PTSD Flashcards
over everything else, ____ is needed in a PTSD diagnosis
trauma
trauma and life prevalence
- necessary (not sufficient) for PTSD diagnosis
- experience or witness of a life threatening event
- life prevalence: 60.7% for men, 51.2% for women
lifetime prevalence of ptsd and ptsd specific traumatized groups
- 10.4% women, 6.8% men
- specific: 9/11 survivors (20%), BC residential school survivors (64%), sexual assault survivors (20.2%)
DSM ptsd criteria for trauma
- exposure to actual/threatened death, serious injury, or sexual violence in 1+ ways: direct experience, witnessing event in person as it occurs, learning that event occurred to close friend/family (violent or accidental), experience repeated/extreme exposure to aversive details of trauma event (first responders)
DSM criteria for ptsd diagnosis
- exposure to trauma
- intrusion (persistent/distressing memories, nightmares, flashbacks, intense psychological/physiological responses to trauma cues)
- avoidance (effortful avoidance of int/ext cues and reminders)
- negative cognition and mood (numbing, guilt, anger, fear, neg self/other/world beliefs
- arousal and reactivity (sleep difficulty concentration impairment, exaggerated startle, hyper vigilance, irritability/aggressively, reckless or self-destructive behaviour
- duration: 1 month
traumatic grief
- guilt
- not yet in DSM
- PTSD x depression
- death of a loved one causing extreme distress
PTSD vs acute stress disorder
- PTSD: at least 1 month duration
- Acute stress disorder: 3 days-1 month duration
what are factors that make a person exposed to trauma higher risk of developing ptsd
- pre-trauma: intergen trauma, anx sensitivity, characteristics/vulnerabilities of the individual and environment preceded trauma exposure
- peri-trauma: characteristics of trauma and enviro and individual response to trauma
- post-trauma: individual/enviro factors that occur after trauma
ex of pre trauma factors
- vulnerabilities
- lower SES
- lower intelligence
- childhood trauma
- prior adult/child trauma
- prior worse adjustment
ex of peri trauma factors
- trauma severity and reaction of trauma
- perceived life threat
- peri trauma emotions
ex of post trauma factors
- ongoing life stress
- lack of social support
- neg cognitions
conditioning and extinction model of PTSD
- genetic and environmental factors> trauma> impaired extinction learning> PSTD
- heightened fear response, fear generalization, attentional bias to threat, avoidance, stronger link between fear/trauma
In a meta analysis on the risk factors of ptsd, what pre/peri/post trauma factors were found to have the largest effect sizes
- biggest: lack of social support
- others: life stress, trauma severity
What systems make up the accelerator break model of ptsd
- break → cortical (later evolved, larger in humans than other mammals) which dampens fear response
- accelerator → limbic
what is involved in the break/cortical system for ptsd
- dlPFC (dorsolateral prefrontal cortex-cognitive regulation)
- vmPFC/IL (ventromedial prefrontal cortex - threat inhibition)
- aACC/PL (dorsal anterior cingulate - threat expression)
what is involved in the accelerator/limbic system for ptsd
- amygdala (threat learning)
- hippocampus (context-specific threat)
- hypothalamus/brainstem
reduced top down control of the amygala results in _________ to fearful stimuli and impaired _________
hyper-responsiveness, fear extinction
cognitive model of PTSD
- pre-trauma: beliefs abt self, world, others +coping styles
> peri-trauma: characteristics of the trauma, cognitive processing during the trauma
> negative appraisals of trauma and sequelae (ie self blame/doubt) AND/OR > trauma memory (fragmented, not integrated into autobiographical memory)
> sense of current threat/PTSD symptoms
>coping strategies intended to control ongoing threat/manage symptoms
what are common (short term not therapy related) coping strategies used by people with PTSD
- avoidance
- safety behaviours
- rumination
examples of negative appraisals of trauma
- nowhere is safe
- i attract disaster
- i am a victim
- i brought this on myself
- nobody is there for me
in people w ptsd, intentional recall is _____ and unintentional recall is ____
- intentional is low (memory paradox, trouble bringing to mind/talking abt it, poorly integrated into autobiographical memory base, no clear context for time, place, other)
- unintentional is vivid (flashbacks as if there, despite recently learned contradicting info, triggered by wide range of stim)
what are involuntary and intrusive memories referred to as
flashbacks
PE for treatment of PTSD
- Prolonged exposure
- exposure to trauma-related memories and situations
- helps with emotional engagement (active trauma memory), habituation, and cognitive restructuring
prolonged exposure involves exposure to trauma-related memories, or ______ exposure and exposure to trauma-related situations, or ______ exposure
- imaginal (repeatedly tell story of trauma as vivid and detailed as possible
- in vivo
CPT for PTSD
- cognitive processing therapy
- write a narrative account of the trauma and read it a loud
- identify and challenge problematic thoughts
- ex negative appraisals, hindsight bias, self blame, just world violations
CISD (PSTD)
- critical incident stress debriefing
- 3-4 hour group intervention for victims 24-48 hours after trauma
- educate ppl on and normalize stress reactions
- coping strategies
- promote emotional processing and sharing
primary vs secondary trauma victims
- primary: accident/SA/natural disaster victims (‘average ppl’)
- secondary: first responders/emerg service ppl (mandated CISD)
efficacy of CISD
- primary victims: worse off
- secondary: higher levels of stress
what is the word for when treatment makes symptoms etc worse and not better
iatrogenic
MDMA and PTSD
- encourages serotonin release by binding to presynaptic serotonin transporters
- also helps bond oxytocin chemicals
- in humans: reduces amydala activity to negative stimuli, also can help recall while lessening negative emotions and hyperarousal
- study showed a significant decrease larger than placebo group when used w exposure therapy
