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Psychopathology > Task 2 - PTSD > Flashcards

Task 2 - PTSD Flashcards

1
Q

Traumas leading to PTSD

A
  • natural disasters
  • human-made disasters (wars, terrorist attacks, torture)
  • sexual assault
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2
Q

environmental/social factors

A
  • strong predictors of reaction to events: severity, duration, individual proximity
  • social support -> the more the better
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3
Q

Psychological factors

A
  • if experiencing anxiety/depression already before trauma -> PTSD more likely
  • style of coping:
  • self destructive/avoidant coping -> more likely
  • dissociative -> those who do shortly after trauma are more likely
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4
Q

gender

A
  • women more likely
  • may experience triggers for anxiety disorders more often (rape)
  • types of trauma frequently experienced are stigmatized -> decreases social support
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5
Q

Cultures

A
  • more pressure in Mexico than US for women to be passive, self-sacrificing, compliant and for men to be dominant, fearless and strong
  • > mexican women feel more helpless than men following a trauma
  • > tendency to dissociate greater among latinos
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6
Q

Neuroimaging findings

A
  • > brain regions regulating emotion, fight or flight response and memory
  • Amygdala: more actively responding to emotional stimuli
  • Medial PFC: modulates activity of Amygdala -> less active in people with severe symptoms -> less able to dampen reactivity
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7
Q

hippocampus

A
  • shrinkage
  • > possibly due to overexposure to neurotransmitters and hormones in stress response
  • > may lead to memory problems
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8
Q

cortisol

A
  • released as fight flight response
  • resting levels of cortisol tend to be lower! among people with PTSD
  • those who developed: lower levels after trauma

-> lower levels may result in prolonged activity of sympathetic NS following stress

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9
Q

cortisol

A
  • released as fight flight response
  • resting levels of cortisol tend to be lower! among people with PTSD
  • those who developed: lower levels after trauma
  • > lower levels may result in prolonged activity of sympathetic NS following stress
  • > cortisol breaks down stress-related substances in your body -> so with lower amounts of cortisol -> body will stay ‘stressed’ for a longer time
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10
Q

Hypothalamic-pituitary-adrenal (HPA) axis

A
  • unable to shut down response of sympathetic NS by secreting necessary levels of cortisol
  • overexposure of brain to epinephrine, norepinephrine
  • > cause memories to be ‘overconsolidated’ or planted more firmly in memory
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11
Q

Genetics

A
  • vietnam veterans: if one identical twin had PTSD, other one was more likely than if fraternal twins
  • adult children of holocaust survivers with PTSD -> 3x more likely to also develop it
  • abnormally low cortisol levels may be one heritable risk for PTSD
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12
Q

CBT

A
  • systematic desensitization
  • relaxation techniques
  • imagine event vividly
  • help client to habituate to anxiety and distinguish memory from present reality
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13
Q

Stress-management interventions / stress- inoculation therapy

A
  • teach clients skills for overcoming problems in their lives that increase their stress and may result form PTSD
  • when patient cannot tolerate exposure to traumatic events as in exposure or cbt
  • example: marital problems, social isolation
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14
Q

Biological Therapies

A
  • selective seretonin reuptake inhibitor

- benzodiazepines (but less effective)

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15
Q

conditioning theory

A
  • Trauma (US) associated with situational cues (CS)
  • when cues encountered again -> arousal and fear
  • conditioned responses do not extinguish bc of avoidance responses
  • theory doesn’t explain why some people develop it and other don’t
  • cannot explain symptoms like dissociation
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16
Q

Emotional processing theory

A
  • severe traumatic experiences are of such major significance to individual
  • > lead to formation of representations and associations in memory
  • > quite different to those formed as a result of everyday experience

-Individuals who prior to trauma have fixed views about themselves and world are more vulnerable to PTSD.

