W6: Trauma & Stressor Related Disorders

Question 1

What are some types of trauma and stressor related disorders

Answer 1

Post traumatic stress disorder PTSD

Acute stress disorder ASD

Complex post-traumatic stress disorder

Question 2

What are some examples of trauma

Answer 2

Motor vehicle accidents 
sexual or nonsexual assault 
domestic violence 
natural disasters 
war 
terrorism

Question 3

What aspects of traumatic events make it more likely to develop ASD or PTSD

Answer 3

The severity, duration and proximity of exposure to the trauma

Question 4

Explain acute stress disorder

Answer 4

Post traumatic reactions in the first month after trauma

Has a similar symptom profile to PTSD apart from its greater emphasis on dissociation

Question 5

What is a goal of diagnosing people with acute stress disorder

Answer 5

To assist in the identification of individuals who are at risk of developing PTSD this is based on the theoretical position that acute dissociation is a precursor to PTSD

Question 6

What does the DSM say about acute stress disorder

Answer 6

Exposure to actual or threatened death, serious injury, or sexual violation, but either experience or witnessing the event, or learning of the event occurring to a close person

8 (3-31 days):
Intrusive memories that are recurrent or involuntary, Dreams of the event, dissociative reactions, intense or prolonged distress or physiological reactivity when exposed to cues, inability to perceive things as positive, altered sense or reality or self, inability to remember important aspects of the event, avoid internal reminders, avoid external reminders, sleep disturbance, hypervigilance, irritable or aggressive behaviour, exaggerated startle response, agitation or restlessness, concentration problems

Question 7

What does the DSM say about PTSD (7)

Answer 7

Stressor

Intrusion symptoms

Avoidance

Negative alterations in cognitions and mood

Alterations in arousal and reactivity

Duration

Functional significance

Question 8

Explain what the DSM says about the stressor in PTSD

Answer 8

The person was exposed to death, threatening death, actual or serious injury or sexual violence

This can be through direct exposure, witnessing it in person, indirectly through learning it happened to a close friend or relative or repeated or extreme in direct exposure via professional duties

Question 9

Explain what the DSM says about intrusion symptoms in post-traumatic stress disorder

Answer 9

Need to of had one or more in the previous month

Recurrent involuntary and intrusive memories - in children these may be repetitive play

Traumatic nightmares

Dissociative reactions such as flashbacks which may occur on a continuing from brief episodes to a complete loss of consciousness - this is more than a memory they’re actually going back there in their mind

Intense or prolonged distress/physiological reactivity after exposure to a trauma reminder

Question 10

Explain what the DSM says about avoidance in PTSD

Answer 10

It’s a persistent effort for avoidance of distressing trauma related stimuli after the event – only one is required

Trauma related thoughts or feelings through suppression maybe alcohol use

Trauma related external reminders such as people places conversations activities objects or situations

Question 11

What does the DSM say about negative alterations in cognitions and mood in PTSD

Answer 11

They should have began or worse and after the trauma – and two are required

Inability to recall features of the traumatic event

Persistent negative beliefs of oneself and the world

Persistent distorted blame of self to others for causing the trauma or for the resulting consequences

Persistent negative trauma related emotions such as fear horror or guilt

Marked diminished interest in pre-traumatic activities

Feeling alienated from others

Constricted affect persistent inability to feel positive emotions

Question 12

What does the DSM say about alterations in arousal and reactivity in PTSD

Answer 12

to have begin or worse and after the trauma and two are required

Irritable or aggressive behaviour

Self-destructive or reckless behaviour

Hypervigilant-high alert waiting for the next occurrence

Exaggerated startle response - high sympathetic nervous system activity

Problems with concentration

Sleep disturbance this is a result of hyper arousal or nightmares

Question 13

What does the DSM say about the duration of PTSD

Answer 13

Persistence of symptoms for more than one month before one month it is considered acute stress disorder

Question 14

What does the DSM say about the functional significance of PTSD

Answer 14

Significant symptoms related distress or functional impairment not due to medication, substance use or other illnesses

Question 15

What is complex PTSD

Answer 15

Develops following exposure to an event or series of event of an extremely threatening or horrific nature most commonly prolonged or repetitive from which escape is difficult or impossible

