4.2- Posttraumatic Stress Disorder

Case 4 - Case Formulation Using The Integrative Model: (pp. 48-51)

Answer: B. Exposure to a traumatic event

Explanation: Trauma exposure is necessary for PTSD to develop, though it is not sufficient by itself. Other factors (biological, psychological, social) influence whether PTSD emerges.

Which of the following is considered a necessary factor in the development of PTSD according to the integrative model?

A. Preexisting biological vulnerability
B. Exposure to a traumatic event
C. Lack of social support
D. Avoidant coping style

Answer: B. Her father’s history of PTSD from Vietnam

Explanation: Predisposing factors are vulnerabilities present before the trauma (e.g., family history of PTSD). Cindy’s father’s PTSD may have indicated a genetic or familial vulnerability.

Which of the following best represents a predisposing factor for PTSD in Cindy’s case?

A. Her extramarital affair that triggered flashbacks
B. Her father’s history of PTSD from Vietnam
C. The repeated sexual assaults she experienced
D. Her avoidance of treatment and disclosure

Answer: B. The extramarital affair that triggered trauma reminders

Explanation: The extramarital affair acted as a trigger (precipitating factor) because it resurfaced trauma-related memories, leading to flashbacks and re-experiencing symptoms.

What was the precipitating factor that contributed to Cindy’s relapse of PTSD symptoms 10 years after the assaults?

A. Her avoidance of treatment contacts
B. The extramarital affair that triggered trauma reminders
C. Her low level of social support
D. Use of alcohol and marijuana

Answer: C. Perpetuating factor

Explanation: Perpetuating factors maintain the disorder. Avoidance prevents extinction of fear responses and blocks cognitive restructuring, thereby sustaining PTSD symptoms.

Cindy’s persistent avoidance of thoughts, places, and discussions related to her trauma represents which of the following in the 4Ps framework?

A. Predisposing factor
B. Precipitating factor
C. Perpetuating factor
D. Protective factor

Answer: C. Supportive friends and family who validate the trauma

Explanation: Protective factors reduce the likelihood of PTSD or aid recovery. Social support is one of the strongest buffers against developing chronic PTSD.

Which of the following is most accurately described as a protective factor against PTSD?

A. Negative social and political context of the Vietnam War
B. Avoidant coping and substance use
C. Supportive friends and family who validate the trauma
D. Lack of disclosure of traumatic experiences

Answer: C. Avoidance strengthens learned alarms by blocking exposure and cognitive restructuring

Explanation: Avoidance prevents natural extinction of conditioned alarms and prevents reappraisal of maladaptive trauma-related cognitions, thereby maintaining PTSD symptoms.

Which mechanism explains why avoidance maintains PTSD symptoms over time?

A. Avoidance prevents re-experiencing of trauma
B. Avoidance reduces immediate anxiety, reinforcing the behavior
C. Avoidance strengthens learned alarms by blocking exposure and cognitive restructuring
D. Avoidance increases biological vulnerability to trauma

Answer: B. The negative reactions when she tried to disclose her experiences

Explanation: Negative social responses discouraged Cindy from disclosing her trauma, increasing isolation and avoidance—social context can exacerbate or buffer PTSD outcomes.

In Cindy’s case, which factor illustrates the role of social context in the maintenance of PTSD?

A. Her distancing from her brother (the assailant’s best friend)
B. The negative reactions when she tried to disclose her experiences
C. Her father’s Vietnam-related PTSD
D. Her extramarital affair

Answer: B. Monozygotic twins were more likely than dizygotic twins to both develop PTSD after combat exposure

Explanation: True et al. (1993) showed that identical twins (sharing 100% of genes) had higher concordance rates for PTSD compared to fraternal twins (sharing 50%), suggesting moderate heritability.

Which finding from twin studies best supports the role of genetics in PTSD?

A. Dizygotic twins showed equal rates of PTSD when exposed to similar trauma
B. Monozygotic twins were more likely than dizygotic twins to both develop PTSD after combat exposure
C. Genetic influence was stronger than trauma exposure in predicting PTSD
D. PTSD was found to be entirely unrelated to heritability

Answer: C. In PTSD the initial alarm is true, while in panic disorder it is false

Explanation: In PTSD, the initial alarm is a real response to actual trauma (true alarm), but later learned alarms develop to trauma reminders. In panic disorder, the alarm is false (no real danger).

According to the integrative model, how does the alarm reaction in PTSD differ from that in panic disorder?

A. In PTSD the alarm is false, while in panic disorder it is true
B. In both, the alarm is false but equally distressing
C. In PTSD the initial alarm is true, while in panic disorder it is false
D. In both, the alarm is always based on real danger

Answer: D. All of the above

Explanation: Research shows that extreme trauma overwhelms protective factors (most will develop PTSD), but at moderate trauma levels, individual vulnerabilities (biological, psychological) are more predictive of outcome.

Which statement best reflects the relationship between trauma severity and vulnerability in the development of PTSD?

A. At high trauma severity, vulnerability factors are irrelevant
B. At low trauma severity, vulnerability factors play a greater role
C. At high trauma severity, nearly everyone is at risk regardless of vulnerability
D. All of the above

Answer: B. “The world is an unsafe place and I can never trust anyone.”

Explanation: Negative core beliefs such as “the world is unsafe,” “people cannot be trusted,” or “I am to blame” reinforce avoidance and sustain PTSD symptoms.

Which of the following is an example of a maladaptive cognition that may maintain PTSD symptoms, according to information-processing models?

A. “This event was horrible, but I can move forward.”
B. “The world is an unsafe place and I can never trust anyone.”
C. “I should seek help to overcome this trauma.”
D. “Avoidance is unhealthy, I need to face my fears.”

Answer: C. Use of alcohol and marijuana to numb distress

Explanation: Avoidance behaviors (substance use, short treatment contacts, distancing from others) maintained Cindy’s PTSD by preventing emotional processing of trauma.

In Cindy’s case, which of the following best illustrates a perpetuating factor through avoidance?

A. Her father’s history of PTSD
B. Repeated sexual assault by her assailant
C. Use of alcohol and marijuana to numb distress
D. Her extramarital affair triggering flashbacks

Answer: D. All of the above

Explanation: Multiple social-context factors contributed to her isolation and avoidance. Negative reactions, embarrassment, and loss of support reinforced her tendency to keep silent, perpetuating symptoms.

Which aspect of Cindy’s social context most strongly contributed to her ongoing PTSD symptoms?

A. Lack of disclosure of the assaults due to embarrassment
B. Negative reactions when she attempted to share her trauma
C. Distancing herself from her brother (friend of the assailant)
D. All of the above

Answer: B. Precipitating factor

Explanation: The repeated trauma (sexual assault) was the direct precipitating factor that triggered her PTSD symptoms.

In the case formulation framework (4Ps), Cindy’s repeated sexual assault would be classified as:

A. Predisposing factor
B. Precipitating factor
C. Perpetuating factor
D. Protective factor