Clinical -Trauma related Disorders

Question 1

When people experience a psycho-trauma, what are the possible results?

Answer 1

• Post-traumatic growth
• No problems/recovery
• Mental Health problems: Trauma-Related Disorders

Question 2

What are Trauma-Related Disorders?

Answer 2

Disorders/conditions that can be linked to a specific trauma (caused by a traumatic event)

Question 3

What can a traumatic event be?

Answer 3

Any negative experience. Everybody perceives different events as traumatic or non-traumatic. Factors that determine in each one of us what might be traumatic or not are a lot, and we can’t always know them all (personality, past experiences, associations, memories, environment etc.)
!!! Reminder of a traumatic event might not cause PTSD. Then a change in your life might change the way you think, and the same reminder that caused you no harm, now brings about symptoms of PTSD !!!

Question 4

What are some similarities between OCD and Trauma-Related Disorders?

Answer 4

• Anxiety plays a big role in both
• Similar ways of treatment

Question 5

What are some examples of Trauma-Related Disorders?

Answer 5

• PTSD
• ASD
• Adjustment Disorder
• …

Question 6

What is PTSD (Post-Traumatic Stress Disorder)?

Answer 6

Disorder defined as the extreme response to a severe stressor

Question 7

Description of PTSD and ASD

Question 8

What are some Demographic details on PTSD?

Answer 8

• 2/3 of people report at least one serious trauma during their lifetime.
• out of 80.7% of the population that experiences a trauma, 7.4% of them develop PTSD
• Most common traumatic event in men: Military service
• Most common traumatic event on women: Rape

Question 9

Which gender is more likely to develop PTSD and why?

Answer 9

Women (1.5-2 times more likely to develop PTSD than men). This happens mainly due to different life circumstances (sexual assault in childhood and adulthood):
- 1 of 6 women: raped
- 1 of 10 women: physical harm after refusing physical contact

Question 10

What are the 4 definitions of trauma according to the DSM-5?

Answer 10

Exposure to death, sexual violence or serious injury in one of the three following ways:
- Personally experiencing the event (1 of the above 3)
- Witness one of the 3 happen to somebody else
- Learn that one of the 3 happened to someone you know/somebody else
- Repeated/extreme exposure to aversive details of a traumatic event

Question 11

What are the four symptom clusters that are needed for diagnosing PTSD?

Answer 11

• Intrusion Symptoms
• Avoidance Symptoms
• Negative Alterations in Cognition and Mood
• Arousal and Reactivity Symptoms
  !!! (In order to diagnose PTSD, patient must have one of the symptoms from each category, [see below]) !!!

Question 12

Intrusion Symptoms

Answer 12

(In Adults):
- Distressing Memories
- Nightmares
- Flashbacks (as if you’re in the traumatic event again)
- Distress in response to reminders of trauma
(In Children):
- Repetitive play regarding trauma themes
- Reenactment of trauma during play

Question 13

Avoidance Symptoms

Answer 13

Avoid:
- Internal reminders (thoughts)
- External reminders (environment)

Question 14

Negative Alterations in Cognition and Mood

Answer 14

(In Adults):
- Dissociative Amnesia: Inability to remember important aspects of trauma
- Extreme negative beliefs about self and others
- Self-blame for trauma
- No interest/participation in activities
- Detached/estranged from others
- Can’t experience positive emotions
(In Children):
- More frequent negative emotions
- Social withdrawal

Question 15

Arousal and reactivity

Answer 15

• Aggressive Behavior
• Hypervigilance, startle response
• Poor concentration
• Sleep disturbance

Question 16

What is the onset of PTSD, and how long do the symptoms last?

Answer 16

1. PTSD may develop soon after trauma or years after it
2. Symptoms are chronic
   - Bare minimum for symptoms are a month
   - Military veterans even 20-40 years later report symptoms for PTSD

Question 17

What are some difficulties with PTSD?

