Trauma Flashcards

Question

What is the rate of PTSD as measures as lifetime prevalence and 12 month prevalence.

Answer 1

8% lifetime (Kessler) 1.33% (Australian rate over 12 months) 6.4% (Slade et al. 2009, 12 month prevalence) \<--- different/better way of asking questions.

Answer 2

Interpersonal Trauma! Sexual assault (31-47-94%) depending on time when assessed. Intimate partner violence (31-84%) War (30-67%) Refugees (50-90%) Physical assalts (13%) Motor vehicle accident (12%) Disaster (8-10%)

Answer 3

Depression, substance misuse/abuse and anxiety disorders.

Answer 4

MDD (Major Depression Disorder) 30-50% of PTSD Trauma PTSD = 4x more likely to develop depression. Trauma exposure without PTSD = normal chance of depression Prior depression = increased risk for exposure to trauma AND ptsd after trauma

Answer 5

Major depressive episode 5 symptoms over the past 2 weeks. \*depressed mood most of the day, daily or nearly daily \*decreased interest in activities/reduced pleasure \*Weight gain/loss nearly everyday \*Poor sleep \*Psychomotor retardation or agitation \*Fatigue or loss of energy nearly every day \*Sense of worthlessness/guilt \*Decreased concentration \*Suicidal ideation; recurrent thoughts of death

Answer 6

A maladaptive pattern of substance use leading to significant clinical impairment or distress over the past 12 months. 3 of the following: 1. Tolerance 2. Withdrawal 3. Large amounts taken 4. Desire or attempt to cut down 5. Time spent obtaining substance 6. Social occupational, recreational activities given up on reduced due to substance. Use continues despite knowledge of physical and psychological effects of use.

Answer 7

Panic attack = discrete period of intense fear in which 4 or more of the following symptoms develop abruptly and reach peak within 10 minutes. \*increased heart rate (palpitations/pounding) \*Sweating \*Trembling/shaking \*Derelisation/depersonalisation \*Fear of losing control/dying \*Sensations of shortness of breath or smothering \*Feeling of choking \*Paresthesias (numbness or tingling sensation) \*Chest pain or discomfort \*Feeling dizzy lightheaded or faint \*Chills or hot flushes

Answer 8

Common during trauma, high prevalence after trauma - both more-so if person is diagnosed with ASD STATS - Peritraumatic (during) panic rates approx 53-90% depending on type of trauma} 100% of people diagnosed with ASD experienced a panic attack at the time of their trauma versus. 47% who were exposed to trauma and not diagnosed with ASD. 93% of ASD participants had recurrent panic attacks after trauma versus. 7% of non-ASD participants.

Answer 9

1. trauma trigger the development of a memory framework that is extremely sensitive to what is perceived to be danger-related cues or materials. 2. When this network is activated reexperiencing or intrusive thoughts of the trauma occur but, people then attempt to shut this process down (mental or physical avoidance). 3. Good adjustment occurs when 1. people access trauma memory and habituate to the anxiety the memory causes. 2. New learning occurs (new associations become stronger than old associations) \*Cognitions such as lack of competency and the world being dangerous are argued to be core unhelpful beliefs that maintain symptoms.

Answer 10

Patricia Resick

Answer 11

Theories based on the idea that after primary and basic emotions that occur when a trauma occurs (fear, anger, sadness) MANUFACTURED emotions can occur (shame, guilt etc) which interfere with recovery. Proponents of these theories stress the importance of the MEANING of the event. In particular, how people appraise themselves and the world significantly contribute to post-trauma adjustment. They agree that interference of information being processed occurs when it conflicts with prior thought patterns/styles (or schema) some support for the theory - see littleton & grills-taquechel, 2011

Answer 12

They occur because of distorted perceptions and cognitions if there is a lot of emotion post-trauma, this interferes with cognitive process.

