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YEAR 2 Mental Health > Trauma > Flashcards

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

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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

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3
Q

Traumatic experiences might have a particular impact if they are…?

List 3 points

A
  1. Repeated or prolonged
  2. Interpersonal
  3. Multiple or occurring at critical stages of
    development.
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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

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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)

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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

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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%

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8
Q

In a study conducted in England, __ % reported 4 or more ACEs

a. 9%
b. 22%
c. 41%
d. 77%

A

a. 9%

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9
Q

What are the 3 types of consequences to ACEs and they can result in a reduced lifespan?

A
  1. Biological
  2. Psychological
  3. Social
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10
Q
  1. Biological
  2. Psychological
  3. Social

These are the 3 types of consequences to ACEs and they can result in …?

A

Reduced lifespan

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11
Q

Research has shown a link between ACEs and mental health difficulties such as …?

List 2

A
  1. Depression
  2. Anxiety
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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

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13
Q

The link between childhood adversity and _____ is as strong as the link between smoking and lung cancer

A

Psychosis

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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

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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%

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16
Q

Around 25–30% of people experiencing a traumatic event go on to develop …?

A

PTSD

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17
Q

What are the 4 things required to diagnose an individual with having trauma?

A
  1. Intrusion
  2. Avoidance
  3. Hyperarousal
  4. Alteration in mood/beliefs
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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

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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

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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

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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

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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

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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

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24
Q

Difficulty concentrating

Which does the above apply to?

a. Intrusion
b. Avoidance
c. Hyperarousal
d. Alteration in mood/beliefs

A

c. Hyperarousal

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25
Q

Of trauma-related thoughts and feelings

Which does the above apply to?

a. Intrusion
b. Avoidance
c. Hyperarousal
d. Alteration in mood/beliefs

A

b. Avoidance

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26
Q

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

A

d. Alteration in mood/beliefs

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27
Q

Distressing dreams (nightmares)

Which does the above apply to?

a. Intrusion
b. Avoidance
c. Hyperarousal
d. Alteration in mood/beliefs

A

a. Intrusion

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28
Q

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

A

d. Alteration in mood/beliefs

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29
Q

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

a. Intrusion

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30
Q

Hyper-vigilance

Which does the above apply to?

a. Intrusion
b. Avoidance
c. Hyperarousal
d. Alteration in mood/beliefs

A

c. Hyperarousal

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31
Q

Exaggerated startled response

Which does the above apply to?

a. Intrusion
b. Avoidance
c. Hyperarousal
d. Alteration in mood/beliefs

A

c. Hyperarousal

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32
Q

What are intrusions?

List 4 points

A
  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
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33
Q

What is avoidance?

List 2 points

A
  1. Of circumstances resembling or associated with the stressor
  2. Of trauma-related thoughts and feelings
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34
Q

What is hyperarousal?

List 5 points

A
  1. Difficulty falling or staying asleep
  2. Irritability or outbursts of anger
  3. Difficulty concentrating
  4. Hyper-vigilance
  5. Exaggerated startle
    response
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35
Q

What is alteration in mood/beliefs?

List 3 points

A
  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)
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36
Q

True or False?

Complex trauma is a diagnosis in the DSM

A

False

Complex trauma is not a diagnosis in the DSM

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37
Q

All of the difficulties commonly associated with trauma are also related to difficulties with…?

List 3 points

A
  1. Relationships
  2. Emotion regulation
  3. Self-concept
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38
Q

All of the difficulties commonly associated with trauma are also related to difficulties with relationships

Explain how

A

Difficulties in forming and maintaining close relationships with others

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39
Q

All of the difficulties commonly associated with trauma are also related to difficulties with emotion regulation

Explain how

A
  1. Experiencing strong emotions such as anger, fear
  2. Feeling emotionally numb
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40
Q

All of the difficulties commonly associated with trauma are also related to difficulties with self-concept

Explain how

A
  1. Beliefs about oneself as worthless
  2. Feelings of shame and guilt
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41
Q

What is the NICE guideline for post-traumatic stress disorder?

A

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

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42
Q

What are the 4 different types of interventions for PTSD?

A
  1. Cognitive processing therapy
  2. Cognitive therapy for PTSD
  3. Narrative exposure therapy
  4. Prolonged exposure therapy
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43
Q

What intervention is recommended for non-combat related trauma only?

A

EMDR

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44
Q

EMDR is also recommended for ______ only

A

Non-combat related trauma

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45
Q

How many PTSD treatment sessions should be conducted ideally?

List 2 points

A
  1. Over 8 to 12 sessions
  2. But should be more if individual is clinically indicated, for example if they have experienced multiple traumas
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46
Q

What should PTSD treatment include to inform individuals of their circumstances?