Answer 17

• Social: Difficulties with relationships (divorce) and unemployment
• Personal: Suicidal thoughts, self-injury, medical illness

Question 18

What is Complex PTSD?

Answer 18

Usually comes about when somebody is exposed to prolonged trauma or/and had childhood disorders as well.
- Shows a broader range of symptoms than PTSD
- Because it’s just more severe PTSD symptoms, there’s no distinctive subtype, so DSM-5 doesn’t classify it as a specific disorder.

Question 19

What are some general criteria for PTSD?

Answer 19

• Duration of symptoms: at least 1 month
• Psychological symptoms aren’t caused by any substance use
• Disturbance causes clinically significant distress or impairment in social, occupational or other forms of functioning

Question 20

What are some other general characteristics of PTSD?

Answer 20

• Usually comorbid with another disorder
• Culture shapes risk for PTSD: Minorities in U.S., Northern Ireland -> more conflict, therefore more PTSD
• Usually people go from ASD to PTSD (50% of people that have ASD develop PTSD)
• PTSD can also develop though from nothing (no ASD)

Question 21

What are the differences between ASD (Acute Stress Disorder) and PTSD?

Answer 21

• ASD has a broader range of diagnostic criteria than PTSD (specifically, it doesn’t specify that symptoms from each of the 4 symptom categories of PTSD must be present for somebody to be diagnosed with ASD)
• Diagnosis is applicable only when symptoms last for 3 days to maximum a month

Question 22

What are some problems with the ASD Diagnosis?

Answer 22

• Stigmatizes very common reactions to trauma, reactions that aren’t indicative of any problem/disorder and are very healthy and natural
• Not predictive of who will develop PTSD (less than1/2 of those who have ASD don’t develop PTSD)

Question 23

]What is a good aspect with ASD Diagnosis?

Answer 23

Helps us identify those who need some support after trauma

Question 24

What is Adjustment Disorder?

Answer 24

• When somebody has experienced a trauma, but doesn’t meet all criteria for PTSD or ASD
• When somebody meets all criteria for PTSD or ASD, but hasn’t experienced a traumatic event (symptoms come about from a rather trivial event)

Question 25

Etiology of PTSD

Question 26

What does Etiology mean?

Answer 26

- Factors that increase likelihood for a disease/disorder - Causes for a disease/disorder - (In this case as well) Factors that either perpetuate or reduce the prevalence of a disease/disorder

Question 27

What are the three risk factors/factors that influence the likelihood of PTSD?

Answer 27

- Severity and Nature of Trauma - Neurobiology (then specifically hippocampus) - Coping mechanisms

Question 28

Severity and Nature of Trauma

Answer 28

- More severe, more likely to develop PTSD - Nature: More likely for PTSD to develop if trauma is caused by humans instead of something else (e.g. natural disorders)

Question 29

Neurobiology

Answer 29

- dysregulation of amygdala & PFC - Increased release of norepinpehrine: hyperreactivity to threat-related stimuli - Disrupted Brain networks ~Salience Network (process/respond to emotionally relevant stimuli) ~ Central executive Network (Regulate emotions ~ Default mode Network (introspection, processing of self-relevant memories) - Hippocampus

Question 30

How can the hippocampus play a role in developing and having PTSD?

Answer 30

Dysfunction/diminished activation of hippocampus during cognitive tasks/emotion regulation makes it difficult for people to analyze memories of a traumatic event or put them into context. This leads to excessive fear and stress, even when there's just a reminder of trauma, completely out of context

Question 31

Coping mechanisms - Maladaptive Strategies

Answer 31

- Avoid thinking about trauma -Dissociation: Feeling removed from body's thoughts/emotions. -> People use this strategy to avoid conftronting memories of trauma -> Levels of dissociation are highest in the weeks after the trauma, and slowly diminish -> Symptoms of Dissociation show immediately after/during trauma = more likely to develop PTSD Both strategies increase likelihood for PTSD

Question 32

Coping mechanisms - Adaptive Strategies

Answer 32

- Strong Social Support - Cognitive/intellectual ability -> make sense of horrifying events

Question 33

What are some other general risk factors that predict PTSD?

