Responses to Trauma

Question 1

What are some physical reactions to trauma?

Answer 1

Muscle tension
Headaches
Nausea
Shakes and tremors
Choking sensation
Palpitations
Dizziness

Question 2

What are some trauma-related risk factors to mental illness?

Answer 2

Sudden, unexpected events
Man-made rather than natural events
Prolonged exposure
Perceived threat to life 
Multiple deaths/mutilation
Dose response relationship (proximity)
Personally relevant factors- child involvement/ identification with the victim or family

Question 3

What types of traumatic event may cause mental illness?

Answer 3

Rape-associated with highest incidence of PTSD
Combat exposure
Childhood neglect and physical abuse
Sexual abuse
Physical attack-threatened with weapon, kidnapped or held hostage

Question 4

What happens when the limbic brain judges that neither fight or flight are possible and death or severe injury is inevitable?

Answer 4

It will evoke a freeze response

Question 5

Describe freeze responses

Answer 5

To distant threat can be voluntary- stop, watch and listen pattern
When inescapable threat
-involuntary state of profound (reversible) motor inhibition
-especially when direct physical contact with predator/aggressor

Question 6

What happens during a freeze response?

Answer 6

Body goes into shut down
Altered state of reality 
The body becomes immobile 
Pain sensations are reduced
An adaptive and protective last ditch response

Question 7

What contributes to developing traumatic stress?

Answer 7

When the trauma is overwhelming
When there is a threat to body integrity/safety
When witnessing death/injury to a loved one
When in such situations one experiences intense
fear, helplessness or horror

Question 8

What are the two types of trauma?

Answer 8

Type 1-simple

Type 2-complex

Question 9

What are the symptoms of PTSD?

Answer 9

Cognitive disturbances-low self esteem, self blame, hopelessness, pre-occupation with threat
Mood disturbances/emotional dysregulation
Somatisation
Identity disturbance
Chronic interpersonal difficulties
Dissociation
Tension reduction activities

Question 10

What happens in the resolution of the stress response?

Answer 10

Parasympathetic system kicks in: 
 Muscles relax
 Skin becomes warm 
Pupils return to normal
Attention can be refocused 
Heart rate slows
Blood pressure is reduced
Eat, digest and rest and growth can begin

Question 11

What does the hippocampus do in the limbic brain?

Answer 11

Locates memories in the right time, place and context

Question 12

What does the amygdala do in the limbic brain?

Answer 12

Stores emotionally charged memories, and connects to medial prefrontal cortex

Question 13

What does the medial prefrontal cortex do?

Answer 13

Regulates emotional and fear responses

Question 14

What is the cognitive model related to PTSD?

Answer 14

Suggests that PTSD arises if the person processes a traumatic event/consequences as if to generate a sense of current threat

Question 15

Describe trauma memories

Answer 15

Easily triggered
Difficult to translate into words
Fragmented
Affect laden
Inability to recall some aspects of the trauma

Question 16

What are some visual triggers?

Answer 16

Uniforms may be associated with torture

Black bin liners with body bags

Question 17

What are some auditory triggers?

Answer 17

Christmas carol playing from radio of a car involved in a RTA around Christmas time triggered fireman called to site

Question 18

What are some smell triggers?

Answer 18

Strong smell of tobacco/alcohol reminding a woman of rape

Question 19

What are some taste triggers?

Answer 19

Never being able to stomach thin chicken flavoured soup again from a hostage situation

Question 20

What are some kinaesthetic triggers?

Answer 20

Tensing when required to brake following RTA

Question 21

Describe flashbacks in PTSD

Answer 21

Like being back in moment with associated sights, sounds, smell, feelings and emotions
Not conscious worries or ruminations
Intrude and engulf
Can last seconds to days
May be triggered by insomnia, tiredness of stress

Question 22

Describe nightmares in PTSD

Answer 22

Occur commonly
No sense of safety
Sufferers delay going to sleep
Bedroom may be associated with nightmares, so sufferer sleeps on coach leading to poor sleep hygiene
May consist of event or variations
Wake up shouting, screaming and drenched in sweat or hot and trembling

Question 23

Describe avoidance that occurs in PTSD

Answer 23

Person may refuse to talk about what happened for fear of being overwhelmed or lose control
May avoid people connected to trauma
May avoid place it happened, certain roads, weather or stop driving/working

Question 24

Describe the increased arousal that occurs in PTSD

Answer 24

Hypervigilance
Sufferers can appear threatening to others
Exaggerated startle response to sounds/personal proximity
Irritability, bursts of anger and aggression
Vulnerability
Inability to sleep, poor concentration and memory
Keeping weapons to safeguard themselves

Question 25

Describe the emotional numbing that occurs in PTSD

Answer 25

Detached from world Unable to have loving feelings, feeling removed and alone Loss of interest in hobbies, family and friends Inability to look beyond the event or look forward to the future Sufferer detaches themselves from loved ones

Question 26

Describe the dissociation that occurs in PTSD

Answer 26

The mind's way of walling off painful experience Offers temporary relief Person may feel like they are observing themselves from above Or they may feel like it is not really happening

Question 27

When is dissociation more likely to occur in PTSD?

Answer 27

``` If trauma is: Severe Prolonged Repeated/horrific/shaming If victim is very young ```

Question 28

How may dissociation in PTSD present?

Answer 28

Dissociative flashbacks Fugue states Dissociative Identity Disorder

Question 29

What are some indicators of dissociation?

Answer 29

Things look strange, colours may appear brighter/faded, tunnel vision Sounds appear muted/far away/louder Person may be rocking, tapping, twitching or grimacing Things seem to move in slow motion Feeling like a robot-functioning but not feeling Feeling like an observer than participant

Question 30

Describe re-enactment in PTSD

Answer 30

Recreating trauma Putting themselves in dangerous situations similar to original event Other risk taking behaviour Conceptualised as attempt to master event

Question 31

What conditions other than PTSD can occur in people post trauma?

Answer 31

``` Adjustment disorder Depression Anxiety disorder including panic disorder EUPD Dissociative disorder Somatisation Enduring personality change ```

Question 32

What is the timeline of traumatic disorders post event

Answer 32

48 Hrs- Acute stress reaction Up to 4wks- Acute stress disorder Up to 3 months- Acute PTSD Over 3 months- Chronic PTSD

Question 33

What happens in acute stress disorder?

Answer 33

Dissociative symptoms- numbing, depersonalisation/realisation, detachment, amnesia Persistent re-experiencing-intrusions, nightmares Increased arousal-anxiety, alertness, poor sleep

Question 34

How long must acute stress disorder last?

Answer 34

Within 1 month of trauma and lasting at least 2 days

Question 35

What is the treatment for post trauma sufferers?

Answer 35

Debriefing should not be undertaken If symptoms mild and present for less than 4 weeks- watchful waiting Access appropriate support Remove or manage continuing threat

Question 36

What are some psychotherapeutic models for post trauma treatment?

Answer 36

``` Trauma focused CBT Eye Movement Desensitisation and re-programming (EMDR) Prolonged exposure Cognitive Processing Therapy Sensorimotor Therapy ```

Question 37

What are some pharmacological treatments for post trauma sufferers?

Answer 37

Antidepressants Paroxetine licensed for PTSD Mirtazepine, amitriptyline or phenelzine can be used alternatively Specialist alternatives- prazosin, atypicals or mood stabilisers