Answer 13

Belief systems: Assimilation - change the meaning or interpretation of the event (poor response) Accommodation - Adjust schemes/belief in light of the event (reasonable adjustment) Over-accomodation - over-generalize and rigidly change schemas after the event (poor response) Can both ASSIMILATE and OVERACCOMODATE at the same time.

Answer 14

Prior thought patterns/styles/beliefs

Answer 15

Trauma occurs -\> memory frame-work develops that is sensitive to danger-cues (attentional bias). When memory framework is ACTIVATED (by cues) = re-experiencing and intrusive thoughts Two responses: avoidant (maladaptive) or habituation to anxiety/new learning (adaptive). Core unhelpfull beliefs (e.g lack of competency, world is dangerous) maintain symptoms.

Answer 16

CPT begins with the trauma memory and focuses on feelings, beliefs and thoughts that directly emanated from the traumatic event. The therapist then helps the client examine whether the trauma appeared to disrupt of confirm beliefs prior to this experience, and how much the clients have overgeneralized (over-accomodated) or attempt to undo the event (assimilation) from the event to their beliefs about themselves and the world. Clients are then taught to challenge their own self-statements and to modify their extreme beliefs to bring them in balance. Write an account of the trauma including meaning (read daily), taught to challenge and replace maladaptive thoughts and beliefs

Answer 17

Also includes modeling disclosure ofabuse-related information, focus on coping stratergies, gradual exposure usng alternative exposure methods of child's choice (doll, play, imagery, drawing, reading, letter writing, poetry and singing). Education and revictimisation prevention. Also therapy with non-offending parent to prevent behaviours that may foster PTSD in their child.

Answer 18

Flooding differs from SD n that the exposures are based on extended exposure to moderate or strong fear-producing cues. (both imaginal and in vivo) Systematic desentisation is the gradual exposure to fear-provoking stimuli based on a hierachy from least-worst

Answer 19

The theory that lateral eye movements facilitate cognitive processing of the trauma. No contains a number of components, incldign both exposure and cognitive components. The core 'lateral eye movement' procedure involves 1. visualising the memory, 2 rehearsing the negative thoughts, 3 concentrating on the physical sensation of the anxiety and 4 visually tracking the therapists index finger as it moves rapidly back and forth 30-35 cm from the clients face with 2 back-and-forth movements per second. This is epeated 24 times.

Answer 20

Around 75-78%, but of those who were subthreshold on dissociative symptoms alone 60-70% met criteria for PTSD - indicating that the need for dissociation symptoms is not absolute. ASD has better negative predictive power than positive predictive power

Answer 21

Parents tend to say a traumatic vent was criteria a less often (62%) than the child themselves (92%) why?: many reasons, child does not tell parent to protect them, seems bigger to the child, parents underestimate

Answer 22

* Prior psychopathology * permenent injury sustained * Parent's stress over trauma * age (debated - younger) * female (debated)

Answer 23

8% lifetime, 1.33-6.4%(better study) over the 'last 12 months'

Answer 24

93% (versus 7% of non-ASD participants)

Answer 25

Cognitive Processing Therapy

Answer 26

Cognitive processing therapy (CPT) is an adaptation of the evidence-based therapy known as cognitive behavioral therapy (CBT) used by clinicians to help consumers explore recovery from posttraumatic stress disorder (PTSD) and related conditions. It is a manualized therapy that includes common elements from general cognitive-behavioral treatments. During the course of CPT, the primary focus is to help patients gain an understanding of, and modify the meaning attributed to, their traumatic event. In pursuit of this objective, an important goal of CPT is to decrease the pattern of avoiding the trauma memory so that beliefs and meanings can be further evaluated and understood within the original context.

