Response to Trauma

Question 1

Type 1 response to trauma?

Answer 1

Single events, sudden and unexpected

Question 2

Type 2 response to trauma?

Answer 2

Repetitive trauma, 3x risk of PTSD vs type 1 trauma

Question 3

Neurobiology of responses to trauma?

Answer 3

Under threat: activity shift from the prefrontal cortex to brainstem (superior colliculus and PAG)

May be hippcampal atrophy

INCREASED ACTIVATION OF AMYGDALA AND OTHER LIMBIC AREAS

Question 4

What happens to Brocas area when individuals access personal traumatic memories?

Answer 4

Sometime deactivates

Question 5

What might explain timeless qulity of trauma?

Answer 5

Right hemispheric lateralisation (because RH doesn’t have time sense)

Question 6

What is PTSD not?

Answer 6

NOT normal adaptation to severe traumatic stress

• NOT a stress response per se but overwhelming of the stress response
• NOT inevitable response to trauma
• NOT only response to trauma

Question 7

PTSD symptoms/criteria?

Answer 7

• Traumatic events
• Intrusive symptoms (1 or more of 5)
• Avoidance symptoms (1 or both of 2)
• Negative alterations in cognition and mood (1 or more of 7)
• Increased arousal and reactivity (2 or more of 6)
• Functional impairment
• Symptoms need to be for at least a month

Question 8

Intrusive symptoms examples?

Answer 8

Recurrent distressing recollections 
Nightmares 
Flashbacks 
Distress accompanying reminders 
Physiological reactions

Question 9

Negative alterations in cognitions and mood examples?

Answer 9

• Amnesia for important aspect of trauma
• Loss of interest in activities
• Negative affect
• Overly negative thoughts and assumptions about world/self
• Exaggerated blame
• Feeling isolated
• Difficult in experiencing positive emotion

Question 10

Negative alterations in cognitions nd mood symptoms?

Answer 10

• Amnesia for mportant aspects of trauma
• Loss of interest in activities
• negative affect
• Overly negative thoughts and assumptions about self/world
• Exaggerated blame for causing traumatic events
• Feeling isolated/detached
• Difficulty experiencing positive emotion

Question 11

Avoidance symptoms?

Answer 11

• Avoidance of thoughts or feelings about event

- Avoidance of external reminders

Question 12

Increased arousal and reactivity examples?

Answer 12

• Sleep disturbance
• Irritability/aggression
• Concentration difficulties
• Hypervigilance
• Exaggerated startle response
• Risky and destructive behaviour

Question 13

1st line management of PTSD?

Answer 13

CBT

Question 14

2nd line management of PTSD?

Answer 14

Eye movement desensitisation and reprocessing therapy

Question 15

How are eye movements involved in trauma?

Answer 15

The superior colliculus stores trauma and is also responsible for movement in response to visual stimuli so eye movements can help reprocess trauma

Question 16

Why will CBT not always help?

Answer 16

Top down processing (how thoughts influence feelings) so it will not address brainstem led responses to trauma

Question 17

How can traumatic events be classified?

Answer 17

• Intentional (robbery, assault)
• Unintentional (MVA, human made accident)
• Natural (earthquake, floods)

Question 18

Type 2 trauma expanded on?

Answer 18

Repetitive trauma

-Ongoing abuse, hostage taken, genocide, developmental trauma

Question 19

Emotion arises from?

Answer 19

Neural processes that prompt us to freeze or to flee

Question 20

Much more than just fight or flight though there is also?

Answer 20

Freeze, hide, seek, avoid, attach, submit, despair and uncontrolled activiation states

Question 21

Where do all of the reponses connected to fight or flight originate from?

Answer 21

PAG (periaqueductal grey)

Ventral tegmental area

Question 22

What is complex PTSD?

Answer 22

Core PTSD symptoms +

• Negative self concept. low self esteem, hopelessness
• Emotional dysregulation- violent or emotional outbursts, reckless or self-destructive behaviour, dissociation