Trauma Flashcards
1
Q
Define trauma
A
Exposure to events and circumstances that are experienced as harmful (physically or emotionally) and that have lasting impacts on mental, physical, emotional and/or social well- being
2
Q
Exposure to events and circumstances that are experienced as harmful (physically or emotionally) and that have lasting impacts on mental, physical, emotional and/or social well- being
This is known as…?
A
Trauma
3
Q
Traumatic experiences might have a particular impact if they are…?
List 3 points
A
- Repeated or prolonged
- Interpersonal
- Multiple or occurring at critical stages of
development.
4
Q
Define Adverse Childhood Experiences (ACEs)
A
Adverse Childhood Experiences (ACEs) are traditionally understood as a set of 10 traumatic events or circumstances occurring before the age of 18
5
Q
A set of 10 traumatic events or circumstances occurring before the age of 18
This is known as…?
A
Adverse Childhood Experiences (ACEs)
6
Q
What is the prevalence of Adverse Childhood Experiences (ACEs) in England?
A
In a study conducted in England, 47% of participants reported at least 1 ACE and 9% reported 4 or more ACEs
7
Q
In a study conducted in England, ___% of participants reported at least 1 ACE
a. 39%
b. 62%
c. 12%
d. 47%
A
d. 47%
8
Q
In a study conducted in England, __ % reported 4 or more ACEs
a. 9%
b. 22%
c. 41%
d. 77%
A
a. 9%
9
Q
What are the 3 types of consequences to ACEs and they can result in a reduced lifespan?
A
- Biological
- Psychological
- Social
10
Q
- Biological
- Psychological
- Social
These are the 3 types of consequences to ACEs and they can result in …?
A
Reduced lifespan
11
Q
Research has shown a link between ACEs and mental health difficulties such as …?
List 2
A
- Depression
- Anxiety
12
Q
True or False?
The link between childhood adversity and psychosis is as strong as the link between smoking and lung cancer
A
True
13
Q
The link between childhood adversity and _____ is as strong as the link between smoking and lung cancer
A
Psychosis
14
Q
True or False?
We should ask what’s wrong with you instead of what’s happened to you
A
False
We should ask what’s happened to you instead of what’s wrong with you
15
Q
Around _____% of people experiencing a traumatic event go on to develop PTSD
a. 10-15%
b. 25–30%
c. 15-20%
d. 35-40%
A
b. 25–30%
16
Q
Around 25–30% of people experiencing a traumatic event go on to develop …?
A
PTSD
17
Q
What are the 4 things required to diagnose an individual with having trauma?
A
- Intrusion
- Avoidance
- Hyperarousal
- Alteration in mood/beliefs
18
Q
Difficulty falling or staying asleep
Which does the above apply to?
a. Intrusion
b. Avoidance
c. Hyperarousal
d. Alteration in mood/beliefs
A
c. Hyperarousal
19
Q
Inability to recall key features of the traumatic event
Which does the above apply to?
a. Intrusion
b. Avoidance
c. Hyperarousal
d. Alteration in mood/beliefs
A
d. Alteration in mood/beliefs
20
Q
Recurrent, involuntary, intrusive memories
Which does the above apply to?
a. Intrusion
b. Avoidance
c. Hyperarousal
d. Alteration in mood/beliefs
A
a. Intrusion
21
Q
Of circumstances resembling or associated with the stressor
Which does the above apply to?
a. Intrusion
b. Avoidance
c. Hyperarousal
d. Alteration in mood/beliefs
A
b. Avoidance
22
Q
Re-living the traumatic experience(s) in the here and now (flashbacks)
Which does the above apply to?
a. Intrusion
b. Avoidance
c. Hyperarousal
d. Alteration in mood/beliefs
A
a. Intrusion
23
Q
Irritability or outbursts of anger
Which does the above apply to?
a. Intrusion
b. Avoidance
c. Hyperarousal
d. Alteration in mood/beliefs
A
c. Hyperarousal
24
Q
Difficulty concentrating
Which does the above apply to?
a. Intrusion
b. Avoidance
c. Hyperarousal
d. Alteration in mood/beliefs
A
c. Hyperarousal
25
Of trauma-related thoughts and feelings
Which does the above apply to?
a. Intrusion
b. Avoidance
c. Hyperarousal
d. Alteration in mood/beliefs
b. Avoidance
26
Change to beliefs and expectations about oneself, the world and others.
