Theoretical Perspectives of Trauma

Question 1

The primary theoretical limitation of early conditioning models and fear reduction of trauma reaction approaches:

Answer 1

The inability of these theories to provide adequate explanations of all the core features of PTSD and the role of responses and emotions other than fear (Brewin & Holmes, 2003; Foa & Kozak, 1986; McGarvey & Collins, 2001).

Question 2

Contemporary theories also enjoy the advancement of technology that has led to…….. and use the role of neuropsychology to expand…….

Answer 2

To an increase in knowledge in the field of neuropsychology.

Expand our understanding of the normal and abnormal processes involved in trauma exposure

Question 3

When and who first identified the dual nature of PT symptoms as both physiological and psychological:

Responses to trauma are associated with (3 F’s)
Each of these responses have 3 elements to them.

Answer 3

As early as the 1940s, Kardiner (1941) and other theorists.

Fight, Flight or Freeze
Elements of: physiological/arousal, cognitive and affective.

Question 4

Physiological Response to Trauma

• purpose of the physiological response
• 2 systems responsible for mediating the process
  (and how they act - by releasing what chemicals in brain)

Answer 4

Purpose involves a number of systems that prepare the body to respond (fight, flight or freeze) to the threat and subsequently return the body to homeostasis.

The autonomic nervous system and the hypothalamic-pituitary-adrenal axis. These systems act primarily via the “release of endogenous stress responsive neurohormones including cortisol, epinephrine and norepinephrine, vasopressin, oxytocins and endogenous opioids” (van der Kolk, 1994, p. 255)

Question 5

Normal physiological response to a stressor in the environment:

1. Incoming stimuli are processed in ….. however the …. is responsible for….
2. This activity directs activation of …… leading to secretion of ……. (3 hormones) into bloodstream
3. This then results in secretion of …… via adrenal medulla into ………. + what does this do to prepare the body
4. How does the body react to the last step (characteristics of flight or fight) and how they help the body’s senses
5. What happens in the brain (hormone is trasnformed) when step 4 is occuring.. and what it allows the individual to focus on
6. What is important for activation of the flight/fight response and for returning the body to homeostasis and how does this occur in the brain
7. What are also released into the brain to act as an analgesic - and how does this help a person in a fight or flight situation

Answer 5

1. Incoming stimuli are initially processed in the cerebral cortex. However, the amygdala is responsible for the determination of threat and the activation of a series of appropriate neuro-chemical systems
2. This activity directs activation of the hypothalamus, leading to the secretion of corticotropin-releasing hormone (CRH) and arginine vasopressin, signalling the anterior pituitary gland to secrete adrenocorticotropic hormone (ACTH) into the bloodstream.
3. This then results in the secretion of glucocorticoids (primarily cortisol), epinephrine and norepinephrine (NE) via the adrenal medulla and adrenal cortex. This cascade of neuro-chemical activity activates the body, allowing it to deal with the current threat, known as the flight or fight reaction
4. Thus, the body reacts via increased heart rate and respiration, dilation of the pupils, and release of sugar into the blood. All of these functions serve to heighten the body’s senses and access strength and energy in order to deal with the crisis
5. Simultaneously, in the brain, adrenalin is transformed into norepinephrine, allowing the individual’s attentional resources to focus narrowly on the threat at hand.
6. Glucocorticoids are responsible for the activation of the flight/fight response and for returning the body to homeostasis. This occurs via the delivery of information from the glucocorticoid receptors to the hippocampus, which in turn signals the hypothalamus to stop releasing glucocorticoids
7. Endorphins are also released into the brain and act as an analgesic, thus improving the likelihood of survival by ensuring that the individual will not be preoccupied by physical pain

Question 6

The encoding of the trauma memory and the response is adaptive for future survival; the retrieval of such information allows for…
—-
Kolb (1987) proposed that encoding trauma information efficiently is compromised when ….
—-
Kolb suggested that excessive peritraumatic stimulation of the central nervous system might result in….