A

Psychoeducation

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47
Q

What types of psychoeducation should be included in PTSD treatments?

List 3

A
  1. Reactions to trauma
  2. Strategies for managing arousal and flashbacks
  3. Safety planning
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48
Q

True or False?

PTSD interventions should not involve elaboration and processing of the trauma memories

A

False

PTSD interventions should involve elaboration and processing of the trauma memories

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49
Q

True or False?

PTSD interventions should involve processing trauma-related emotions, including shame, guilt, loss and anger

A

True

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50
Q

PTSD interventions should involve processing trauma-related emotions, including…?

List 4

A
  1. Shame
  2. Guilt
  3. Loss
  4. Anger
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51
Q

Why should we provide help for individuals with PTSD?

A

To help them overcome avoidance

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52
Q

We should not exclude people with PTSD from treatment based solely on…?

A

Comorbid drug or alcohol misuse

53
Q

True or False?

It is fine to exclude people with PTSD from treatment based solely on comorbid drug or alcohol misuse

A

False

Do not exclude people with PTSD from treatment based solely on comorbid drug or alcohol misuse

54
Q

What are the 5 ways to encourage stabilisation within PTSD patients?

A
  1. Psychoeducation
  2. Grounding
  3. Breathing
  4. Mindfulness
  5. Trigger discrimination
55
Q

Give 3 examples of what we should be including in psychoeducation

A
  1. The body’s threat response
  2. Memory processing during a trauma
  3. The window of tolerance
56
Q

What is grounding?

A

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
Q

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…?

A

Grounding

58
Q

Give 2 examples of a grounding technique

A
  1. Using sensory items
  2. 5 4 3 2 1 technique
59
Q
  1. Using sensory items
  2. 5 4 3 2 1 technique

These are examples of…?

A

Grounding techniques

60
Q

Give 2 examples of breathing techniques

A
  1. Soothing rhythm breathing
  2. Square breathing (picturing a square and breathing in around the sides of the square)
61
Q

What are the 2 ways we can encourage mindfulness?

A
  1. Guided practice
    vs
  2. Mindfulness in daily life
62
Q

What is trigger discrimination?

A

A strategy for managing re- experiencing by breaking associations between past trauma and present-day reminders

63
Q

A strategy for managing re- experiencing by breaking associations between past trauma and present-day reminders

This is known as…?

A

Trigger discrimination

64
Q

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…?

A

Trigger discrimination

65
Q

Give an example of trigger discrimination

A

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
Q

Describe the defence cascade

List 6 points

A
  1. Freeze
    - Increasing arousal
  2. Flight
  3. Fight
  4. Fright
    - Degreasing arousal
  5. Flag
  6. Faint
67
Q

The instant, unconscious weighing up on what is happening in the situation

This is known as…?

A

Freeze

68
Q

What is ‘Freeze’ in the defence cascade?

A

The instant, unconscious weighing up on what is happening in the situation

69
Q

What is ‘Faint’ in the defence cascade?

A

The shut down response

70
Q

Defence cascade often involves increasing dissociation

What does this mean?

A

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
Q

What metaphor is treatment for PTSD often referred to?

A

Linen closet metaphor

72
Q

Based on the linen closet metaphor, treatment for PTSD involves…?

List 4 things

A
  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
Q

What are the 3 key goals of trauma-focused CBT?

A
  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
Q
  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…?

A

Trauma-focused CBT

75
Q

How can we update trauma memories?

List 3 points

A
  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
  1. Evaluate the meaning and identify information to update this meaning
  2. Incorporate the updating information into the hot spot
76
Q

How can we work on coping strategies?

List 2 points

A
  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
Q

How can we re-claim life?

List 3 ways

A
  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
Q

What is the procedure of Narrative Exposure Therapy (NET)?

List 4

A
  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
Q
  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…?

A

Narrative Exposure Therapy (NET)

80
Q

What are the 4 Therapeutic elements of NET with proven efficacy?

A
  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
Q

What is the evidence supporting Narrative Exposure Therapy (NET)?

A

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
Q

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%

A

b. 71%

83
Q

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…?

A

PTSD criteria

84
Q

When laying a Narrative Exposure Therapy (NET) lifeline, what do flowers represent?

A

Positive events

85
Q

When laying a Narrative Exposure Therapy (NET) lifeline, what do stones represent?

A

Negative events

86
Q

When laying a Narrative Exposure Therapy (NET) lifeline, what do candles represent?

A

Loss

87
Q

When laying a Narrative Exposure Therapy (NET) lifeline, what do sticks represent?

A

Violence

88
Q

What is a Narrative Exposure Therapy (NET) lifeline?

A

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
Q

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…?