Which does the above apply to?
a. Intrusion
b. Avoidance
c. Hyperarousal
d. Alteration in mood/beliefs
d. Alteration in mood/beliefs
27
Distressing dreams (nightmares)
Which does the above apply to?
a. Intrusion
b. Avoidance
c. Hyperarousal
d. Alteration in mood/beliefs
a. Intrusion
28
Persistent trauma-related emotions (e.g. fear, horror, guilt, shame)
Which does the above apply to?
a. Intrusion
b. Avoidance
c. Hyperarousal
d. Alteration in mood/beliefs
d. Alteration in mood/beliefs
29
Experiencing distress when confronted with reminders of the trauma
Which does the above apply to?
a. Intrusion
b. Avoidance
c. Hyperarousal
d. Alteration in mood/beliefs
a. Intrusion
30
Hyper-vigilance
Which does the above apply to?
a. Intrusion
b. Avoidance
c. Hyperarousal
d. Alteration in mood/beliefs
c. Hyperarousal
31
Exaggerated startled response
Which does the above apply to?
a. Intrusion
b. Avoidance
c. Hyperarousal
d. Alteration in mood/beliefs
c. Hyperarousal
32
What are intrusions?
List 4 points
1. Recurrent, involuntary, intrusive memories
2. Re-living the traumatic experience(s) in the here and now (flashbacks)
3. Distressing dreams (nightmares)
4. Experiencing distress when confronted with reminders of the trauma
33
What is avoidance?
List 2 points
1. Of circumstances resembling or associated with the stressor
2. Of trauma-related thoughts and feelings
34
What is hyperarousal?
List 5 points
1. Difficulty falling or staying asleep
2. Irritability or outbursts of anger
3. Difficulty concentrating
4. Hyper-vigilance
5. Exaggerated startle
response
35
What is alteration in mood/beliefs?
List 3 points
1. Inability to recall key features of the traumatic event
2. Change to beliefs and expectations about oneself, the world and others.
3. Persistent trauma-related emotions (e.g. fear, horror, guilt, shame)
36
True or False?
Complex trauma is a diagnosis in the DSM
False
Complex trauma is not a diagnosis in the DSM
37
All of the difficulties commonly associated with trauma are also related to difficulties with...?
List 3 points
1. Relationships
2. Emotion regulation
3. Self-concept
38
All of the difficulties commonly associated with trauma are also related to difficulties with relationships
Explain how
Difficulties in forming and maintaining close relationships with others
39
All of the difficulties commonly associated with trauma are also related to difficulties with emotion regulation
Explain how
1. Experiencing strong emotions such as anger, fear
2. Feeling emotionally numb
40
All of the difficulties commonly associated with trauma are also related to difficulties with self-concept
Explain how
1. Beliefs about oneself as worthless
2. Feelings of shame and guilt
41
What is the NICE guideline for post-traumatic stress disorder?
Offer an individual trauma-focused CBT intervention to adults with a diagnosis of PTSD or clinically important symptoms of PTSD who have presented more than 1 month after a traumatic event
42
What are the 4 different types of interventions for PTSD?
1. Cognitive processing therapy
2. Cognitive therapy for PTSD
3. Narrative exposure therapy
4. Prolonged exposure therapy
43
What intervention is recommended for non-combat related trauma only?
EMDR
44
EMDR is also recommended for ______ only
Non-combat related trauma
45
How many PTSD treatment sessions should be conducted ideally?
List 2 points
1. Over 8 to 12 sessions
2. But should be more if individual is clinically indicated, for example if they have experienced multiple traumas
46
What should PTSD treatment include to inform individuals of their circumstances?
Psychoeducation
47
What types of psychoeducation should be included in PTSD treatments?
List 3
1. Reactions to trauma
2. Strategies for managing arousal and flashbacks
3. Safety planning
48
True or False?
PTSD interventions should not involve elaboration and processing of the trauma memories
False
PTSD interventions should involve elaboration and processing of the trauma memories
49
True or False?
