PTSD Flashcards
What is Trauma
experiencing or witnessing a life-threatening event
What is the diagnostic criteria for PTSD
- exposure to a traumatic event
- one intrusion symptom
- one avoidance symptom
- two+ negative cognitions and mood
- two arousals and reactivity
what is the duration required to be diagnosed with PTSD
at least one month
Provide examples of intrusion symptoms
- persistent and distressing memories
- recurrent nightmares
- dissociative reactions
- intense psychological and physiological reaction in response to trauma cues
Provide an example of a negative cognition and mood symptom
- guilt, anger, fear
- numbing and amnesia of positive feelings
- self-blame
- blame of others
- negative beliefs of self, others, and world
Provide an example of arousal and reactivity symptoms
- sleep difficulties
- concentration impairment
- hypervigilance
- aggressive or irritable behaviour
- recklessness
- self-destructive behaviour
What is PTSD with delayed expression
when the diagnostic threshold is not met until at least 6 months after the traumatic event
What is acute PTSD
PTSD with a duration of 3 days to one month
What is PTSD subtype for children
- do not display as many avoidance and mood symptoms
- more behaviorally anchored
What is PTSD with prominent dissociative symptoms
- meet criteria of PTSD
- experience depersonalization or derealization
What is the internalizing subtype of PTSD
those with a tendency to direct distress inwardly through shame and self-deprecation
What is the externalizing subtype of PTSD
those with a tendency to express distress outwardly by blaming others and acting out
What is the lifetime prevalence of PTSD
~7%
What is the gender ratio for PTSD
3:1
women 3x more likely to have a diagnosis
what is the gender ratio is veteran populations for PTSD
1:1
What disorders is PTSD frequently comorbid with
- MDD
- GAD
- Alcohol and Substance abuse
What does it mean when it is said: “ exposure to trauma is a necessary but not a sufficient cause of PTSD.”
Explains that some people are more at risk for developing PTSD in the face of trauma than others
What are the demographic risk factors for the development of PTSD
- female gender
- lower levels of income
- lower levels of education
- divorced/widowed
- minority status
What are the psychological risk factors for the development of PTSD
- family psychiatric history
- intergenerational trauma
What are the environmental risk factors for the development of PTSD
- childhood abuse
- exposure to violence
- adverse childhood experiences
What are pre-traumatic risk factors
characteristics of the individual and their environment that preceded the trauma and impact their response to it
What are peri-traumatic risk factors
characteristics of the trauma, the individual, and their environment that impact the response to the trauma
What are post-traumatic risk factors
characteristics of the individual and their environment that occur after the trauma and impact their response to it
What are examples of per-traumatic risk factors
- assault
- sudden death of a loved one
What are examples of post-traumatic risk factors
- lack of social support
- additional stressful life events
What are resilience factors related to PTSD
- spirituality
- connections to family and friends
- close bonds as a result of shared history and experiences or culture
How does the Nonadrenigc system act as a risk factor for PTSD
heightened norepinephrine reactivity is an important marker for PTSD
How does the HPA axis act as a risk factor for PTSD
- those with PTSD have higher corticotrophin-releasing factors in spinal fluid
- promotes the release of cortisol (more stress)
How is GABA a risk factor for PTSD
- those with PTSD were found to have reduced benzodiazepine receptor density in the prefrontal cortex
- lower plasma GABA levels
How is Serontonin a risk factor for PTSD
those with PTSD found to have decreased platelet serotonin uptake
How is Dopamine a risk factor for PTSD
those with PTSD found to have excessive dopamine release
What brain regions were implicated in PTSD
- amygdala
- medial prefrontal cortex
- anterior cingulate cortex
- hippocampus
How did PTSD impact amygdala responsiveness
positive correlation between the structures with heightened activity in the amygdala
How did PTSD impact mPFC responsiveness
negative correlation with less activity in the mPFC
What brain structures showed decreased volume in PTSD
hippocampus
What is the dual representation theory of PTSD
accounts for the phenomena of flashbacks, intrusive memories and fragmented memory
What does the dual representation theory of PTSD say about memory storage
memories of a traumatic experiecne can be stored in two ways:
1. verbally accessible memories
2. situationally accessible memories
What are verbally accessible memories
Information the individual can attend to before, during and after the trauma & can be transferred into long term memory
What are situationally accessible memories
memories that contain nonconscious and nonverbal information about the trauma & cannot be accessed or altered deliberately
How are situational accessible memories triggered
flashbacks, nightmares, intrusive images
What are primary emotions? provide examples
emotions conditioned during the traumatic event
Examples:
1. fear
2. helplessness
3. horror
What are secondary emotions? provide examples
emotions that result from remembering the event
examples:
1. anger
2. shame
3. sadness
What is the apparent paradox of memory
Memory that is encoded during the trauma is integrated poorly with other memories. This explains why people with PTSD have poor autobiographical memory of the event but may be triggered to have memory fragments
What are memory fragments
Memories that have a her-and-now quality (no time context) and do not have appropriate post-trauma appraisals
Why does the paradox of memory occur
Intentional memory recall is poor, so it is hard to recall a complete trauma memory.