Answer 6

Increased speed and efficiency of the body in activating emergency systems, should a similar trauma event present again.
—–
Excessive traumatic stimulation overwhelms the brain’s capacity to process the information, resulting in subsequent PTSD symptoms.
—–
Posttraumatic neuronal changes

Question 7

NEUROBIOLOGICAL MODEL OF PTSD

The resultant changes signify a permanent sensory imprint of ____________________ , which imposes an imbalanced degree of __________. This, in turn, results in behavioural reactions of _____ or ____ that are focused on defending against future trauma via the activation or deactivation of biological systems in a bid to secure __________.

Answer 7

The resultant changes signify a permanent sensory imprint of maladaptive processing of the experience, which imposes an imbalanced degree of emotional importance. This, in turn, results in behavioural reactions of activation or restraint that are focused on defending against future trauma via the activation or deactivation of biological systems in a bid to secure homeostasis

Question 8

NEUROBIOLOGICAL MODEL OF PTSD

According to Sherin and Nemeroff, the lack of baseline cortisol which is consistently reported at the time of trauma may facilitate the ________ of the central CRH-NE cascade. This is thought to result in amplified and prolonged __________.

Inadequate _______ effects of the gamma-aminobutyric acid, neuropeptide Y and serotonin neurotransmitters may further ________ this amplification of _________

It is argued that the PTSD feature of the ________of learned fear to unrelated trauma contexts, as well as ________ in discerning threatening and non-threatening stimuli, are associated with an ________ functioning hippocampus

Answer 8

According to Sherin and Nemeroff, the lack of baseline cortisol which is consistently reported at the time of trauma may facilitate the over-activation of the central CRH-NE cascade. This is thought to result in amplified and prolonged stress responses

Inadequate regulatory effects of the gamma-aminobutyric acid, neuropeptide Y and serotonin neurotransmitters may further exaggerate this amplification of stress responsiveness

It is argued that the PTSD feature of the generalisation of learned fear to unrelated trauma contexts, as well as deficits in discerning threatening and non-threatening stimuli, are associated with an abnormally functioning hippocampus

Question 9

NEUROBIOLOGICAL MODEL OF PTSD

Common in individuals meeting the ____ diagnostic criteria is abnormal _______ function, as well as overactive _______ response, in combination, these deficits are thought to be in part responsible for paranoia, hyper-vigilance, behavioural activation, exaggerated ______ responses and the further acquisition of ______ associations

Disrupted _____ cortical functions may, in turn, facilitate ______ symptomology due to the inadequate suppression of stress responses and fear associations, as well as extinction

Answer 9

Common in individuals meeting the PTSD diagnostic criteria is abnormal hippocampus function, as well as overactive amygdala response, in combination, these deficits are thought to be in part responsible for paranoia, hyper-vigilance, behavioural activation, exaggerated stress responses and the further acquisition of fear associations

Disrupted prefrontal cortical functions may, in turn, facilitate PTSD symptomology due to the inadequate suppression of stress responses and fear associations, as well as extinction

Question 10

NEUROBIOLOGICAL MODEL OF PTSD

M____ distrubance is one of the core characteristics of PTSD.
And what does this result in? (Characteristics)

What is the Declarative Memory System

Impairment of the Declarative Memory System is attributed to…. (and a feature of)

Answer 10

Memory disturbance is one of the core clinical characteristics of PTSD. Typically associated with PTSD are intrusive memories, which are generally accompanied by high levels of arousal and behavioural responses, and fragmented or impoverished memory, which is associated with poor encoding and retrieval

General impairment of the declarative memory system (also known as explicit memory) = consists of facts and events that can be explicitly stored and consciously recalled or “declared”.

Impairment of the Declarative Memory System is also a feature of PTSD (van der Kolk & Fisler, 1995), and is attributed to an abnormally functioning hippocampus.

