Trauma Flashcards
What are the immediate instinctual responses to trauma?
Fight or Flight, Dissociative/freeze reaction
Patricia Resicks Socio-cognitive theory and cognitive processing theory consider the secondary emotions of guilt and shame to be ________. (these occur after primary emotions e.g fear, anger and sadness)
Manufactured Emotion
What is “hindsight bias”
Belief that you should have know that the event was going to happen
Which of the following symptoms may children display after exposure to a traumatic event? A. Nightmares, B. bedwetting, C. Reenactment behaviours, D. All of the Above
D. All of the above
What are reenactment behaviours?
In some way replicating the trauma. Including victim or victimiser roles resulting in harm to others, self-destructiveness or revictimisation. Lingering behavioural enactment and automatic repetition of the past.
Dissociative symptoms are included among the criteria for all of the following disorders EXCEPT: A. Posttraumatic stress disorder B. Acute stress disorder, C. Dissociative identity disorder, D. Adjustment disorder.
D. Adjustment disorder
Which theory regarding children’s adjustment following exposure to parental/caregiver violence suggests that children develop beliefs about the usefulness and appropriateness of aggressive behaviour?
Social Learning Theory
After a trauma, what is the ripple effect?
When a trauma affects the family members, friends and community of the victim.
How common is trauma?
50% + (Norris 69%, Creamer 57%, Nixon 75%)
Why is the rate of PTSD lower then the rate of trauma?
Most people adjust and recover without formal treatment
What is the diagnostic criteria for Acute Stress Disorder (ASD) according to the DSM-IV
- Criteria A Stressor (the trauma) 2. Diagnosed between 2days and 4 weeks after trauma. 3. 3x dissociative symptoms 4. at least 1x re-experiencing symptoms OR avoidance OR hyperarousal. MUST cause clinically significant distress or impairment MUST not be due to effects of substances or a general medical condition.
List some dissociative symptoms
numbing, reduced awareness, derealisation, depersonalisation, traumatic amnesia.
Problems with ASD as a diagnosis? and by extension problems with it’s heavy reliance on dissociative symptoms.
Lack of research - heavy reliance on restrospective accounts. Hard to draw a line between peri (during) and post-trauma experience. Dissociation no necessarily found to predict poor outcome. Dissociation not found to predict PTSD - when ASD is meant purported to predict PTSD. Dissociation is vague and hard to measure
Should ASD be used as the sole predictor of PTSD? Why/why not?
No. Because individuals who don’t develop ASD can still develop PTSD - particularly given the over-reliance on dissociative symptoms. STATS/Detail 75-78% hit chance (Richard Bryant), BUT of those who were subthreshold (i.e had less than 3 dissociative symptoms, but all other symptoms) 60-70% met criteria for PTSD. The need for dissociation symptoms is not absolute. Dissociative symptoms have better negative than positive predicting power and the cluster of symptoms are highly correlated (i.e may be the same construct).
List predictors of ASD development.
Premorbid psychiatric and trauma history Deppression reaction to trauma Avoidant coping style Tendency to use dissociative mechanisms may also contribute (mixed role) Premorbid and post trauma unhelpfull cognitions (how one views/makes sense of the trauma)
In ASD in children, why is it important to ask/talk to the child victim?
Parents are less likely (62%) to consider a traumatic event a CRITERIA than the child themselves (92%) Could be parents underestimate or children overestimate or that children tell their parents that the trauma was not severe so as not to upset them.
What are risk factors for ASD in children?
Prior psychopathology, Permanent injury sustained, parent’s stress over trauma, age (debatable), female (debatable)
What are the PROPSED ASD diagnosis criteria in the new DSM-5?
A. Criteria A trauma B. Presence of 9 (or more) of the following symptoms in any of the four categories: intrusion (4), dissociation (3), avoidance (2) and arousal (5) - that begun or worsened after the traumatic events occurred. C. Duration 3days –> 1 months following trauma D. Impariment E. Not due to substance/medical reason or brief psychotic disorder
What are the DSM-IV diagnostic criteria for PTSD
A. Criteria A stressor (direct and indirect exposure) B. diagnosed after 4 weeks C. Immediate trauma response involved fear, horror, helplessness THREE CLUSTERS OF SYMPTOMS D. re-experiencing symptoms (thoughts nightmares, flashbacks) E. Avoidance (effortfull/numbing/amnesia) F. Hyperarousal (startle, hypervigilance, insomnia) G. Causes significant distress or impairment
What are re-experiencing symptoms?
intrusive thoughts, nightmares or flashbacks regarding the traumatic experience
What is the PROPOSED DSM-5 PTSD diagnostic criteria?
