PTSD Flashcards
DSM Definition of Trauma
→ 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
Basic Criteria for a DSM Classification of PTSD
- 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
Intrusion (Category of PTSD Symptoms)
- Recurrent, involuntary and intrusive memories
- Traumatic nightmares
- Flashbacks
- Psychological distress to reminders
- Physiological distress to reminders
Persistent Avoidance of Internal or External Stimuli Associated With the Trauma (PTSD Symptoms)
- Avoidance of trauma-related
- Thoughts or feelings
- External reminders (e.g significant objects within the events)
Negative Alterations in Cognition or Mood (Category of PTSD Symptoms)
- 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)
PTSD Alterations in Arousal or Reactivity Symptoms
- Irritability or aggressive behaviour
- Self-destructive or reckless behaviour
- Hypervigilance
- Problems in concentration
Sleep disturbance
PTSD Prevalence
→ lifetime prevalence in general population: 7-8%
→ lifetime prevalence in trauma-exposed individuals
- Women - 20.4%
- Men - 8.2%
PTSD and the Inequality of Traumatic Events
- 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
Heterogeneity to the PTSD Course
- 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
Acute Stress Disorder
→ 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
Vulnerability Factors to Acute Stress Disorder
- Gender
- Prior trauma
- Past psychiatric illness
- History of abuse
Peritraumatic Factors to Acute Stress Disorder
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
Posttraumatic Factors to Acute Stress Disorder
- Level of support
- Safety
Mowrer’s Two Factor Theory
- 1947
- classical conditioning
- operant conditioning
Lang’s (1977) Information Processing Theory of Anxiety Development Adapted by Foa et al., 1989
- 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
Cognitive Model of PTSD (Ehlers & Clark, 2000)
- 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
Psychological Debriefing as Early Intervention for PTSD
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
Psychological First Aid as Early Intervention for PTSD
Principles
- Sense of safety
- Calming
- Connectedness to others
- Self-efficacy/empowerment
- Hopefulness
Little research, unethical to trial, most common
Pharmacological Interventions for PTSD
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
Psychological Interventions for PTSD
- 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)
Use of Psychoeducation for PTSD
- Provide information about common response to trauma
- Normalise symptoms
- Outline treatment, including underlying theoretical models
- Maximise engagement with treatment
Imaginal Exposure for PTSD
“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
In Vivo Exposure for PTSD
Generate hierarchy of feared situations
- Gradually expose client to these situations
- Stay in situation until
anxiety decreases - Facilitate cognitive change
Cognitive Therapy for PTSD
It is common to develop maladaptive and unhelpful cognitions following exposure to trauma
- Identify maladaptive thoughts
- Scrutinise the evidence for and against these thoughts
- Develop alternative, more realistic thoughts
Relapse Prevention for PTSD
- Revise content of intervention
- Prepare for the future
- Learn difference between lapse and relapse
- Plan for lapses
Define the Term Peritraumatic
the emotional and physiological distress that occurs during or immediately after a traumatic event
