Post Traumatic Stress Disorder (PTSD)

increased arousal

-Difficulty falling or staying asleep -Irritability or outbursts of anger -Difficulty concentrating -Hyper-vigilance -Exaggerated startle response -lab tests confirmed increased physiological reaction in combat imagery and higher magnitude of startle response -insomnia leading to depression, anxiety and low mood -more sudden and apparent

consequences of PTSD

-SEVERE -loss of social and occupational functioning -anxiety disorders -depression -substance abuse -suicidal thoughts and plans common -psychophysiological complaints

what is essential for PTSD diagnosis?

-a traumatic event must have occurred -e.g. war, victim of a crime -specifies initial event that begins PTSD must be identified for diagnosis -for men, military combat is the most common cause of trauma -for 1/3 of women the cause is physical or sexual assault -other common experiences that may be associated with extreme stress include being involved in a car accident, disaster or terrorist attack

ironic memory processing and AM

-attempts to avoid thinking about something actually makes it come to mind -avoidance of negative memories in depressed and traumatised patients leads to increased access to these events

avoidance of stimuli in PTSD

-avoid reminders of event -avoid thinking about trauma; memory of disorganised fragments of event -fluctuations between re-experience and avoidance -repression of thought -disjointed memory -paradoxical -oscillation between positions

exposure therapies

-behavioural techniques, such as systematic desensitisation, that treat anxieties by exposing people (in imagination or actuality) to the traumatic experience -relaxation techniques used to reduce anxiety -client stops avoiding and it breaks operant conditioning; fear extinguishing -learn to cope through experience -flooding -effective, rarely used alone but in conjunction with CBT

signs of mood and cognitive change

-black and white cognition -no flexibility in thinking -pervasive negative emotions -inability to experience positive emotions -lack of interest or involvement in activity -inability to remember important parts of event -persistently negative cognition -blaming self or others -feeling distracted

exposure to trauma

-can be direct or indirect -most common= 1 time event -exposure to death or threatened death, actual or threatened injury or actual or threatened sexual isolation which a person may; -experience personally, observe happening, hear about occurring to a someone close or experience through repeated extreme exposure to traumatic details and images

symptoms of PTSD

-clustered in four major categories in DSM-5 -intrusively re-experiencing the traumatic event -avoidance of stimuli associated with the traumatic event -other signs of mood or cognitive change after the trauma -symptoms of increased arousal or reactivity

EMDR

-controversial form of therapy for post-traumatic stress disorder and similar anxiety problems in which the client is directed to move the eyes rapidly back and forth while thinking of a disturbing memory -similar to exposure -patient asked to track therapists finger or light moving back and forth in visual field -some evidence to support efficacy

other cognitive aspects of PTSD

-dysfunctional beliefs -loss of control and predictability -changes in attention

biological factors

-genetic vulnerability -cortisol higher in PTSD -heightened startle response -increased cortisol in response to stress paradigms -paradoxically lower basal cortisol and raised adrenaline and noradrenaline have been found -stressor related cortisol responses are important for breaking sympathetic stress responses -unopposed sympathetic nervous system activation may enhance the consolidation of the traumatic memory -fear circuit; failure of regions important for learning and extinguishing fears, e.g. ventromedial frontal cortex to dampen activation of brains fear co-ordinating centre the amygdala -genetic diathesis; symptoms more common in identical than fraternal twins. Uniquely related to function of hippocampus. Smaller hippocampus is a risk factor for the development of PTSD following traumatic experience -longitudinal research following up twins suggests that smaller hippocampal volume may precede PTSD

what is PTSD?

-heightened state of arousal -stress in response to danger and trauma is a normal human reaction but PTSD entails an extreme response to a severe stressor -this includes increased anxiety, avoidance of stimuli associated with the trauma and symptoms of increased arousal -symptoms persist for longer than one month -lifetime prevalence = 7%

long-term outcome for PTSD

-if trauma is severe enough it may persist for decade in the absence or late or incorrect intervention -even with most effective biological and psychological treatments recovery can be slow

type of trauma

-important -Jones and Wessely -no of casualties in battalions in WW2 -shell shock=PTSD -linear association between casualties and psychiatric admissions -9/11 -closer to location 20% symptoms of PTSD and further away only 7% -still reporting 1-2 years after -prevalence, level of exposure and distance from event -Charuvastra and Cloitre 2008; traumas caused by people are more likely to cause PTSD than natural disasters -perpetrator with intent to harm and lives in danger, challenging the views and approach to life of the individual and shaking strong moral beliefs

psychodynamic account of PTSD

-least evidence based -related to id -pushed in unconscious providing the function of relief -trauma overwhelms ego defences, causing the person to regress to earlier models of functioning -trauma reactivates unresolved conflicts from childhood -triangle of conflict; defences/ego, anxiety and hidden feelings -doesn't capture full range of symptoms

who gets PTSD?

