1
Q
How was trauma defined in the early 20th century?
A
A very distressing incident
2
Q
How did Freud define trauma?
A
Analogy to physical injury,
Something that penetrates a person’s ‘mental skin’,
Overwhelming to the psyche: causes mental shock
3
Q
How did Janoff-Bulman define trauma?
A
An event that shatters assumptions about the world, self and others
4
Q
How does the DSM-III define trauma?
A
A recognisable stressor that would evoke significant symptoms of distress in almost everyone.
Outside of the range of normal experience.
5
Q
What are other DSM-5 Trauma and Stressor-Related Disorders?
A
- Reactive attachment disorder
- Disinhibited social engagement disorder
- PTSD
- Acute stress disorder
- Adjustment disorder
- Other specified trauma and stressor-related disorder
- Unspecified trauma and stressor-related disorder
6
Q
What are the DSM-5 symptoms involved in each criterion for PTSD?
A
A - The Event, Experience of the Event
B&C - Intrusion Symptoms, Avoidance Symptoms
D&E - Negative Mood/Cognitions, Arousal Symptoms
7
Q
How is The Event defined in PTSD?
A
Exposure to actual or threatened death, serious injury, or sexual violence
8
Q
How does the experience of the event change in definition?
A
- Directly experiencing
- Witnessing
- Learning that the traumatic event(s) occurred
- Experiencing repeated or extreme exposure
9
Q
What are intrusion symptoms?
A
- Recurrent, involuntary & intrusive distressing memories
- Recurrent distressing dreams of the event
- Dissociative reactions (e.g. flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring
- Intense or prolonged psychological distress in response to reminders
- Physiological reactions in response to reminders
10
Q
What are avoidance symptoms?
A
- Avoid or attempt to avoid distressing memories, thought, or feelings associated with the trauma
- Avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts or feelings about the event
11
Q
What are negative mood/cognition symptoms?
A
- amnesia for part of trauma (linked to dissociation not head injury)
- persistent and exaggerated negative beliefs about self/others/world
- persistent distorted cognitions about the cause or consequences of the trauma
- persistent negative emotional state
- diminished interest in activities
- feelings of detachment from others
- inability to experience positive emotions
12
Q
What are arousal symptoms?
A
- Irritable behaviour & angry outbursts
- reckless or self-destructive behaviour
- hypervigilance
- exaggerated startle response
- problems with concentration
- sleep disturbance
13
Q
What is involved in the DSM-5 Criteria F, G , and H for PTSD?
A
- The duration of the disturbance must be more than 1 month
- The disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
- The disturbance is not attributable to the physiological effects of a substance (e.g. medication, alcohol) or another medical condition
14
Q
What is acute stress disorder?
A
Similar to PTSD but occurs less than 1 month after the trauma is experienced. Duration is from 3 days to 1 month.
15
Q
What is Type 1 trauma?
A
Single-incident trauma
16
Q
What is Type 2 trauma?
A
Prolonged/repeated trauma (aka complex trauma)
17
Q
Who experiences trama?
A
70-80% lifetime prevalence
However estimates vary greatly according to how trauma is defined
18
Q
What were Sareen’s empirically-derived risk factors for the development of PTSD?
A
- Pre-trauma factors
- Trauma factors
- Post-trauma factors
19
Q
What early theories of PTSD are there?
A
- Social-cognitive theories
- Conditioning theories
- Information-processing theories
20
Q
What modern cognitive models of PTSD?
A
- Brewin’s Dual Representation Theory
- Ehlers and Clark’s (2000) Cognitive Model
21
Q
What is Dual Representation Theory?
A
- Sensory input is subject to both conscious and non-conscious information processing
- 2 different memory systems (SAM & VAM)
- There is very limited capacity in what we can process consciously at one time, so the rest of it will all be processed non-consciously
22
Q
What are Verbally Accessible Memories (VAMs)?
A
- conscious experience of the trauma
- primarily in hippocampus
- deliberate retrieval
23
Q
What are Situationally Accessible Memories (SAMs)?
A
- non-conscious processing of the trauma
- primarily in the amygdala
- not available through conscious retrieval
- triggered involuntarily and automatically
- highly associated with emotion from the trauma
- do not interact or get updated by other memories
24
Q
How are SAMs triggered?
A
- External cues - sights, sounds, smells
- Internal cues - changes in bodily response, mental process
25
Why are trauma memories stored as SAMs?
Prolonged intense stress associated with high levels of cortisol impairs functioning of the hippocampus and the amygdala functions more optimally, so we're more likely to store those memories in the amygdala.
26
Explain how trauma memories are formed
- amygdala is like the brain's alarm system
- body prepares you to respond in the most likely way to survive
- hippocampus goes offline
- therefore in times of extreme trauma, your memories are not processed in the same way and your brain stores a different type of memory - a trauma memory
27
How are characteristics of a trauma memory different to a normal memory?
- not well organised or sequential
- fragmented
- little control over retrieval - they come back involuntarily
- situationally accessible - triggered by reminders in the environment
- not time-tagged
- when they come back they seem to be associated with all the same emotions at the time of trauma
- the more you try to keep stop thinking about something, the more you will think of it
28
Who has evidence for dual representation theory?
Holmes et al, 2002 - analogue studies
Hallawell & Brewin, 2002 - case studies
29
Explain Clark's 2000 cognitive model?
- suggests that PTSD becomes persistent when processed in a way that leads to a sense of serious, current threat.
- believed to be a consequence of excessively negative appraisals of the trauma and the nature of the trauma memory
30
How does the nature of the trauma memory affect the symptoms of PTSD?
