week 7

Question 1

whats PTSD symptoms and diagnosis

Answer 1

A: Exposure to actual or threatened death, serious injury, or sexual violence.
B: Presence of 1 or more intrusion symptoms associated with the traumatic event/s beginning after the event
C: Persistent avoidance of stimuli associated with the traumatic event/s beginning after the event
D: Negative alterations in cognitions and mood associated with the traumatic event/s beginning after the event evidenced by 2 or more of….
E: Marked alterations in arousal and reactivity associated with the traumatic event/s beginning or worsening after the event – 2 or more of….
F: Duration of the disturbance (Criteria BCDE) more than 1 month
G The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning
H:The disturbance is not attributable to the physiological effects of substance (medication or alcohol) or other medical condition

Question 2

types of post traumatic responses

Answer 2

Existential impact – profound emptiness, loss of connection with one’s spirituality [self], disruption to the ability to hope, trust, or care about oneself or others
Depression – mild to severe psychotic depression
Complicated or traumatic grief
Anxiety – generalised anxiety, panic, phobic anxiety
Stress disorders –Acute stress disorder, PTSD
Dissociation – “a disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control and behavior”

Question 3

whats resilience

Answer 3

Resilience: Resilience is fundamentally a property that gives individuals, social institutions, organisations and/ or ecosystems the ability to cope with shocks without losing their essential functions, characteristics and identity (Walker and Salt 2006)

• a resilient individual is not invincible to all life events but has the capacity to endure in most circumstances.
• Clients who sustain traumatic injuries or witness traumatic events have a greater vulnerability to stress disorders like posttraumatic stress disorder (PTSD).
• Without resilience, communities are not likely to recover after disaster.

Question 4

PTSD sleep

Answer 4

• Hyperarousal → problems with sleep transition
• REM arousal due to intrusive dreams
• REM behaviour disorder due in older sufferers
• Evidence of increased activation of amygdala in REM
  Catecholamine disturbance
  Increased CRF levels
  Orexins (circadian peptides in hyper thalamus)

Question 5

Neurobiology of PTSD

Answer 5

Chronic PTSD

• Increased circulating levels of Noradrenaline
• Increased reactivity of α 2-adrenergic receptors, blood vessel reactivity
• Increased thyroid hormone levels
• Explains some of the somatic symptoms
• Increased catecholamine levels potentiate threat response of AMYGDALA
• Differences in hippocampal function have been reported – important in memory formation
• Hippocampus lower volume in PTSD – twin studies
• Alterations in limbic and paralimbic areas – perception and mood
• May be neuroanatomical correlate for the intrusive memories and other cognitive problems.
• It has been reported that cortisol levels are low in PTSD

Question 6

predisposing factors PTSD

Answer 6

• In normal subjects Cortisol exerts strong negative feedback effects on CRF – homeostatic levels
• Major depression – less feedback
• PTSD – especially strong negative feedback effect leads to low cortisol response to stressors
• Failure of biological stress protection?
  o Decreased cortisol levels at the time of stress could prolong availability of noradrenaline in periphery and brain
  o Animal studies suggest that adrenergic arousal with low cortisol facilitates learning
  o Thus, memories and perception of the traumatic event may be heightened or laid down in a different form in PTSD

Question 7

Skills in psychological recovery (SPR):

Answer 7

• Systematically work through a manualised approach to delivering SPR
• A manualised approach is not a “cookbook”
• Vital issues such as empathy, rapport, and building a therapeutic alliance are assumed and not covered in the manual.
• It is expected that the SPR interventions would be delivered in a compassionate, flexible and responsive manner
• This is necessary to facilitate appropriate engagement and to adequately identify and meet the needs of survivors

Question 8

Basics of Psychological First Aid (PFA) whos it for

Answer 8

Individuals experiencing acute stress reactions or who appear to be at risk for significant impairment in functioning

Question 9

Basics of Psychological First Aid (PFA) who is it delivered by

Answer 9

Disaster response workers who provide early assistance

Question 10

Basics of Psychological First Aid (PFA) When is it intended to be delivered?

