CBT for PTSD Flashcards
(16 cards)
What is PTSD?
- Psychological Trauma: blowing out a psychological structure (a belief structure)
Ex: thinking people are trustworthy and then having that belief blown up - The more the event kicks out an existing belief system = the more distress
- Events with responsibility: leads to feelings of guilt and shame and horror
- Stuck points: why thew haunting gets stuck (most of the time for years and years)
What experiences are more/less likely to cause trauma?
Rate of PTSD is higher if its an interpersonal trauma (worse with trust) vs. a natural disaster
DSM criteria for PTSD (A and B)
Criterion A: the trauma
Criterion B: Feeling haunted by the trauma
- Intrusive memories
- Upsetting dreams (with themes of the trauma)
- Feeling like the event is happening again
- Having the same emotions that happened at the time of the event again and again
- Can be triggered by things that have some sensory similarities to the event (someone is wearing the same color as some prominent object of the event like a car)
- Changes in beliefs about self, other, and the world
How common are psychological trauma experiences?
- Lots of people end up having an experience that would count as a trauma
Ex: Being surprised by the death of a loved one - Most of us don’t develop persistent PTSD, there’s usually a natural resolution
What percentage of people who develop full PTSD recover from it within the first year?
25-40%
What are the effect sizes like for the majority of interventions for PTSD
- above .8 which is considered a large treatment effect size)
- there is definitely evidence that this intervention is useful for people stuck in that state
What are the main focuses with CT-PTSD?
- Focus on big emotions that are being influenced by cognitions (thinking)
- Focus on understanding the trauma more accurately and trying to face the trauma more directly
What does it mean to reclaim your life assignments?
- do things that you used to do that you stopped doing after the event
- assigning things a client used to find happiness in
- like behavioural activation
What does it mean to change problematic appraisals?
identifying and modifying the unhelpful or distorted interpretations (appraisals) a person has about their trauma, themselves, or the world as a result of what they experienced
- Ex: it was my fault
What is something that is very common that occurs when someone experiences a traumatic event? what do clinicians do to resolve it?
- people are on purpose trying not to think about it.
- traumas are surprising and confusing so during the experience a person may have misinterpreted something
Example: - disjointed memory
- wrong order of events
- missing details
- false info encoded as true
Clinically you need to go back to the trauma experience and try to recall the story more accurately to update meanings
- Write it in a narrative
- More vividly reexperience it - recall the experience
What is a hot spot? Give an example from a video watched in class
- part of a memory associated with strong strong feeling
Example: linked to shame
- needed to pee but couldn’t move so she wet herself (very embarrassing and felt ashamed for not being able to control her bladder)
- thoughts: “I’m disgusting”, “so embarrassing”, “I should be able to control my bladder”
where do you need to begin when reliving experiences? how do you work through a hot spot?
With reliving exercises you have to start before the event to capture the whole image of the event not just the worst parts
need to try to restructure the cognitions:
- Its actually extremely common to lose control of your bladder when stuck in a car for hours and hours, happens all the time
- Paramedics are used to dealing with other peoples body fluids
- Use a pie chart to summarize factors that could have caused her to wet herself - reduces responsibility
- Socratic questioning and consulting professionals is also helpful
- This will help update the belief
Effects of spotting memory triggers
- Help patients discriminate between then vs. now (stimulus discrimination)
- Sights, sounds, smells, bodily sensations can trigger intrusive trauma memories if they overlap with those of the trauma
how to help a patient identify triggers that are less obvious:
ask the client to think of times in the last week that the memories have intruded
- discuss similarities between the trauma situation and the new situation
Example:
- In the kitchen speaking with the housemate
- Similarities: housemate was using a knife to chop vegetables and the way she was holding the knife (towards her in a gesture) was triggering
- She can now learn to discriminate this from the trauma situation better and understand that the situation is different
What is thought suppression:
the idea is to show people that they are trying to suppress thinking about the trauma memories but it doesn’t work
Example: rabbit on head eating hair example
behaviour experiment to overcome PTSD safety behaviours:
Example:
- a woman avoid leaving the house alone and any males on the street which increases her sense of being in danger
Socratic questioning is used to loosen the belief:
- Calculating how often she has left the house alone and seeing the amount of times she has been attacked (only the 1 time) - put into perspective that it’s not common to be attacked by a man when leaving the house daily
- Estimated chance = 0.022%
- Feels 80% likely but the estimated reality is only 0.022% (not realistic) - belief dropped to 60%
Then put it into reality:
- Go outside on a walk and leave phones in the office - 60% belief of being attacked
- Therapist walks with her to help reduce scanning and safety behaviours (walking close to roadside not to be trapped)
- Encouraged the walk down the street alone - no one assaulted her