Question 11

Integrated Model of Foa and Colleagues:

Foa and Kozak proposed what theory? (FNT)

Trauma info biased by extreme peritraumatic emotions would result in ________________________ of the event.
———
Meaning of process: Extinction
——–
Abnormal processes of learning and extinction in people with PTSD may be a consequence of (hormone/chemical)

Answer 11

Accordingly, trauma information that is biased by extreme peritraumatic emotions would arguably result in a fragmented and disorganised memory of the event.
——-
Extinction = the gradual weakening of a conditioned response that results in the behaviour decreasing or disappearing
——–
Abnormal processes of learning and extinction observed in individuals with PTSD may be a consequence of altered norepinephrine and stress hormone activity

Question 12

Integrated Model of Foa and Colleagues:

Norepinephrine enhances the encoding of ____memories.

Glucocorticoids block the retrieval of _______memories.

The combination of elevated noradrenergic activity and relative hypocortisolism may strengthen the ______ of _______ memories, thereby explaining the reduced inhibition of ______ retrieval; both of which are thought to trigger the re-experience phenomenon in PTSD.

Answer 12

Norepinephrine enhances the encoding of fear memories.

Glucocorticoids block the retrieval of emotional memories.

The combination of elevated noradrenergic activity and relative hypocortisolism (low cortisol level) may strengthen the encoding of traumatic memories, thereby explaining the reduced inhibition of memory retrieval; both of which are thought to trigger the re-experience phenomenon in PTSD

Question 13

Foa and Rothbaum (1998)

As inflexibility of _____ and ______ increases, so too does the individual’s vulnerability to developing ____.

For those who have poor self and worldviews, this vulnerability acts to confirm their _________.

Oppositely: those with positive self and worldviews, the trauma _____ and ______ their previously held beliefs.
Therefore hindering successful _________________ of the trauma information..

Answer 13

Foa and Rothbaum (1998) proposed that, as inflexibility of self and worldviews increases, so too does the individual’s vulnerability to developing PTSD.

For those with poor self and worldviews, this vulnerability occurs because the trauma acts to confirm previously held beliefs.

In contrast, for those with rigid inflexible positive self and worldviews, the trauma contradicts and challenges previously held beliefs. This arguably hinders the successful information processing of the trauma information

Question 14

In Foa and colleagues expanded and contemporary model:

Greated emphasis placed on ______ appriasals of ____ and _____ during and after trauma.

This includes post trauma symptoms and responses that intensify perceptions of ______.

Model proposes that pre, peri and post traumatic beliefs may interact to strengthen current beliefs of ______ and _____ which are believed to underlie chronic ____.

Answer 14

In Foa and colleagues expanded and contemporary model, greater emphasis is placed on the role of negative appraisals of responses and behaviours during the trauma and after the trauma.

Including post-trauma symptoms and the responses of others that intensify perceptions of incompetence.

For that reason, the model proposes that pre-trauma, peritraumatic and posttraumatic beliefs may interact to strengthen current beliefs of incompetence and danger, which are believed to underlie chronic PTSD

Question 15

Foa and Kozak (1986) proposed exposure therapy as an effective treatment for PTSD.

This identified benefits of _____
Countering belief that symptoms are _____
+ 4 other things they looked into and changed.

Other benefits include:

• reuduction in global ____ _____
• cohesive memory _____in integration of ____ memory.
• promotion of personal _______

Answer 15

Identifying the benefits of the habituation of fear, countering the belief that symptoms are permanent, prevention of negative reinforcement of the trauma memory, incorporation of safety information, and disconfirmation of negative trauma information allowing for the modification of negative trauma memories.

Other benefits have been found to include a reduction in global danger beliefs, promotion of cohesive memory aiding in the integration of the trauma memory, and promotion of a sense of personal resiliency

Question 16

DRT Stands For:

DRT of PTSD is a complex _______ theory, reformulated and grounded in ________ that explains the core features of ____.

The DRT of PTSD attempts to explain the ________ and ________ of PTSD from two pathological pathways: the trauma-related appraisal and emotional processing which underlie the _____ processes related to the processing of trauma information.

