Week Six - Trauma & Stress Related Disorders Flashcards
Acute Stress Disorder (ASD)
Posttraumatic reactions in the first month after trauma
(PTSD has to be longer than 1 month = cannot diagnose
within the month preceding the trauma)
How is ASD similar to PTSD?
has greater emphasis on dissociation
ASD DSM-5 Diagnostic criteria? (all in here)
A. Exposure to actual or threatened death, serious
injury, or sexual violation, by either experience the
event, witnessing the event, learning of the event
occurring to a close person, or repeated/extreme
exposure to the event (other than through media)
B. At least 8 of the following symptoms, either beginning or worsening since trauma and lasting 3 – 31 days: • Recurrent involuntary and intrusive memories of the event (repetitive play in child) • Recurrent dreams of event • Dissociative reactions • Intense or prolonged distress or physiological reactivity when exposed to cues • Persistent inability to experience positive events • Altered sense of reality of surrounding or self • Inability to remember an important aspect of the event • Avoid internal reminders of the trauma • Avoid external reminders of the trauma • Sleep disturbance • Hypervigilance • Irritable or aggressive behaviour • Exaggerated startle response • Agitation or restlessness • Problems concentrating
PTSD Diagnostic criteria? (all in here)
A. Stressor:
The person was exposed to: death, threatened death,
actual or serious injury or sexual violence, as follows (1
required)
• Direct exposure
• Witnessing, in person
• Indirectly – learning a close friend/relative exposed
• Repeated or extreme indirect exposure via professional duties (not e-media, TV, videos, movies)
B. Intrusion Symptoms (one or more in the previous
month)
• Recurrent involuntary and intrusive memories (may
be repetitive play in kids older than 6)
• Traumatic Nightmares
• Dissociative reactions (e.g., flashbacks) which may occur on a continuum from brief episodes to complete loss of consciousness
• Intense or prolonged distress after exposure to
trauma reminder
• Marked physiological reactivity after exposure to
trauma-related stimuli
C. Avoidance – persistent effortful avoidance of
distressing trauma-related stimuli after the event (1
required)
• Trauma-related thoughts or feelings (e.g though
suppression)
• Trauma-related external reminders (e.g. people,
places, conversations, activities, objects, or
situations)
D. Negative Alterations in Cognitions and Mood
Negative alterations in cognitions or mood that began or
worsened after the trauma (2 required):
• Inability to recall features of the traumatic event
• Persistent negative beliefs of oneself and the world
• Persistent distorted blame of self or others for causing the
trauma or for the resulting consequences
• Persistent negative trauma-related emotions (e.g. fear, horror,
guilt)
• Markedly diminished interest in (pre-traumatic) activities
• Feeling alienated from others (detachment/estrangement)
• Constricted affect: persistent inability to feel positive
emotions
E. Alterations in Arousal and Reactivity Trauma-related alterations in arousal and reactivity that began or worsened after the trauma (2 required): • Irritable or aggressive behaviour • Self-destructive or reckless behaviour • Hypervigilance • Exaggerated startle response • Problems with concentration • Sleep disturbance
F. Duration
– Persistence of symptoms for more than one month
G. Functional significance
– Significant symptom-related distress or functional
impairment (Social, occupational)
– Not due to medication, substance use or other illness
– Specifier: With or without dissociative symptoms
(derealisation, numbing, loss of identity)
PTSD diagnostic criteria simplified?
A. Stressor
B. Intrusion Symptoms (one or more in the previous
month)
C. Avoidance
– persistent effortful avoidance of distressing trauma-related stimuli after the event
D. Negative Alterations in Cognitions and Mood
E. Alterations in Arousal and Reactivity
F. Duration (more than one month)
G. Functional significance
Complex PTSD?
Develops following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible.
To have complex PTSD?
All diagnostic requirements for PTSD are met.
1. problems in affect regulation
2. beliefs about oneself as diminished, defeated or worthless, accompanied by
feelings of shame, guilt or failure related to the traumatic event
3. difficulties in sustaining relationships and in feeling close to others.
Fight Flight Freeze Flop Friend
Talking back to adults, showing aggression, blaming others, defiance
Leaving class, spacing out, distracted
Giving up quickly, not listening, frustration
Disengaged, little emotion, missing class
Not taking responsibility, relying on others
Trauma Focused CBT?
focuses on changing the way people think and act,
regardless of what is happening externally. It helps with:
• Identifying distressing emotions and unhelpful thoughts
• Coping with loss and grief
• Emotion regulation
• Managing chronic pain
• Dealing with PTSD and overcoming trauma
Trauma-Focused CBT (PRACTICE)
P – Psychoeducation
R – Relaxation Methods
A – Affective Expression and Regulation Skills
C – Cognitive Coping Skills and Processing
T – Trauma Narrative and Processing
I – In Vivo Exposure
C – Conjoint Therapy Sessions
E – Enhancing Personal Safety and Future Growth
EMDR for PTSD
EMDR focuses directly on the memory, and is intended to
change the way the memory is stored in the brain.
EMDR is an individual therapy typically delivered one to
two times per week for a total of 6-12 sessions.
EMDR 8-phase approach?
Phase 1: History-taking Phase 2: Preparing the client Phase 3: Assessing the target memory Phases 4-7: Processing the memory to adaptive resolution Phase 8: Evaluating treatment results
What does EMDR not include?
EMDR does not include extended exposure to the distressing memory, detailed descriptions of the trauma, challenging of dysfunctional beliefs or homework assignments.
Trauma Focused CBT Goals?
Help the individual recognise and accept that they are not responsible for the trauma
Decrease the person’s sense of shame
Reduce symptoms related to or triggered by the trauma
Assist the person in improving all areas of functioning that were affected by the trauma
Lessen any maladaptive behaviours connected
to the trauma
Help mend and strengthen relationships, including communication and attachment
CPTSD treatment?
Good therapeutic relationship
- Secure base
Emotion regulation
