task 6 Flashcards
Trauma
Disordered psychic/ behavioral state resulting from mental or emotional stress or physical injury.
Single blow trauma and Repeated trauma
single blow trauma: just happens once (e.g. seeing 9/11)
repeated trauma: multiple traumatic events, usually more interpersonal
Impersonal and interpersonal trauma
Impersonal: no person who is agent of trauma (e.g. natural disaster)
Interpersonal: another person conflicting something serious –> almost always involves perpetrators (daders) and victims.
Different perspectives on trauma (4)
- Psychiatric perspective: Focus on symptoms and disorders and their causes (e.g. diathesis stressor model)
- Cognitive perspective: focus on a persons beliefs which are known as schemas
- Feminist perspective: focusses on inequalities in power and social status
- Psychoanalytic perspective: Focus on early experience as a determinant of later behavior.
Risk factors of PTSD
- Prior history of trauma (rape/ childhood abuse)
- Pre-existing psychiatric illness, especially mood and anxiety disorders
- Family history of mental disorders
- lower social support
- Lower intelligence
- Female gender
Distal factors PTSD
Pretraumatic factors: characteristics of the traumatized individual or his/her life history and include features such as gender, family history of psychopathology and prior trauma history
Proximal factors PTSD
- Peritraumatic factors: factors operating during the trauma and include variables such as perceived life threat during the trauma, peritraumatic emotional responses and dissociation, and peritraumatic cognitions/ behaviors and physiological reactions.
- Posttraumatic factors: factors operating after the trauma, such as posttrauma social support and posttraumatisch life stress.
PTSD and HPA-axis
PTSD patients do not exhibit a normal cortisol response to stress. They show super-suppression of cortisol on the dexamethasone suppression test, suggesting a HPA-axis that is supersensitive to stress.
Is PTSD an anxiety disorder?
Yes:
- Like many anxiety disordered patients, PTSD show physiological over-reactivity to feared stimuli
- In laboratory tests, both anxiety disordered an PTSD patients show heightened sympathic nervous system arousal, such as increased heart rate and blood pressure, and lowered skin conductance. when presented a feared stimuli
- Like many anxiety disordered patients, persons with PTSD avoid feared situations
- Flashbacks also have some phenomenological similarity to panic attacks
No:
- Only anxiety disorder where patients actually need to experience a traumatic event or be exposed to a traumatic event, in anxiety disorders, there is no need for exposure
- It was concluded that PTSD does not load on the fear disorders, but instead loads best on an internalizing disorder that the authors called ‘anxious misery’ along with the mood disorders.
Eye movement Desensitization Reprocessing (EMDR)
Treatment to treat adults with PTSD. It is an effective treatment for alleviating trauma symptoms.
A crucial part of the procedure involves recalling traumatic memories, while simultaneously making horizontal eye movements. (Eyemovement is crucial for effectivity). Patient has to rate the memory in terms of vividness and emotionality.
With this the nervous system will be rebalanced, and this leads to a shift in information that is dysfunctionally locked in the nervous system.
Imagery rescripting (IR)
Tries changing the traumatic imagery to correct the situation in fantasy, and to produce a more favorable outcome (without denying the trauma).
Patient is stimulated to expess emotions, impulses and needs experienced during imaginal reliving of trauma.
–> This often leads not only to (imagined) expression of inhibited emotions and actions, but also to new viewpoints brining about a change in meaning of the traumatic event.
Imaginal exposure (IE)
Patients are asked to recall the details of the traumatic event while focusing their attention on any occurring sensory feelings, thoughts and emotions. Exposure to such memories results in reduction of fear and avoidance.
The presumed underlying mechanism is the loosening to the association between unconditioned and conditioned stimuli.
Flashforwards
Intrusive vivid images of future catastrophe. Flashforwards are important in social fears, like performance anxiety.
What is PTDS
A. Exposure to actual threatened death, serious injury or sexual violence in one (or more) of the following ways:
- Directly
- witnessing, in persons the events as it occurred to others
- Learning that the traumatic events occurred to a close family member or close friend. In cases of actual or threatened death of a family member or close friend the events must have been violent or accidental
- Experiencing repeated or extreme exposure to aversive details of the traumatic events. (e.g. police officers repeatedly exposed to details of child abuse/ first responders collecting human remains).
B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic events. Beginning after traumatic events.
- Nightmares related to traumatic events
- Involuntary memories
- Dissociative reactions (e.g. flashbacks) in which the individual feels or acts as if the traumatic events were recurring
- Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic events
- Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic events.
c. Persistent avoidance of stimuli associated with the traumatic events beginning after the traumatic events occurred, as evidenced by one or both of the following
- Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic events.
- Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about of closely associated with the traumatic events.
D. Negative alterations in cognitions and mood associated with the traumatic events, beginning or worsening after the traumatic events occurred.
- inability to remember (due to amnesia not to factors such as alcohol/drugs/ head injury)
- persistent negative beliefs/ expectations about oneself/world/others
- feelings of detachment of others
- inability to experience positive emotions
- diminished interest/participation from significant activities
- persistant negative emotional sate
- distorted cognitions about the cause or consequences of the traumatic events that lead the individual to blame her/himself or others.
E. alterations (wijzigingen) in arousal and reactivity associated with traumatic evens.
F. duration of the disturbance a,b,c,d and e is one month
G. Disturbance causes clinically significant distress/ impairment in social, occupational, or other important areas of functioning
H. the disturbance is not attributable to the physiological effects of a substance (e.g. medication, alcohol) or another medical condition.
