Chapter 11: PTSD Flashcards
Definition of PTSD
- Expsoure to actual or threatened death, injury, sexual violence
- Recurrent intrustive recollections or re-experienceing of a traumatic event
- Avoidance of external or internal trauma reminders
- Negative changes in cognitions & mood
- changes in arousal and reactivity
Exercise and PTSD
- Aerobic exercise and walking are beneficial
- Types of aerobic exercise needs to be studied (cycling was not beneficial)
- The exercise needs to be maintained for benefits to be ongoing
Categories of Meditation Practices
- Attentional (foster self-regulation)
- Deconstructive (thoughts/ emotions are mental events rather than reflections of reality)
- Constructive (strengthen positive psychological patterns)
Transcendental / Mantram Repition & PTSD
- Mainly attentional type of meditation
- Both are beneficial for PTSD
- TM typically eyes closed 15-20 min, BID
Mindfulness Meditation & PTSD
- Has both attentional and deconstructive elements
- MBSR and MBCT are two of the most widely available programs
- pay attention to your experience with curiosity
- can be a form of exposure therapy in PTSD
- RCTs comparing meditation practices showed no benefit of one vs the other (MBSR, yoga, mantram)
- The longer the intervention, the more reduction in PTSD
Compassion & Loving Kindness Meditation
- Constructive category of meditation
- addresses emotional numbing, moral injury, trauma-related shame, social disconnectedness
Yoga and PTSD
- Fosters upregulation of PANS, downregulation of SANS, decreased cortisol and catecholamine levels
- Trials demonstrate significant benefit
Tai Chi and Qigong have not been studied
Visualization / Guided Imagery and PTSD
- focus on chronic nightmares
- Imaginal confrontation with nightmare contents (ICNC)
- Imagery rescripting and rehearsal (IRR)
- Imargery rehearsal therapy (IRT)
- Imagery rescripting and exposure therapy (IRET)
Evidence is too underdeveloped to determine it’s value! May be a supplement to other care
Emotional Freedom Technique and Thought Filed Therapy
Combination of exposure through visualization plus acupoint tapping on energy meridians to release energy blockages that create the negative emotions.
Study shows that the tapping on acupoints is an active component!
Evidence is encouraging, but lack of active controls and other methodoligcal shortcomings preclude firm conclusions.
Hypnotherapy and PTSD
- Guided, controlled access to traumatic memories that may be kept out of normal consciousness
- Hypnotherapetic Olfactory Conditioning - resistant olfactory induced flashbacks
- Abreactive Ego State Therapy - views personality as several ego states, and PTSD results from memory being tied to a particular ego state and being treated with emotional cathatrsis. Used more in other countries.
- Hypnosis has large effect size, but need more research
Acupuncture and PTSD
- Large effect size in short term, medium effect size in follow up
- Low quality evidence. But studies are encouraging.
- May be appropraite for patients who prefer not to engage in more conventional therapies
Trauma Focused Therapies
- CPT: cognitive processing therapy.
- PE Therapy: prolonged exposure
- EMDR: recount trauma memory while doing eye movements
- Narrative Exposure Therapy: create a story about their life and tell another person
Exposure treatments have stronger longer term outcomes than other forms
Trauma focused therapies do marginally better than non-trauma focused
Non-trauma Focused THerapies
Emphasize strength-based activation of existing coping skills
- PCT: Present Centered Therapy. uses patient’s own coping skills. Inferior results to trauma-focused CBT but has better retention.
- SIT: stress inoculation training. Teaches new skills. Reasonable second line, effective in short term. Not as longer lasting effects as trauma-focused options.
- Psychodynamic therapies
Psychotherapy after trauma to prevent PTSD
- debriefing sessions may increase risk of PTSD
- brief trauma-focused CBT may reduce acute traumatic stress (rather than post-traumatic stress, occuring within one month after trauma)
- modified trauma-focused interventions (very brief ones within a few wks of trauma) may help prevent PTSD
SSRIs for PTSD
- Sertraline and Paroxetine are FDA approved for PTSD
- Paroxetine has better evidence than sertraline (which doesnt always do better than placebo)
- Fluoxetine and venlafaxine have some benefit too