midterm Flashcards
1
Q
what is trauma
A
single or repeated events that overwhelm individual’s ability to cope or integrate the ideas & emotions involved in experience
2
Q
what determines trauma
A
individuals experience of the event and meaning they make of it
3
Q
what does not determine trauma
A
the event
4
Q
why is trauma hard to study
A
no true definition exists, method of research depends on how it was defined, its subjective, many have difficulty speaking about it because of stigma
5
Q
what are the dimensions of trauma
A
magnitude, complexity, frequency, duration, cause from interpersonal or external source
6
Q
single incident trauma
A
unexpected & overwhelming incident (accident, natural disaster, single episode of abuse)
7
Q
complex or repetitive trauma
A
chronic, ongoing abuse: physical/sexual assault, DV
8
Q
developmental trauma
A
early life trauma of chronic nature that may involve child’s caregiving system
9
Q
intergenerational trauma
A
trauma impacts are essentially “passed down” from one generation to another
10
Q
historical trauma
A
cumulative “wounding” over the lifespan from massive group trauma
collective trauma, often of a particular cultural group
11
Q
what is an important variable of trauma
A
the age it occurs at
12
Q
what effects can early trauma have on children
A
negative consequences, impacting the development of the brain and normal developmental progression
13
Q
what are some common side effects of someone who has experienced trauma
A
nightmares, depression, irritability, and jumpiness
14
Q
whar are some personal responses to trauma one may face
A
sense of safety, self and self efficacy, ability to regulate emotions and navigate relationships
15
Q
physiological adaptations develop in response to trauma is called…
A
dysregulation
16
Q
what is dysregulation
A
difficulty controlling or regulating emotional reactions/behaviours and imbalances in the body
17
Q
what does dysregulation result in
A
hyperarousal, hypervigilance, listlessness and dissociation
18
Q
why is trauma-informed practice important
A
prevents re-traumatization, gives insight into behaviours, and allows for individualized and more effective care by finding the root of the problem
19
Q
what were the 5 personal risk factors of the ACE study
A
physical, sexual, emotional abuse, physical neglect and emotional neglect
20
Q
what were the 5 family member risk factors of the ACE study
A
domestic violence towards mother, household substance abuse, household mental illness, parental separation or divorce, the incarceration of a household member
21
Q
what was the most prevalent category of childhood exposure seen on the ACE study
A
substance abuse in the household
22
Q
as the number of ACE’s increased, so did adult risk factors including:
A
smoking, alcohol and drug abuse, and severe obesity
23
Q
what are some findings from the ACE study
A
children who suffered severe adversity more likely to duffer from long-term intellectual, behavioural, physical, and mental health problems
increased # of ACEs correlated w/ increased in risk factors for substance abuse, health risks (cancer, heart disease)
4+ categories correlated w/ 4-12 fold increased in health and substance abuse risks
24
Q
what are the 3 categories of abuse as defined by ACE
A
sexual, emotional, physical
25
what did harlow's monkey show
the devastating effects of deprivation on young rhesus monkeys. Harlow's research revealed the importance of a caregiver's love for healthy childhood development
26
what was found from quality of the emotional bond between infant and caregivers
lays foundatin for future relationships
27
what is bolby's attachment theory
first 2 years of life considered "critical period" for bond to develop
children have biological need to develop close relationship with 1 key figure
when bond not form, negative effects occur in development
28
what are social releasers
innate behaviours exhibited by babies such as crying, smiling, vocalizing to increase proximity + contact with mother
29
what are the signs of attachment
social referencing, separation anxiety, stranger anxiety
30
what is social referencing
begins ~ 6mons when child looks to primary caregiver to determine how to respond in new/ambiguous situation
31
when does separation anxiety begin
6-8mon & peaks at 14-18mon
32
what is stranger anxiety
begins 8-10mon and peaks at 2 yrs - child anxious in the presence of a stranger especially when primary caregiver not around
33
patterns of attachment is invented by
ainsworth
34
what is secure attachment
IDEAL attachment: caregivers consistent, appropriate responses to child's attachment behaviours, child feels confident to explore when caregiver present, becomes mildly upset when primary caregiver leaves and seeks contacts upon return
35
what are the types of insecure attachment:
anxious-ambivalent, anxious-avoidant, disorganized
36
describe anxious-ambivalent attachment
- child both clings to and resists care providers
- child is anxious of exploration and strangers, even w/ primary caregiver present
- extremely distressed when caregiver leaves, but is ambivalent to when they return
- clingy, passive aggressive when caregiver returns (punish caregiver)
37
What is anxious-avoidant attachment?
- child largely ignores caregiver
- shows little reaction upon leaving or return
- child treats caregiver similar to strangers
38
What is disorganized attachment?
