Task 2 - PTSD

Question 1

Brain structures involved in Fight-or-Flight response

Answer 1

• The sympathetic division of the autonomic nervous system triggers bodily changes, such as increased heart rate, blood pressure, and glucose release.
• The adrenal-cortical system releases hormones, with cortisol being a major stress hormone (Cortisol levels are often used to measure stress)

Question 2

Three types of responses to threats

Answer 2

• Emotional responses include terror, dread, irritability, and restlessness.
• Cognitive responses involve heightened vigilance for danger.
• Behavioral responses include seeking to confront the threat or escape

Question 3

Prevalence for PTSD

Answer 3

Lifetime prevalence rate of about 1-3%, but higher for some groups
* 12-33% of civilians living in war zones
* 10% of rescue workers
* 13.2% of members of operational infantry in Iraq or Afghanistan conflicts

Question 4

Post-Traumatic Stress Disorder

Definition

Answer 4

A set of persistent anxiety-based symptoms that occurs after experiencing or witnessing an extremely fear-evoking or life-threatening traumatic event

Question 5

Acute Stress Disorder (ASD)

Definition

Answer 5

A short-term psychological and physical reaction to severe trauma, Symptoms are very similar to those of PTSD (but only 3 days to 1 month after trauma exposure)

Question 6

Adjustment disorder

Definition

Answer 6

Consists of emotional and behavioral symptoms that arise within of 3 months after experience

Question 7

DSM-5 Criteria for PTSD

Answer 7

A. Exposure to actual or threathened death, serious injury, or sexual violence
B. Presence of one (or more) of the following symptoms associated with the traumatic event, beginning after it occured (include flashbacks, distressing dreams, dissociation, distress etc.)
C. Persistent avoidance of stimuli associated with the traumatic event
D. Negative alterations in cognitions and mood associated with the event
E. Altercations in arousal and reactivity
F. Duration is more than 1 month
G. Significant distress
H. Not explainable by something else

Question 8

Subtypes of PTSD

Answer 8

1. With dissociative symptoms (including either of the following):
   * Depersonalization
   * Derealization
2. With delayed expression (when criteria are not met until at leaast 6 months after event)

Question 9

Complex PTSD

Definition

Answer 9

A severe form of PTSD often associated with early age interpersonal trauma and with dissociative symptoms from that early age

Question 10

Zoet et al.: Treatment of the dissociative subtype

Answer 10

• Study aims to determine the impact of dissociation on PTSD treatment outcomes
• Prolonged exposure and EMDR therapy, combined over eight days
• Significant reduction in PTSD symptoms for both DS and non-DS groups

Question 11

Biological factors of PTSD

Answer 11

• A small or underdeveloped hippocampus
• The failure of brain centers such as the ventromedial frontal cortex to dampen activation of the amygdala (so individual is unable to control activation of fear)
• A genetically heightened startle response and fear-relevant endocrine secretion

Question 12

Vulnerability factors of PTSD

Answer 12

• Strongest predictors of people’s reaction to trauma including: 1) severity, 2) duration and 3) proximity
  Certain other character traits make individuals more likely to develop PTSD after trauma such as:
• Early separation from parents and unstable family life
• A family history of PTSD
• Existing high levels of anxiety or a pre-existing psychological disorder
• Availability of social support

Question 13

Intrusion-based reasoning

Definition

Answer 13

Refers to cognitive process where individuals make inferences about danger not only from the presence of objective danger but also from occurence of intrusive thoughts or or memories

Question 14

Engelhard et al.: Intrusion-based reasoning in PTSD

Answer 14

• Assessments conducted in participants home for intrusion-bases reasoning (IR), trauma exposure and PTSD
• 3 weeks after the train crash and then reassessed after 3.5 months
• IR did not significantly contribute to chronic PTSD beyond acute symptoms, but the partial correlation suggests a potential association

Question 15

Emotion-based reasoning

Definition

Answer 15

Involves the strong influence of negative emotions, particularly fear, anxiety, and distress, on how a person interprets and responds to situations.