Answer 27

2 Formats: CPT includes a brief written trauma account component, along with ongoing practice of cognitive techniques: patients discuss their traumatic experiences in efforts to clarify and modify their maladaptive beliefs. Clinicians use Socratic dialogue to discuss the details of the trauma, which helps patients gently challenge their thinking about their traumatic event and become increasingly able to consider the context in which the event occurred, with the goal of decreasing self-blame and guilt and increasing acceptance. CPT-Cognitive (CPT-C) omits the written trauma account, and includes more practice of cognitive techniques: relies instead on Socratic dialogue between therapist and client to bring out the details of the trauma that might refute the client’s assumptions and appraisals about their worst traumatic experience

Answer 28

Assimilation is when a trauma victim changes the meaning or interpretation of the event so it fits into their prexisting schema, instead of reconciling/modifying. i.e ignoring the trauma's conflict with their current schemas. It is maladaptive.

Answer 29

When a victim of trauma adjusts schemas/beliefs in light of the event. reasonable adjustment. It is adaptive.

Answer 30

when a trauma victim overgeneralises and ridgidly vchange schemas after the event. i.e all-or-nothing beliefs "the world is a totally unsafe place"

Answer 31

Dual-representational theory.

Answer 32

1. Consciously through verbally accessible memory (VAM) which is information about some sensory input, some emotion and some physiological reactivity which occurs at the time of the trauma. 2. Non-conscious processing, through situationally accessed memory (SAM) this is extensive memory but cannot be deliberately accessed and cannot be easily altered. Contains emotions that were conditioned during the traumatic event (e.g fear and anger), from which secondary emotions can occur. This information may be accessed automatically when an individual is faced with triggers of the trauma, such that intrusive and re-experiencing symptoms can occur.

Answer 33

Socio-cognitive theory - VAMs (resick) and Emotional Processing Theory (Foa) - SAMs

Answer 34

1. Activate the SAM and feed in corrective information which can be corrective cognitive information and sensory data (e.g relaxation) 2. The VAM needs to be adressed with conscious examination of the belief system.

Answer 35

Contact made to an authorised department by persons or other bodies making allegations of child abuse or neglect.

Answer 36

The process of obtaining more detailed information about a child who is the subject of a notification and the assessment of the degree of harm or risk of harm for that child.

Answer 37

It is concluded after investigation that the child has been, is being or is likely to be abused or neglected or otherwise harmed. Then a decision is made regarding appropriate level of continued involvement by the state or territoty child protection and support services.

Answer 38

20,298 notifications 1815 substabtuated case but rates are most-likely high because of willingness to report. Recent 'increases' in child abuse could simply be an increase in reporting due to less-acceptance and more awareness of child abuse.

Answer 39

Rejecting, degrading, shaming and humiliation

Answer 40

Threatning, placing in dangerous situations

Answer 41

unreasonable limitations on social interaction, confining

Answer 42

encouraging inappropriate behaviour

Answer 43

Tends to be a chronic behavioural pattern direted at a child whereby a child's self-esteem and social competence are undermined or erroded over time.

Answer 44

Interpersonal - poor attachment, poor social skills. Emotional - low self-esteem, withdrawal, shame/guilt. Cognitive - learning difficulty, poor verbal reasoning, lower IQ. Psychological - Anxiety, deppression, personality disorder, suicidality. Behavioural - Aggression, over-reliance on adults for support and help, attention problems.

Answer 45

* often seen as less detrimental * Hard to objectively measure emotional abuse * Correlational nature of research

Answer 46

Better functioning families (communication/rights/democratic) = less violence Less funtioning families (chaotic, hierachial, dominate) = more violence, in particular if the father is aggressive, critical or authoritarian.

Answer 47

Yes, it increases their risk of other forms of abuse. The abused parent (and abuser parent) are unlikely to be able to provide good emotional support for the child.

Answer 48

* Emotional - guilt, low-self esteem, trauma reactions, internalizing problems (CBCL) * Behavioural - Extrenalizing problems (CBCL), AOD problems * Cognitive - poor academic performance, poor problem solving * Physical - somatic complaints, health problems * Social - poor peer relationships

Answer 49

* Multiple subtypes of abuse, different types of abuse leading to different outcomes * Types of exposure not taken into account (direct, hearing, seeing bruises) * Individual difference in terms of protective and vulnerability factors for children to have maladaptive adjustment probaby vary, but not always taken into account in research.

