Trauma and PTSD

Question 1

stress response

Answer 1

Person’s reaction to demands. Influenced by how we judge both the events and our capacity to react to them effectively- people who sense they have the ability and resources to cope are more likely to take stressors in stride and respond well.

Question 2

How does stress impact vulnerability to disorder?

Answer 2

Experiencing a large number of stressors makes someone more vulnerable to developing a disorder.

Question 3

Hypothalamic-Pituitary-Adrenal (HPA) Pathway

Answer 3

one route by which the brain and body produce arousal- pituitary gland secretes ACTH (major stress hormone), which stimulates the adrenal glands which secrete corticosteroids (stress hormones)

Question 4

Positive stress

Answer 4

Moderate, brief, normal part of life

Question 5

Tolerable stress

Answer 5

Occur infrequently and give the brain and body time to recover.

Question 6

Toxic stress

Answer 6

Strong, frequent, prolonged activation of the body’s stress response system (chronic neglect)

Question 7

Toxic stress and the brain

Answer 7

Toxic stress causes changes to brain structure or chemical activity, which causes changes in emotional and behavioral functioning

Question 8

What is trauma?

Answer 8

Exposure to physical harm, risk of death.

• Temporarily overwhelms the individual
• Exposed to actual/threatened death, injury, violence by witnessing it directly, learning it happened to a loved one, or experiencing repeated exposure to aversive details of event through work.
• NOT media exposure

Question 9

Types of trauma

Answer 9

• war/combat
• physical or sexual assault
• child abuse
• motor vehicle accident
• mass interpersonal violence
• partner battery
• violent or sudden death of loved one
• emergency worker exposure to trauma

Question 10

Prevalence of types of trauma

Answer 10

1 in 4 females sexually assaulted by 18 (1 in 8 males)
Between 13-30% exposed to natural disaster
20% involved in serious motor vehicle accident
25% in serious relationship at least one incident of violence
12% report an incident of serious violence in a relationship

Question 11

If you’ve been exposed to one trauma, are you more likely to be traumatized again?

Answer 11

Depends on type of initial trauma, reaction to initial trauma, and treatment for initial trauma. If interpersonal trauma, more likely to have multiple instances that non-interpersonal

Question 12

PTSD

Answer 12

Response to traumatic event.
Symptoms:
-intrusion (nightmares, flashbacks), re-experiencing
-negative alterations in cognitions or moods
-avoidance-triggers and cues of trauma, talking about it
-arousal and reactivity: irritability, reckless/self destructive bx, sleep disturbance, difficulty concentrating

Must last longer than one month, otherwise it is acute stress disorder.

Question 13

Acute stress disorder

Answer 13

Same core symptoms as PTSD, but symptoms last less than 4 weeks. People with ASD tend to go on to develop PTSD (but not necessarily)

Question 14

Prevalence and demo info for PTSD

Answer 14

Women 2:1 over men
20% of women exposed to trauma, 8% of men
Low income 2x risk compared to high income
30% of Vietnam vets, 40% of rape/sexual assault victims, 15-20% of those in natural disaster.

Question 15

What impacts whether someone develops PTSD?

Answer 15

• severity and duration of event
• injury
• genetics
• coping
• social support
• view of the world
• resilient or hardy personality

Question 16

Neurobiology of PTSD

Answer 16

Traumatic events trigger physical changes in brain and body. Some research suggests abnormal neurotransmitter and hormone activity (especially norepinephrine and cortisol). Once a stress disorder sets in, further biochemical arousal and damage may also occur (especially in the hippocampus and amygdala)

Question 17

Fear structure

Answer 17

When something traumatic happens, we develop a mental representation of the event called a fear structure

Question 18

What maintains PTSD?