Question 16

Conditioning model of PTSD

Answer 16

Explains the symptoms of PTSD with Classical Conditioning
⇨ Trauma (US) becomes associated at the time of the trauma with situational cues associated with the place and time of the trauma (CS)

Question 17

Emotional processing theory of PTSD

Answer 17

Theory that claims that severe traumatic experiences are such major significance to an individual that they lead to the formation of representations and associations in memory that are quite different to those formed as a result of everyday experience

Question 18

Mental defeat

Answer 18

A specific frame of mind in which the individual sees themselves as a victim. This is a psychological factor that is important in making an individual vulnerable to PTSD

Question 19

Dual representation theory

Answer 19

An approach to explaining post-traumatic stress disorder (PTSD) suggesting that it might be a hybrid disorder involving two separate memory systems:
1. The verbally accessible memory (VAM) system registers memories of the trauma that are consciously processed at the time
* Integrated with other autobiographical memories and can be readily retrieved
2. The situationally accessible memory (SAM) system registers information from the trauma that may have been to brief to consciously notice (e.g. sights and sounds and extreme bodily reactions)
* Responsible for vivid, uncontrollable flashbacks

Question 20

Hellawell and Brewin: Evidence for Dual representation theory

Answer 20

• When describing memories, PTSD sufferers characterized flashback periods with greater detail, especially perceptual detail
• Findings are consistent with view that flashbacks are the result of sensory and response information stored in the SAM system

Question 21

Psychological debriefing

Defintion

Answer 21

A structured way of trying to intervene immediately after trauma in order to present the development of PTSD, typically done with a technique called critical incident stress managment (CISM)

Question 22

Critical incident stress management (CISM)

Answer 22

Elements of this therapy typically are:
* Explanation of the purpose of the intervention
* Asking participants to describe their experiences
* Discussions of feelings about the event
* Discussion of any trauma-related symptoms the participant might be experiencing
* Encouraging the participant to view their symptoms as normal reactions to trauma
* Discussing needs for the future

Question 23

Imaginal flooding

Definition

Answer 23

A technique whereby a client is asked to visualize feared, trauma-related scenes for extended periods of time

Question 24

Eye movement desensitization and reprocessing (EMDR)

Definition

Answer 24

A form of exposure therapy for PTSD in which clients are required to focus their attention on a traumatic image or memory while simultaneously visually following the therapists finger moving backwards and forwards before their eyes

Question 25

Van den Hout and Engelhard: How does EMDR work?

Answer 25

Simultaneous eye movements and memory recall compete for limited working memory capacity and lead to “imagination deflation”
* If this is true, other WM tasks besides eye movement should also work and they do
* Various tasks, including auditory shadowing, copying a complex figure, playing Tetris, mental arithmetic, calculating out loud, and mindful breathing, were performed during recalling negative memories.
* Compared to ‘recall only,’ memories became less vivid and/or less emotional during all these tasks.

Question 26

Inverted-U effect of memory taxation

Answer 26

There’s an inverted U relationship between taxing and memory effects, optimal taxing level is somewhere between ‘too little’ and ‘too much’

Question 27

Stress-inoculation therapy

Definition

Answer 27

Therapists teach clients skills for overcoming problems in their lives that increase their stress and problems that may result from PTSD, such as marital problems or social isolation

Question 28

MDMA therapy for PTSD

Therapeutic rationale and administration

Answer 28

Therapeutic rationale
* Increases release of serotonin, dopamine and other hormones
* Also reduces amygdala activity
* Increases openness and trust

Administration
* At start of therapy session, typically around 75-125mg
* Typically 3 sessions, spaced 1 month apart

Question 29

Ketamine therapy for PTSD

Therapeutic rationale and administration

Answer 29

Therapeutic rationale:
* NDMA receptor antagonist
* Facilitates fear extinction and blocks memory reconsolidations

Administration:
* Administration at the start of session, dose around 0.50mg
* Single or multiple administrations spaced days to weeks apart

Question 30

Classical psychedelics therapy for PTSD

Therapeutic rationale and administration

Answer 30

Therapeutic rationale:
* 5-HT2A receptor antagonist
* Increase synaptic plasticity
* Can reduce amygdala activity during emotional processing
* Helps with introspection

Administration:
* At the beginning of the session, dose around 10-25mg
* Single or multiple sessions, weeks to months apart

Question 31

Cannabis therapy for PTSD

Therapeutic rationale and administration

Answer 31

Therapeutic rationale:
* Symptom managment
* May increase fear extinction

Administration:
* Daily administration, if used for symptom managment
* Varrying doses

Question 32

Dissociative disorders

Definition and disorders included

Answer 32

Include a wide variety of symptoms whose common core is an alteration in consciousness that affects memory and identity
Includes:
1. Dissociative Amnesia
2. Dissociative Fugue
3. Dissociative Identity Disorder (DID)
4. Depersonalization Disorder
5. Dissociative Disorders Not Otherwise Specified

Question 33

The trauma-memory argument

Context: Dissociative disorders

Answer 33

Often discussed in the context of dissociative disorders, suggests that individuals may experience amnesia for traumatic events as a psychological defense mechanism