Answer 50

Social learning theory, PTSD, attachment theory.

Answer 51

Observation of aggression, becomes acceptable, failure to learn alternative resolution skills, continue poor problem solving stratergies.

Answer 52

Reactions occur due to the traumatic nature of the violence

Answer 53

Poor attachment formed to parents, interfere with the parent-child relationship, now at increased risk of behavioural problems.

Answer 54

The chronicity, severity and type of abuse + who was the perpatrator Child factors: gender (female usually worse, but this could be a product of the types of trauma exposed to),a ge, intelligence, coping abilties, thinking styles (attributions e.g it's my fault vs. it's the abusers fault), trauma cognitions (beliefs about the abuse e.g my life has been destroyed vs, I will get over this)

Answer 55

Social support, non-offending parent, alternative positive role models, response from others is validating (e.g believed, helped, not-blamed)

Answer 56

Continuation of previous risk-factors. no. of sexual partners. alcohol use. Learned helplessness.

Answer 57

* Low sexual refusal assertiveness, drug use * Continuation of previous risk factors. Learned helplessness. * Subtle queues picked up by predatory perpatrators. * Continuation of ongoing abusive relationship.

Answer 58

Findings are consistent with prior research indicating that perpetrators who are less well acquainted with the victim are more likely to use intoxication tactics than are intimate partners, who already have sexual access. heavy episodic drinking, because it typically occurs outside the home and in the presence of others who are also drinking, reflects a lifestyle that poses a greater risk for sexual victimization by men who are less well known. Women who use drugs, may also have partners who use drugs. Drug use occurs more privately and is linked with aggressive or sexual abuse.

Answer 59

Trauma-focused cognitive behavioural therapy

Answer 60

Involves exposure to the feared memory for extended periods of time (45-60 minutes) with an ai of teaching clients that their anxiety habituates if they remain focused on the memory. Also corrective information can be included.

Answer 61

Involves gradual exposure (exposure heirachy) to real situations that cause fear anxiety and are avoided (but which are objectively safe situations)

Answer 62

Originally designed by Aaron Beck for treatment of depression, CT techniques have been used to treat a variety of disorders, including ASD and PTSD. It involes examining the thinking patterns/styles of victims and teaching clients to challenge and realistically appraise unhelpful, distorted or maladaptive beliefs.

Answer 63

Combins Cognitive Therapy (CT) techniques with exposure techniques (writing of trauma). In order to allow appropriate emotional processing and to examine/challenge secondary emotions such as guilt and shame. * Uses a written trauma account, no verbal exposure. * Strong cognitive component targetting theme sof self-blame, safety, trust, esteem, power/control, intimacy * Focus on assimilation or over-accomodation beliefs in therapy.

Answer 64

Includes the follow-up and analysis of participants regardless of how much treatment has occured, including partial treatment or zero treatment. Because nobody wants a therapy that nobody wants to do (high attrition). The measure gets an idea of attrition and response to partial treatment.

Answer 65

Not widely used amongst community clinicians or non-trauma specialist clincians. 10-25% using non-evidence based trauma Because: **Practitioner** * Pre-existing skills * Beleifs exp regarding evidence-based practice and beliefs specific to trauma focussed therapy * Self efficacy **Training** * Accessibility, cost * stand alone versus ongoing consult/support, format of training * Availiability of supervisor etc **System** * Trauma-informed * group cohesiveness * Leadership * Practical - staffing levels, resources, waiting lists.

Answer 66

CSA - Child sexual abuse CPA - child physical abyse Exposure to violence (IPV) Natural disaster Exposure to violence - war Emotional abuse Single-incident trauma (car accident)

Answer 67

CBT - Cognitive Behavioural Therapy But needs more investigation, particularly in children.

Answer 68

To provide children and parents with a tool-box of stratergies to manage their trauma symptoms.