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17
Q

Mental defeat theory

A
  • negative frame of thinking
  • process info about trauma negatively and view themselves as unable to act effectively as well as victims
  • negative approach ads to distress and influences way individual recalls trauma
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18
Q

Evidence for mental defeat theory

A
  • PTSD sufferers have negative views of self and world
  • > negative interpretations of trauma, PTSD and of responses of others
  • > belief that trauma has permanently changed their life
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19
Q

Dual representation theory

A

hybrid disorder involving two separate memory systems

1) Verbal Accessible Memory (VAM): registers memories consciously processed at the time, narrative, contain info about event, context, personal evaluations
- > can be easily retrieved

2) Situationally Accessible Memory (SAM): records info of trauma too brief to take in consciously, info about sight and sound, extreme bodily reactions
- > responsible for flashbacks

-> memory systems linked to amygdala

20
Q

Intrusions

A
  • flashbacks
  • a scream for example > reminds you of war
  • > assume there must be threat
21
Q

Intrusion based reasoning (IR)

A

-tendency to interpret distressing intrusions themselves as evidence that danger is impending, regardless of objective danger information

22
Q

Article: intrusion based reasoning and PTSD after exposure to a train disaster - findings

A
  • when having intrusions about train disaster (e.g. sight of blood, sounds of crying)
  • > situation is held to be more dangerous than without cues
  • correlation of IR with acute and chronic PTSD was quite robust -> suggest strong relationship
23
Q

Article: intrusion based reasoning and PTSD after exposure to a train disaster - method

A
  • 4 descriptive scenarios
  • objective danger info , distressing intrusions, no distressing intrusions etc
  • > identify themselves as well as possible with main character of each scenario
  • > rate perceived danger and trauma exposure scale
24
Q

Article: Emotion- and Intrusion based reasoning in Vietnam veterans with and without PTSD -findings

A
  • veterans without PTSD: inferred danger from objective information
  • with PTSD: higher danger ratings on scenarios with anxiety info ( ER-> larger effect) and with intrusions (IR-> smaller effect)
25
Q

ways in which ER and IR contribute to persistence of PTSD

A

1) intrusions and anxiety are taken as evidence that world is unsafe
2) foster avoidance cues (avoidance reduces arousal but hinders emotional processing)
3) amplify distress -> increases frequency of intrusive thoughts
4) lead patients to confirm rather than disconfirm beliefs about threat

26
Q

Article: Eye movement desensitisation and reprocessing EMDR

A
  • patient recalls traumatic memories while simultaneaously making horizontal eye movements
  • eye movement matters
  • interhemispheric communication theory seems wrong
  • eye movement taxes WM
  • any taxing task can attenuate vividness and hence emotional tone of a memory
  • pleasant memories become less pleasant
  • flash forwards become less vivid
  • eye movement and Mindfulness breathing taxes WM to same degree
27
Q

Dissociative Disorders

A
  • wide variety of syndromes

- common core: alteration in consciousness that affects memory and identity

28
Q

Dissociative Disorders (DD) - 5 entries

A

1) dissociative amnesia
2) dissociative fugue
3) dissociative identity disorder (DID)
4) Depersonalized Disorder
5) Dissociative Disorder not otherwise specified

29
Q

dissociative amnesia

A

-loss of autobiographical memory for certain past experiences

30
Q

dissociative fugue

A
  • amnesia covers the whole (or large part) of patients life

- accompanied by loss of personal identity and physical relocation

31
Q

dissociative identity disorder

A
  • formerly multiple personality disorder (MPD)
  • patients appears to possess and manifest 2 or more distinct indentities that that alternate in control over conscious experience, thought, and action
  • are typically separated by some degree of amnesia
  • host personality/host/host ego/alter egos/ego states
32
Q

Depersonalization Disorder

A

-patients believe that they have changed in some way or are in some way no longer real

33
Q

dissociative disorders not otherwise specified

A
  • display some symptoms
  • not to extent that they qualify for one of major diagnosis
  • includes certain culturally ‘spirit possession’ states
  • includes Ganser syndrome (jüngere, männliche patienten antworten falsch)
34
Q

Broadly DSM 5

A

A) death, violence, sexual assault

  • witness
  • directly experienced
  • family/close friend
  • exposure to aversive details

