Task 2 - PTSD Flashcards
Traumas leading to PTSD
- natural disasters
- human-made disasters (wars, terrorist attacks, torture)
- sexual assault
environmental/social factors
- strong predictors of reaction to events: severity, duration, individual proximity
- social support -> the more the better
Psychological factors
- 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
gender
- women more likely
- may experience triggers for anxiety disorders more often (rape)
- types of trauma frequently experienced are stigmatized -> decreases social support
Cultures
- 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
Neuroimaging findings
- > 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
hippocampus
- shrinkage
- > possibly due to overexposure to neurotransmitters and hormones in stress response
- > may lead to memory problems
cortisol
- 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
- 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
Hypothalamic-pituitary-adrenal (HPA) axis
- 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
Genetics
- 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
CBT
- systematic desensitization
- relaxation techniques
- imagine event vividly
- help client to habituate to anxiety and distinguish memory from present reality
Stress-management interventions / stress- inoculation therapy
- 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
Biological Therapies
- selective seretonin reuptake inhibitor
- benzodiazepines (but less effective)
conditioning theory
- 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
Emotional processing theory
- 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.
Mental defeat theory
- 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
Evidence for mental defeat theory
- 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
Dual representation theory
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
Intrusions
- flashbacks
- a scream for example > reminds you of war
- > assume there must be threat
Intrusion based reasoning (IR)
-tendency to interpret distressing intrusions themselves as evidence that danger is impending, regardless of objective danger information
Article: intrusion based reasoning and PTSD after exposure to a train disaster - findings
- 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
Article: intrusion based reasoning and PTSD after exposure to a train disaster - method
- 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
Article: Emotion- and Intrusion based reasoning in Vietnam veterans with and without PTSD -findings
- 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)
ways in which ER and IR contribute to persistence of PTSD
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
Article: Eye movement desensitisation and reprocessing EMDR
- 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
Dissociative Disorders
- wide variety of syndromes
- common core: alteration in consciousness that affects memory and identity
Dissociative Disorders (DD) - 5 entries
1) dissociative amnesia
2) dissociative fugue
3) dissociative identity disorder (DID)
4) Depersonalized Disorder
5) Dissociative Disorder not otherwise specified
dissociative amnesia
-loss of autobiographical memory for certain past experiences
dissociative fugue
- amnesia covers the whole (or large part) of patients life
- accompanied by loss of personal identity and physical relocation
dissociative identity disorder
- 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
Depersonalization Disorder
-patients believe that they have changed in some way or are in some way no longer real
dissociative disorders not otherwise specified
- 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)
Broadly DSM 5
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
DSM 5 - intrusive symptoms (5)
- 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
DSM 5 - Avoidance (2)
- 1 or more :
- avoid memories, thoughts, feelings
- avoid external reminders (people, places etc.)
DSM 5 - Alterations in cognition and mood (7)
- 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
DSM 5 - Alterations in arousal and activity (6)
- 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
Exposure therapy
- most effective
- imaging event, in attempt to extinguish fear symptoms
- > extinguish associations between cues and fear response
- > disconfirms symptom maintaining dysfunctional beliefs
Forms of exposure therapy
- 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)
psychological debriefing - treatment
- 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
cognitive restructuring
-treatment
- 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
Cognitive restructuring together with exposure therapy
-does NOT produce a significant increase in exposure therapy in producing changes in dysfunctional cognitions
Article Kihlstrom - DD Trauma - memory argument
- 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
Type 1 and type 2 traumas - trauma memory argument
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
Dissociative subtype PTSD
- PTSD patients also exhibit dissociative phenomena
- depersonalization: experience of feeling detached from one’s own body
- derealization: experience of unreality of surroundings
Zoet article - Dissociative subtype - treatment
-findings
- 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