Answer 16

Dual Representation Theory

DRT of PTSD is a complex social cognitive theory, reformulated and grounded in neuropsychology that explains the core features of PTSD

The DRT of PTSD attempts to explain the development and maintenance of PTSD from two pathological pathways, namely, the trauma-related appraisal and emotional processing which underlie the neural processes related to the processing of trauma information

Question 17

A fundamental tenet of DRT is that memories are encoded into……..

Within the revised model of DRT, verbally accessible memory is referred to as _______ memory (C-memory). + why they changed it?

Information contained in the C-memory structure is said to comprise ____ _____ ______, allowing for ______ recall, _____ editing and re-appraisal.

Answer 17

A fundamental tenet of DRT is that memories are encoded into dual memory systems: verbally accessible memory and situationally accessible memory. Both types of memory are encoded in an associated and parallel fashion (Brewin, 2001; Brewin et al., 1996)

Within the revised model of DRT, verbally accessible memory is referred to as contextual memory (C-memory). This change represents a more adequate description of this memory store, indicating that it is more than verbally accessible.

Information contained in the C-memory structure is said to comprise elaborate contextual information, allowing for deliberate recall, progressive editing and re-appraisal

Question 18

The C Memory system facilitates the interpretation of___________

C-Memory Function

C-reps are representations within _______

C-memory, maintained by the medial temporal lobes system, is responsible for ________ memory, including the hippocampus which is responsible for the _____ and ______ specific information associated with _____memories and the para-hippocampus

Answer 18

C-memory facilitates the interpretation of meaning from events by merging information in various forms, including abstracted, generalised ideals and novel images from objective and conceptual information, all of which are considered allocentric, or viewpoint-independent.

C-Memory Function is to manipulate new information in such a way that it can be located contextually, spatially and temporally.

C-reps are representations within this memory store and are not purely verbal, but comprise properties encoded within the ventral stream in a manner that allows for the contextual integration of new information with existing autobiographical information

C-memory, maintained by the medial temporal lobes system, is responsible for declarative memory, including the hippocampus which is responsible for the spatial and temporal specific information associated with episodic memories and the para-hippocampus (Brewin et al., 2010).

Question 19

S - Memory = _____ based memory
S Memory consists of………….

Information in the S Memory is encoded in a egocentric fashion = just as it was experienced. Meaning….

Answer 19

Sensation-based memory = S-memory.
S-memory consists of a rich store of sensory and affective (emotional) information related to specific events, known as sensory representations (S-reps)

Information in this system is encoded in an egocentric fashion = just as it was experienced.
Information contained in this memory structure is not located contextually, spatially or temporally, and cannot be deliberately recalled or edited. Rather, activation of this memory store occurs via cued stimuli of the original event

Question 20

Normal encoding of events (involving integration of the S-Rep and C-Rep)

DRT, at the time of processing highly ________ events representing threat, the stress response of the body compromises the ________ capacities of the individual. The person responds to limitations of ______ by processing large amounts of ______ information.

This is a highly adaptive function, as it allows for the automatic retrieval of information by similar cues (critical for___________________). The other advantage of storing information in this manner is that the _________ of S-reps and C-reps of the event can occur at a more appropriate or safer time without being lost

Answer 20

Normal encoding is described as the integration of information into autobiographical memory via the creation of an association between the S-rep and corresponding C-rep for the new information. The encoding and partnership of the two systems is a normal process of memory.

DRT, at the time of processing highly emotionally salient events representing threat, the stress response of the body compromises the attentional capacities of the individual. The person responds to limitations of attention by processing large amounts of sensory information (as S-reps in the unconscious memory store of S-memory)

This is a highly adaptive function, as it allows for the automatic retrieval of information by similar cues (critical for successful avoidance and reaction in similar future events). The other advantage of storing information in this manner is that the integration of S-reps and C-reps of the event can occur at a more appropriate or safer time without being lost.

Question 21

When encoding of memories occurs normally, associations form between the _______ and ________elements of the incoming information

Where the normal retrieval of traumatic memories occurs, the visual recall of the event proceeds in a top-down manner, dominated by C-reps of the event and driven by the _______ cortex. This process activates egocentric visual imagery, allowing for the _______ and _______ of the S-reps of the experience.