Answer 69

* Therapy is time limited * rapport between tharapist and child is highlighted * Making therapy interesting * Parents may be involved (moreso in younger children), but it is important that therapy skills are reinforced at home * Use of behavioural management (praise, ignore, time-outs, use of behaviour charts) * Reduce fear and avoidance by modelling and gradul exposure

Answer 70

* **Coping skills** - Emotional expression = vocab. emotion charts, identification of emotion, appropriate vs. inappropriate management of emotion. - Cognitive coping = relationship of thought, feelings and behaviour; target distorted/trauma related congitions and how to challenge them. - Relaxation = proggressive muscle relaxation (PMR) * **Graded exposure, cognitive and affective processing of the trauma.** - imaginal exposure (graded) - in vivo (graded) - cognitive and affective processing of the trauma = after exposure, examine thoughts and feelings about rauma and cognitive distortions or misperceptions to be further adressed and challenged. * **Education** information about the natures and causes of trauma symptoms provided to parents and children. for CSA - safety skills, correct information, what is and is not appropriate touching and assertion skills.

Answer 71

an inability to remember certain facts and experiences that can not be attributted to ordinary forgetting - triggered by and about a traumatic event.

Answer 72

Organic amnesia is caused by events, such as a blow to the head, that produce memory loss by damaging the brain. Psychogenic amnesia is caused by events whoes psychological or emotional meaning produces memory loss without damaging the brain. (usually retrograde amnesia, rarely anterograde)

Answer 73

psychogenic amnesia is short term, involves loss of personal identity, non-specific loss of 'time' and recovers quickly without psychotherapy. Traumatic amnesia is typicall long-term (lasting many years), does not involve the loss of personal identity and usually only involves the 'loss' of the memory of a specific event.

Answer 74

Fails to encode the mans face into memory due to focus on the weapon.

Answer 75

The evidence points to them being more likely to remember.

Answer 76

An automatic, unconcious process, that removes a memory from consciousness and prevents it from being recalled later. proponents of 'recovered memory' in trauma victims arue that certain types of trauma, especially prolonger sexual abuse, are likely to result in repression. and that these memories must be 'recovered' in order to progress therapeutically.

Answer 77

* Confusing avoidance of thinking about trauma memories with amnesia. * Misintepretation of studies (see MCnally) - poorly operationalised or explained "amnesia" * Confusing everyday forgetting (or DMV-IV memory symptoms of PTSD) with Amnesia for trauma * Difficult getting corroboration regarding the truth of traumatic events in addition: * memory ability of young-children-tend ot forget over time * May know trauma has happened, but have incomplete details (this is normal) * Overlooks substantial evidence that the more distressing the event, thre more likely it is to be remembered * Flies in the face of what we know about autobiographical memory tending to fade over time, not beginning weak and becoming more vivid. * After-trauma, people may not report it due to forgetting, social desirability, shame etc

Answer 78

Stroop task - typical effect for PTSD sufferers is delayed response on trauma related words. PArticipants presented with words (trauma, positive, neutral etc) and told to remember some and forget others. PSTD group had better memory for trauma words,

Answer 79

underestimation of prior recollections of past events. failure by people to remember what they had remembered. The basic idea is that during the discovered memory experience, the person thinks about the episode in a different way.

Answer 80

* re- membering a past event in a different way can result in a failure to remember a prior instance of recalling that event. i.eWhen the memory in question is thought of differently (e.g different emotional frame) at first-recall than it is at second-recall e. g from a study in the readings: "were more likely to forget that they had pre- viously recalled a studied item if they were cued to think of it differently on two recall tests than if they were cued to think of it in the same way on the two tests. "

Answer 81

it is possible that some victims of abuse underestimate their prior recollections of the abuse when they recall the abuse in a qualitatively different manner than they did previously, leading to a false impression of having had repressed memories. There is evidence that individuals reporting recovered memories are more prone to memory distortions than other in- dividuals are reported an association between reporting recovered memories and tendencies toward dissociation, which in turn appear to be related to susceptibility to memory errors.

