Lecture 12: PTSD

Question 1

What is trauma?

Answer 1

• Traumatic events overwhelm the ordinary human adaptations to life
  = generally involves threats to life or bodily integrity or a close personal encounter with violence & death
  = confront people with extremities of helplessness & terror, & evoke the responses of catastrophe

Question 2

DSM-5 Criteria

Answer 2

• Exposure to traumatic event
  = exposure can be direct, witnessing, learning about a loved one or hearing details
• Intrusion (re-experiencing) e.g. memories, flashbacks, nightmares
• Avoidance of memories or external reminders
• Negative alterations in cognition & mood e.g. numbing, self blame…
• Arousal: hyper-vigilance, anger, irritable…
• Disturbance for >1 month after trauma

Question 3

Aetiology-Risk factors

Answer 3

• Many people exposed to trauma: 61-90%
• Many experience short-term distress but most spontaneously remit
• Only 20% of women & 8% of men develop PTSD
• Human inflicted violence - more likelihood of PTSD
• Prior traumatic experience (cumulative effect)
• Early rather than later trauma
• Lack of support

Question 4

Biological explanations of PTSD

Answer 4

• Simple explanation = release of stress neurochemical responses during the trauma produces strong conditioned fear responses to trauma cues
• More complex = trauma memories laid down differently to normal memories - not integrated with normal autobiographical memory
  = instead are: 1) sensation/perception based sight, smell, touch
  2) Have a piecemeal quality
  3) Vivid
  4) Occur in the present
  5) Not under conscious or intentional control
  6) Disjunction between these memories & autobiographical memories

Question 5

Learning models

Answer 5

• Classical conditioning leads to association between traumatic event & intense fear response
• This conditioned response is triggered by stimuli in the env. or in memory that seem similar to original event
• Avoidance of trauma helps to maintain conditioned response by impeding extinction

Question 6

Cognitive Models

Answer 6

• “Trauma challenges all our beliefs about our own safety, invincibility & goodness of others + world. The shattered self”
• Distortions related to event itself e.g. overgeneralising - ‘I attract disaster’
• Distortions related to the post-traumatic recovery e.g. ‘I am going mad’
• Distortions related to managing the effects - related to avoidance e.g. ‘I must keep away from people’

Question 7

Biological Treatment

Answer 7

• “SSRIs are an effective class of treatments for PTSD”
• “The effect sizes for pharmacological treatments for PTSD compared with placebo are low & inferior to those reported for psychological treatments with a trauma focus”

Question 8

Psychological Treatments

Answer 8

• Shift away from trauma-debriefing (but that doesn’t mean you must’nt talk about it!)
• Psycho-education re. common symptoms, valdiation, normalisation
• Establishing safety & control
• Anxiety management techniques (or emotional regulation techniques)
• Prolonged exposure
• Cognitive restructuring
• Meaning making

Question 9

Criticisms of PTSD

Answer 9

• Human-inflicted trauma arises out of a social context
  = Inequalities of power - children & adults
  = Gender inequalities
  = War etc.
• Diagnosis of PTSD medicalises, pathologises, individualises social problems