A

Narrative Exposure Therapy (NET) lifeline

90
Q

When engaging in a Narrative Exposure Therapy (NET) lifeline task, should we start with cold or hot memory? Why?

A

Cold memory to not trigger the individual too much of their trauma

91
Q

Trauma informed care relates to creating services that aim to…?

A

Reduce harm and promote healing

92
Q

What is trauma informed care?

A

Creating services that aim to reduce harm and promote healing

93
Q

How can services (as part of trauma-informed care) re-traumatise service users?

A

By replicating abusive relational patterns

94
Q

By replicating abusive relational patterns, what can services (as part of trauma-informed care) do?

A

Re-traumatise service users

95
Q

Give 4 examples of how services (as part of trauma-informed care) can re-traumatise service users

A
  1. By removing choice
  2. By being overly controlling
  3. Lack of collaboration
  4. By focusing on the individual as the problem
96
Q
  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?

A

Re-traumatise service users

97
Q

Experience of trauma can influence the way that someone …?

A

Makes sense of and responds to their surroundings

98
Q

What are the 3 goals of a trauma-informed approach

A
  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
Q
  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…?

A

Trauma-informed approach

100
Q

What are the 6 key principles of trauma informed practice?

A
  1. Safety
  2. Trust
  3. Choice
  4. Collaboration
  5. Empowerment
  6. Cultural consideration
101
Q
  1. Safety
  2. Trust
  3. Choice
  4. Collaboration
  5. Empowerment
  6. Cultural consideration

These are the key principles of…?

A

Trauma informed practice

102
Q

What are the 2 levels of trauma-informed approaches?

A
  1. Service level
  2. Staff level
103
Q

What is involved in the service level of trauma-informed approaches?

List 5

A
  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
Q

What is involved in the staff level of trauma-informed approaches?

List 8

A
  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
Q

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

a. Service level

106
Q

What level of trauma-informed approaches does this apply to?

Gentle approach

a. Service level
b. Staff level

A

b. Staff level

107
Q

What level of trauma-informed approaches does this apply to?

Use of language

a. Service level
b. Staff level

A

a. Service level

108
Q

What level of trauma-informed approaches does this apply to?

Consistency

a. Service level
b. Staff level

A

b. Staff level

109
Q

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

a. Service level

110
Q

What level of trauma-informed approaches does this apply to?

Active listening

a. Service level
b. Staff level

A

b. Staff level

111
Q

What level of trauma-informed approaches does this apply to?

Empathic responding

a. Service level
b. Staff level

A

b. Staff level

112
Q

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

A

b. Staff level

113
Q

What level of trauma-informed approaches does this apply to?

Being aware of imbalance of power

a. Service level
b. Staff level

A

a. Service level

114
Q

What level of trauma-informed approaches does this apply to?

Respect service users wishes

a. Service level
b. Staff level

A

b. Staff level

115
Q

What level of trauma-informed approaches does this apply to?

Clearly communicating boundaries and
keeping to them

a. Service level
b. Staff level

A

b. Staff level

116
Q

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

A

b. Staff level

117
Q

What level of trauma-informed approaches does this apply to?

Minimise barriers to access

a. Service level
b. Staff level

A

a. Service level

118
Q

If you are unable to deliver on a plan made, what should you do?

List 2 points

A
  1. Clearly communicate this to the service user
  2. Acknowledge how they might feel
119
Q

How many adults in England report experiencing at least one adverse childhood experience?

A

Nearly half of adults in England

120
Q

Nearly half of adults in England report experiencing at least one …?

A

Adverse childhood experience (ACE)

121
Q

Key difficulties associated with experience of trauma include …?

List 4 points

A
  1. Intrusions
  2. Avoidance
  3. Hyperarousal
  4. Alterations in mood / beliefs
122
Q

Complex trauma includes difficulties in …?

List 3 points

A
  1. Relationships
  2. Emotion regulation
  3. Self-concept
123
Q

What are the 5 interventions NICE guidelines recommend for trauma/PTSD?

A
  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
Q

Intervention for PTSD

a. Cognitive processing therapy

b. Cognitive therapy

c. Narrative exposure therapy

d. Prolonged exposure therapy

e. EMDR

A

b. Cognitive therapy

125
Q

Intervention for non-combat related trauma

a. Cognitive processing therapy

b. Cognitive therapy

c. Narrative exposure therapy

d. Prolonged exposure therapy

e. EMDR

A

e. EMDR

126
Q

What should grounding techniques and psychoeducation be based on?

A

Topics such as the body’s threat response and memory processing during a traumatic event

127
Q

What are the aims of trauma informed care?

List 2

A
  1. Reduce harm
  2. Promote healing
128
Q

Creating services that aim to reduce harm and promote healing

This is known as…?

A

Trauma informed care

YEAR 2 Mental Health (11 decks)

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