Module 3: Trauma Flashcards
What makes an event traumatic (Giller)?
- it overwhelms the individual’s ability to cope
- it is perceived as threatening
- it exceeds the ability to integrate the emotional experience into schemas
What are the typical reactions to trauma?
- physical,
- behavioral
- cognitive
- emotional
Types of traumatic events
- Acts of mass violence
- Natural disasters
- Acts of interpersonal violence
- Accidents
- Psychological abuse
- Deprivation of human rights
- Illness/Injury and its treatment
What is vicarious trauma?
- the individual does not directly experience the traumatic event, but feels traumatized in response to hearing about or seeing images (e.g., photos or videos) of the event.
- can also be from witnessing family/friends go through an event
What factors increase risk of developing vicarious trauma?
o organisational environment
o the therapist’s work experience
o interactions with clients
What is the strongest risk factor of vicarious trauma?
sense of isolsation both at work and home
How to protect psychologists from vicarious trauma?
CARE:
- Connection (managers, friends)
- Awareness (of symptoms)
- Resourcing (work-life balance)
- Effectiveness (training and supervision)
Assumptive World Model
- Janoff Bulman
- We live with 3 underpinning sets of assumptions:
1. benevolent world
2. meaningful world
3. worthiness of self. - these can become shattered and trauma leads to new world views
- Dual Representation Model
- Brewin
- information processing occurs at two levels from the outset of the traumatic event
- Verbally accessible memories (VAM): superficial level, can be accessed as desired, explicit memories.
- Situationally accessible memories (SAM): unconscious level, cannot be deliberately accessed by the victim, automatically triggered
Psychodynamic model - Freud
Traumatic neuroses
Failure of the pleasure principle
Wounding of the mind
Psychodynamic model - Horowitz
Drive towards completion
Active memory storage
Processing overload
Humanistic/existential models
- Considers how the client’s perceived world is changed by the trauma and sees that trauma divides a person’s life into: 3 Phenomenological ‘movements’: Before, during and after trauma
2 major concepts:
1. Emotional processing conflict model
(unfinished business to resolve)
Trauma-related emotion schemes model
(changes in the client’s view of the world, others and self)
Biological impact of trauma:
- attempting to keep homeostasis through allostasis
- neurotransmitters: catecholamines (norepinephrine, epinephrine and dopamine) and glucocorticoids (cortisol).
- emotional loop between the hypothalamus and the amygdala (allostatic load)
What percentage of Australians will experience PTSD in 12 months?
4.4% / 1 million
Life time prevalence of PTSD in Aus?
7.2%
What gender is more likely to experience PTSD?
Women 2 x more likely
What is the military rate of PTSD?
8.3% per 12 months
What are the neurological factors in PTSD?
- endocrine factors
- nuerochemistry
- brain circuitry
What are endocrine factors of PTSD?
- abnormal cortisol and thyroid regulation
- dysregulation of HPA axis
- hypocortisolism (low cortisol)
- HPT axis: elevated levels of tri-odo-thyronine (T3 - anxiety) and thyroxine (T4) in trauma victims
What are neurochemistry factors of PTSD?
Abnormal regulation of:
- catecholamine (dopamine, norepinephrine and epinephrine)
- serotonin
- amino acid (GABA and glutamate),
- peptide,
- opiod neurotransmitters.
What does norepinephrine do PTSD:
- central in the brain’s response to stress,
- norepinephrine and corticotropin-releasing hormone interact in a feed-forward circuit of the amygdala, hypothalamus and locus ceruleus to increase fear conditioning
What does Elevated catecholamines contribute to?
sustained hyperactivity within the autonomic sympathetic nervous system, thereby increasing physiological markers of stress
What does serotonin contribute to? PTSD:
impulsivity, hostility, aggression, depression and suicidality
What does Impaired GABA-benzodiazepine receptors contribute to? PTSD:
may lessen GABA’s ability to reduce the physiological response to stress.
What does glutamate contribute to? PTSD:
crucial role in memory encoding and extremely high levels of glutamate can be excitotoxic
What does Neuropeptide Y contribute to? PTSD:
thought to inhibit corticotropin-releasing hormone and reduce norepinephrine release, therefore reducing activation of the sympathetic nervous system.
What may increased endogenous opioid neurotransmitter activity do?
may play a role in numbing and dissociation.
What are Brain circuitry factors of PTSD?
- hippocampus, amygdala, and cortical regions
- Reduced hippocampal volume (adults only)
- abnormalities in the corpus callosum (kids and teens only)
- hyper-responsiveness in amygdala
- Decreased volume of prefrontal cortex
Changes of PTSD in DSM-5
o a tighter definition of traumatic events, exclusion of electronic exposure as a source of trauma
o removal of the criteria requiring intense emotional response (e.g., fear, helplessness or horror)
o inclusion of 4 rather than 3 symptom clusters, encompassing negative changes in cognition and mood, including persistent blame of self or others
DSM-5 elements of PTSD
o A. Exposure to actual or threatened death, serious injury, or sexual violence
o B. Intrusion symptoms associated with event(s)
o C. Persistent avoidance of associated stimuli
o D. Negative alterations in cognitions and mood
o E. Marked alterations in arousal and reactivity
o F. more than 1 month.
o G. clinically significant distress or impairment in social, occupational, or other important areas of functioning.
o H. The disturbance is not attributable to the physiological effects of a substance or another medical condition.