PTSD interventions should involve processing trauma-related emotions, including shame, guilt, loss and anger
True
50
PTSD interventions should involve processing trauma-related emotions, including...?
List 4
1. Shame
2. Guilt
3. Loss
4. Anger
51
Why should we provide help for individuals with PTSD?
To help them overcome avoidance
52
We should not exclude people with PTSD from treatment based solely on...?
Comorbid drug or alcohol misuse
53
True or False?
It is fine to exclude people with PTSD from treatment based solely on comorbid drug or alcohol misuse
False
Do not exclude people with PTSD from treatment based solely on comorbid drug or alcohol misuse
54
What are the 5 ways to encourage stabilisation within PTSD patients?
1. Psychoeducation
2. Grounding
3. Breathing
4. Mindfulness
5. Trigger discrimination
55
Give 3 examples of what we should be including in psychoeducation
1. The body’s threat response
2. Memory processing during a trauma
3. The window of tolerance
56
What is grounding?
Strategies that help to keep you in the present moment and connected with your surroundings when your brain is trying to pull you back into past trauma
57
Strategies that help to keep you in the present moment and connected with your surroundings when your brain is trying to pull you back into past trauma
This is known as...?
Grounding
58
Give 2 examples of a grounding technique
1. Using sensory items
2. 5 4 3 2 1 technique
59
1. Using sensory items
2. 5 4 3 2 1 technique
These are examples of...?
Grounding techniques
60
Give 2 examples of breathing techniques
1. Soothing rhythm breathing
2. Square breathing (picturing a square and breathing in around the sides of the square)
61
What are the 2 ways we can encourage mindfulness?
1. Guided practice
vs
2. Mindfulness in daily life
62
What is trigger discrimination?
A strategy for managing re- experiencing by breaking associations between past trauma and present-day reminders
63
A strategy for managing re- experiencing by breaking associations between past trauma and present-day reminders
This is known as...?
Trigger discrimination
64
Wearing military boots can trigger trauma from war experiences
But the individual thinks about how the present moment is different to the moment when they were at war
This is an example of...?
Trigger discrimination
65
Give an example of trigger discrimination
Wearing military boots can trigger trauma from war experiences
But the individual thinks about how the present moment is different to the moment when they were at war
66
Describe the defence cascade
List 6 points
1. Freeze
- Increasing arousal
2. Flight
3. Fight
4. Fright
- Degreasing arousal
5. Flag
6. Faint
67
The instant, unconscious weighing up on what is happening in the situation
This is known as...?
Freeze
68
What is 'Freeze' in the defence cascade?
The instant, unconscious weighing up on what is happening in the situation
69
What is 'Faint' in the defence cascade?
The shut down response
70
Defence cascade often involves increasing dissociation
What does this mean?
Sometimes in therapy people may dissociate
Therapy should aim to get their blood pressure running to allow them to be in the moment to process their feelings/thoughts
71
What metaphor is treatment for PTSD often referred to?
Linen closet metaphor
72
Based on the linen closet metaphor, treatment for PTSD involves...?
List 4 things
1. Slowly taking things out of the cupboard
2. Examining them carefully
3. Folding them neatly
4. Putting them back in the right place
73
What are the 3 key goals of trauma-focused CBT?
1. Elaborate and integrate the trauma memory
2. Evaluate appraisals relating to the trauma
memory
3. Work on coping strategies which may be unhelpful
74
1. Elaborate and integrate the trauma memory
2. Evaluate appraisals relating to the trauma
memory
3. Work on coping strategies which may be unhelpful
These are the key goals of...?
Trauma-focused CBT
75
How can we update trauma memories?
List 3 points
1. Identify the “hotspots” in the trauma memory and explore what was the worst thing about this? What did this mean to you?
- Imagine reliving, talk in great detail
2. Evaluate the meaning and identify information to update this meaning
3. Incorporate the updating information into the hot spot
76
How can we work on coping strategies?
List 2 points
1. Identify coping strategies being used and evaluate their effectiveness e.g. look at advantages / disadvantages or a thought suppression experiment
2. Try out new strategies, usually in a behavioural experiment
77
How can we re-claim life?
