Responses to Traumatic Stress

Question 1

types of traumatic events

Answer 1

intentional

unintentional

Question 2

examples of intentional trauma

Answer 2

assault
robbery
rape

Question 3

examples of unintentional trauma

Answer 3

motor vehicle accident

industrial accident

Question 4

what is human made trauma

Answer 4

technological

train/plane crash

Question 5

what is natural trauma

Answer 5

hurricane, tornado

earthquake, flood

Question 6

what is type 1 trauma

Answer 6

single incident, trauma unexpected

Question 7

what is type 2 trauma

Answer 7

repetitive trauma 
ongoing abuse 
betrayal of trust 
developmental trauma 
attachment/attunement disruption 
may effect as many as 1 in 10 
1 in 7 children 
x3 risk of PTSD

Question 8

what is a major incident

Answer 8

any situation associated with multiple casualties and fatalities and damage to property due to natural or unnatural causes that is belyond what can be coped with ordinarily by the deployment of the emergency services

Question 9

true/false trauma is equal opportunity without respect for social class or economic status true/false

Answer 9

poor and marginalised are much more likely to be victims

Question 10

what does a history of trauma predict in depression

Answer 10

that the need psychotherapy as well as pharmacotherapy

Question 11

how can childhood predict future mental heath

Answer 11

high percentage of patients with bipolar had childhood deprivation or abuse

Question 12

what is anxiety and fear

Answer 12

a genetically ingrained function of the nervous system

evolutionary significants - promotes survival

Question 13

what are peoples responses to fear/trauma

Answer 13

more than ‘fight or flight’

fight 
flight 
freeze 
hide 
avoid 
attach 
submit 
despair 
uncontrolled activation status

Question 14

what is the freeze response

Answer 14

either voluntary - to ‘stop, watch and listen’

not voluntary - inescapable threat

• tonic immobility occurs
• involuntary state of profound (but reversible) motor inhibition
• especially when direct physical contact with predator/aggressor

Question 15

features of tonic immobility

Answer 15

decreased vocalisation 
intermittent eye contact
rigidity and paralysis 
muscle tremors in extremities 
chills 
unresponsiveness to pain 

may be associated with peri-traumatic dissociation

Question 16

how can tonic immobility increase survival

Answer 16

predators less likely to attack immobile prey
if attack immobility may cause a loosening of grip
decrease risk of extreme violence which fighting back could trigger
some attackers loose interest if victim is immobile and unresponsive

aka, playing possum

Question 17

what is the reptilian brain hypothesis

Answer 17

as predator closes in, brain activity shifts from ventromedial prefrontal cortex to periaqueductal grey

activity in PAG correlated with the subjective experience of dread and capture

Question 18

trauma related risk factors

Answer 18

Sudden, unexpected events
Man-made events 
Prolonged exposure 
Perceived threat to life 
Multiple deaths and/or mutilation 
Dose response - relationship
Personally relevant factors

Question 19

what are patient related risk factors

Answer 19

Severe acute stress reaction 
low serum cortisol increase acutely 
family or personal history of mental disorder 
serious physical injury 
loss of normal daily function 
extremes of age 
genetic predisposition 
epigenetic - transgenerational effects 
past experiences of trauma

Question 20

environmental risk factors

Answer 20

lack of a support network 
ongoing life stresses 
reactions of others 
economic resources 
disadvantage 
displacement

Question 21

is resilience global

Answer 21

No

not global- can be resilient to some situations and not others

Question 22

what are some psychological reactions after trauma

Answer 22

Depression 
Grief reactions 
Panic attacks/agrophobia 
Alcohol/drug dependance 
Brief hypomania 
Specific phobia eg. travel

Question 23

PTSD criteria

Answer 23

traumatic event 
1 or more intrusive symptoms 
3 or more avoidance symptoms 
2 or more increased arousal 
duration 1 months 
distress and impairment in social or occupational functioning 
acute/chronic/delayed onset

Question 24

what is intrusive phenomena

Answer 24

recurrent distressing recollections 
nightmares 
flashbacks, in any modality 
distress accompanies reminders 
physiological reactions (fight or flight)

Question 25

what are avoidance symptoms

Answer 25

Avoidance of thinking or talking about the event
Avoidance of reminders such as activities, places or people
Amnesia for important aspects of trauma
Loss of interest in activities
Detachment
Emotional numbing
Sense of foreshortened future

Question 26

what are hyperarousal symptoms

Answer 26

sleep disturbance 
irritability/anger 
concentration difficulties 
hyper-vigilance 
exaggerated startle response 
Risky and destructive behaviour

Question 27

what are associated symptoms with PTSD

Answer 27

Dissociative symptoms 
-depersonalisation - observing self from distance
-derealisation - things dont feel real 
-awareness of surroundings 
Survivor guilt 
Performance guilt

Question 28

what is the just world hypothesis

Answer 28

after v bad trauma any underlying assumption of justice and fairness if shattered

confirmation that the world is a bad place

Question 29

what is complex PTSD

Answer 29

PTSD symptoms +

• cognitive disturbance
• identity disturbance
• emotional dysregulation
• chronic interpersonal difficulties
• dissociation
• somatisation
• tension reduction activities

Question 30

areas of the brain involved in PTSD

Answer 30

Hippocampus
-involved in explicit memory and stress response

Amygdala
-role of fear during both trauma and its recollection

Question 31

why is the hippocampus smaller in PTSD sufferers

Answer 31

due to high cortisol level (also seen in cushings)

Question 32

how can PTSD affect broca’s area

Answer 32

Broca’s area is decreased

brain can’t tell the difference between a memory and a real life event, so every memory is like you experiencing it again

Question 33

memory formation filters

Answer 33

1st filter - is it important
2nd filter - is it emotionally important organisation

then memory is processed and stored?

Question 34

what does the amygdala trigger

Answer 34

HPA and production of cortisol??

Question 35

general principles of PTSD treatment

Answer 35

Ensure safety before starting treatment - eg. trauma is not still going on

importance of therapeutic relationship

guidance

Question 36

general principles of PTSD treatment

Answer 36

Ensure safety before starting treatment - eg. trauma is not still going on

importance of therapeutic relationship

guidance - trauma focused psychological therapy

Question 37

main treatment for PTSD

Answer 37

psychological therapy

drugs - second line to manage individual symptoms