What % of people with PTSD have another psychiatric diagnosis?
80-85%
What is first line of treatment for PTSD?
Psychological treatment
Creamer and Carty (2016) suggest six general phases of CBT for people with PTSD:
o a) stabilisation and engagement, o b) psychoeducation, o c) symptom management, o d) prolonged exposure, o e) cognitive restructuring, o f) relapse prevention.
Stages of EMDR:
Full history Preparation Commencement of processing Eye movement Memory access Tension assessment Assessment of intervention- Review
Prevalence of PTSD in Emergency Service Workers
- Police: 7-26%
- Fire fighters: 11-32% (7% high levels of symptoms, 68% moderate symptoms)
- Ambulance: 15-37%
First Responder stress mediators:
- Social support
- Sense of control
- First responder resilience (self-compassion)
- Psychoeducation on responder self-care
What are the three concepts Critical Incident stress management (CISM) is based on:
- potentiating pairings (combining interventions)
- catalytic consequences (sequencing interventions),
- polythetic nature of a crisis (tailoring interventions to a situation)
Whats the difference between cultural syndromes and cultural idioms of distress?
- Cultural syndromes – cluster of symptoms and attributions that tend to happen in particular cultural groups
- Cultural idioms of distress – how people describe and express distress
How many refugees have PTSD?
1/3
What are the components of culturally competent care?
o Building cultural knowledge
o Perceptions of mental health
o Understanding cultural barriers
o Valuing cultural communities
What are the CBT adaptations of traumatised refugees?
o Extending the psycho-educational component of therapy.
o Explore the symptoms of PTSD in the clients’ own words.
o Explore the impact of trauma on role functioning-
o Involve the client in therapeutic goal setting to create a collaborative connection
o Obtain supervision.
what is ethnic terrorism?
Based upon grievances, usually long-held, by ethnic minorities in an attempt to defend or create a distinct identity and ultimately create national liberation.
Examples include Tamil Liberation Tigers in Sri Lanka and Hamas.
what is ideological terrorism?
Protest against the dominant political, economic and social system based upon political principles or religious doctrine.
Examples include The Order (Neo-nazi group in the USA) and Hezbollah in Lebanon.
what is state based therapy?
2 forms:
1. State terrorism - the use of terror by a government against its own citizens” (Nazi Germany, Communist China)
State-sponsored terrorism: occurs when a country’s foreign policy supports a terrorist organisation through the provision of money, arms, political allegiance etc. (iran providing safe haven to some members of Al- Qaida)
what is terror management theory (TMT)?
o provides a foundation for understanding how social influences create attitudes that may lead to terrorism
o ‘existential anxiety’- the fear that humans experience about their vulnerability and eventual mortality
o Social psych theory (meaningful world, benevolent world, worthiness of individual)
What does terrorism do to the brain?
- fear alters the balance in the nervous system, bringing forth the sympathetic nervous system to a dominant position, preparing the body to fight or flee and activating stress hormones such as adrenaline (epinephrine) and cortisol
- activates amygdala
What are the types of terrorism anxiety?
o 1. Anxiety relating to being physically harmed;
o 2. Political fear, relating to anxiety about the social consequences that communal fear generates by targeting and demonising one element of society;
o 3. Fear of losing civil liberties, and;
o 4. A sense of insecurity brought about by feelings of reduced safety
what is Post Traumatic Growth (PTG)?
- Posited on the notion that a persons’ struggle with negative and traumatic events can lead to positive outcomes
- Find the good in the bad
- Strongest kind of growth
- 3 main changes:
o In self-perception, in relationships and in life philosophy (mixed for life philosophy)
What is the Theory of Posttraumatic Growth -
(Calhoun & Tedeschi)
o proposes that traumatic events challenge people’s underlying assumptions, requiring the person to engage in the cognitive processes of rumination and narrative construction to accommodate the changes the trauma has induced.
what is the Theory of Cognitive Adaptation of PTG?
(Taylor, 1983),
o positions PTG as a coping process and involves three cognitive elements: the search for meaning, mastery and self-enhancement.
o It is acknowledged that these cognitive processes may be illusory, but not all cognitive illusions are negative and contribute to mental illness, but rather can be adaptive.
what is the Janus Face Model of PTG?
- proposes that PTG is best conceptualised as both an outcome (i.e., concrete, measurable, positive changes) and a coping process (i.e., engaging in illusory thinking)