- propose that the trauma memory is poorly elaborated and inadequately integrated into its context in time and place and subsequent information
- strong classical conditioning
31
How do negative appraisals & incorrent memory processing maintain PTSD?
- directly producing negative emotions
- encouraging individuals to engage is dysfunctional coping strategies
32
What are the remission stats for PTSD?
- 6 months -26%
- 12 months - 40%
- 5 years - 65%
33
What do the NICE guidelines suggest for initial response to trauma?
- brief, single sessions (debriefing) not recommended
- active monitoring instead, follow up in 1 month
34
What do the NICE guidelines suggest in terms of trauma-focused psychological treatment?
- individual trauma focused CBT
- EMDR
35
What do the NICE guidelines suggest as a drug treatment for PTSD?
- consider venlafaxine or a SSRI, such as sertraline for adults with a diagnosis of PTSD if the person has a preference for drug treatment
- review this treatment regularly
36
What are the 2 main aims of CBT for PTSD?
- Exposure: Reliving
- Cognitive restructuring
37
What is a good analogy to use to explain CBT for PTSD to patients?
The Linen Cupboard Metaphor
38
What should we do during cognitive restructuring?
- identify unhelpful beliefs
- challenge these
- construct new beliefs
- incorporate this information into the next reliving
39
How does EMDR for PTSD work?
Shapiro argues that by using bilateral stimulation, the brain processes traumatic material that has been 'stuck'
40
What is the role of eye movements in EMDR?
- decrease vividness of autobiographical memories
- enhance retrieval of episodic memories
- increase cognitive flexibility
- may change interhemispheric coherence in the frontal areas of the brain
- decrease arousal when accessing distressing memories
41
What did Bradley et al (2005) find about psychotherapy in PTSD?
- leads to large initial improvement from baseline
- more than half the patients who complete treatment improve
- exclusion criteria and failure to address polysymptomatic presentations render generalisability to the population of PTSD patients indeterminate
- majority of patients post-treatment continue to have substantial residual symptoms & follow-up data have been largely absent
42
What is complex PTSD? (Herman, 1992)
- evidence for the existence of a complex form of PTSD
- in survivors of prolonged, repeated trauma
- undefined syndrome may coexist with simple PTSD, but extends beyond it
- characterised by a pleomorphic symptoms picture, enduring personality changes, and high risk for repeated harm
- commonly risk being misdiagnosed as having personality disorders
43
What is the Adaptive Information-Processing model? (AIP)
- proposes that new experiences are processed by assimilating them with existing memory networks
- adaptive learning takes place
- pathology arises when memories of an experience are not adequately processed - the memory is dysfunctionally stored in its own neural network, which is like a fear network
- contains thoughts, images, emotions, and sensations associated with the event that, when triggered, influence perceptions, attitudes, and behaviour in the present
44
What is PTSD?
a set of persistent anxiety-based symptoms that occurs after experiencing or witnessing an extremely fear-evoking or life-threatening traumatic event
45
What is acute stress disorder (ASD)?
a short-term psychological and physical reaction to severe trauma. symptoms are very similar to those of PTSD, but the duration is much shorter (3 days to 1 month after trauma exposure)
46
What is the aetiology of PTSD?
- Biological factors
- Avoidance and dissociation
- Conditioning theory
- Emotional Processing Theory
- Dual Representation Theory
47
What biological factors of PTSD are there?
- smaller/undeveloped hippocampus
- failure of brain centres e..g. ventromedial frontal cortex to dampen activation of the brain's fear coordinating centre (amygdala)
48
What is emotional processing theory?
theory that claims that severe traumatic experiences are of such major significance to an individual that they may lead to the formation of representations and associations in memory that are quite different to those formed as a result of everyday experience
49
What is mental defeat?
a specific frame of mind in which the individual sees themselves as a victim. this is a psychological factor that is important in making an individual vulnerable to PTSD
50
What is dual representation theory?
an approach to explaining PTSD suggesting that it may be a hybrid disorder involving 2 separate memory systems (VAM and SAM)
51
What treatment options are there for PTSD?
- Psychological debriefing
- Exposure therapies
- Cognitive restructuring
- Drug treatment
52
What is psychological debriefing?
a structured way of trying to intervene immediately after trauma in order to try and prevent the development of PTSD
53
What components are involved in psychological debriefing?
- explanation of the purpose of the intervention
- asking PPs to describe their experiences
- discussion of the participant's feelings about the event
- discussion of any trauma-related symptoms the PP may be experiencing
- encouraging the PP to view their symptoms as normal reactions to trauma
- discussing the PPs needs for the future
54
What is imaginal flooding?
a technique whereby a client is asked to visualise feared, trauma-related scenes for extended periods of time
55
What is eye movement desensitisation and reprocessing (EMDR)?
a form of exposure therapy for PTSD in which clients are required to focus their attention on a traumatic image or memory while simultaneously visually following the therapist's finger moving backwards and forwards before their eyes.
This continues until the client reports a significant decrease in anxiety to the image or memory.
The therapist then encourages the client to restructure the memory positively, by thinking positive thoughts in relation to that image
56
What is the lifetime prevalence of PTSD?
between 1-3%
even though about 50% of adults experience at least one event in their lifetime that might qualify as a PTSD-causing event
57
What are come vulnerability factors to PTSD?
- tendency to take personal responsibility for the event
- developmental factors such as an unstable early family life
- family history of PTSD
- existing high levels of anxiety or a pre-existing psychological disorder
CBT
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