List 3 ways
1. What activities or interests have stopped or not been possible since the trauma?
2. What would an achievable first step be?
3. Homework activities throughout therapy
78
What is the procedure of Narrative Exposure Therapy (NET)?
List 4
1. Normalisation and psychoeducation
2. Laying the lifeline (see next slide)
3. Narrating the lifeline paying attention to traumatic events and going through these in slow motion
4. Reading the narrative
79
1. Normalisation and psychoeducation
2. Laying the lifeline (see next slide)
3. Narrating the lifeline paying attention to traumatic events and going through these in slow motion
4. Reading the narrative
This is the procedure of...?
Narrative Exposure Therapy (NET)
80
What are the 4 Therapeutic elements of NET with proven efficacy?
1. Chronological reconstruction of memories across the lifespan
2. Prolonged exposure to the “hot spots” and full activation of the fear memory
3. Linking of physiological, sensory, cognitive and emotional responses with time, place and life context
4. Revisiting of positive life experiences for support and to adjust basic assumptions
81
What is the evidence supporting Narrative Exposure Therapy (NET)?
Schaal et al (2009) compared NET with Interpersonal Psychotherapy for Rwandan genocide orphans
At 6-month follow-up, only 25% of NET, but 71% of IPT participants still fulfilled PTSD criteria
82
Schaal et al (2009) compared NET with Interpersonal Psychotherapy for Rwandan genocide orphans
At 6-month follow-up, only 25% of NET, but ___% of IPT participants still fulfilled PTSD criteria
a. 54%
b. 71%
c. 88%
d. 36%
b. 71%
83
Schaal et al (2009) compared NET with Interpersonal Psychotherapy for Rwandan genocide orphans.
At 6-month follow-up, only 25% of NET, but 71% of IPT participants still fulfilled the...?
PTSD criteria
84
When laying a Narrative Exposure Therapy (NET) lifeline, what do flowers represent?
Positive events
85
When laying a Narrative Exposure Therapy (NET) lifeline, what do stones represent?
Negative events
86
When laying a Narrative Exposure Therapy (NET) lifeline, what do candles represent?
Loss
87
When laying a Narrative Exposure Therapy (NET) lifeline, what do sticks represent?
Violence
88
What is a Narrative Exposure Therapy (NET) lifeline?
When individuals lay out key events in their lives and they go through each event one at a time to discuss how they felt, what they were thinking, etc.
89
When individuals lay out key events in their lives and they go through each event one at a time to discuss how they felt, what they were thinking, etc.
This is known as...?
Narrative Exposure Therapy (NET) lifeline
90
When engaging in a Narrative Exposure Therapy (NET) lifeline task, should we start with cold or hot memory? Why?
Cold memory to not trigger the individual too much of their trauma
91
Trauma informed care relates to creating services that aim to...?
Reduce harm and promote healing
92
What is trauma informed care?
Creating services that aim to reduce harm and promote healing
93
How can services (as part of trauma-informed care) re-traumatise service users?
By replicating abusive relational patterns
94
By replicating abusive relational patterns, what can services (as part of trauma-informed care) do?
Re-traumatise service users
95
Give 4 examples of how services (as part of trauma-informed care) can re-traumatise service users
1. By removing choice
2. By being overly controlling
3. Lack of collaboration
4. By focusing on the individual as the problem
96
1. By removing choice
2. By being overly controlling
3. Lack of collaboration
4. By focusing on the individual as the problem
What can these actions do?
Re-traumatise service users
97
Experience of trauma can influence the way that someone ...?
Makes sense of and responds to their surroundings
98
What are the 3 goals of a trauma-informed approach
1. To raise awareness among staff about the wide impact of trauma
2. To prevent re-traumatisation of clients
3. To prevent vicarious trauma by supporting staff regularly working with trauma
99
1. To raise awareness among staff about the wide impact of trauma
2. To prevent re-traumatisation of clients
3. To prevent vicarious trauma by supporting staff regularly working with trauma
These are the goals of...?
Trauma-informed approach
100
What are the 6 key principles of trauma informed practice?
1. Safety
2. Trust
3. Choice
4. Collaboration
5. Empowerment
6. Cultural consideration
101
1. Safety
2. Trust
3. Choice
4. Collaboration
5. Empowerment
6. Cultural consideration
These are the key principles of...?
