembering event
Avoidance symptoms - avoiding memories/reminders of event
Arousal symptoms - sleep difficulty, hypervigilance, irritability, anger,
Whats the difference between ASD and PTSD?
ASD has broader criteria than PTSD,
+ focus on dissociative symptoms
PTSD lasts more than one month - years, focus on avoidance, changes in cognition and mood
What are the two disadvantages of ASD?
- ASD could stigmatise very common short term reactions to serious traumas, as many report significant symptoms after 1 month of assault
- ASD has low predictive validity for those to develop PTSD
What is the one advantage of ASD?
identifying and treating symptoms of ASD could help prevent PTSD
What symptoms do you need in PTSD?
Meet at least 1 intrusive symptom: re-experiencing the event, dreams, nightmares, intrusive memories provoked by minor sensory cues, eg. smell, similar resemblance to someone, physical locations
Meet at least 1 avoidant symptom: of stimuli associated with event (often fails)
Meet at least 2 negative mood symptoms: - inability to feel happy feelings, detachment, social withdrawal, distrust of others and the world, self-blame, disordered cognitions
Meet at least 2 arousal and reactivity symptoms - always on guard, monitoring environment, heightened physiological responses to small events, jumpiness, sleep issues, self-destructive behaviour
What THREE specifiers are included in PTSD?
*think of what could also occur in severe trauma
- Depersonalisation - persistent feeling of being detached from ones body and mental processes, dream-like state
- Derealisation - persistent experience of unreality of surroundings of outside world seems unreal/dream like
- Delayed expression - instance where full diagnostic criteria not met until at least 6 months after the event
What are examples of maladaptive appraisals that influence the onset of ASD and PTSD?
- Self blame thoughts “I was weak so this happened to me”
- Individual feelings of hopelessness “I am pathetic I cannot cope”
- Environmental feelings of hopelessness “I do not feel safe in this space/with these people”
What 2 stress neurotransmitters influence the fear conditioned response?
Noradrenaline & adrenaline
- hyperawareness, startle responses, being on edge
“N - A” - “Naaaaaaa!!!”
What 3 things is the hyperactive amygdala involved in in PTSD?
- Fear conditioning: neutral stimuli linked to trauma led to exaggerated responses in PTSD
- Emotional memory: emotional dysregulation & memories add to vivid intrusiveness
- Hypervigilance: become conditionally related to traumatic event
How is the amygdala linked with the hippocampus in PTSD?
because the amygdala disrupts contextualisation of memories from hippocampus and regulation of emotions in trauma
What 4 things is the diminished hippocampus involved in in PTSD?
- Disrupts memory encoding and retrieval of trauma
- Disrupts emotional regulation
- Disrupts contextual processing
- temporal disruption leads to difficulty distinguishing past/present
- leads to intrusive recollections and detaches them from original context
- Disrupts neuroplasticity
- neurogenetic and dendritic branching, impacting ability to recover from trauma
How is the hippocampus linked with the amgydala?
Disrupts interactions with amygdala through its reduced hippocampal volume and function and leds to exacerbating activity in the amygdala
What’s the prevalence of adverse childhood experiences in the US?
62.5% of US adults have at least one ACE, 25% have at least 3 ACE
What 3 effects does ACEs have on a person?
- damage to neurodevelopment
- heightens risk of chronic health problems, eg. chronic obstructive pulmonary disease
- heightens risk of health risk behaviours, eg. smoking/drugs
When does toxic stress occur?
from strong, frequent and prolonged adversarial experiences
What’s the critical period of children’s development?
around the first 1000 days from birth
What 2 things can trauma impact in critical period of child’s development?
- short term memory
- emotional regulation
What neurochemicals are linked with poor neurological development in prolonged exposure?
- cortisol
- adrenaline
How long does ACEs affect people?
People with trauma carry markers of stress, eg. increased cortisol in the brain long after their ACEs occurred, and as trauma varies in duration and intensity for individuals, it resulting in different brain chemistry across individuals
- often struggle with mood disorders relating to emotional regulation, eg. depression and anxiety
Identify and provide examples of one for Specialist Winski:
- intrusive symptom
- avoidance symptom
- Intrusive symptom - recalling vivid memories from war, nightmares
- Avoidance symptom - avoiding people and social events, reluctance to acknowledge and discuss the duration and severity of symptoms, reluctance to answer questions
What are the limitations of diagnostic categories and how they may have impacted Specialist Winski’s resistance to the proposed diagnosis?
His reluctance to acknowledge and discuss the duration and severity of symptoms may impact him receiving a diagnosis, even though they are most likely the product of PTSD
Explain an alternative framework of psychopathology could be used to discuss Specialist Winski’s symptoms during a clinical interview
- A cultural framework interview (CFI)
- CFI provides insight into the clients perspective of their own illness
- “Language matching” - clinician is encouraged to use the same words as patient to build rapport
- considers how the cultural context could influence how the patient thinks, feels and interprets their symptoms
- assess patient’s perceived needs, and if they perceive differences/misunderstandings between them and the clinician