B) 1 or more intrusive symptoms

C) Avoidance 1 or more

D) Alterations in cognition and mood , 2 or more

E) Alterations in arousal and reactivity, 2 or more

-> more than one month

35
Q

DSM 5 - intrusive symptoms (5)

A
  • 1 or more needed
    (1) flashbacks
    (2) recurrent, involuntary, intrusive distress, memories
    (3) recurrent distressing dreams
    (4) psychological stress when exposed to internal/external cues
    (5) physiological reactions
36
Q

DSM 5 - Avoidance (2)

A
  • 1 or more :
  • avoid memories, thoughts, feelings
  • avoid external reminders (people, places etc.)
37
Q

DSM 5 - Alterations in cognition and mood (7)

A
  • 2 or more
    1) inability to remember
    2) persistent and exaggerated negative believes about oneself/others/world
    3) persistent/distorted cognitions about cause -> blaming oneself
    4) persistent negative emotional state (fear, horror, guilt)
    5) diminished interest/participation in activities
    6) feelings of detachment/estrangement from others
    7) inability to experience positive emotions
38
Q

DSM 5 - Alterations in arousal and activity (6)

A
  • 2 or more
    1) irritable behavior/angry outbursts
    2) reckless, self destructive behavior
    3) hypervigilance (enhanced state of sensory sensivity)
    4) exaggerated startle response (schreckreaktion)
    5) problems concentrating
    6) sleep disturbance
39
Q

Exposure therapy

A
  • most effective
  • imaging event, in attempt to extinguish fear symptoms
  • > extinguish associations between cues and fear response
  • > disconfirms symptom maintaining dysfunctional beliefs
40
Q

Forms of exposure therapy

A
  • asking client to provide detailed written narrative of traumatic events
  • imaginal flooding: visualize feared, trauma-elated scenes for extended periods of time

-EMDR: focus attention on traumatic image/memory while following finger with eyes
(apparently higher relapse rate)

41
Q

psychological debriefing - treatment

A
  • structured way to intervene immediately after trauma to prevent development of PTD
  • used with survivors, victims, relatives, emergency care workers
  • use crisis intervention stress management (CISM): reassure people they are normal and just experienced abnormal event
  • unclear if victims gain benefit from being counselled by stranger and coerced into revealing memories difficult to reveal
42
Q

cognitive restructuring

-treatment

A
  • evaluate and replace negative automatic thoughts
  • evaluate and change dysfunctional beliefs
  • Those who avoid trauma-related thoughts will avoid disconfirming these extreme views
  • > leads to development of chronic PTSD
43
Q

Cognitive restructuring together with exposure therapy

A

-does NOT produce a significant increase in exposure therapy in producing changes in dysfunctional cognitions

44
Q

Article Kihlstrom - DD Trauma - memory argument

A
  • victims typically develop psychological defences
  • > example: repession or dissociation to block their awareness of the trauma
  • > result: anamnesis
  • researchers argue traumatic stress interferes with consolidation of consciously available memory
  • > but enhances nonverbal sensory, motor and affective representation of trauma
  • conflict in research: some do not find evidence for amnesia after traumatic event, whereas others do
45
Q

Type 1 and type 2 traumas - trauma memory argument

A

Type 1:

  • terror traumas
  • single, well-defined event
  • > memory is enhanced for this type

Type 2:

  • betrayal traumas
  • involves incest and other childhood sexual abuse
  • > denial, numbing and dissociation -> creates amnesia for this type
46
Q

Dissociative subtype PTSD

A
  • PTSD patients also exhibit dissociative phenomena
  • depersonalization: experience of feeling detached from one’s own body
  • derealization: experience of unreality of surroundings
47
Q

Zoet article - Dissociative subtype - treatment

-findings

A
  • patients with and without DS showed significant reductions in PTSD symptoms
  • > more than 50p lost their PTSD diagnosis
  • both DS and non-DS groups decreased from severe PTSD to mild or no PTSD
  • > NOT supporting hypothesis that DS has negative impact on trauma focused treatments

Psychopathology (15 decks)

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