Answer 82

May be seeking a source of their current feelings/life-situation, perception that finding a 'repressed' trauma offers tremendous relief.

Answer 83

1. A person is presented/exposed/suggested information that increases their belief that the unusual event COULD occur. 2. The person develops the belief that the event has occured to them. 3. Thoughts/dreams/fantasies are interpreted as actual memories of a real event (typically aided by anauthority figure/therapist.

Answer 84

* Coax along, give information about 'event' * pair with emotions - make a link between feelings now and symptoms now, being due to past event. * Ask leading questions, encourage confirmation bias * Be/use an authority figure to present this information

Answer 85

Your personal life story, integral to self-identity, different types of autobiographical memory. Contains both episodic and semantic memory i.e **specific:** single incident, events (Detailed) and **Overgeneral**: repeated categories of events (e.g multiple lectures) or extended (lasting longer than a day, e.g holidays)

Answer 86

Lifetime events (e.g life-stages/transitions)----\> general events (e.g going to lectures) ---\> specific events

Answer 87

Direct retrieval occurs when a cue is strong enough to spontaneously bring a memory to mind i.e straight to event specific knowledge. Trauma, through direct retrieval, increases the likelhood of intrusive memories.

Answer 88

Generative retrieval is voluntary, it is the controlled search of memory down the memory structure i.e from lifetime event -\> general event -\> specific event. Trauma interupts the controlled search down the memory structure 'gets stuck'. Unable to get all the way down through memory structure leading to overgeneral memory (OGM).

Answer 89

Inability to retrieve specific memories (when you ture). Sometimes genralising memories is good for understanding what to do in new situations, but overgeneral memeory sometimes can't/can't access specific memory if they try

Answer 90

Rumintion, executive function and functional avoidance.

Answer 91

When information relevent to the self captures/hijacks attention. Lifetime event (being at uni) ---\> general event (going to parties) ---\> HIJACKED CAPTURED ATTENTION\*\* aspects of the self, begin ruminating 'no one talks to me at parties' Does not make it to ....//-----\> specific event

Answer 92

Executive functioning = meta-cognitions to control/direct our mind. Working memory - search is not controlled Inhibition - irrelevant information is not restrained. --------------\> -----\> ------------\> (going to lectures) ----------\> --------------------\> Lifetime events --------\> general events (going to party) //---------\> specific event (not reached!) -----------\> --------------\> ---------------\> (working at the bar) -----------\>

Answer 93

Specific memories are distressing ---\> avoid to regulate emotions.

Answer 94

Negatively - High-OGM = low PTSD Is an early protective factor.

Answer 95

Its long term effects: * Impaired problem solving * Difficulty imagining future events * Poorer prognosis for depression * Long-term impact of ptsd is currently unclear.

Answer 96

Depression

Answer 97

OGM is malleable to chance through memory specificity training (otherwise it is relatively stable) Interventions aimed at reducing OGM to reduce depression

Answer 98

* Improved research * longitudinal research (improving on correllational research) * valid and reliable measures * Expanding theoretical conceptualisations (biological, genetic, environemnt) * Matching individuals to treatments * Randomisation, increased sample ize, better description of programs and participants * FOLLOW-UP * Prevention research and its evaluation * Appropriate training for other proffessionals, law enforcement, judicial.

Answer 99

1. Trauma impact, clinical disorders, implications of DSM-5, natural recovary vs. PTSD 2. Trauma theories and Child abuse, refinement of trauma theories, focus on psychological abuse in children. do we need a theory of maladjustment following child abuse or are disorder-specific theories enough? 3. revicitimisation, are different types of revictimisations predicted by different factors. how will preventative programs take this into account. 4. TREATMENTS for adults and childer. How to best treat non-responders, treating comorbidities, matching client to treatment, triage, role of care-giver in treatment outcomes, effective dissemination of evidence based therapies 5. Flase/recovered memory - processes underlying recovered memories, greater testing within clinical samples.

Trauma Flashcards

(130 cards)