33. Head trauma/ mTBI

Question 1

Symptoms of PTSD include:

Answer 1

• distressing or intrusive memories of incident
• Intense emotional upset
• Avoidence of things that remind of event
• reliving event thru nightmares/flashbacks
• ongoing anxiety

Question 2

symtom duration to qualify for dx of PTSD

Answer 2

DSM says symptoms must persist >1m

can be a 6 m delay from trauma to onset of PTSD

Question 3

what did ICD do to improve the PTSD dx

Answer 3

divides PTSD into 2 separate dx: PTSD and complex PTSD

Question 4

What is the core criteria for the dx of PTSD according to ICD (3)

Answer 4

Several weeks of:

1. reexperiencing the trauma
2. Avoiding reminders of the event
3. Sense of weighted threat and arousal

Question 5

What additional symptoms does complex PTSD come with along with 3 core symtoms (4)

Answer 5

• difficulty managing emotion
• belief that one is worthless
• Feelings of shame, guilt, or failure
• trouble maintaining relationships

Question 6

What is the criteria for a clinical traumatic event in PTSD

Answer 6

The person was exposed to:

• death or threatened death
• actual or threatened serious injury
• Actual or threatened sexual violation

In one or more of the following ways:

• experiencing event themselves
• Witnessing the event as they occur to others
• learing about it happening to friens/relitive
• experiencing details of it over n over

Question 7

cultivating mindfulness in trauma

Answer 7

It is not possible to control the occurrence of trauma, but as one cultivates broad mindfulness, one can begin to see that one can use the experiences as an opportunity to transform life

-as people learn to let go of a state f blame and remorse, they can transform painful affliction into compassionate self acceptance and forgiveness

Question 8

Role of psychologists in trauma

Answer 8

can guide patient into path of self discovery where in the ego is deemphasized and an awareness of the interconnected nature of life arises

Question 9

what are neural networks

Answer 9

are made up of complex connection bw neurone , formed by initial experiences and reinforced when those experiences are repeated

Question 10

What areas of the brain are responsible for state dependent learning (4)

Answer 10

cortical brain regions
middle insular cortex
anterior cingulate cortex
hippocampus

Question 11

What part of the brain does mindfulness affect

Answer 11

Thickens the right anterior insula (part of the brain associated with self awareness)

-ALSO shown to reduce the size of the amygdala

Question 12

goals of tx in PTSD

Answer 12

• tx should be aimed at helping pts to live fully and securely in present
• involves neural restructuring to bring back the involvement of brain structures that are overwhelmed by trauma

Question 13

bents of langerian mindfulness

Answer 13

• reducing hypertension
• lessening anxiety
• improving isomnia
• avoiding depressive relapses and self injury
• improved ability to cope w trauma

Question 14

What is the short dynamic therapy stress syndrome theory to PTSDY

Answer 14

PSTD rxns occur when people have had a hard time successfully navigating the phases that everyone must face when dealing w trauma

Question 15

The phases of trauma (5)

Answer 15

1. Initial outcry
2. . Danial and numbness (dissociation from world)
3. Intrusive thoughts/feelings (about event)
4. Working through (integrating thoughts/feeling w self
5. Completion

Question 16

What are the 12 sessions of short dynamo therapy of stress syndrome (w1-4, 5-8, 9-12)

Answer 16

1-4– Establish trust so pt can safely recount truama

5-8– Work thru pts unconscious conflicts, maladaptive interpersonal patterns and problematic beliefs

9-12– Integrate strides patients have made and process feeling about end of therapy

Question 17

Behavioural approaches for tx of PTSD

Answer 17

1. exposure therapy for PTSD
2. exposure therapy for prolonged grief
3. Behavioural activation for PTSD

Question 18

What is exposure therapy for PTSD

Answer 18

-1st line intervention
Uses techniques such as: 
=exposure + response activation (usually imagery or virtual reality)
=Systemic desensitization
=Modeling

Question 19

What part of the brain may exposure therapy normalize

Answer 19

Normalize amygdala and prefrontal cortex

Question 20

What is exposure therapy for prolonged grief

Answer 20

The patient gradually confronts loss by focusing on the most painful parts of a loved ones passing
–the goal is to stop avoiding feelings about loss and rather face the reality

Question 21

What is behaviour activation for PTSD

Answer 21

• exists due to concerns that exposure therapies are often impractical in the real world
• pts are encouraged to engage in activities that they find rewarding

Question 22

What is the cognitive approach to PTSD

Answer 22

cognitive approaches to PSTD aim to educate patients about typical responses to trauma and to challenge their automatic beliefs about the event

Question 23

What are the different types of cognitive approaches (7)

Answer 23

1. Emotional processing theory
2. Dual representation theory
3. Cognitive processing therapy
4. Negative Appraisals theory
5. Stress inoculation training
6. Mindfulness and acceptance approaches
7. Eye movement desensitization reprocessing

Question 24

What is emotional processing theory

Answer 24

cognitive theory that attributes post traumatic stress as well as other fear anxiety responses to dysfunctional fear structures

Question 25

What is a fear structure

Answer 25

Associated thoughts, feelings, beliefs and bahaviours that are elicited when faced with a threatening event

Question 26

What is the dysfunctional fear state of those w PTSD

Answer 26

- The world isn’t safe | - Theur symptoms prove they are crazy and incapable of managing their distress

Question 27

What is dual representation theory

Answer 27

refers that people encode trauma in 2 different ways thru: 1. Verbally accessible memories (VAMS) 2. Situationally accessible memories (SAMS)

Question 28

What is the key aspect of therapy in dual representation theory

Answer 28

Adress SAMs and turn them into VAMs by encouraging PTSF clients to focus on them when elicited rather than avoid

Question 29

What is cognitive processing theory and how is it different from emotional processing theory

Answer 29

This approach combines exposure + focus on revising cognitions about the trauma (places less emphasis on fear structures though) - instead CPT attributes problems with PTSD zoo self esteem, competence and emotional intimacy

Question 30

What does cognitve processing theory focus on in tx

Answer 30

- help them reduce the tendency to overgeneralize beliefs about the traumatic event to other situations - teaching them to challenge calculations that result in self blame and avoids the exposure component involved

Question 31

What is negative appraisals in relation to PTSD

Answer 31

people interpret the external world as dangerous and come to see themselves as damaged and no longer able to function effectively

Question 32

what is the 3 main goals in negative appraisal theory tx

Answer 32

1. Alter negative appraisals of the trauma 2. Reduce reexperiencing the trauma by elaborating mens of it and identifying triggers 3. Eliminate dysfunctional cognitive and behaviour strats

Question 33

What is stress inoculation training

Answer 33

Combines a variety of CBT techniques to decrease avoidence and anxiety related to the trauma - education - mm relaxation train - Breathing techniques - role playing - guidled șelf dialogue

Question 34

What is mindfulness and acceptance approaches

Answer 34

the goal of therapy is to stay in touch with the present moment, rather than being pre occupied by traumatic memories -to experience the moment without being emotionally triggered by it

Question 35

What is eye movement desensitization reprocessing

Answer 35

has pt imagine the traumatic event while engaging in bilateral stimulation

Question 36

What is the humanistic perspective to PTSD

Answer 36

most peple report that having to cope with the event transformed them in unexpected ways-- Post Traumatic growth