Trauma Flashcards
(22 cards)
Does trauma increase the risk for psychosis?
Yes, victimisation, descrimination, bullying, migration, seperation and loss, war trauma, ubran dwelling, childhood truma/ avercity, any trauma exposure have all been found to increase the risk for psychosis
What is the implicated biological mechanisms for trauma ‘causing’ psychosis?
HPA axis disregulation
Clinical and functional outcomes of PTSD on psychosis
Greater PTSD symptomatology results in:
* Higher levels of depression/affective symptoms
* Higher risk for psychosis
* Increased severity of psychotic & negative symptoms
* Earlier onset of full threshold psychosis
* More hospitalisations
* Increased rates of suicide
* Increased risk of substance use
* Worse functional outcome
Which types of trauma are associated with with psychosis symptoms?
- Childhood sexual abuse- Auditory hallucinations
- Bullying- Persecutory delusions
- Neglect- Persecutory delusions
- Emotional Abuse- Persecutory & referential delusions
- Disorganised parental communication- Thought Disorder
What biological mechanisms are related to trauma having an impact on psychosis?
- Neurobiological disruption:
- HPA axis over-activation –> increases dopamine release
- Reduced hippocampal volume in clients with psychosis
- Reduced BDNF – which is necessary for hippocampal neurogenesis – following exposure to stress and in those with psychosis
- Impaired Neurocognition
*Increased stress sensitivity
Four Subgroups of Trauma in Psychosis
(Stevens, 2017
Traumatic Psychosis
Neurodevelopmental Psychosis
Psychotic PTSD
Psychosis-Induced PTSD
Traumatic Psychosis
Childhood trauma leading to schematic vulnerability, exacerbated by later triggers e.g. hear voice of perpetrator
Neurodevelopmental Psychosis
Genetic/organic vulnerability manifesting in affective blunting, poorer premorbid functioning, poor concentration, slowness, making them vulnerable to victimisation
Psychotic PTSD
Psychosis secondary to PTSD symptoms. Flashbacks/nightmares/hyper-vigilance, resulting in insomnia and increased arousal leading to emergence of psychosis
Psychosis-Induced PTSD
The triggering of PTSD as a result of acute psychosis
Comonnalities between PTSD and psychosis
- Re-experiencing memories, perceptions, sensations, feelings, nightmares — Hallucinations and delusions, sensory and perceptual intrusions and cogntions.
- Hypervigilance/arousal to threat — agitation/ arousal
- Avoidance — Expressive & experiential negative symptoms
- Negative cognition and mood — Expressive & experiential negative symptoms
NICE (2014) guidelines on PTSD and psychosis
Assess people with psychosis for PTSD; if nessesary follow guidelines for PTSD
NICE (2018) PTSD guidelines
Consider Eye Movement Desensitisation & Reprocessing (EMDR)
Offer individual trauma-focused CBT
Cognitive model of PTSD (Ehlers & Clark, 2000)
PTSD persistence due to porcessin trauma can leade to serious current threat
It is dirven by:
1. Negative appraisals
2. Memory disturbance
3. Unhelpful cognitve and behavioural strategies
Trauma appraisals
- Believes about self (I am weak, cannot cope, I attract disasters, bad things will always happen to me)
- Believes about others (Untrustworthy, dangerous, abusers)
- Believes about the world (Unpredictable, unforgiving, punishing, dangerous)
Unhelpful behavioural mechanisms (coping strategies)
The negative trauma appraislas maintain PTSD symptoms by producing negative emotions thus encouraging negative ‘coping’ behaviour
- Avoidance
- Hypervigilance
- Rumination
Memories
Fragmented, details missing, temporal order
unclear
*BUT- also experience a high frequency of involuntarily triggered intrusive memories involving re- experiencing aspects of the event in a very vivid and emotional way.
Discrepancy between difficulties in intentional recall and easily triggered re-experiencing of the event.–> If they try they can’t remember but if they are triggered they remember all details
Re-experiencing
- Sensory impressions in any sensory modality (physical sensations/visual imagery/smells/sounds)
- Experienced as happening right here right now
- ‘Affect without recollection’- re-experiencing physiological sensations/emotions associated with the trauma without recollecting
the event - Re-experiencing triggered by wide range of stimuli- temporal rather
than semantic associations with the event
Engagement in PTSD
Client pase
Speak with heal-lines/ themes
Promote psychoeducation about trauma-normalising, destigmatising (Explain their experience as PTSD- (intrusions, numbing,
hyper-arousal) are common reactions to a traumatic event.)
Manage intensity of arousal in session (don’t talk about all trauma all at once)
Collaborative, empathic, facilitate trust
Metaphorical panic button (way to escape and not get a panic attack/ feel trapped in the session)
Providing reassurance and support
Reinforcing resilience and strengths
Time-line
Types of trauma
- Physical Abuse
- Sexual Abuse
- Verbal Abuse
- Emotional Abuse
- Neglect
- Abuse in Childhood vs Adulthood
- Trauma of psychosis
Assessment
Risk
Listen out for trauma events
Ask about the worse moment of the traumatic even - traumatic hotspot
Explore what aspect of the memory cause most distress
Triggers to intrusions
Predominant emotion?
Current coping mechanisms
Imagery re-script
Challanges of CBT for PTSD
*Substantial co-morbidity-what to target first?
[Substance misuse/psychosis/affect?]
* Client disengagement
* Reluctance to discuss the trauma
* Reliving deemed too aversive by client
* Fear of psychosis relapse
* Fear of increasing self-harm & suicidal ideation RISK
* Therapist anxiety about hearing traumatic events
* Traumatising effects on the therapist/Therapist burnout
* Need for supervision & managing self-care