It has been suggested that disruption during the _______ process of trauma information results in the necessary associations between S-reps and C-reps being _____ or _________

Answer 21

When encoding of memories occurs normally, associations form between the contextual and sensory elements of the incoming information

Where the normal retrieval of traumatic memories occurs, the visual recall of the event proceeds in a top-down manner, dominated by C-reps of the event and driven by the prefrontal cortex. This process activates egocentric visual imagery, allowing for the retrieval and matching of the S-reps of the experience. (NOTE: Re-experiencing does not occur under these encoding conditions, as the activation of weaker S-reps is contingent upon attention being directed to matching the details in the retrieved imagery)

It has been suggested that disruption during the encoding process of trauma information results in the necessary associations between S-reps and C-reps being lost or impaired

Question 22

When activation of an S-rep occurs due to a cue or trigger, the memory of the event __________

Involuntary flashbacks of trauma events are said to occur in a ________ fashion. More specifically, the S-reps activated by _________ cues or triggers fail to activate the corresponding C-reps that would provide top-down control over the memory. Persistent flashbacks occur due to the ___________ ___________ between both the contextual and sensory representations of the experience.

Symptomology is argued to continue until the ______ and _______ elements of the event are integrated

Answer 22

When activation of an S-rep occurs due to a cue or trigger, (and the association between the S-rep and C-rep of that event is absent or impaired) the memory of the event is experienced as if it were occurring in the present time (flashbacks)

Involuntary flashbacks of trauma events are said to occur in a bottom-up fashion. More specifically, the S-reps activated by situational cues or triggers fail to activate the corresponding C-reps that would provide top-down control over the memory. Persistent flashbacks occur due to the unsuccessful integration between both the contextual and sensory representations of the experience

Symptomology is argued to continue until the sensory and contextual elements of the event are integrated

Question 23

Brewin and Holmes (2003), proposed that information in the sensory and contextual systems compete for ______ and _________. This indicates that S-reps with impaired or lost associations to corresponding C-reps will be ______ if cued or triggered, as there is no top-down processing mechanism to temper the strength of the activated S-rep.

Integration of the two systems does not imply that the originally encoded trauma memory has been _____ in the sensory system. Rather, when the individual is able to contextualise the ______ elements, these remain intact but are ______ and unable to elicit the original response under the control of C-memory.

Answer 23

Brewin and Holmes (2003), proposed that information in the sensory and contextual systems compete for dominance and retrieval. This indicates that S-reps with impaired or lost associations to corresponding C-reps will be dominant if cued or triggered, as there is no top-down processing mechanism to temper the strength of the activated S-rep.

Integration of the two systems does not imply that the originally encoded trauma memory has been altered in the sensory system. Rather, when the individual is able to contextualise the sensory elements, these remain intact but are weakened and unable to elicit the original response under the control of C-memory.

(Maintaining symptomology is discussed in terms of individual differences in DRT. Included are event and symptom appraisals, self-world cognitions and maladaptive strategies that suppress symptoms and distress)

Question 24

Brewin (2003) suggested that commonly retrieved self-representations include those that feature ______, ______ and _________.

Commonly retrieved world-other representations include themes of (3 - different from above), leading to the activation of ________ ___ ____ representations making it difficult to retrieve ______ ones. This, in turn, plays a key role in appraisal of the trauma event in the context of the ______ and _____.

Answer 24

In respect to trauma, Brewin (2003) suggested that commonly retrieved self-representations include those that feature powerlessness, inferiority and futurelessness.

