L4: (COMPLEX) TRAUMA Flashcards
(49 cards)
List the main DSM-V symptom categories for PTSD
1) Intrusions
2) Avoidance
3) Heightened Arousal
4) (Change in) Thoughts & Feelings
2
List avoidance symptoms of PTSD
- Resisting conversations about the event
- Avoidance of physical reminders
5
List intrusion symptoms of PTSD
- Repeated unwanted memories
- Flashbacks
- Recurrent nightmares
- Physical sensations
- Distress when reminded of the event
5
List arousal symptoms of PTSD
- Increased awareness of surroundings & potential threats
- Trouble falling/staying asleep
- Diminished concentration
- Easily startled/fearful
- Irritability/anger outbursts
4
List thoughts/feeling symptoms of PTSD
- Struggle to remember important parts of the event
- Distorted beliefs about the self, world, and others
- Recurrent anger, fear, guilt, shame
- Detachment from others
What the main differences between PTSD and CPTSD?
- CPTSD involves recurrent, longer lasting, earlier occuring traumatic experiences
- Experiences are usually of interpersonal nature
- CPTSD is associated with more severe disturbances in self-organization
Explain the development of (C)PTSD
- Classical conditioning causes (natural/adaptive) behavioural/emotional reactions to trauma
- These reactions might later generalize to innocuous trauma reminders
- Avoidance of trauma reminders is reinforced via operant conditioning. Avoidance is adaptive in the short-term by preventing negative arousal/cognitions triggered by trauma reminders, but it is maladaptive in the long term as the trauma response is not extinguished, increasingly limiting the child’s ability to engage in the world
3 , 1 , 2
List additional DSM-V symptoms of CPTSD
CPTSD is associated with severe disturbances in self-organization
1) Emotional Dysregulation
* Persistent sadness
* Recurrent suicidal thoughts
* Explosive anger
2) Negative Self-perception
* Feelings of worthlessness, shame, guilt
3) Interpersonal Disturbances
* Relational difficulties
* Feeling distant from others
Explain the Emotional Processing Theory
- PTSD symptoms reflect the development of a problematic fear structure which produces maladaptive reactions when triggered
- Exposure to trauma reminders promotes habituation and reduces reinforcement of avoidance
- Exposure facilitates the pairing of fear memories with corrective experiences, by which new adaptive associations are created within the fear structure
Explain the Social-cognitive Theory
- Focus on impact of trauma on pre-existing/developing beliefs about oneself, others, and the world
- Aims to correct dysfunctional beliefs and address secondary emotional reactions
- Method - reviewing trauma-related feelings and thoughts to fully process the experience
7
List impairments associated with (C)PTSD
- Health conditions
- Disorders (Anx, MDD, ADHD)
- Lower perceived social support
- Lower social skills
- Behavioural/conduct problems
- Poor sleep quality
- School-related problems
What is the nature of the relationship between (C)PTSD and associated impairments?
It follows a dose-response relationship, with more trauma experiences and symptoms associated with greater adversity/more impairments
What is the overall goal of (C)PTSD treatments for children/adolescents?
Goal of treatment is to optimize functioning in all domains of life to prevent potential harmful developmental trajectories
List the steps of TF-CBT
1) Psychoeducation
2) Parenting Skills
3) Relaxation Skills
4) Affective Modulation
5) Cognitive Coping
6) Trauma Narration & Cognitive Processing
7) In Vivo Exposure
8) Conjoint Child-parent Sessions
9) Enhancing Safety & Future Developmental Trajectory
Explain Step 1 of TF-CBT
Psychoeducation
* Teaching about the nature of their traumatic experience
* Teaching about trauma reminders and connecting these to trauma responses
* Normalizing the experience
GE:
Therapist models non-avoidance:
* Direct naming/labeling of the traumatic experience (not using euphemisms)
* Factual description of the trauma
* Eye contact with parents/child when referring to the trauma
* Not lowering tone of voice
Explain Step 3 of TF-CBT
Relaxation Techniques
* Parents and children are taught various relaxation methods to tolerate distress brought on by trauma reminders in various situations
GE:
* Reduced avoidance to trauma reminders by teaching relaxation skills to cope with distress
Explain Step 2 of TF-CBT
Parenting Skills
* Parents express their own feelings about the traumatic experience
* Parents become a source of strength, support, and encouragement for the child
Effects:
* Increase positive parenting practises (praise and positive attention)
* Reduced parent distress
* Increased Parental Support
* Improving parent-child relationship
GE:
* Making connections between parent/child behaviours and the traumatic experience
Explain Step 4 of TF-CBT
Affective Modulation
Children:
a) Affective Dysregulation
* Children are often taught that they cant express any emotions or only express anger
* Child is encouraged to express their emotions through use of creative interventions
b) Affective Modulation
* Introducing skills (like problem solving or positive imagery) to help children manage distruptive feelings
Parents:
* Parents express their feelings about the traumatic event
* Develop optmal coping strategies for managing these emotions
* Learn how to assist their children in expressing their feelings by:
- Learning how to tolerate, encourag,e and understand their childs expression of feelings
- Modeling appropriate affective modulation and expression
GE:
* Increased exposure to trauma-associated negative affective states through teaching coping strategies
Explain Step 5 of TF-CBT
Cognitive Coping
* Cognitive coping: understanding, recognizing, and altering dysfunctional cognitions (thoughts, feelings, behaviours)
* Start with maladaptive cognitions about everyday events
* Parents will apply cognitive coping to maladaptive cognitions about the traumatic event
GE:
* Parents apply cognitive coping to process maladaptive thoughts about the traumatic event
Explain Step 6 of TF-CBT
Trauma Narration & Cognitive Processing
* Child creates a detailed narrative of the traumatic event over the course of several sessions, producing a physical product (like a book)
* For complex trauma, the child creates a life narrative which included both the traumatic experiences and positive life events, in order to contextualize the trauma
GE:
* Child is encouraged to gradually include more details about the experience across sessions
Explain Step 8 of TF-CBT
Conjoint Parent-child Sessions
* Child shares their trauma narrative with parents
* Family communication of the trauma is faciliated through the interchange of questions about the experience between parents and the child
GE:
* Parents and child openly share the trauma narrative and discuss it
Explain Step 7 of TF-CBT
In Vivo Exposure
* Should only be done if the trauma-associated stimuli is innocent and is not a valid cue for vigilance
* Child is exposed to increasingly distressing trauma reminders in real life
* With each milestone, the child develops greater feelings of mastery
GE:
* Gradual exposure to feared trauma reminders in real life
Explain Step 9 of TF-CBT
Enhancing Safety & Future Developmental Trajectory
* Important for children who are at risk for future dangerous situations
* Personal safety skill training to prevent future trauma experiences
GE:
* Discussion of potential future traumatic experiences
Explain how gradual exposure is incorporated into TF-CBT
Gradual exposure is incorporated into each step of TF-CBT by incrementally increasing the intensity and duration of trauma-reminded exposure (for both children and parents)