Answer 33

- Family Psychiatric History - Low SES - Race - Younger Age - Life Stress

Question 34

What is the Cognitive Model of PTSD?

Answer 34

(Image from slide, page 21)

Question 35

Treatment of PTSD and ASD

Question 36

What is the medical treatment for PTSD?

Answer 36

- Paxil and Zoloft: Serotonin reuptake inhibitors (SSRI's): more serotonin flow through the brain - Antidepressants maybe work. A problem with them is that the relapse of people with PTSD is often discontinued, and patients go back to were they were. - Benzodiazepines (used for anxiety disorders) are sometimes prescribed: no scientific evidence to support this

Question 37

Is medical or psychological treatment preferred?

Answer 37

Psychological

Question 38

What are some psychological treatment methods for PTSD?

Answer 38

- Prolonged Exposure Therapy (!!! Learning Theory !!!) ~ Imaginal Exposure Therapy ~ Virtual Reality ~ EMDR - Cognitive Therapy - (NET) (Not that important)

Question 39

What is the best and most common psychological treatment method for PTSD?

Answer 39

Prolonged Exposure Therapy (Benefits persist for over 5 years) - 8-15 90 minute sessions, once or twice per week

Question 40

What is the goal of Prolonged Exposure Therapy?

Answer 40

- Make the general fear response go away - Challenge the idea that the person can't cope with the fear and anxiety generated by trauma-related stimuli

Question 41

On which theory is the idea of exposure therapy based on, and what does that theory state?

Answer 41

Learning Theory !!! If there's an association between CS - fearful US, the therapist tries to pair the same CS with non-fearful US. this new association between CS - non-fearful US competes/inhibits with the original association of CS - fearful US !!!

Question 42

What are the methods of Prolonged Exposure Therapy

Answer 42

- Face worst memories through exposure: hierarchical exposure (from less intense to most intense fears) ~ a lot of times exposure in vivo as well (return to scene of traumatic event) - Challenge negative beliefs about self: develop more positive narrative about ability to cope with trauma ~ CPT (Cognitive Processing Therapy) helps in this: Especially good in reducing self-blame and guilt - Because trauma can interfere with ability to cope with emotions, it's important to teach people emotion regulation skills - Psychoeducation on nature of PTSD - Breathing exercises for relaxation

Question 43

What are some variations on Exposure Therapy?

Answer 43

- Imaginal exposure: If in exposure therapy it's too difficult for patient to return to scene of traumatic event, therapists instead deliberately ask patients to remember the event - Virtual reality: not as effective - EMDR

Question 44

What is EMDR? (Eye Movement Desensitization and Reprocessing)

Answer 44

Recall trauma-related scene while therapist moves fingers back and forth in front of the client's eyes -> helps reduce vividness and intensity of memories

Question 45

How is the effectiveness of EMDR explained?

Answer 45

1/. long-term memory (traumatic memory) 2/. working memory 3/. fingers moving: competing tasks (recall memory, focus on moving fingers) makes us balance out how many resources we focus on each task. Thus we focus less resources recalling memory than we usually do, reducing the vividness/emotionality of memory 4/. Modified memory gets reconsolidated into long-term memory

Question 46

How is Cognitive Therapy used to tackle PTSD?

Answer 46

- Identify and challenge dysfunctional/negative cognitions - often combined with ~ Exposure Therapy ~ CBT

Question 47

Is it possible to prevent PTSD by treating people with ASD?

Answer 47

Yes. Early exposure therapy: - Risk of PTSD is reduced from 58% to 32% - PTSD symptoms are less severe (if ASD treatment doesn't completely help tackle ASD and PTSD develops)