PTSD

Question 1

DSM Definition of Trauma

Answer 1

→ an event where a person is exposed to death, threatened death, actual or threatened serious injury or actual or threatened sexual violence

• Direct exposure
• Witnessing, in person
• Indirectly (through friend etc)
• Related or extreme indirect exposure to aversive details of the event usually in the course of professional duties

Question 2

Basic Criteria for a DSM Classification of PTSD

Answer 2

• Exposure to actual or threatened death, serious injury or sexual violence
• Intrusion Symptoms (1 or more)
• Persistent avoidance of internal or external stimuli associated with the trauma (1 or more)
• Negative alterations in cognition or mood (2 or more)
• Alterations in arousal or reactivity (2 or more)
• Duration more than one month
• Not related to another condition

Question 3

Intrusion (Category of PTSD Symptoms)

Answer 3

• Recurrent, involuntary and intrusive memories
• Traumatic nightmares
• Flashbacks
• Psychological distress to reminders
• Physiological distress to reminders

Question 4

Persistent Avoidance of Internal or External Stimuli Associated With the Trauma (PTSD Symptoms)

Answer 4

• Avoidance of trauma-related
• Thoughts or feelings
• External reminders (e.g significant objects within the events)

Question 5

Negative Alterations in Cognition or Mood (Category of PTSD Symptoms)

Answer 5

• Inability to recall features of traumatic event
• Persistent negative beliefs and expectations about self and world
• Negative trauma-related emotions (fear, horror, guilt)
• Diminished interest in activities
• Alienation from others
• Constricted affect (unable to experience strong emotions, emotional numbing)

Question 6

PTSD Alterations in Arousal or Reactivity Symptoms

Answer 6

• Irritability or aggressive behaviour
• Self-destructive or reckless behaviour
• Hypervigilance
• Problems in concentration
  Sleep disturbance

Question 7

PTSD Prevalence

Answer 7

→ lifetime prevalence in general population: 7-8%
→ lifetime prevalence in trauma-exposed individuals

• Women - 20.4%
• Men - 8.2%

Question 8

PTSD and the Inequality of Traumatic Events

Answer 8

• Human–instigated trauma is much more likely to give rise to PTSD rather than something that is accidental, because there is the threat that it can happen again
• In initial weeks, most people suffer trauma-related symptoms
• However, for most people, these reduce with time
• Transient stress after trauma is normal and understandable .. it only becomes a disorder if it persists and causes impairment

Question 9

Heterogeneity to the PTSD Course

Answer 9

• Chronic group – went up and eventually lessened
• Worsening group - went high then crashed
• Resilient - went low
• Recovered - consistently lowered
• Delayed - consistently increased
• Therefore PTSD varies on the type, person etc

*requires more context

Question 10

Acute Stress Disorder

Answer 10

→ less specific of PTSD

→ was meant to be used to prevent the onset of PTSD earlier on

→ but it is a controversial diagnosis - positive predictive power, but low sensitivity (a lot of people that didn’t meet the criteria for ASD later got PTSD) (led to changes in dsm-5 criteria, and now it is moderate in value)

9 out of 14 symptoms from five categories

• Intrusions
• Negative mood
• Dissociative symptoms
• Avoidance
• Arousal

Question 11

Vulnerability Factors to Acute Stress Disorder

Answer 11

• Gender
• Prior trauma
• Past psychiatric illness
• History of abuse

Question 12

Peritraumatic Factors to Acute Stress Disorder

Answer 12

peritraumatic: the emotional and physiological stress experienced during or after a traumatic event

• Traumatic severity
• Type, extent, repetition, perceived life threat, controllability, proximity, effect on others, dissociation

Question 13

Posttraumatic Factors to Acute Stress Disorder

Answer 13

• Level of support
• Safety

Question 14

Mowrer’s Two Factor Theory

Answer 14

• 1947
• classical conditioning
• operant conditioning

Question 15

Lang’s (1977) Information Processing Theory of Anxiety Development Adapted by Foa et al., 1989

Answer 15

• Argued that we all have mental fear structures of stimuli, response and meaning elements
• In people with PTSD, the fear network is stable, broadly generalised and easily accessed
• Activated by reminders, information enters consciousness (intrusions)
• i.e if one part of the networks is activated then the other parts of it are activated subsequently

Question 16

Cognitive Model of PTSD (Ehlers & Clark, 2000)

Answer 16

• Memory of trauma in PTSD patients is fragmented, poorly elaborated and integrated with the autobiographical memory base
• Explains why both difficulty remembering, but easily triggered
• Prominence of appraisals about self, world and trauma

Question 17

Psychological Debriefing as Early Intervention for PTSD

Answer 17

psychological debriefing occurs immediately after a traumatic event to prevent PTSD symptoms from developing by giving emotional and psychological support

• It was originally designed for emergency personnel (firefighters, police) but has since been widely applied
• Typically a single debriefing session

However, meta-analyses show it is not effective and may be harmful as it can interfere with natural recovery and force premature processing of their trauma without follow-up care

• it is hard to separate whether the trauma in the moment will eventually turn into PTSD, it may just be a normal stress response that they end up pathologising

Question 18

Psychological First Aid as Early Intervention for PTSD

Answer 18

Principles

• Sense of safety
• Calming
• Connectedness to others
• Self-efficacy/empowerment
• Hopefulness

Little research, unethical to trial, most common

Question 19

Pharmacological Interventions for PTSD

Answer 19

Of the existing tentative evidence,

• Propranolol in the first few hours may reduce likelihood of developing PTSD
• Benzodiazepines may increase risk of PTSD
• Tricyclics may be effective in reducing arousal

Question 20

Psychological Interventions for PTSD

Answer 20

• Trauma-focused therapies are first line treatments for
  chronic PTSD
• Require the survivor to “re-live” the event in a way to integrate and contextualising the memory to remove the response

Exposure therapies

• Prolonged exposure therapy
• Cognitive processing therapy
• Eye movement desensitisation and reprocessing
• Narrative exposure therapy

More effective than treatments without a solidified focus on the trauma itself (such as psychoeducation, relaxation training, supportive counselling)

Question 21

Use of Psychoeducation for PTSD

Answer 21

• Provide information about common response to trauma
• Normalise symptoms
• Outline treatment, including underlying theoretical models
• Maximise engagement with treatment

Question 22

Imaginal Exposure for PTSD

Answer 22

“Reliving” of traumatic event

• Focus on sensory information

Potential mechanisms

• Habituation
• Emotional processing
• Change cognitions

Important for client buy-in, expect symptoms to increase initially, play a part in treatment with homework

Question 23

In Vivo Exposure for PTSD

Answer 23

Generate hierarchy of feared situations

• Gradually expose client to these situations
• Stay in situation until
  anxiety decreases
• Facilitate cognitive change

Question 24

Cognitive Therapy for PTSD

Answer 24

It is common to develop maladaptive and unhelpful cognitions following exposure to trauma

1. Identify maladaptive thoughts
2. Scrutinise the evidence for and against these thoughts
3. Develop alternative, more realistic thoughts

Question 25

Relapse Prevention for PTSD

Answer 25

• Revise content of intervention
• Prepare for the future
• Learn difference between lapse and relapse
• Plan for lapses

Question 26

Define the Term Peritraumatic

Answer 26

the emotional and physiological distress that occurs during or immediately after a traumatic event