But unintentional recall is vivid, so an individual may have flashbacks that feel as though they are occurring in the present - not reliable and may contradict learned information.
What are maladaptive coping strategies
coping strategies that increase symptoms, prevent change in negative appraisals, and prevent change in trauma memory
What are examples of maladaptive coping strategies
- though suppression
- safety behaviours
- avoidance
- drugs and alcohol
- rumination
- dissociation
What are altered cognitions
When trauma victims integrate their traumatic events into their overall conceptual systems (schemas, scripts, etc.)
what are the three major assumptions that may be shattered in the face of a traumatic event
- personal invulnerability
- the world as a meaningful and predictable place
- self as positive or worthy
what are six major areas of functioning that can be disrupted by traumatic victimization
- agency
- safety
- trust
- power/control
- esteem
- intimacy
What is the two-factor theory?
Proposed that anxiety is first acquired through classical conditioning
anxiety is then maintained because the person escapes or avoids the conditioned stimuli in an attempt to stop the negative emotions
What is the pathological fear structure theory of PTSD
Following traumatic events, a fear structure develops that is composed of fear stimuli and responses
the structure can be activated by the environment and trigger false alarms and axiety. fear of false alarms ignites avoidance behaviour
What is the conservation of resources theory
Stress occurs when resources are threatened. Traumatic stress results in the sudden and rapid loss of resources
What is the goal of CBT of PTSD
- restructure maladaptive thoughts
- integrate trauma memory into autobiographical memory
- replace maladaptive behaviours with adaptive ones
what is prolonged exposure treatment
involves both imaginal and in vivo exposure techniques
What is imaginal exposure
exposure of the trauma memory through story telling
What are the mechanisms of imaginal exposure
- promote habituation
- reduce anxiety
- confront memory blocks
- incorporate safety information
- differentiate memory
- modify negative evaluations
What is in vivo exposure
exposure to trauma-related stimuli in the environment
What are the mechanisms of in vivo exposure
- emotional engagement
- habituation
- cognitive restructuring
how does prolonged exposure treatment work
A person much activate the trauma, block the negative reinforcement, habituate to anxiety, and disconfirm maladaptive beliefs
Through this, anxiety diminishes - as anxiety diminishes, they can change their beliefs
What is cognitive processing therapy
uses cognitive approaches with progressive worksheets to teach clients to become their own therapists
What is critical incident stress debriefing
group intervention to educate individuals about stress reactions and ways of coping
What are the tenets of psychological first aid
- victims demonstrate resilience and services should be provided to those requesting assistance
- for those who ask for help the provision of basic support might help reduce distress
What are the components of psychological first aid
- contact and engagement
- stabilization
- needs assessment
- safety planning
- practical assistance
- connection with social support
- information on coping
- linkage with professional services
What is the frontline pharmacological treatment for PTSD
SSRIs
