Module 5 - Trauma and Stressor-Related Disorders

Stressor

This can be any event—either witnessed firsthand, experienced personally, or experienced by a close family member—that increases physical or psychological demands on an individual.

• These events are significant enough that they pose a threat, whether real or imagined, to the individual.

• While many people experience similar stressors throughout their lives, only a small percentage of individuals experience significant maladjustment to the event that psychological intervention is warranted.

Rape

Forced sexual intercourse or other sexual act committed without an individual’s consent, occurs in one out of every five women and one in every 71 men.

PTSD

Disorder identified by the development of physiological, psychological, and emotional symptoms following exposure to a traumatic event.

• Individuals must have been exposed to a situation where actual or threatened death, sexual violence, or serious injury occurred.

Categories of PTSD

1. Recurrent experiences 

2. Avoidance of stimuli 

3. Negative alterations in cognition or mood

4. Alterations in arousal and reactivity 

Acute Stress Disorder

• This disorder is very similar to PTSD except for the fact that symptoms must be present from 3 days to 1 month following exposure to one or more traumatic events.

• If the symptoms are present after one month, the individual would then meet the criteria for PTSD.

• Additionally, if symptoms present immediately following the traumatic event but resolve by day 3, an individual would not meet the criteria for acute stress disorder.

Adjustment Disorder

• Occurs following an identifiable stressor that happened within the past 3 months.

• This stressor can be a single event (loss of job, death of a family member) or a series of multiple stressors (cancer treatment, divorce/child custody issues).

• does not have a set of specific symptoms an individual must meet for diagnosis.

  • whatever symptoms the individual is experiencing must be related to the stressor and must be significant enough to impair social, occupational, or other important areas of functioning and causes marked distress “...that is out of proportion to the severity or intensity of the stressor”

Prolonged Grief Disorder

• This condition is noted as a condition for further study 

• defined as an intense yearning/longing and/or preoccupation with thoughts or memories of the deceased who died at least 12 months ago.

• The individual will present with at least three symptoms to include feeling as though part of oneself has died, disbelief about the death, emotional numbness, feeling that life is meaningless, intense loneliness, problems engaging with friends or pursuing interests, intense emotional pain, and avoiding reminders that the person has died. 

Hypothalamic-pituitary-adrenal (HPA) axis

involved in the fear-producing response, and some speculate that dysfunction within this axis is to blame for the development of trauma symptoms

Amygdala

serves as the integrative system that inherently elicits the physiological response to a traumatic/stressful environmental situation

• sends this response to the HPA axis to prepare the body for fight-or-flight

Epinephrine

known to cause physiological symptoms such as increased blood pressure, increased heart rate, increased alertness, and increased muscle tension, etc. 

Cortisol

responsible for returning the body to homeostasis once the dangerous situation is resolved

Psychological Debriefing

Considered a type of crisis intervention that requires individuals who have recently experienced a traumatic event to discuss or process their thoughts and feelings related to the traumatic event, typically within 72 hours of the event.

Steps are:

1. Identifying the facts (what happened?)

2. Evaluating the individual’s thoughts and emotional reaction to the events leading up to the event, during the event, and then immediately following

3. Normalizing the individual’s reaction to the event

4. Discussing how to cope with these thoughts and feelings, as well as creating a designated social support system

Imaginal Exposure

Exposure therapy where the individual mentally re-creates specific details of the traumatic event. The
patient is then asked to repeatedly discuss the event in increasing detail, providing more information
regarding their thoughts and feelings at each step of the event.

In Vivo

• Exposure therapy, where the individual is reminded of the traumatic event through the use of videos, images, or other tangible objects related to the traumatic event, which induces a heightened arousal response.

• While the patient is re-experiencing cognitions, emotions, and physiological symptoms related to the traumatic experience, they are encouraged to utilize positive coping strategies, such as relaxation techniques, to reduce their overall level of anxiety

Flooding

• Exposure therapy where involves disregard for the fear hierarchy, presenting the most distressing memories or images at the beginning of treatment.

• While some argue that this is a more effective method, it is also the most distressing and places patients at risk for dropping out of treatment

Trauma-focused cognitive-behavioral therapy (TF-CBT)

• adaptation of CBT that utilizes both CBT techniques and trauma-sensitive principles to address the trauma-related symptom

• can be summarized via the acronym PRACTICE:

  • P: Psycho-education about the traumatic event. This includes discussion about the event itself, as well as typical emotional and/or behavioral responses to the event.

  • R: Relaxation Training. Teaching the patient how to engage in various types of relaxation techniques such as deep breathing and progressive muscle relaxation.

  • A: Affect. Discussing ways for the patient to effectively express their emotions/fearsrelated to the traumatic event.

  • C: Correcting negative or maladaptive thoughts.

  • T: Trauma Narrative. This involves having the patient relive the traumatic event (verbally or written), including as many specific details as possible.

  • I: In vivo exposure (see above).

  • C: Co-joint family session. This provides the patient with strong social support and a sense of security. It also allows family members to learn about the treatment so that they are able to assist the patient if necessary.

  • E: Enhancing Security. Patients are encouraged to practice the coping strategies they learn in TF- CBT to prepare for when they experience these triggers out in the real world, as well as any future challenges that may come their way.