Answer 10

Immediate aftermath

Question 11

Basics of Psychological First Aid (PFA)

Answer 11

A broad range of emergency settings, in either single or multiple sessions

Question 12

Goals of SPR

Answer 12

Acceleration of recovery
Secondary prevention of mental health problems
Support for post-disaster role functioning
Prevention of maladaptive behaviors
Flexible delivery suited to needs of survivors
Referral to more intensive mental health interventions

Question 13

interventions for PTSD

Answer 13

• Strategies need to be embedded in relationship psychotherapy (therapeutic relationship)
• Teach the person mindfulness and self-care strategies
• Mental health centre clients are often more complex
• Existing clinical trial evidence often based on screened high functioning populations with high attrition (e.g. supporting cognitive therapy approaches, look for high drop out rates

Question 14

Guidelines for talking with a person following a traumatic event

Answer 14

4 phases of debriefing used for professional helpers who may have been involved in multiple traumatic situations

1. Description of factual event
2. Expression of feelings and reactions
3. Discussion and validation of coping strategies
4. Termination

Question 15

Describe and explain how an occupational therapist may work during the disaster

Answer 15

Occupational therapy practitioners can provide a variety of services to individuals and families who have evacuated their homes and workplaces and are living in emergency shelters, or who are sheltering in a new place.
Using a client-centred approach, occupational therapy practitioners can evaluate the needs of people in the shelter and provide appropriate services. Interventions might include;
• Providing structure in daily routines
• Identifying and emphasizing people’s strengths
• Coordinating age-appropriate play for children
• Providing opportunities for stress management

Question 16

Describe and explain how an occupational therapist may work Recovering from the disaster

Answer 16

• First, OT clinical practise includes assessment, mental health services, engagement in meaningful occupations and other services after a disaster. Based on the results of these assessments, OTs can apply their clinical skills to release the psychological distress of survivors and their families.
• Another clinical skill that OTs have is to help survivors engage in meaningful activities. OTs can train survivors in ADLs and strive to establish the occupational balance of survivors in work, leisure and social participation.
• Occupation and activity can help clients cope with traumatic stress and meet survival needs. Occupational engagement provides diversion from stressful events and helps re-establish a sense of mastery in a situation in which a person feels a loss of control. Participation in occupation facilitates restoration of adaptive habits, supports a person’s sense of identity, and helps establish a spiritual connection in the disaster situation
• Educating and training local personnel, volunteers and caregivers

Question 17

Outline the State Emergency Management Plan

Answer 17

1. Understand the context: successful recovery is based on the understanding of the community context, with each community having its own history, values, and dynamics
2. Recognise complexity: Successful recovery is responsive to the complex and dynamic nature of both emergencies and the community
3. Use community led approaches: Successful recovery is community-centres, responsive and flexible, engaging with community and supporting them to move forward
4. Coordinate all activities: successful recovery requires a planned, coordinated, and adaptive approach, between community and partner agencies, based on continuing assessment of impacts and needs.
5. Communicate effectively: successful recovery is built on effective communication between the affected community and other partners
6. Recognise and build capacity: successful recovery recognises, supports, and builds on individual, community and organisational capacity and resilience.

Question 18

occ issues with suriviroes of a bushfire disaster

Answer 18

Occupational issues
- self care: affected due to level of burns
• Productivity: role loss, loss of job etc, overwork
• Loss of patterns, habits and roles
• Lose access to leisure facilities (park/sports centre)

Question 19

Occupational Performance Model (Australia)

Answer 19

occupational role
occupational performance
core elements of occupational performance

Question 20

components of occupational role

Answer 20

• self-maintenance (habitual routines such as dressing may be affected due to loss of home and clothes. Normal meals may be different at different times, prepared by health workers, or other members of community, medication may be managed by someone else, disability may mean they need assistance with self-maintenance – burns, mental disorders)
• rest (less time devoted to sleep due to stress, anxiety or depression or disability. This occupation may not be deemed important.)
• leisure (entertainment, creativity and celebration may not be as meaningful for client. May not get as much joy out of the activity or prioritise other things over leisure or ‘fun’. Disability may also affect the ability to do these things.
• productivity (parents may not be able to provide support for self, family or community due to loss of home and / or income, disturbance in mental health may mean they cannot work / study – loss of goods and services within community, loss of productivity due to disability caused by fire.)

Question 21

components of occupational performance

Answer 21

• Biomechanical
• Sensory – motor
• Cognitive – mental processes during task performance (thinking, perceiving, recognising, remembering, judging, learning etc) – tasks may appear more complex to someone experiencing major life changes eg. Can’t think straight, OR , thinking about other things that deem more important. What kind of impact does this have on productivity?
• Intrapersonal – internal psychological processes (emotions, self-esteem, mood, rationality) People affected by fires may have a low attitude, loss of emotion, heightened emotions, distraught, feelings of distress, anxiety and depression. Low self-esteem due to loss of house, income or suffered serious injury. How would this affect someone’s ability to communicate with others?
• Interpersonal – interaction between a person and others during task performance (partners, families, communities) Interactions with others may be different, especially if loss or family or friend.

