Tsk 2 Flashcards
(27 cards)
Criterion A
Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of following ways:
(1) Directly experiencing traumatic event(s); (2) Witnessing, in person, the event(s) as it occurred to others; (3) Learning that traumatic event(s) occurred to close family member or friend (must have been violent or accidental); (4) Experiencing repeated or extreme exposure to aversive details of traumatic event(s) (this last one does not apply to exposure through media, TV, movies, pictures, unless this exposure is work-related).
CRITERION B
Presence of one (or more) of following intrusion symptoms associated with traumatic event(s), beginning after traumatic event(s) occurred:
(1) Recurrent, involuntary, and intrusive distressing memories of traumatic event(s); (2) Recurrent distressing dreams in which content and/or affect of dream are related to traumatic event(s); (3) Dissociative reactions (such as flashbacks) in which individual feels or acts as if traumatic event(s) were recurring; (4) Intense/Prolonged psychological distress at exposure to internal or external cues that symbolize or resemble aspect of traumatic event(s); (5) Marked physiological reactions to internal or external cues that symbolize or resemble aspect of traumatic event(s).
CRITERION C
Persistent avoidance of stimuli associated with traumatic event(s), beginning or worsening after traumatic event(s) occurred, as evidence by:
(1) Avoidance of or efforts to avoid internal reminders (distressing memories, thoughts, or feelings about or closely associated with traumatic event(s)); (2) Avoidance of or efforts to avoid external reminders that arouse distressing memories, thoughts, or feelings about or closely associated with traumatic event(s).
Criterion D
Negative alterations in cognitions and mood associated with traumatic event(s), beginning or worsening after traumatic event(s) occurred, as evidenced by two (or more) of following:
(1) Inability to remember important aspect of traumatic event(s) (due to dissociative amnesia); (2) Persistent and exaggerated beliefs/expectations about oneself, others, or the world; (3) Persistent, distorted cognitions about cause/consequences of traumatic event(s) that lead individual to blame himself/herself (survivor guilt) or others; (4) Persistent negative emotional state; (5) Markedly diminished interest/participation in significant activities; (6) Feelings of detachment or estrangement from others; (7) Persistent inability to experience positive emotions.
Criterion E
Marked alterations in arousal and reactivity associated with traumatic event(s), beginning or worsening after traumatic event(s) occurred, as evidenced by two (or more) of following:
(1) Irritable behavior and angry outburst (little or no provocation needed), typically expressed as verbal/physical aggression; (2) Reckless or self-destructive behavior; (3) Hypervigilance; (4) Exaggerated startle response; (5) Problems with concentration; (6) Sleep disturbance.
Criterion F
Duration of disturbance (Criteria B, C, D and E) is more than 1 month.
Criterion G
Disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.
Criterion H
Disturbance is not attributable to physiological effects of substance (medication or alcohol) or another medical condition.
Depersonalization
Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body.
Example – Feeling as if one were in dream; sense of unreality of self or body or of time moving slowly.
Derealization
Persistent or recurrent experiences of unreality of surroundings.
Example – World around individual is experienced as unreal, distorted.
DISSOCIATIVE SUBTYPE OF PTSD
TO USE THIS SUBTYPE, DISSOCIATIVE SYMPTOMS MUST NOT BE ATTRIBUTABLE TO PHYSIOLOGICAL EFFECTS OF SUBSTANCE OR ANOTHER MEDICAL CONDITION- 1/3 od PTSD patients experience this
Acute Stress Disorder (short-term response to Trauma)
Diagnosed when symptoms arise within 1 month of exposure to stressor and last no longer than 4 weeks.
Dissociative symptoms – Numbing, reduced awareness of surroundings, derealization, depersonalization and inability to recall important aspects of trauma.
Similarity with PTSD – Individual persistently reexperiences trauma through flashbacks, nightmares, intrusive thoughts; avoids reminders; constantly aroused.
People who experience ASD are at high risk of continuing to experience PTSD for many months.
Adjustment Disorder / Mild (not extreme) trauma
Emotional and behavioral symptoms (depressive, anxiety and/or antisocial behaviors) that arise within 3 months of experience of stressor.
Difference to PTSD and ASD – Stressor can be of any severity, it does not have to be by definition, extreme.
People are said to have this disorder when they fail to meet criteria for PTSD or ASD, or anxiety/mood disorder resulting from stressful experience.
Conditioning theory
Trauma (= US) becomes associated at the time of trauma with situational cues associated with place and time of trauma (= CS). When these cues are encountered again, they elicit arousal and fear that was experienced during trauma.
