PTSD Lecture 3 Flashcards
Debriefing
- Early interventions that vary in: content (with(out) education or disclosure), form (individual/group), target population (military/civilian)
- Single session, +- 2 hours, several days post trauma
- Emergency personnel, then civilians/primary victims
- 7 phases: introduction, facts, thoughts, feelings, symptoms, education, closure
- Possible aims: prevention, support, education
Guidelines for Debriefing
NICE and Dutch guidelines both discourage the use of debriefing, stating that it is ineffective and sometimes even harmful.
Explanation of harm of Debriefing
- Disturbs natural processing/oscillation of reexperiencing vs avoidance
- Discourages using social support
- Sensitization instead of habituation
Pharmacological treatment of PTSD
It may be effective but cannot process in and of itself, but i may help to process.
Symptom reduction may lead to more or less avoidance.
Possibility of side effects and relapse.
NICE guidelines on pharmacological treatment of PTSD
SSRI’s and venlaxafine are effective in treating PTSD. However there is lack of follow up data for these 2 drugs. EMDR is also more cost effective.
NICE guidelines on psychological treatment for PTSD
Offer individual trauma-focused CBT intervention to adults with a diagnosis of PTSD or clinically important of PTSD who have presented more than 1 month after a traumatic event. Interventions include:
- Cognitive processing theory
- Cognitive therapy for PTSD
- Narrative exposure therapy
- Prolonged exposure therapy
Consider EMDR for patients who have symptoms for 1-3 months after a non-combat related trauma
Offer EMDR if more than 3 months
Dutch guideline on psychological treatment of PTSD
- Diagnosis
- First choice treatment: exposure/EMDR/cognitive therapy/ Trauma CBT
- Try other first choice treatment
- Intensified care (pharmacotherapy/ condensed treatment)
- Alternative/complementary treatments
Prolonged exposure
Exposure in vivo:
- Patient exposes themselves to traumatic memories through internal or external cues, until they no longer evoke problematic fear.
- First person present tense, ‘as if it is happening again’.
- Therapist guided in session, audiotapes between sessions
Prolonged exposure learning theory explanation
- Neutral stimuli become associated with anxiety response
- Avoidance of these stimuli becomes reinforced by reduced fear
- Avoidance hinders habituation and extinction, fear and avoidance remain
- Exposure promotes habituation and extinction, fear and avoidance reduce
Cognitive theory on Prolonged exposure
- Changes in explicit cognitions about trauma (and about exposure)
- Changes in memory representation (integration in autobiographic memory)
Cognitive restructuring
Form of TF-CBT
Identifying and modifying irrational dysfunctional cognitions
Writing therapy: imaginal exposure
- Descrive the event as detailed and completely as possible. Write in the first person present tense, as if you are experiencing the event again.
Writing therapy: cognitive restructuring
- Imagine that a close friend has experienced the event that you have exprienced. You decide to write them the advice that you would have wanted to get yourself on your most difficult moments. To be of as much help as possible, you use your own experiences in choosing the right words.
Writing therapy: social sharing
- Write a letter to a trusted person. Descrive what you expect from the addressee, for instance that you write them a letter to share your experiences and feelings with somebody. The most important aim however is to express the event and it’s emotional consequences, so as for you to be not the only one who knows.
Working memory theory EMDR
Long term memory (stable) -> Working memory (labile, limited capacity) -> Competing task (reduces vividness and emotionality traumatic memory) -> Modified memory reconsolidating into long term memory -> Long term memory
