Prevention of PTSD

Question 1

What is the definition of trauma?

Answer 1

A deeply distressing or disturbing experience

Question 2

What are the criteria for PTSD?

Answer 2

A traumatic event involves ‘’ exposure to actual or threatened death, serious injury or sexual violence’’

• Direct exposure: self, important other
• Indirect exposure: witnessing, repeated confrontation to details (i.e., not through media unless occupationally)

Question 3

What are causes for PTSD with men and women

Answer 3

Men > women: physical violence, accidents, disasters, combat, rescue
Women > men: sexual violence, life-threatening illness, loss of child

Question 4

What are the two systems to activate fight/flight?

Answer 4

SAM (sympatho-adrenomedullary pathway)
* Within seconds, stimulates the adrenal glands to produce adrenaline to activate flight or figth

HPA (hypothalamus - pituitary - adrenal axis)
* After minutes, stimulates production of cortisol to suppress immune system to prolong the stress response, sufficient cortisol levels then provide negative feedback to the pituitary to decrease cortisol production and restore balance

Question 5

Are acute stress reactions normal?

Answer 5

Yes, but body and mind need time to recover
What can acute stress reactions be?
* Recurrent images, 
* Urge to avoid reminders
* Heightened emotional state
* Numbness 
* Watchfulness
* Irritability 
* Anger 
* Etc.

Question 6

What are risk factors for PTSD?

Answer 6

PRE trauma

• Genetic vulnerability
• Being female
• Low age
• Intelligence
• Low SES
• Prior trauma
• Prior psychiatric symptoms

PERI trauma

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

POST trauma

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

Question 7

What are some possibilities within prevention of PTSD?

Answer 7

• Distinct stressor, clear onset point
• Early symptoms (mostly) develop within days of trauma exposure
• Organised professional response

?? theory-informed vs practice-informed ??

Question 8

Is psychological debriefing part of universal prevention an effective prevention method?

Answer 8

It is a way where victims tell about their experiences and emotions in detail

It is not effective, it is even harmful in cases of high arousal symptoms

Question 9

What aspects are part of the Guidelines Psychological First Aid?

Answer 9

• Psycho education
• Material and practical support
• Emphasis on distraction relaxation, rest
• Involvement of social network

Persons w/ high early stress symptoms benefitted most from the program

Question 10

Methods within targeted prevention of PTSD?

Answer 10

Step 1: Screening for PTSD

• Known risk factors (gender, SES, previous trauma, previous psypath)
• Early symptoms

Step 2: Early intervention

• (brief) psychotherapy within 1st month
• Self-guided e-health

Question 11

A way to screen for psychotrauma via app?

Answer 11

Smart Assessment on your Mobile (SAM)

Question 12

Pharmacotherapy for prevention?

Answer 12

No firm evidence for effectiveness

Question 13

Early treatment for PTSD?

Answer 13

Expert guidelines (GGZ standaard, international society for traumatic stress studies, national institute for clinical excellence):

• Trauma focused psychotherapy
• trauma-focused CBT)
• EMD