-lifetime prevalence of PTSD 7% (females 10%, males 5%) -low intelligence -culture may shape risk; latinos and minority populations in US -comorbidity due to; shared neurobiological pathways, overlap in diagnostic categories, development of these disorders due to PTSD -women more likely to experience trauma -environmental factors -worse cognition -more prone to political violence

pharmacological interventions

-not good long-term effects -many types of drugs -antidepressants -anxiolytics -may act to relieve co-morbid conditions -not recommended as first line of treatment

Acute stress disorder

-pathologises normal reactions to stress -not always equivical -included in DSM -symptoms similar to PTSD but duration is shorter -not as well accepted -stigmatises short term reactions to trauma, PTSD sufferers don't experience ASD in first month after trauma, ASD does predict higher risk of developing PTSD within 2 years

re-experiencing of the traumatic event

-patient frequently remembers event and often experiences nightmares about it -intense emotional upset is caused by stimuli that symbolise the traumatic event -re-experiencing is considered by many as the central feature of PTSD -all senses are aware of re-experiencing -very real, believable -could be time or day -hyper-vigilant, absent-minded, cut off from real world, shut-down, mirrored behaviour

psychodynamic therapy

-patients encouraged to discuss trauma -examine relationship between trauma and pre-trauma personality -focus on defences and transference -some limited evidence of the efficacy of this type of therapy

how is PTSD treated?

-pharmacological interventions; antidepressants and anxiolytics to treat symptoms -psychotherapy; psychological debriefing, psychodynamic therapy, exposure based cognitive-behavioural therapy, eye movement desensitisation and reprocessing

cognitive models of memory in PTSD

-possibly related to findings regarding the hippocampus -fragmented disjointed autobiographical memories for trauma are categorical -hippocampus; ability to locate autobiographical memories in space, time and context -frequent intrusions cued by sensory memory sensory stimuli triggers powerful memories but the person is unable to consolidate and organise memories in a way allowing for effective coping and decreased anxiety -alternatively; focus on categorical memories allows for avoidance of specific memory, could poor AM be a regulating strategy not a deficit -categorical memories are associated with an avoidant coping style in students

type of trauma prevalence

-rape 49% -severe beating or physical assault 31.9% -other sexual assault 23.7% -serious accident or injury 16.8% -shooting or stabbing 15.4% -sudden, unexpected death of friend/family 14.3% -child's life-threatening illness 10.4% -witness to killing or serious injury 7.3% -natural disaster 3.8%

emotional stroop and PTSD

-read of colour is slower in words associated with trauma -correlates with PTSD symptomatology

social support

-shown to be important in the course of PTSD -rap groups in war veterans -victim support groups

behavioural factors; two-factor conditioning model

-similar to anxiety disorders -learning theorists propose PTSD is a consequence of conditioned fear via classical conditioning -trauma leads to strong conditioned fear -factor 1 is classical conditioning -factor 2 is operant conditioning -no time to learn counter-conditioning -avoidant behaviour is negatively reinforced by decreased anxiety -cannot account for why some people develop PTSD and others don't

exposure based CBT

-three treatment goals -reduce re-experiencing by elaboration of trauma memory building up and updating memories -modify excessively negative appraisals discuss worst moments and their meaning -getting client to drop maintaining behaviours and cognitive strategies -evidence to suggest more effect than treatments as usual, waitlist and other therapies

efficacy of PTSD treatments

Exposure therapies; 66% outcome of loss of PTSD diagnosis, infrequent relapse, mild side effects, inexpensive, takes weeks and overall good Drug treatments; better than placebo, moderate relapse, moderate side effects, inexpensive and tasks weeks, overall marginal -efficacy of EMDR is debatable, 64% of individuals achieved outcome of loss of PTSD diagnosis, the strength of evidence is low