- child exhibits fear of caregiver
- often appears in a daze
- often a consequnce of mistreatment from caregivers
39
what are the adult attachment styles
secure, dismissing, preoccupied, fearful
40
What is secure attachment? (Adults)
Received reliable caregiving in childhood, positive view of self and others, able to form trust in others
- trusts others, healthy view of self, shares wants & needs easily, interdependent, not triggered easily, can manage and cope when triggered
41
What is dismissive attachment? (Adults)
Received unresponsive caregiving in childhood. Considers themselves self sufficient; refuses to rely on others
- wants love but is fearful, doesn't trust easily, builds up walls, ultra independent
42
What is preoccupied attachment? (Adults)
Received inconsistent caregiving in childhood, feels "unlovable", can become "clingy"
- high anxiety, codependency, insecure, fear of abandonment, fear of being alone, chronic survival mode (me)
43
What is fearful attachment? (Adults)
Had rejecting experience w/ caregivers, have desire for intimacy but fear rejection, may alternate between approaching and avoiding ppl
- unsure if want love (sometimes do & sometimes don't), push pull dynamic, confused about love, downplays relationships, trouble feeling emotions
44
True of false: secure attachment is believed to protect against trauma
True: it is thought to increase resilience
45
What is the relationship between trauma and attachment?
- interpersonal trauma appears to be more closely ass w/ attachment insecurities than non-interpersonal trauma
- dismissive attachment style appeared to be the lowest associated w/ PTS
- PTS symptoms could erode attachment security
- insecure attachment appears to increase risk for PTS symptoms
46
which type of attachment style would be described by the child's needs have not been met by the caregiver which is why there is no reaction when the caregiver comes/goes
anxious-avoidant
47
secure attachment could have what kind of factors
protective (buffer system)
48
insecure attachment can have heightened
vulnerability
49
how is trauma informed care defined
strengths-based framework thats grounded in understanding & responsiveness to impact of trauma, emphasizing physical, psychological, and emotional safety for both providers and survivors & creates opportunities for survives to rebuild sense of control and empowerment
50
trauma & violence - informed care defined
TVIC expands concept of TIC to account for the intersecting impacts of systemic & interpersonal violence & structural inequities on person's life. this shift important as emphasizes both historical & ongoing violence & their traumatic impacts & focuses on person's experiences of past and current violence so problems are seen as residing in both their psychological & social circumstances
51
what are trauma informed services
- approach / way of being in a therapeutic relationship
- universal precautions for trauma approach
- place priority on individual's safety, choice and control
- provide treatment culture of nonviolence, learning, and collaboration
- safety & empowerment for user are central, & embedded in policies, practices, and staff relational approaches
52
what emphasizes creation of treat where clients don't experience further traumatization & where they can make decisions about their treatment needs at pace that feels safe for them
trauma informed services
53
trauma-specific services does
facilitate recovery through specialized counselling & other clinical interventions & generally requires some processing of traumatic experiences
54
examples of trauma specific services
trauma focused CBT, exposure therapy, EMDR
55
in trauma specific services, you need to consider the client's ....
readiness to engage in the services
56
what is meant by client readiness
have good coping skills since opening up about what has happened people tend to unravel
57
what are the trauma informed practice principles
- trauma awareness
- emphasis on safety & trustworthiness
- opportunity for choice, collaboration & connection
- strengths based & skill building
- recognition of cultural, historical, gender and sexuality issues
- promotion of people with lived experience (peer involvement)
58
what is trauma awareness
- building awareness about prevalence of trauma, its effects, & how ppl cope
- how symptoms & behaviours represent adaptations to trauma
- recognizes potential for vicarious/secondary trauma & emphasizes self-care
- promotes awareness of relationship b/w trauma & health
59
what is emphasis on safety & trustworthiness
- physical, emotional & cultural safety essential to address the survivors tendency to feel unsafe
- recognizes survivors often in unsafe situations
- staff safety also stressed
60
examples of practices that promote safety & trustworthiness
confidentiality, body language, active listening, genuine, honesty, informing ppl know what is happening with their care
61
examples of practices/policies that promote safety & well-being for staff
open-door policy with leader, having actual policies like debriefing
62
what is oppprtunity for choice, collaboration & connection
- foster self-efficacy, self-determination, dignity & personal control
- open-communication, equalize power imbalances, encourage expression of feelings, non-judgmental approach, provide options, work collaboratively w/ clients
- connection among families, peers and community encouraged
63
what is strength-baed and skill building
- assisted to identify strengths & develop coping skills & foster resiliency
- teaching/modeling of skills for recognizing triggers, calming, centering, grounding
64
recognition of cultural, historical, gender and sexuality has trauma rooted in societal issues like
- racism, classism, sexism & homophobia/transphobia
- retraumatization in HC can increase stereotyping, social exclusion, discrimination
65
what is promotion of people with lived experience
