PTSD

Question 1

over everything else, ____ is needed in a PTSD diagnosis

Answer 1

trauma

Question 2

trauma and life prevalence

Answer 2

• necessary (not sufficient) for PTSD diagnosis
• experience or witness of a life threatening event
• life prevalence: 60.7% for men, 51.2% for women

Question 3

lifetime prevalence of ptsd and ptsd specific traumatized groups

Answer 3

• 10.4% women, 6.8% men
• specific: 9/11 survivors (20%), BC residential school survivors (64%), sexual assault survivors (20.2%)

Question 4

DSM ptsd criteria for trauma

Answer 4

• 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)

Question 5

DSM criteria for ptsd diagnosis

Answer 5

• 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

Question 6

traumatic grief

Answer 6

• guilt
• not yet in DSM
• PTSD x depression
• death of a loved one causing extreme distress

Question 7

PTSD vs acute stress disorder

Answer 7

• PTSD: at least 1 month duration
• Acute stress disorder: 3 days-1 month duration

Question 8

what are factors that make a person exposed to trauma higher risk of developing ptsd

Answer 8

• 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

Question 9

ex of pre trauma factors

Answer 9

• vulnerabilities
• lower SES
• lower intelligence
• childhood trauma
• prior adult/child trauma
• prior worse adjustment

Question 10

ex of peri trauma factors

Answer 10

• trauma severity and reaction of trauma
• perceived life threat
• peri trauma emotions

Question 11

ex of post trauma factors

Answer 11

• ongoing life stress
• lack of social support
• neg cognitions

Question 12

conditioning and extinction model of PTSD

Answer 12

• genetic and environmental factors> trauma> impaired extinction learning> PSTD
• heightened fear response, fear generalization, attentional bias to threat, avoidance, stronger link between fear/trauma

Question 13

In a meta analysis on the risk factors of ptsd, what pre/peri/post trauma factors were found to have the largest effect sizes

Answer 13

• biggest: lack of social support
• others: life stress, trauma severity

Question 14

What systems make up the accelerator break model of ptsd

Answer 14

• break → cortical (later evolved, larger in humans than other mammals) which dampens fear response
• accelerator → limbic

Question 15

what is involved in the break/cortical system for ptsd

Answer 15

• dlPFC (dorsolateral prefrontal cortex-cognitive regulation)
• vmPFC/IL (ventromedial prefrontal cortex - threat inhibition)
• aACC/PL (dorsal anterior cingulate - threat expression)

Question 16

what is involved in the accelerator/limbic system for ptsd

Answer 16

• amygdala (threat learning)
• hippocampus (context-specific threat)
• hypothalamus/brainstem

Question 17

reduced top down control of the amygala results in _________ to fearful stimuli and impaired _________

Answer 17

hyper-responsiveness, fear extinction

Question 18

cognitive model of PTSD

Answer 18

• 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

Question 19

what are common (short term not therapy related) coping strategies used by people with PTSD

Answer 19

• avoidance
• safety behaviours
• rumination

Question 20

examples of negative appraisals of trauma

Answer 20

• nowhere is safe
• i attract disaster
• i am a victim
• i brought this on myself
• nobody is there for me

Question 21

in people w ptsd, intentional recall is _____ and unintentional recall is ____

Answer 21

• 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)

Question 22

what are involuntary and intrusive memories referred to as

Answer 22

flashbacks

Question 23

PE for treatment of PTSD

Answer 23

• Prolonged exposure
• exposure to trauma-related memories and situations
• helps with emotional engagement (active trauma memory), habituation, and cognitive restructuring

Question 24

prolonged exposure involves exposure to trauma-related memories, or ______ exposure and exposure to trauma-related situations, or ______ exposure

Answer 24

• imaginal (repeatedly tell story of trauma as vivid and detailed as possible
• in vivo

Question 25

CPT for PTSD

Answer 25

• 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

Question 26

CISD (PSTD)

Answer 26

• 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

Question 27

primary vs secondary trauma victims

Answer 27

• primary: accident/SA/natural disaster victims (‘average ppl’)
• secondary: first responders/emerg service ppl (mandated CISD)

Question 28

efficacy of CISD

Answer 28

• primary victims: worse off
• secondary: higher levels of stress

Question 29

what is the word for when treatment makes symptoms etc worse and not better

Answer 29

iatrogenic

Question 30

MDMA and PTSD

Answer 30

• 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