A. exposure to trauma - but now includes extreme exposure to adverse details of trauma (e.g first responders) A2 dropped - no longer requires that the trauma induced intense fear, horror or helplessness. FOUR rather than three clusters of symptoms B. 1 re-experiencing/intrusive symptoms C. 1 Avoidance (active) symptoms D. 2 Alterations in cognition and mood (with new items) E. Hyperarousal (now also includes self-destructive or reckless behaviour)
What are the DSM-5 PTSD symptoms that are “alterations in cognition and mood”?
persistent and exaggerated negative beliefs or expectations about oneself, others or the world. Persistent distorted blame of self or others about the cause or consequences of the traumatic event. Persistent negative emotional state. Amnesia and lack of interest.
How does the DSM-5 PTSD criteria for children under 6 (sub-type) differ to that of adults?
Less clusters, less symptoms required
The DSM-5 includes a PTSD subtype for children under 6, what is the other sub-type?
Sub-type of PTSD with prominent dissociative (depersonalisation/derealisation) symptoms.
What is the rate of PTSD as measures as lifetime prevalence and 12 month prevalence.
8% lifetime (Kessler) 1.33% (Australian rate over 12 months) 6.4% (Slade et al. 2009, 12 month prevalence) <— different/better way of asking questions.
What type of trauma yields the highest rates of PTSD?
Interpersonal Trauma! Sexual assault (31-47-94%) depending on time when assessed. Intimate partner violence (31-84%) War (30-67%) Refugees (50-90%) Physical assalts (13%) Motor vehicle accident (12%) Disaster (8-10%)
What % of PTSD will have a comorbid disorder?
80%
List the common comorbids of PTSD
Depression, substance misuse/abuse and anxiety disorders.
How does comorbid depression interact with trauma and PTSD? (give % and interaction with trauma w/o ptsd, ptsd after trauma and prior depression etc)
MDD (Major Depression Disorder) 30-50% of PTSD Trauma PTSD = 4x more likely to develop depression. Trauma exposure without PTSD = normal chance of depression Prior depression = increased risk for exposure to trauma AND ptsd after trauma
What is the DSM-IV criteria for depression?
Major depressive episode 5 symptoms over the past 2 weeks. *depressed mood most of the day, daily or nearly daily *decreased interest in activities/reduced pleasure *Weight gain/loss nearly everyday *Poor sleep *Psychomotor retardation or agitation *Fatigue or loss of energy nearly every day *Sense of worthlessness/guilt *Decreased concentration *Suicidal ideation; recurrent thoughts of death
What is the DSM-IV criteria for substance abuse?
A maladaptive pattern of substance use leading to significant clinical impairment or distress over the past 12 months. 3 of the following: 1. Tolerance 2. Withdrawal 3. Large amounts taken 4. Desire or attempt to cut down 5. Time spent obtaining substance 6. Social occupational, recreational activities given up on reduced due to substance. Use continues despite knowledge of physical and psychological effects of use.
What is the DSM-IV criteria for Anxiety (panic attacks and panic disorder)
Panic attack = discrete period of intense fear in which 4 or more of the following symptoms develop abruptly and reach peak within 10 minutes. *increased heart rate (palpitations/pounding) *Sweating *Trembling/shaking *Derelisation/depersonalisation *Fear of losing control/dying *Sensations of shortness of breath or smothering *Feeling of choking *Paresthesias (numbness or tingling sensation) *Chest pain or discomfort *Feeling dizzy lightheaded or faint *Chills or hot flushes
Why is looking at panic attacks important in regards to trauma? (percentages)
Common during trauma, high prevalence after trauma - both more-so if person is diagnosed with ASD STATS - Peritraumatic (during) panic rates approx 53-90% depending on type of trauma} 100% of people diagnosed with ASD experienced a panic attack at the time of their trauma versus. 47% who were exposed to trauma and not diagnosed with ASD. 93% of ASD participants had recurrent panic attacks after trauma versus. 7% of non-ASD participants.
Who is the primary psychologist/researcher/proponent of Emotional Processing Theory?
Edna Foa
Outline the Emotional Processing Theory? (Adjustment following trauma) (clue: development, activation, how good adjustment occurs [i.e theory underlining treatment])
- trauma trigger the development of a memory framework that is extremely sensitive to what is perceived to be danger-related cues or materials. 2. When this network is activated reexperiencing or intrusive thoughts of the trauma occur but, people then attempt to shut this process down (mental or physical avoidance). 3. Good adjustment occurs when 1. people access trauma memory and habituate to the anxiety the memory causes. 2. New learning occurs (new associations become stronger than old associations) *Cognitions such as lack of competency and the world being dangerous are argued to be core unhelpful beliefs that maintain symptoms.