- meaningful participation of ppl with experience essential in design & implementation of services
- feedback is crucial & should be ongoing
- integration of peer support in HC promotes safety
- talking to clients allow us to provide better trauma informed care
66
why is normal brain development called "bottom up" process
starts with most primitive functions of body & concludes with most complex (brainstrem ---> cortex)
67
t/f: at 6 years old, your brain is 90% the size of your adult brain
TRUE
68
what is formed at an alarming rate during early childhood (0-3)
synapses or neural connections
69
what does pruning mean
synapses are discarded based on the child's learning and experiences
70
what is myelination
formation of a insulating sheath around brain cells that make nerve impulse transmission more efficient (also bottom up process & influenced by experiences
71
when does the brain stop growing/developing
mid 20's
72
during teenage years, what happens to synapses
pruning & increased white matter forms
73
which area of the brain lags development in adolescents
frontal lobe
74
what occurs when the frontal lobe develops after the physical development of brain in adolescents
poor impulse control, decision making and increase risk-taking behaviour due to using lower level of brain
75
what part of the brain is growing and which part of the brain is underdeveloped in adolescents
limbic system & cortex
76
what is the limbic system
responsible for emotions
77
what is the cortex
responsible for reason, abstract thinking
78
what can occur when the limbic system trumps the cortex
emotion-based interpretations and reactions
79
neuroplasticity allows the brain to be...
adaptive
80
what is neuroplasticity
rewiring brain by forming new connections & weakening old ones
81
how are memories formed
experiences strengthen neuron pathways, they become encoded which leads to memories & responses become more automatic
82
implicit memories
perception of environment & recall of experiences unconscious (babies born with this)
83
explicit memories
conscious memories & is tied to language (develops ~ 2 yrs)
84
how does trauma impact brain
- positive experiences assist healthy brain development, negative experiences can have consequences on brain development
- includes changes to structure & activity of brain & can lead to alterations in emotional& behavioural functioning
85
what are some factors that influence trauma's impact on brain
age (early more severe), single incident vs chronic, type & severity, role/identity of abuser when trauma is interpersonal (ex. attachment figure vs stranger)
86
how does trauma impact the cortex
- decreased activity
- danger = limbic system activated b4 prefrontal cortex (less developed) can assess danger
- staying in heightened danger response prevents prefrontal cortex to be activated which causes problems with problem-solving & learning
87
how does trauma impact the limbic system
- increased activity
- initiates fight, flight & freeze
- amygdala processes emotions & instigates release of hormones based on emotional responses (fear)
- after trauma, amygdala may remain activated & continue to sound alarm inappropriately
88
what does the limbic system control
fundamental emotions & survival instincts
89
what structures are found within the limbic system
amygdala & hippocampus
90
how does trauma impact the hippocampus
decreases volume
- stress hormones released by amygdala's alarms suppresses hippocampus, losing function
- info not passed to cortex
91
what does the hippocampus do
processes info & gives time & spatial context to memories/events
transmits info to cortex, for interpretation
92
what is decreased volume of hippocampus closely correlated with
PTSD & depression
93
what is the corpus callosum
info pathway between right and left hemispheres of brain
94
impact of trauma on corpus callosum
smaller corpus callosum in abused children = less integration of hemisphere
contribute to greater fluctuations in mood or personality changes
95
what is the neuro-endocrine system
interaction b/w brain and the hormones in the body
96
what does the neuro-endocrine system help regulate
mood, stress responses, immunity, digestion
97
what is chronic neuro-endocrine dysregulation linked to
prolonged exposure to trauma, and has been identified as a significant factor in many of its longterm effects
98
alternations in what occurs in both children and adults who have experienced abuse
cortisol production
99
stressful prenatal environment may lead to alternations in
cortisol levels
100
low cortisol levels can lead too
decreased energy, impacting learning and socialization as well as increased risk of autoimmune disorders
101
high cortisol levels are linked to
cognitive problems, mood problems and reduced immune response
102
children who have experienced trauma may have difficulty
retaining or accessing explicit memories but implicit memories of the trauma remain resulting in nightmares, flashbacks
103
during extreme trauma, info is not processed in the same way and the brain stores it as a different kind of memory called
trauma memory
104
brain and body respond quickly to danger which results in
the hippocampus going offline
105
a trauma memory is
not organized, sequential, fragmented, little control over retrieval, come back involuntarily and situationally accessible
106
how is a trauma memory situationally accessible
triggered by reminders in the environment
107
since trauma memories aren't time tagged, it makes it
hard to place when they happened, feels like frozen in time, when come back - feels like occurring again in present which is associated with all same emotions & unpleasant physiological sensations
108
how do people try to prevent trauma memories from recurring
avoid anyone/thing that may trigger, develops strategies to block and suppress (drugs & alcohol, distractions so no space to feel)
109
the more you try and block and suppress trauma, the more . . .