Commonly retrieved world-other representations include themes of betrayal, hostility and abandonment, leading to the activation of negative self-world representations making it difficult to retrieve positive ones. This, in turn, plays a key role in appraisal of the trauma event in the context of the self and others

Question 25

Even with the successful reactivation of dominant positive self-world representations via therapy occur, the original ________ will remain unchanged but dormant (Brewin, 2003) The individual has many _______ of the self in ________. For some people, experiencing trauma prompts the exploration of ______ identities in order to ______ the new trauma information. This explains why some people have a sense that they have been profoundly or irrevocably ______ from the trauma experience

Answer 25

Even with the successful reactivation of dominant positive self-world representations via therapy occur, the original negative representations will remain unchanged but dormant (Brewin, 2003) The individual has many representations of the self in memory. For some people, experiencing trauma prompts the exploration of alternative identities in order to reconcile the new trauma information. This explains why some people have a sense that they have been profoundly or irrevocably changed from the trauma experience.

Question 26

The activation of systems comprised of ____ and _____ representations may facilitate the integration of information within the two systems, - referred to as i____ and c_____. When successful integration of trauma information into a____________ memory occurs, __ and ___ concepts, safety and realistic expectations for the future are re____. The associations between S-reps and C-reps are also ____ or ________, resulting in the dominance of top-down retrieval of trauma information and a weakened response from the S-reps Successful integration is not always possible, and chronic attempts to process the trauma information may result in symptoms of _____, including arousal, intrusive visual symptoms (e.g., flashbacks), verbal symptoms (e.g., worry), avoidance and dissociation

Answer 26

The activation of systems comprised of sensory and contextual representations may facilitate the integration of information within the two systems,- referred to as integration and completion When successful integration of trauma information into autobiographical memory occurs, self and world concepts, safety and realistic expectations for the future are restored The associations between S-reps and C-reps are also restored or strengthened, resulting in the dominance of top-down retrieval of trauma information and a weakened response from the S-reps Successful integration is not always possible, and chronic attempts to process the trauma information may result in symptoms of PTSD, including arousal, intrusive visual symptoms (e.g., flashbacks), verbal symptoms (e.g., worry), avoidance and dissociation

Question 27

Ehlers and Clark’s cognitive model of persistent PTSD: Primary tenets of this model are that appraisal of the trauma, and the nature of trauma memory, is central to maintaining PTSD symptoms Individuals who develop persistent symptoms of PTSD experience the memory of the event as an ____ ___, with over-generalised _______ for their future. A number of pathways are identified as playing a ___ in this sense of ongoing threat. A primary component of the model focuses on the role of trauma ____. PTSD is characterised by ____memory elaboration because the memory is often _____, indicating that inadequate integration with existing autobiographical memories has occurred. This results in ____ in the voluntary ___ of trauma information, often accompanied by involuntary ____ and re-experiencing. This is due to the presentation of _____ cues that are closely matched to the ____ stimuli. These associations lead to a _____ in the perceptual threshold for trauma-related stimuli

Answer 27

Primary tenets of this model are that appraisal of the trauma, and the nature of trauma memory, is central to maintaining PTSD symptoms Individuals who develop persistent symptoms of PTSD experience the memory of the event as an ongoing threat, with over-generalised implications for their future. A number of pathways are identified as playing a role in this sense of ongoing threat A primary component of the model focuses on the role of trauma memories. In this context, PTSD is characterised by poor memory elaboration because the memory is often impaired temporally, spatially and contextually, indicating that inadequate integration with existing autobiographical memories has occurred. This results in deficits in the voluntary recall of trauma information, often accompanied by involuntary retrieval and re-experiencing. This is due to the presentation of environmental cues that are closely matched to the original stimuli. (as well as benign but vaguely matched cues to the original stimuli; which, in turn, influences the appraisal of future threat) These associations lead to a reduction in the perceptual threshold for trauma-related stimuli

Question 28

Trauma information processing at the time of exposure is seen to be either ____-driven or _____-driven. Data Driven Processing (Predominantly S_____) = Conceptually Driven Processing (C_________d) =

Answer 28

Foa and colleagues’ (1986, 1989) and Brewin and colleagues’ (1996) DRT, the trauma information processing at the time of exposure is seen to be either data-driven or concept-driven Data-driven (predominantly sensory) processing of information results in intrusive symptoms related to the unintentional recall of trauma information Conceptually-driven (contextualised) processing is related to the increased integration of trauma information into existing autobiographical memory stores

