PTSD

Question 1

What is anxiety?

Answer 1

Future-directed, combining negative mood and physical symptoms and apprehension (APA, 2000)

Question 2

Moderate and high amounts of anxiety?

Answer 2

Moderate are useful as strong motivation to improve performance. High levels impede performance

Question 3

High levels of anxiety

Answer 3

Anxiety emerges in absent of immediate threat, evoking a stop, look, listen response

Question 4

Features of anxiety

Answer 4

Affective (worry), physiological (heart racing), cognitive (catastrophic thoughts), behavioural (avoidance), mood (anger, depression)

Question 5

According to NICE (2011), what are the gender stats for PTSD

Answer 5

3% women, 2.5% men

Question 6

Triple vulnerability threat of anxiety (Barlow, 2000)

Answer 6

Genetic vulnerability + acquired psychological vulnerability + specific psychological vulnerability (event/threat)

Question 7

Chapter of PTSD in DSM 5 (APA, 2013)

Answer 7

Trauma and Stress Related Disorders

Question 8

What is PTSD triggered by?

Answer 8

An event e.g war, accident, natural disasters, sudden death of a loved one

Question 9

Highest percentages of people with PTSD

Answer 9

50% abused children, 45% battered women, 36% raped adults then veterans, firefighters and police

Question 10

Characteristics of PTSD during event

Answer 10

Feelings of fear, helplessness and horror

Question 11

Characteristics of PTSD after event

Answer 11

Flashbacks, avoidance of reminders, detachment, sleep disturbance. In children- regressive behaviours e.g bed wetting

Question 12

Example of the Joneses PTSD

Answer 12

Albano et al (1997): dog attacked 6 y/o, facial injuries; mum and 4 siblings got PTSD.

Question 13

What category did PTSD used to be in the DSM 4?

Answer 13

Anxiety disorders and syndromes

Question 14

What is acute stress disorder

Answer 14

Only diagnosed within 1st month, 70% will develop PTSD

Question 15

What is chronic stress disorder

Answer 15

More than 3 months after event: avoidant, comorbidity, delayed response

Question 16

DSM 5 criteria of PTSD

Answer 16

Exposure to event, persistent re-experience of event, persistent avoidance of stimuli associated with event, persistent symptoms of increased arousal, duration more than 1 month, disturbance causes clinically significant distress/ impairment

Question 17

Stats of PTSD

Answer 17

Low rates in UK war aid WW2 study (Rachman, 1991)

20% post car accident (Taylor and Koch, 1995), 1 in 3 who have trauma (NICE, 2005; 2012)

Question 18

Cognitive predictors from prospective cohorts directly after trauma and follow up

Answer 18

Catastrophic thinking and guilt

Question 19

Longitudinal study (Breslau and colleagues, 2006)

Answer 19

• 823 6 year olds
• measured acting out
• followed until 17
  Found:
• acting out more than doubled risk of exposure to trauma
• high IQ decreased chances of exposure to trauma
• Anxiety rates increased risk of PTSD

Question 20

Evidence that proximity and severity are predictors of PTSD

Answer 20

Only present in 67% of Vietnam war prisoners despite them all being tortured and deprived

Question 21

Barlow (2000) triple vulnerability theory predictor

Answer 21

PTSD- biopsychosocial predictor

Question 22

Longitudinal study (Breslau and colleges, 2006)

Answer 22

• 823 6 year olds
• measured acting out
• followed until 17 and measured traumatic events
• Found: acting out doubled risk, high IQ decreased chances, anxiety rates increased risk of PTSD

Question 23

Gunner and Fisher (2006)

Answer 23

Parenting styles affect anxiety

Question 24

Basoglu et al (1997): 2 groups (N=34, N=55) torture survivors from turkey

Answer 24

Unpredictability and uncontrollability of stressors increase PTSD distress

Question 25

Cognitive explanations for flashbacks

Answer 25

Encoding (fragmented) and retrieval (triggered through external stimuli)

Question 26

Dual response theory (Brewin et al., 2010)

Answer 26

2 types of memory during trauma: sensory-bound representation; contextual representation (often impaired)

Question 27

CBT for treating PTSD

Answer 27

• education about normal trauma reactions
• breathing and anxiety management
• cognitive restructuring
• exposure (Bisson et al, 2013)

Question 28

Reifels et al (2013) consensus reports

Answer 28

Use of social networks, outreach, screen and refer, Maslow hierarchy of needs

Question 29

Comorbidities that need to be treated first

Answer 29

Suicide, drug/alcohol problem, personality disorders, extended grief

Question 30

NICE (2005, 2012) recommend

Answer 30

Trauma focused CBT or EMDR at three months for at least a week

Question 31

Screening recommendation from NICE (2005, 2012)

Answer 31

High risk groups after 1 month and routinely screen vulnerable groups

Question 32

Who was EMDR introduced by?

Answer 32

Sharipo (1980)

Question 33

Goal of EMDR

Answer 33

Reprocess experiences of trauma into new, healthier ones

Question 34

EMDR process

Answer 34

1. Identification of target
2. Preparation
3. Assessment through processing
4. Desensitisation
5. Installing positive beliefs and cognition
6. Body scan with recall
7. Closure
8. Re-evaluation

Question 35

Sharipo’s comparison of EMDR to exposure

Answer 35

“EMDR wonders freely whereas exposure typically focuses on repeatedly feared event”

Question 36

Ironson et al (2002) RCT of EMDR and CBT

Answer 36

Found although equal, EMDR factor (70% good outcome compared to 17% prolonged exposure)

Question 37

Taylor et al (2003)

Answer 37

CBT superior to EMDR

Question 38

Stickgold (2002)

Answer 38

Eye movements linked to REM sleep= helps

Question 39

Guillies et al (2012) meta-analysis

Answer 39

In children and adolescents, 14 studies, most effective is CBT compared to psych interventions