L17- PTSD 2 Flashcards
1
Q
What role does episodic memory have on PTSD?
A
- Lots of nightmares etc. are about memory
- Memories are not stored typically, leading to stress
- Declarative memory = memories that can be consciously recalled like facts/verbal knowledge (e= memories, S = knowledge P=innate motor )
2
Q
What was the study looking at memory systems and PTSD? (Paradox)
A
- Looked at bad natural events e.g 9/11 and looked at the impacts of trauma
- Looked at fetus during 9/11
- The memory paradox: ability to build memories are vital for coping and can help with comfort during a normal grief process but can also be intrusive and can impair functioning due to incorrect processing
- Due to level of distress and level of emotion = interfered with memory process
3
Q
How do we form memories?
A
- Sensory info that comes into STM, then consolidation into LTM = hippocampus = retrieval of info
- Amygdala is seen as the emotion centre of the brain
- in PTSD, issues in acquisition, consolidation and reconsolidation BUT emotional info attached to this info is not stored in episodic memory but in the amygdala
- Treatments help store memories correctly
4
Q
What is the neurocircuitry of PTSD?
A
- Structural and functional abnormalities in
- Amygdala, insula, medial prefrontal cortex, rostral anterior cingulate, hippocampus
- Areas associated with fear conditioning and extinction
5
Q
What is the role of the amygdala and insula in PTSD
A
- Hyperactive in response to trauma script provocation and when processing fearful vs happy faces
- Pos correlation between activation in brain regions and PTSD symptom severity
- Successful exposure therapy associated with decreased amygdala activation in PTSD
6
Q
What is a study looking at Pavlovian fear extinction
A
- Conditioned fear response in people with PTSD and looked at extinction of fear response whilst looking at regions of brain that were activated
- Those with PTSD showed impaired recall of extinction memory and greater amygdala activation
- Fear extinction is impaired in those with PTSD and they have dysfunctional brain activity in brain structures that mediate fear extinction
7
Q
What are therapies in PTSD?
A
- Prevention: education, coping skills, stress inoculation training
- Medications: SSRIs is not very successful, but other medications will be trialed
- Psych Therapy: More successful treatment = Trauma focused approaches are more effective than others = two are more effective than one
- CBT, Prolonged exposure, eye movement desensitisation/reprocessing, emerging therapies: virtual reality and drugs e.g MDMA
8
Q
What are common rules across therapies to ensure safety and stabilisation?
A
- Safe env: can be too much for patient to tolerate if env is not safe
- Enhance coping mechanism/social support
- Relaxation and emotion regulation skills training
- Psychoeducation
- Ward structure and group programme
- Meds are often used to help stabilise the symptoms prior to psychotherapy and because in reality the waiting lists for psych therapy are so long
9
Q
What are common treatment challenges (maintenance)
A
Maintaining factors of trauma:
- Nature and duration of trauma
- Role in trauma
- Meaning of trauma
- If trauma has ended
- Isolation/attachment/social support
- Guilt: omission/commission/survivor
10
Q
What are common treatment challenges (other factors)
A
- Co-morbidity
- Other drugs/alcohol
- Motivation
- Cooperation
- Compliance
- Therapeutic qualities of patient and therapist alliance (idea of hope and how willing people are to engage in therapy)
11
Q
What is Trauma-focused CBT?
A
- Starts with psycho-education
- Relaxation training/emotion regulation skills building
- Stress inoculation
- Exposure: systematically confront traumatic memories in vivo/imagined = repeated exposure = detailed and repeated recounting of traumatic experience
- Behavioural techniques
- Cognitive restructuring: modification of misinterpretations that lead PTSD sufferer to overestimate current threat fear
- Problem solving, recovery focus and relapse prevention
12
Q
How does EMDR develop?
A
- Dr Shapiro had some disturbing thoughts flash in her mind and moved her eyes side to side and felt the neg feelings dissipate = eye movements had a desensitising effect
- Introducing Eye Movement Desensitisation and Reprocessing (EMDR) reflecting cog changes occurring during treatment and identifying info processing theory
- When upset/distressed, brain cannot process info as it would normally
- Trauma provokes intense emotions that become frozen and stuck in info processing system
- EMDR has a direct effect n the way brain processes upsetting material
- Standardised, trauma focused procedure with several elements always using bilateral physical stimulation to stimulate the individuals own info processing in order to help integrate event as an adaptive contextualised memory = useful as you do not have to think
13
Q
What did Shapiro say is important for EMDR?
A
- Therapeutic rapport
- Imagery/envisioning of traumatic scenes
- Focus on sensations of anxiety
- Cog restructuring
- Saccadic movements of eyes
- Extinguishing of the memory
- Specific training package
- Much debate about mechanisms of effect
14
Q
What does EMDR look like in practise?
A
- Requires individual to focus on a traumatic memory and generate a statement summarising thoughts of the trauma
- Service user is instructed to visualise traumatic scene, briefly rehearse the belief statement
that best summarised their memories, concentrate on their associated physical sensations,
and visually track the therapist’s index finger - Finger moved rapidly /rhythmically back & forth across line of vision – extreme left to
right distance of 30-35cm from face at a rate of two back and forth movements per second - At the same time patient asked to focus on bodily experience associated with image as well
as on an incompatible belief statement - This is repeated 12 – 24 times after which patient asked to blank picture out and take a
deep breath
15
Q
What are the three aspects of EMDR in practise?
A
- Disparity: although in activated state – now able to talk to therapist in safe environment. Fear is therefore not reinforced. Negative emotional state generated in a safe environment and the traumatic memories and associated emotional distress is tolerated
- Central Focus: is on awareness. Reliving trauma memories, thoughts, feelings – yet maintain current awareness experience (safe): able to perceive the disparity memory of bad experience activated but need to be present in the here and now co awareness remember it as past aware that this is present.
- Working with traumatic memory:activate the specifics of the memory cue her
memory by asking question about what happened – helps processing