Question 29

Other factors considered to influence the encoding processes: (4) Factors that increase the likelihood of negative appraisals being involved in the development and maintenance of PTSD: (5)

Answer 29

Inability to establish a self-referential perspective, emotional numbing, dissociation and deficits in cognitive capacity (that compromise the accuracy of event appraisal). In their model, Ehlers and Clark (2000) identified a number of factors that increase the likelihood of negative appraisals being involved in the development and maintenance of PTSD: pre-trauma beliefs and experiences, peritraumatic thought processes, post-trauma events related to the trauma, beliefs about trauma sequelae, and mental defeat

Question 30

In the post-trauma stage, _______ self-appraisals and _____ worldview representations are indicative of cognitions about safety. These often involve cognitions such as the belief in the increased probability of being_____ , or a ______ another trauma event. This may manifest in poor self-______ and exaggerations of _____or ______ events that took place in the past. This, in turn, may lead to heightened _______ of negative events occurring in the future.

Answer 30

In the post-trauma stage, negative self-appraisals and negative worldview representations are indicative of cognitions about safety; thus, perceptions of the likelihood of danger become inflated. These often involve cognitions such as the belief in the increased probability of being involved in, or a victim of, another trauma event. This may manifest in poor self-cognitions and exaggerations of negative or aversive events that took place in the past. This, in turn, may lead to heightened expectations of negative events occurring in the future. (These aspects of the model have been widely supported by empirical evidence across numerous types of traumatic events)

Question 31

For some individuals the appraisal of symptoms commonly associated with experiencing a trauma, such as: (3) ^ These are perceived as abnormal, and leads to the belief that they....... In this sense, the trauma is appraised as ongoing in the ______ time, thus maintaining the PTSD symptoms via the generation of negative mood states, such as ______and _______. This often leads to _______coping strategies and _______ that perpetuate the cycle.

Answer 31

Ehlers and Clark (2000) suggested, that for some individuals the appraisal of symptoms commonly associated with experiencing a trauma (such as memory disturbance, problems with mood and concentration) ^^ These are perceived as abnormal, and leads to the belief that they have become permanently damaged In this sense, the trauma is appraised as ongoing in the present time, thus maintaining the PTSD symptoms via the generation of negative mood states, such as anxiety and depression. This often leads to maladaptive coping strategies and behaviours that perpetuate the cycle.

Question 32

Ehlers and Clark’s (2000) cognitive model of persistent PTSD. Main idea = negative reactions from (4 types of people) are consistently associated with..... (3) Self-world cognitions are believed to enhance over-generalised _____ and influence behaviour that, in turn, serves to ________________________________.

Answer 32

Ehlers and Clark’s (2000) cognitive model of persistent PTSD: negative reactions from family members and friends, legal professionals, medical staff, and others are consistently associated with poor psychological outcomes, prolonged recovery from posttraumatic symptoms, and PTSD symptom severity. Self-world cognitions are believed to enhance over-generalised fear and influence behaviour that, in turn, serves to maintain the over-generalisation of fear.

Question 33

Ehlers and Clark’s (2000) cognitive model of persistent PTSD focuses on the ways in which PTSD symptomology is cognitively and behaviourally maintained, suggesting three pathways ........ Commonly adopted maladaptive behavioural strategies include (6 generalised examples) Maladaptive cognitive strategies include (4)

Answer 33

(a) the increased number or frequency of symptom expression, (b) the reduced likelihood of progressive editing of negative trauma appraisal and or sequelae, and (c) the prevention of changes to the nature of the trauma memory Commonly adopted maladaptive behavioural strategies include the avoidance of reminders or cues of trauma, self-distraction, avoidance of previously enjoyed places, people and activities, increased safety behaviours (preventing disconfirmation of current threat appraisals), and the use of alcohol and other drugs Maladaptive cognitive strategies include the suppression of unwanted thoughts (directly increasing PTSD symptoms), dissociation, rumination and heightened vigilance to environmental threat cues (Ehlers & Clark, 2000)