All of the diagnostic requirements for PTSD are met but also:
Problems in affect regulation
Beliefs about oneself as diminished, defeated or worthless, accompanied by feelings of shame, guilt or failure related to the traumatic event
Difficulties in sustaining relationships and feeling close to others

Question 16

What is the main difference between PTSD and complex PTSD

Answer 16

PTSD is one distinct event over a small time but complex PTSD is experiencing several events over the years that gradually accumulate the symptoms are often more severe

Question 17

What is the most effective type of treatment for trauma based disorders

Answer 17

Trauma focused CBT

Question 18

What are the goals of trauma focused CBT

Answer 18

Help with the individual to recognise and accept that they are not responsible for the trauma

To decrease the person sense of shame

Reduce symptoms related to or triggered by the trauma

Assist the person improving all areas of functioning that were affected by the trauma

To lessen any maladaptive behaviours connected to the trauma

To help Mend and strengthen relationships including communication and attachment

Question 19

Trauma focused cognitive behavioural therapy has several main components. These components are represented by using an acronym -what is the acronym and what do the letters stand for?

Answer 19

PRACTICE

Psychoeducation - This can be powerful it gives some information about what they are experiencing

Relaxation methods - Directly addressing physiological arousal

Affective expression and regulation skills

Cognitive coping skills and processing - cognitive restructuring

Trauma narrative and processing

In Vivo exposure - exposure therapy

Conjoint therapy sessions - with significant others

Enhancing personal safety and future growth - setting goals for living fully and functioning

Question 20

What does EMDR stand for

Answer 20

Eye movement desensitisation and reprocessing

Question 21

What is the focus of EMDR?

Answer 21

It focuses directly on the memory and is intended to change the way the memory stored in the brain

Question 22

Can anyone lead EMDR sessions

Answer 22

No it requires a very specific certification training otherwise you can do way more harm than good

Question 23

EMDR uses a structured eight phase approach that includes:

Answer 23

1: history taking
2: preparing the client (psychoeducation)
3: assessing the target memory
4-7: processing the memory to adaptive resolution - holding memory in mind and hearing tones and tapping to move it into LTM(moving away from it being depressive)
8: evaluating treatment results

Question 24

What does EMDR not include

Answer 24

Extended exposure to the distressing memory, detailed descriptions of the trauma, challenging of dysfunctional beliefs or homework assignments

Question 25

Why am I people with PTSD opt for CBT instead of EMDR

Answer 25

CBT is a slower pace and it may mean that it brings up less anxiety

Question 26

What are the most important bits of therapy for complex PTSD

Answer 26

It is important to build a good therapeutic relationship or a secure base especially if they do not trust others so you may need to spend a few sessions building this up

You need to teach good emotion regulation skills such as grounding techniques for dissociation

Question 27

How do grounding techniques work

Answer 27

They help to control symptoms such as flashbacks anxiety etc by turning attention away from the thoughts and memories and worries and refocusing them on the present moment

Question 28

What is the 54321 technique

Answer 28

It is a grounding technique that forces you to take in the details of your surroundings using each of your senses

For example what are five things you can see, for things you can feel, three things you can hear, two things you can smell, one thing you can taste

Question 29

What is the categories grounding technique

Answer 29

Choose at least three of the categories below and name is many items as you can in each one

Movies, countries, books, cereals, colours, fruits, vegetables, animals, cities, TV shows, famous people

Question 30

What is the body awareness grounding technique

Answer 30

This brings you into the here and now by directing your focus to sensations in the body paying special attention to the physical sensations created by each step

For example take five long deep breath‘s through your nose and exhale through your lips, place both feet flat on the floor wiggle your toes curl and uncurl your toes several times spent a few moments noticing the sensations in your feet

Question 31

What are some mental exercises grounding techniques

Answer 31

Please take your mind off of uncomfortable thoughts and feelings they are discreet and easy to use at nearly at any time or place

May include naming all the objects you see, describing the steps in performing an activity you know how to do really well, counting backwards from 100 by sevens, pick up an object and described in detail describe its colour texture size weight scent and any other qualities