Trauma informed practice
102
What are the 2 levels of trauma-informed approaches?
1. Service level
2. Staff level
103
What is involved in the service level of trauma-informed approaches?
List 5
1. Applying a “trauma lens” to all policies and procedures
2. Minimise barriers to access
3. Being aware of imbalance of power
4. Prioritising relationships and being conscious of breaks and endings
5. Use of language
104
What is involved in the staff level of trauma-informed approaches?
List 8
1. Gentle approach
2. Consistency
3. Active listening
4. Empathic responding
5. Be clear and reliable – do what you say you will do, when you say you will do it!
6. Respect service users wishes
7. Clearly communicating boundaries and
keeping to them
8. If you are unable to deliver on a plan made clearly communicate this to the service user and acknowledge how they might feel
105
What level of trauma-informed approaches does this apply to?
Applying a “trauma lens” to all policies and procedures
a. Service level
b. Staff level
a. Service level
106
What level of trauma-informed approaches does this apply to?
Gentle approach
a. Service level
b. Staff level
b. Staff level
107
What level of trauma-informed approaches does this apply to?
Use of language
a. Service level
b. Staff level
a. Service level
108
What level of trauma-informed approaches does this apply to?
Consistency
a. Service level
b. Staff level
b. Staff level
109
What level of trauma-informed approaches does this apply to?
Prioritising relationships and being conscious of breaks and endings
a. Service level
b. Staff level
a. Service level
110
What level of trauma-informed approaches does this apply to?
Active listening
a. Service level
b. Staff level
b. Staff level
111
What level of trauma-informed approaches does this apply to?
Empathic responding
a. Service level
b. Staff level
b. Staff level
112
What level of trauma-informed approaches does this apply to?
Be clear and reliable – do what you say you will do, when you say you will do it!
a. Service level
b. Staff level
b. Staff level
113
What level of trauma-informed approaches does this apply to?
Being aware of imbalance of power
a. Service level
b. Staff level
a. Service level
114
What level of trauma-informed approaches does this apply to?
Respect service users wishes
a. Service level
b. Staff level
b. Staff level
115
What level of trauma-informed approaches does this apply to?
Clearly communicating boundaries and
keeping to them
a. Service level
b. Staff level
b. Staff level
116
What level of trauma-informed approaches does this apply to?
If you are unable to deliver on a plan made clearly, communicate this to the service user and acknowledge how they might feel
a. Service level
b. Staff level
b. Staff level
117
What level of trauma-informed approaches does this apply to?
Minimise barriers to access
a. Service level
b. Staff level
a. Service level
118
If you are unable to deliver on a plan made, what should you do?
List 2 points
1. Clearly communicate this to the service user
2. Acknowledge how they might feel
119
How many adults in England report experiencing at least one adverse childhood experience?
Nearly half of adults in England
120
Nearly half of adults in England report experiencing at least one ...?
Adverse childhood experience (ACE)
121
Key difficulties associated with experience of trauma include ...?
List 4 points
1. Intrusions
2. Avoidance
3. Hyperarousal
4. Alterations in mood / beliefs
122
Complex trauma includes difficulties in ...?
List 3 points
1. Relationships
2. Emotion regulation
3. Self-concept
123
What are the 5 interventions NICE guidelines recommend for trauma/PTSD?
1. Cognitive processing therapy
2. Cognitive therapy for PTSD
3. Narrative exposure therapy
4. Prolonged exposure therapy
5. EMDR for non-combat related trauma
124
Intervention for PTSD
a. Cognitive processing therapy
b. Cognitive therapy
c. Narrative exposure therapy
d. Prolonged exposure therapy
e. EMDR
b. Cognitive therapy
125
Intervention for non-combat related trauma
a. Cognitive processing therapy
b. Cognitive therapy
c. Narrative exposure therapy
d. Prolonged exposure therapy
e. EMDR
e. EMDR
126
What should grounding techniques and psychoeducation be based on?
Topics such as the body’s threat response and memory processing during a traumatic event
127
What are the aims of trauma informed care?
List 2
1. Reduce harm
2. Promote healing
128
Creating services that aim to reduce harm and promote healing
This is known as...?
Trauma informed care
