What are the different ways one could be exposed to actual or threatened death, serious injury or sexual violence?
- directly experiencing
- witnessing, in person
- learning that the traumatic event happened to a close friend or family member. In cases of actual or threatened death, must have been violent or accidental (ie not passing away due to illness)
- experiencing repeated or extreme exposure to aversive details of traumatic event(s) eg first responders collecting human remains; police officers repeatedly exposed to details of child abuse
- experiencing in the media doesn’t count
Criterion B of PTSD = intrusion symptoms
How many do you need?
1 or more
What are the intrusion symptoms?
Must be associated with traumatic event and begin to occur after the event.
- Recurrent, involuntary, distressing memories
- Recurrent distressing dreams
- Dissociative reactions (eg flashbacks) - feels or acts like the traumatic event is recurring
- Intense or prolonged psychological distress at exposure to external or internal cues (eg memories) that are reminders of the event
- Marked physiological reactions to cues that are reminders of the event
Duration of PTSD symptoms must last at least
one month
Criterion C = persistant avoidance of stimuli associated with traumatic event, beginning after the event as evidenced by one or both of the following:
- avoidance of/efforts to avoid distressing thoughts, memories, or feelings about the event
- avoidance of/efforts to avoid external reminders that arouse distressing memories, thoughts, feelings about the event - generalises quickly
Criterion D = negative alterations in cognition and mood, evidenced by TWO or more of the following:
- Inability to remember an important aspect of the event (due to dissociative amnesia, not something else)
fragmented memory - Persistent and exaggerated negative beliefs about oneself, others and the world (eg No one can be trusted) after event
- Persistent, distorted cognitions about the causes/consequences of the event leading the individual to blame themselves or others
- Persistent negative emotions (eg guilt, shame, fear, horror, anger)
- Markedly diminished interest or participation in significant activities
- Feelings of detachment or estrangement from others
- Persistent inability to experience positive emotions
Criterion E = marked alterations in arousal and reactivity as evidenced by TWO or more of the following:
- Irritable behaviour and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression towards people or objects
- seen esp. in war veterans - Reckless or self-destructive behaviour
- Hypervigilance
- Exaggerated startle response
- Problems with concentration
- Sleep disturbance
What are Criteria B-E for PTSD?
Intrusion symptoms (1 or more) Persistent avoidance of stimuli (1+) Negative changes in cognition, mood (2+) Marked alterations in arousal and reactivity (2+)
What is the timeframe for Acute Stress Disorder?
3 days to 1 month
After 1 month, the symptoms of Acute Stress Disorder either..
resolve, or diagnosis is changed to PTSD
ASD places more emphasis on _________ symptoms than PTSD
dissociative symptoms
- depersonalisation
- derealisation
- numbing
- reduced awareness
- dissociative amnesia
Dissociative symptoms are predictive of ______. ASD is like a __________ for PTSD.
PTSD, risk factor
Approximately ___% of people experience a traumatic event
60
About ____ of women and ____ of men develop PTSD after traumatic event
10-20%, 6-8%
Distress following trauma drops substantially within 3 months in ___ of people
75%
PTSD without treatment…
does go away in 50-60% of people
What risk factors are associated with increased likelihood of developing post-trauma problems (not just PTSD)?
For pre-trauma:
- Childhood trauma
- Prior psychiatric history
- Family instability
- Substance abuse
- Socioeconomic disadvantage
in other words, they do not have adequate coping resources - less likely to cope in a normative fashion when faced with trauma
What risk factors are associated with increased likelihood of developing post-trauma problems (not just PTSD)?
Trauma factors:
- degree of life threat or loss
- Severity of exposure to traumatic elements eg grotesque sights, duration (first responders) - more likely to lead to dissociation symptoms, flashbacks
- Location of trauma (eg an attack in a ‘safe’ place changes your perception of the world)
- Individual’s role in the trauma (victim, helper)
- Meaning of trauma (eg uncontrollability)
- eg rape victim who later finds out her rapist was also a serial killer (could have been killed - meaning changes)
What risk factors are associated with increased likelihood of developing post-trauma problems (not just PTSD)?
Post-trauma factors:
- Social support
- Coping style
- Ongoing stressors (eg police investigation, injury)
What are the biological treatments for PTSD?
Benzodiazepines, SSRIs
Do psychological interventions for PTSD work?
Yes, but many people with PTSD simply aren’t ready, can’t go through with it - so recommended to firstly take medication
Core treatment components of CBT for PTSD:
- assess suitability - people need to be in a focused place to start treatment
- psychoeducation
- anxiety management techniques
- cognitive restructuring
- prolonged exposure (record event in present tense, in great detail, about an hour - record over and over again)
- and then listen to the recordings at home until it loses its fear value
- then exposure to stimuli, graded
CBT is more effective than
medication or supportive psychotherapy (placebo)
problems with CBT for PTSD
- drop-out rates high
- research conducted in very controlled settings, participants without comorbid conditions - need to test in community setting
