Week 6 Lecture - Trauma Flashcards

Question

common comorbidities

Answer 1

- 70% of people with PTSD have comorbidities - Depression and anxiety common - Substance misuse, autism and ED increasingly common - Personality disorder 50% overlap - Comorbidities include: ○ Acquired brain injury ○ Depression and anxiety disorders ○ Substance misuse ○ Personality disorder ○ Psychosis ○ Bipolar disorder ○ Attachment disorder ○ Self harm ○ ED ○ Complex/traumatic grief

Answer 2

○ Multiple models ○ Stress the role of neurological factors ○ Memory ○ Abnormal fear learning models (conditioning) ○ Information processing ○ Diminished executive functioning skills ○ Diminished emotional regulation ○ Implications: * Stress the ‘whole’ body response of trauma * Predict difficulties that may develop in psychological therapies and offer an account of why people may drop out of therapy (lack of cognitive resources needed to navigate therapy) * Suggest that talking therapy may not be an efficacious approach and other work maybe needed prior to talking therapy * Have relevance to our understanding of resilience and protective factors * Some clinically based researchers suggest that childhood trauma should be repositioned as an acquired brain injury. * However neurological factors alone, can’t explain all aspects of PTSD, as they don’t take into account contextual and social factors

Answer 3

○ Keane and Barlow ○ Conditioning – older, but often explain how fear / distress are maintained in a way that service users can understand ○ Early models stressed the role of operant and classical conditioning to account for symptoms ○ Fear arises from the learnt association of a neutral (condition) stimuli with an aversive TRAUMA stimuli (unconditioned stimuli) ○ Avoidance behaviours develop as a result of instrumental conditioning, namely the reduction of distress through avoidance / escape of a stimuli (negative reinforcement) ○ Fear doesn’t become extinguished because exposure is incomplete (not sufficient to habituate to).

Answer 4

○ EPT is a trans diagnostic theory focused on information processing ○ Offers an account of both the causes and maintaining factors underlying PTSD ○ Focus on the role of ‘pathological’ fear (Fear networks) and its generalised effects (to stimuli and responses) ○ Based on the premise that as an emotional disorder PTS / PTSD reflect pathological emotion structures in memory and that treatment therefore modifies that pathological representations in memory. 1. Trauma related fear network is activated by stimuli 2. Triggers information from the network to enter our consciousness (intrusive symptoms) 3. Attempts to avoid symptoms (threat information) lead to avoidance behaviours Treatment therefore should focus on integrating information from fear networks into memory systems 4. Therefore to assimilate information you need to trigger it.

Answer 5

○ Builds on basic assumptions of cognitive theory ○ Includes the basic tenants of Foa’s EPS model and basic ideas of Associative network theories ○ PTSD is the manifestation of the reciprocal relationship between: ○ Gives prominence to the role of conscious articulated verbal thoughts ○ Cognitions have a causative mechanism in triggering anxiety ○ (cognitive) appraisals of threat that give rise to the perception of continued threat, even though the trigger event is in the past ○ Triggers for threat can either be internal or external events ○ The nature of the memory and its integration with other episodic memories also influence current perception of threat ○ Trauma memories are fragmented with incomplete narratives, which impacts on processing and differentiating between past and present. ○ Empirical basis: ○ Strong empirical support, especially for single episode trauma’s ○ BUT, including CT to exposure therapy doesn’t lead to better outcomes

Answer 6

○ Focuses on intrusive images in PTSD ○ Focuses on using findings from cognitive neuroscience to drive the theory ○ 2 main components ○ C-Reps: Contextual representations: Verbal narratives § Secondary emotions: Generated through appraisals of information § In trauma responses / presentations C-Reps are weakened ○ S-Reps: Sensation based representations, they can’t be deliberately recalled, but are involuntary triggered (mechanism for flashbacks), § They lack contextualisation § in trauma responses S-Reps are strong ○ Still relatively new model, has potentially greater explanatory power ○ Initial results support elements of the model that have been tested. ○ Is likely to better bridge the gap between psychological and neurological models

Answer 7

- Formulation is a key skill for clinical psychologists: - Can be defined as: “ An ideographic theory” that describes the origins, development and maintenance factors of someone’s difficulties; including how these different parts relate to each other. - Currently there is no agreement to use specific PTSD models.

Answer 8

- Can help determine the problems to prioritise (and safe to address) - anticipate challenges that may arise in therapy (Develop crisis plans) - identify criteria necessary for successful outcome (what would make this worthwhile) - can promote collaborative therapy, by sharing the rationale for intervention (reduce drop out) - Can be experienced as validating to the person “It makes sense now’ - Can be a key relationship building activity with service users (Shared narrative) - Can help explain the relationship between morbidities

Answer 9

- Can be ‘exposing’ and overwhelming - Can be overly complex and inaccessible to people without clinical knowledge or limited educational abilities - Currently no empirically investigated model or method for psychological approaches to formulation in trauma care - Psychological formulations can often reflect the idiosyncrasies and knowledge of the therapist - Inequality of knowledge and power in formulations - Very time consuming to develop and share

Answer 10

- A history of trauma is relatively common in people who come into contact with psychologists who work in applied settings. - Working with people exposed to trauma is a significant aspect to the working life of clinical psychologists - ‘Trauma informed care’ and ‘trauma work’ are commonly used phrases within services. NO consensus as to what this means are looks like - British Psychological Society has outlined standards of care in this area of practice: - Standards for competencies for psychologists working in trauma ○ Trauma informed ○ Trauma Skilled ○ Trauma Expert

Answer 11

- Compared to other mental health needs, stigma has been less investigation in trauma populations - Most of the literature has explored stigma in veteran populations - Some evidence that stigma is less prevalent in PTSD than in other MH needs - Self with stigma (internalising social stigma) is associated with in the trauma research * Hesitancy to seek support, especially in veterans * Drop out in therapy * Poor outcomes in therapy * Exacerbation of PTSD symptoms * Exacerbation of co mood disorders * Reduced sense of self worth * Alienation and social withdrawal

Answer 12

- Working with people who experience trauma is both rewarding and challenging - Increased recognition of the impact trauma can have on health professionals - The risks of developing VT relate to the individual, the nature of the work and organisational factors++ ○ Supervision / training / support ○ Culture / workload - Impact can manifest as ○ PTSD ○ Burnout ○ Altered neurological functioning (MRI scans) ○ Sexual Dysfunction and intimacy difficulties ○ Interpersonal conflict ○ Moral Injury ○ Compassion fatigue or ‘spiritual fatigue’ ○ De sensitisation to traumatic materials - Some Health services now offer trauma support services that focus on the needs of staff - Models can, however, be reactive rather than proactive ○ Reflective practice ○ Post incident de brief ○ EMDR ○ Prolonged exposure therapy