Conditioned responses do not extinguish because of avoidance responses, which distracts them from fully processing such cues.
This theory does not provide full explanation of PTSD – Does not explain why people who experience trauma develop PTSD and others do not, and it cannot explain range of weird symptoms in PTSD (such as dissociative experiences).
Emotional processing theory
Theory that claims that severe traumatic experiences are of such major significance to individual that they lead to formation of representations and associations in memory, quite different to those formed as a result of everyday experience.
Individuals who prior to trauma have fixed views about themselves and world are more vulnerable to PTSD.
Information-Processing model – Theory specifies how fear memories are laid down and activated in fear networks.
Mental defeat
Individuals process information about trauma negatively and view themselves as unable to act effectively as well as victims (= mental defeat). Negative approach to event adds to distress and influences way individual recalls trauma.
Evidence – PTSD sufferers have negative views of self and world, including negative interpretations of trauma, PTSD and of responses of others, as well as a belief that trauma has permanently changed their life.
Dual representation theory
Approach to explaining PTSD suggesting that it may be a hybrid disorder involving two separate memory systems.
1. Verbally Accessible Memory (VAM) – Registers memories of trauma consciously processed at the time. These are narrative and contain information about event, context, personal evaluations of experience. These can be easily retrieved.
- Situationally Accessible Memory (SAM) – Records information from trauma that may have been too brief to take in consciously, and this includes information about sights and sounds, and extreme bodily reactions to trauma. It is responsible for flashbacks.
o These memory systems seem to be linked to brain center associated with fear (amygdala).
Factors increasing likelihodd of PTSD : Environ. & social factors
Severity, duration and individual’s proximity to trauma are strong predictors of people’s reaction it.
Availability of social support is also predictor, those with emotional support recover more quickly.
Factors increasing likelihodd of PTSD :Psychological factors
Those with increased symptoms of anxiety/depression before trauma, are more likely to develop PTSD following it.
People’s styles of coping with trauma also influence vulnerability, those who use dissociative, self-destructive or avoidant coping strategies are more likely to experience PTSD
Factors increasing likelihodd of PTSD :Gender & Cross-Cultural Differences
Women are more likely than men to (1) be diagnosed, same as with most anxiety disorders, (2) experience triggers more often and (3) suffer from trauma often stigmatized, decreasing amount of social support seeking behavior.
African Americans have higher rates compared to whites, Hispanics and Asian Americans; Minority groups less likely to seek mental health treatment.
Factors increasing likelihodd of PTSD :Biological factors
Neuroimaging – Differences in brain activity occur in areas that regulate emotion, FF response and memory Amygdala (responds +), medial PFC (responds -) and hippocampus (shrinks).
• People with severe PTSD are more reactive to emotional stimuli (A), less able to dampen that reactivity (PFC) and fail to return fear response to normal level after threat has passed (H).
Biochemistry – Those with lower cortisol levels are at increased risk for PTSD. Cortisol reduces sympathetic N.S. activity after stress, thus lower levels result in prolonged activity of that system.
• HPA axis may be unable to shut down response of S.N.S. by secreting necessary levels of cortisol, resulting in overexposure to neurochemicals and causing memories to be over-consolidated.
Genetic – Vulnerability to PTSD can also be inherited. Study with twins found that if one developed PTSD, other was more likely to develop it if twins were identical than fraternal. Abnormally low cortisol levels may be one heritable risk factor for PTSD.
TREATMENTS OF PTSD
+PSYCHOLOGICAL DEBRIEFING (RAPID INTERVENTION)
+EXPOSURE THERAPIES (MOST EFFECTIVE)
+COGNITIVE RESTRUCTURING
+BIOLOGICAL THERAPIES
EXPOSURE THERAPIES (MOST EFFECTIVE)
Involve client imagining events during traumatic experience, in attempt to extinguish fear symptoms. Two rationale behind it:
(1) It will help to extinguish associations btw trauma cues and fear responses; (2) It will help disconfirm any symptom-maintaining dysfunctional beliefs.
COGNITIVE RESTRUCTURING
Attempt to help clients do two things: (1) Evaluate and replace negative automatic thoughts; (2) Evaluate and change dysfunctional beliefs.
Those who avoid trauma-related thoughts will avoid disconfirming these extreme views and this will lead to development of chronic PTSD.
Studies suggest that when together, cognitive restructuring does not significantly increase exposure therapy in producing changes in dysfunctional cognitions.
