Trauma, Stress and Loss Flashcards
What is stress and how does it impact mental health?
Stress refers to the feeling of being overwhelmed, worried, or rundown, and can be felt during positive events as well.
However, long-term stress has negative impacts on both physical and mental health.
When a stressor is combined with a person’s perception that they might not be able to handle the problem, it can lead to mental health issues such as anxiety, depression, and PTSD.
What is trauma and what types of events can cause trauma?
Trauma refers to severe, life-threatening, and intense events.
Examples of events that can cause trauma include exposure to actual or threatened death, serious injury, sexual violence, earthquakes, tsunamis, (sexual) abuse, war, or being tortured.
What is secondary trauma? What are some symptoms of this?
Secondary trauma refers to stress experienced by a person due to exposure to events faced by someone who has been through trauma.
It can cause physical symptoms such as fatigue and irritability, as well as emotional symptoms such as hopelessness, sadness, and anger.
What are some Trauma- and Stressor-Related Disorders listed in the DSM-5?
Trauma- and Stressor-Related Disorders listed in the DSM-5 include Posttraumatic Stress Disorder (PTSD), Acute Stress Disorder, Adjustment Disorders, and Dissociation.
What are some of the symptoms of PTSD according to the DSM-5? What’s one identifier?
To be diagnosed with PTSD, the person must have faced a traumatic event +
exhibit at least one intrusive symptom such as
invasive and upsetting recollections of the event
dreams of the event
dissociative re-experiencing of the event
psychological or physical distress when reminded of the event
avoiding thoughts, feelings, memories, and reminders of the event, altered thoughts and feelings about the event
regular feelings of arousal or reactivity
and symptoms lasting for more than a month (no minimum duration in ICD).
Symptoms can also begin up to six months after the traumatic event.
DSM-5-TR Identifier : PTSD with dissociative symptoms included
Why is the prevalence of PTSD higher in wealthier countries as compared to poorer countries?
The prevalence of PTSD is higher in wealthier countries (7.4%) as compared to poorer countries (2.1%) due to the Vulnerability Paradox.
This paradox is related to expectations, where citizens in countries that are better able to protect their citizens think that the world is a safe place. When trauma happens, this image is shattered, resulting in a higher risk for PTSD.
What factors increase the risk for PTSD? What are individuals with PTSD prone to?
Several factors increase the risk for PTSD, including experiencing more serious traumatic events, having prior pathology such as childhood adversity, lack of support, lower SES, and belonging to minority groups.
Individuals with PTSD are prone to anxiety disorders, depression, substance abuse, suicide attempts, and suffering from chronic physical illnesses.
What is Acute Stress Disorder?
Acute Stress Disorder is a condition where individuals experience PTSD symptoms but don’t last long enough to be diagnosed with PTSD. DSM-5 & ICD-10 consider it a disorder, whereas ICD-11 considers it a normal reaction to trauma.
However, at least half of those with Acute Stress Disorder continue to be diagnosed with PTSD.
What is Adjustment Disorder?
Adjustment Disorder is a condition where individuals experience emotional reactions to milder life circumstances and have a hard time coping with stressful life events.
It’s a catch-all diagnosis for people facing continuous life stress but don’t qualify for any other major mental disorder.
The symptoms develop within a month of the stressor and resolve within 6 months once the stressor is eliminated.
What is Persistent Complex Bereavement Disorder/Prolonged Grief?
Persistent Complex Bereavement Disorder/Prolonged Grief is a condition for individuals who feel intense grief and difficulty moving on after the death of a loved one.
It’s not included in DSM-5 but included in DSM-5-TR and ICD-11 as Prolonged Grief.
Symptoms last for 6-12 months.
What are some criticisms to DSM/ICD regarding PTSD and Adjustment Disorder?
Some criticisms to DSM/ICD regarding PTSD and Adjustment Disorder include questioning whether PTSD is a disorder or a reasonable and expected reaction, and whether Adjustment Disorder is too broad and really a disorder.
However, receiving a diagnosis of Adjustment Disorder can be beneficial in receiving financial support for therapy.
What are the biological (chemistry) perspectives on traumatic stress ?
Defects in norepinephrine and serotonin transmission
Antidepressants (SSRIs & SNRIs) are often prescribed
But their effect is small or unclear so secondary treatment more so
Remember – these are responses to stressors in the environment
So 🡪 generally considered less effective than psychotherapy and not the first line of treatment
What are the biological (structure/function) perspectives on traumatic stress ?
Hippocampus (important for remembering long term memories) volume is reduced
PTSD is associated with
Remembering and ruminating about trauma/flashbacks
Trouble recalling the traumatic event
Amygdala (important for emotional memories) highly active
What are the psychological (psychodynamic) perspectives on traumatic stress ?
Traumatic stress reactions might be happening because people have not successfully completed 5 phases
Initial outcry (awareness that the traumatic event occurred)
Denial and numbness (denying the event and dissociation from
the self)
Intrusive thoughts and feelings
Working through the trauma
Completion of the process
The role of the therapist is to help client get through these stages in a safe and non-judgemental environment
Not clear how much this therapy works (Lack of RCTs—randomized control trials)
What are the psychological (CBT) perspectives on traumatic stress ? What are some treatments (behavioural and cognitive).
Educate clients about typical responses to trauma
Challenge automatic beliefs about the event
Accept the experience and their role in it
Become less judgmental about their experience (e.g., recurring thoughts)
Evidence finds these approaches effective; they are often
combined with exposure therapies
Behavioural Perspectives
Exposure therapies
Imaginal or virtual reality exposure to trauma
Gradually making individual focus on the painful parts of the trauma e.g., death of the loved one
So that the person stops avoiding these feelings and accept their reality
Once the person starts talking about these, they start becoming less aroused by this topic and less anxious by it
Generally found to be effective
Behavioral activation
Engage in activities that are rewarding / pleasurable
Cognitive Perspectives
Negative Appraisals Theory
People develop PTSD when they process past traumas in a way
that produces ongoing sense of threat
“Nowhere is safe” “I attract disaster” “I deserve bad that happens to me”
3 therapy goals
Alter negative appraisals of the trauma🡪 think about the vent in a different way (not your fault version)
Reduce re-experiencing the trauma by elaborating memories of it and identifying triggers🡪 write detailed narratives to construct a more coherent story
Eliminate dysfunctional cognitive and behavioral strategies🡪 avoiding is beneficial in short term but not long term
Cognitive therapy based on this theory reduces
posttraumatic stress