Who is the primary psychologist/researcher/proponent of Socio-cognitive theories?
Patricia Resick
What is/are the socio-cognitive theories?
Theories based on the idea that after primary and basic emotions that occur when a trauma occurs (fear, anger, sadness) MANUFACTURED emotions can occur (shame, guilt etc) which interfere with recovery. Proponents of these theories stress the importance of the MEANING of the event. In particular, how people appraise themselves and the world significantly contribute to post-trauma adjustment. They agree that interference of information being processed occurs when it conflicts with prior thought patterns/styles (or schema) some support for the theory - see littleton & grills-taquechel, 2011
In Socio-cognitive theories, why do manufactured emotions (e.g guilt) occur?
They occur because of distorted perceptions and cognitions if there is a lot of emotion post-trauma, this interferes with cognitive process.
According to Patricia Resick and socio-cognitive theories, what is assimilation, accommodation and over-accomodation respectively?
Belief systems: Assimilation - change the meaning or interpretation of the event (poor response) Accommodation - Adjust schemes/belief in light of the event (reasonable adjustment) Over-accomodation - over-generalize and rigidly change schemas after the event (poor response) Can both ASSIMILATE and OVERACCOMODATE at the same time.
In socio-cognitive theories of trauma response what is a schema?
Prior thought patterns/styles/beliefs
How does Edna Foa’s Emotonal Processing Theory (Information processing theory) explain and suggest treating trauma response? (EPT)
Trauma occurs -> memory frame-work develops that is sensitive to danger-cues (attentional bias). When memory framework is ACTIVATED (by cues) = re-experiencing and intrusive thoughts
Two responses: avoidant (maladaptive) or habituation to anxiety/new learning (adaptive).
Core unhelpfull beliefs (e.g lack of competency, world is dangerous) maintain symptoms.
How is Cognitive Processing therapy used (resick) to treat PTSD?
CPT begins with the trauma memory and focuses on feelings, beliefs and thoughts that directly emanated from the traumatic event. The therapist then helps the client examine whether the trauma appeared to disrupt of confirm beliefs prior to this experience, and how much the clients have overgeneralized (over-accomodated) or attempt to undo the event (assimilation) from the event to their beliefs about themselves and the world. Clients are then taught to challenge their own self-statements and to modify their extreme beliefs to bring them in balance.
Write an account of the trauma including meaning (read daily), taught to challenge and replace maladaptive thoughts and beliefs
How is treatment for children sufferers of child abuse differ from treatment of adults with PTSD?
Also includes modeling disclosure ofabuse-related information, focus on coping stratergies, gradual exposure usng alternative exposure methods of child’s choice (doll, play, imagery, drawing, reading, letter writing, poetry and singing). Education and revictimisation prevention.
Also therapy with non-offending parent to prevent behaviours that may foster PTSD in their child.
What is flooding and what is systematic desensitisation SD)? What is the difference?
Flooding differs from SD n that the exposures are based on extended exposure to moderate or strong fear-producing cues. (both imaginal and in vivo)
Systematic desentisation is the gradual exposure to fear-provoking stimuli based on a hierachy from least-worst
What is Eye Movement Desensitization and Reprocessing therapy? (EMDR)
The theory that lateral eye movements facilitate cognitive processing of the trauma.
No contains a number of components, incldign both exposure and cognitive components. The core ‘lateral eye movement’ procedure involves 1. visualising the memory, 2 rehearsing the negative thoughts, 3 concentrating on the physical sensation of the anxiety and 4 visually tracking the therapists index finger as it moves rapidly back and forth 30-35 cm from the clients face with 2 back-and-forth movements per second. This is epeated 24 times.
How good at predicting PTSD is ASD?
Around 75-78%, but of those who were subthreshold on dissociative symptoms alone 60-70% met criteria for PTSD - indicating that the need for dissociation symptoms is not absolute. ASD has better negative predictive power than positive predictive power
Why is it important to ask children directly about their experience or symptoms of trauma?
Parents tend to say a traumatic vent was criteria a less often (62%) than the child themselves (92%)
why?: many reasons, child does not tell parent to protect them, seems bigger to the child, parents underestimate
What are the risk factors for ASD in children?
- Prior psychopathology
- permenent injury sustained
- Parent’s stress over trauma
- age (debated - younger)
- female (debated)
What is the prevalence of PTSD? (lifetime and current measurements)
8% lifetime, 1.33-6.4%(better study) over the ‘last 12 months’
What percentage of PTSD have Major depression disorder as a comorbidity?
30-50%
What percentage of people later diagnoses with ASD experience a panic attack during the trauma?
100%
What percentage of people NOT diagnosed with ASD experienced a panic attack during the trauma?
47%