Answer 18

Negative reinforcement (avoidance of trauma reminders)
Erroneous beliefs of threat

Question 19

Trauma and depression

Answer 19

15-20% of trauma victims are depressed

Comorbidity with PTSD: 47.9% men/48.5% women with PTSD also suffered major depression

Question 20

Substance abuse and trauma

Answer 20

35% men/27% women diagnosed with PTSD also experienced drug abuse or dependence

Question 21

Psychotherapy for PTSD

Answer 21

1st line of treatment

CBT- exposure, cognitive processing therapy

Question 22

Psychotropic meds used for PTSD

Answer 22

SSRI’s/antidepressants
Benzodiazepines (Xanax, Ativan)- not recommended because high addictive potential
Antihypertensive meds- Prazosin, used for sleep issues

Question 23

Principles of exposure therapy

Answer 23

Goal is for clients to learn that they can tolerate distress and that their expectations of stimuli are inaccurate.
Anxiety must be induced during exposure.
Must remain in anxiety producing situation long enough for client’s discomfort to peak and decline- 50% reduction general rule of thumb.

Question 24

Index event

Answer 24

The most distressing event in the traumatic experience.

Question 25

Cognitive Processing Therapy

Answer 25

Utilizes Socratic questioning.
Worksheets to analyze changes in beliefs due to trauma.
Looks at trauma impact in 5 domains: safety, trust, power/control, intimacy, esteem.

Question 26

Written exposure therapy

Answer 26

5-6 sessions used for PTSD: write out traumatic event and re-read repetitively

Question 27

EMDR

Answer 27

Exposure element is the mechanism for change, but lower dropout rate than prolonged exposure.

Question 28

Adjustment disorder

Answer 28

Emotional and/or behavioral symptoms in response to an identifiable stressor.
-within 3 mo of onset of stressor, dissipates within 6mo.
Types:
-with depressed mood
-with anxiety
-with mixed anxiety and depressed mood
-with disturbance of conduct
-with mixed disturbance of emotions and conduct

Question 29

What is the most commonly utilized diagnosis in outpatient?

Answer 29

Adjustment Disorder: less stigmatizing, diagnosis allowed by insurance companies, easily applicable to wide range of common problems. Be careful not to overlook significant mental health issue and fall back on AD.

Question 30

Autonomic nervous system

Answer 30

the network of nerve fibers that connects the central nervous system to all the other organs of the body.

Question 31

Endocrine system

Answer 31

the system of glands located throughout the body that help control important activities such as growth and sexual activity.

Question 32

What brain activity happens when a situation is interpreted as dangerous?

Answer 32

the hypothalamus activates the autonomic nervous system and the endocrine system

Question 33

Sympathetic nervous system

Answer 33

the nerve fibers of the autonomic nervous system that quicken the heartbeat and produce other changes experienced as arousal.

Question 34

Parasympathetic nervous system

Answer 34

the nerve fibers of the autonomic nervous system that help return bodily processes to normal.

Question 35

Corticosteroids

Answer 35

hormones, including cortisol, released by adrenal glands at times of stress.

Question 36

Biological factors in PTSD

Answer 36

• brain-body stress pathways: people who develop PTSD react to stress with especially heightened arousal in the pathways- abnormal activity of cortisol and norepinephrine
• brain’s stress circuit: chronic overactivity of the two stress pathways may help bring about dysfunction in the brain’s stress circuit (amygdala, hippocampus)
• inherited predisposition or acquired during childhood through abuse, neglect, poverty, trauma, etc.
• personal styles: anxious, low self-efficacy (resilient personal styles less likely to develop PTSD)
• social support systems: weak social support systems make people more likely to develop PTSD.
• severity and nature of the trauma

Question 37

Developmental psychopathology perspective on PTSD

Answer 37

certain people have biological predisposition for overactivity in their body-stress pathways. Risk of PTSD increases for these people if they experience stressful events in childhood, acquire poor coping mechanisms, have weak social supports, etc. The presence, timing, and intersections of various factors makes the difference.

Question 38

Prolonged exposure in PTSD

Answer 38

clients confront trauma-related objects and situations, as well as painful memories of traumatic experiences.

Question 39

Crisis debriefing

Answer 39

(used with people traumatized by disasters, victimization, or accidents): a form of crisis intervention in which victims are helped to talk about their feelings and reactions to traumatic incidents