it comes back
110
what is epigenetics
biological mechanisms that will switch genes on and off
how DNA interacts with multitude of smaller molecules found within cells which can activate and deactivate genes
111
life events can cause genes to
be silenced or expressed over time
112
child maltreatment can cause what (genes)
epigenetic mods in victims
113
epigenome is
set of all chemical tags attached to the genome of given cell
114
positive stress is
moderate, brief, normal part of life, learning to adjust essential component of healthy development
115
tolerable stress
events have potential to alter developing brain negatively, occur infrequently & give brain time to recover
116
toxic stress
strong, frequent & prolonged activation of body's stress response
117
adult trauma survivors report more
physical symptoms of concern, poorer overall health, and lower health-related quality of life than non-traumatized counterparts and higher healthcare costs
118
what does multiple types of trauma do
increase negative health conditions
119
2 types of ways that trauma affects the body
lifestyle factors (behavioural pathway) & direct physical effects (biological pathway)
120
describe lifestyle factors and how it affects the body
attempts at coping may lead to maladaptive strategies including use of alcohol and other substances, smoking, over-eating or eating an unhealthy diet, and other high-risk behaviours that contribute to health problems
121
describe direct physical effects and how it affects the body
- exposure to trauma lead to chronic hyperarousal of stress-response, damaging the brain and other systems & resulting in wide range of health problems
- chronic stress = elevated levels of stress hormones which taxing to body (suppressing immune functioning & chronic inflammation)
122
which area is most studied related to trauma affects
pain
123
trauma & pain outcomes
- high rate PTSD & physical pain
- correlation b/w chronic pain in adulthood & childhood abuse
- PTSD & pain = resistant to PTSD treatment
124
sexual abuse =
high outpatient visits for chronic/acute pain
125
possible explanations for the relationship b/w trauma and pain
- experience of pain serve as reminders of event & worsen experiencing symptoms
- shared vulnerability model
126
what did Bartoszek study show
only pain caused by traumatic events themselves triggered experiencing symptoms (memories w/ emotions, flashbacks)
127
what is the shared vulnerability model (Asmundson)
psychological & biological vulnerabilities interact w/ traumatic experience to produce emotional response characterized by hypervigalence, cognitive biases & avoidance.
attentional bias for threat serves as shared cognitive vulnerability for PTSD & chronic
128
somatization refers to
development of somatic (body-based) symptoms for which no organic caused is found
129
somatoform symptoms have been linked to
traumatic exposure, trauma victims tend to score higher on self-reports of somatic complaints than controls
130
possible influences for somatization
neurobiological changes, increased physiological arousal, poorer health behaviour in the aftermath of trauma
131
somatization may be related to other psychological consequences of trauma such as
depression, anxiety, dissociation, PTSD
132
relationship b/w PTSD & somatization may be explained by
lowered responsiveness towards external stimuli combined with an increased awareness of internal stimuli (found in ppl with PTSD)
132
relationship b/w PTSD & somatization may be explained by
lowered responsiveness towards external stimuli combined with an increased awareness of internal stimuli (found in ppl with PTSD)
133
patients with dissociative disorders & PTSD patients present with more
somatoform symptoms
134
it has been proposed that dissociation somehow mediates...
relationship b/w PTSD & somatization
135
research has found .... with relationship to GI disorders
correlation b/w physical & sexual abuse & GI complaints like abdominal pain, nausea & vomiting, pelvic pain, ulcers
136
what is functional GI disorders
chronic or recurrent GI symptoms that are not explained by structural or organic abnormalities
137
what has been correlated with maltreatment & an example
functional GI disorders, ex: irritable bowel syndrome
138
who came up with research about trauma and GI disorders
Sowder, Knight, Fishalow (2017)
139
possible explanations for trauma & GI disorders
- stress may over-activate the nerves that connect brain & gut
- chronic state of sympathetic nervous system arousal we have associated with trauma is thought to be basis for digestion related problems
140
what happens when the amygdala is setting off alarm to the GI
muscle tension clamps down on vagus nerve resulting in blood pump out of gut to prepare for fight or flight, stopping digestion
141
chronic stress state produces what in the GI
all phases of digestion are interrupted or altered
142
what are the outcomes of trauma and the cardiovascular system
- ACE study linked childhood abuse, neglect, and household dysfunction to ischemic heart disease
- later studies replicated this finding, even when controlling for lifestyle factors
- study linking childhood maltreatment & cardiovascular disorders found stronger relationship for women than men