Question 22

core elements of occ performance

Answer 22

• Body – tangible physical elements of human structure
• Mind – defined as the core of our conscious and unconscious intellect that forms the basis of ability to understand and reason.
• Spirit – defined as aspects of humans with seeks as a sense of harmony within self and between self, nature, others as well as hope and meaning

Question 23

what are AUSTRALIAN GUIDELINES FOR TREATEMENT OF ACTURE STRESS AND POSTTRAUMATIC STRESS DISORDER

Answer 23

These Guidelines provide recommendations on the best interventions for children, adolescents and adults who have been exposed to potentially traumatic events as well as those who have developed acute stress disorder (ASD) or posttraumatic stress disorder (PTSD).

Question 24

good practice points from Australian guidelines

Answer 24

GPP15 Mental health practitioners are advised to note the presence and severity of comorbidities in their assessments, with a view to considering their implications for treatment planning.
GPP16 Residual symptomatology should be addressed after the symptoms of PTSD have been treated.
GPP17 The development of a robust therapeutic alliance should be regarded as the necessary basis for undertaking specific psychological interventions and may require extra time for people who have experienced prolonged and/or repeated traumatic exposure. GPP18 Mental health practitioners should provide a clear rationale for treatment and promote realistic and hopeful outcome expectancy.
GPP19 Mental health practitioners and rehabilitation practitioners should work together to promote optimal psychological and functional outcomes.
GPP20 In most circumstances, establishing a safe environment is an important precursor to commencement of trauma-focussed therapy, or indeed, any therapeutic intervention. However, where this cannot be achieved (for example, the person is seeking treatment for their PTSD whilst maintaining a work role or domestic situation that may expose them to further trauma), some benefit may still be derived from trauma-focussed therapy. This should follow careful assessment of the person’s coping resources and available support
GPP21 The practitioner should assess immediate needs for practical and social support and provide education and referrals accordingly.
GPP22 Appropriate goals of treatment should be tailored to the unique circumstances and overall mental healthcare needs of the individual and established in collaboration with the person.
GPP23 From the outset, there should be a collaborative focus on recovery and rehabilitation between the person and practitioner, and where appropriate, family members.
GPP24 Recommended treatments for PTSD should be available to all Australians, recognising their different cultural and linguistic backgrounds.
GPP25 Wherever possible, family members should be included in education and treatment planning, and their own needs for care considered alongside the needs of the person with PTSD.

Question 25

self care good practice points from Australian guidelines

Answer 25

GPP28 In their self-care, practitioners should pay particular attention to skill and competency development and maintenance including regular supervision, establishing and maintaining appropriate emotional boundaries with people with PTSD, and effective self-care. This includes maintaining a balanced and healthy lifestyle and responding early to signs of stress.

GPP29 For those practitioners who work in an organisational context, broader policies and practices should support individual practitioners in these self-care measures.

Question 26

whats declarative memory

Answer 26

Declarative memory formation:

• Declarative memory relates to life events
• These memories can influence mental disorders

Question 27

how to improve sleep

Answer 27

Coping skills & symptom management training
- Involves diaphragmatic breathing, relaxation, and
mindfulness techniques

Question 28

List three neurobiological changes found to be associated with chronic posttraumatic stress disorder (PTSD).

Answer 28

• Increased circulating levels of Noradrenaline
• Increased catecholamine levels potentiate threat response of AMYGDALA
• Differences in hippocampal function have been reported – important in memory formation

Question 29

whats The Australian Centre for Posttraumatic Mental Health/ Phoenix Australia education and training program “Skills for Psychological Recovery” lists three levels for people involved in providing care to survivors of traumatic events

Answer 29

Level 1 support can often be provided by community members with basic training and is often sufficient for individuals with acute or mild reactions.
Level 2: Where mild to moderate distress persists despite the provision of level 1 support, individuals can be taught simple strength-based skills to improve coping and promote recovery. These simple strategies can be provided by practitioners with basic counselling skills working in primary care, mental health, and community-based setting
Level 3: Finally, those individuals who display persistent and severe distress in the weeks and months following a disaster should be provided with and/or referred for more intensive mental health treatment

Question 30

early interveiotns for post truamaitc

Answer 30

Debrifing
Trauma focused counselling
Education perforamned within one moth of trauma

Question 31

interventions for resilience

Answer 31

• Psychoeducation: occurred when they received information that either helped them to manage their emotions and consequently make effective decisions and plans, or enabled access to material and instrumental resources to support planning for their future. Face to face reported more helpful than online. (MICRO)
• Recovery centres arranged social events that created emotional support. (MESOSYSTEM)
• Post-disaster public meetings were reported to be an effective means for supporting networks
  (MESOSYSTEM)
• Recovery centre staff facilitated access to the numerous sources of assistance. They supported an individual’s ability to negotiate through numerous aid providers to access the assistance they were eligible for. (eCOSYSTEM)
• The media (e.g. Internet, TV, radio) played an important role in communication between the disaster area and the community to enable access to volunteers and donations of resources. (ECOSYSTEM)