PTSD

Trauma vs. Acute stress

Trauma is defined as an exposure, whereas Acute Stress and PTSD are the psychopathological outcomes of that exposure.

Lifetime Trauma Statistics (Benjet et al., 2016)

Approximately 70% of people experience a traumatic event in their lifetime, with an average of 3.2 lifetime traumas.

Direct vs. Indirect Exposure (APA, 2013)

Trauma can be experienced Directly (involved/witnessed), Indirectly (affecting loved ones), or Vicariously (secondary trauma from content) .

Acute Stress Timeline

The outcome categorized as occurring within less than 1 month after exposure.

PTSD Timeline

The outcome categorized as occurring more than 1 month after exposure.

WHO Definition of Acute Stress Reaction (2019)

The development of transient emotional, somatic, cognitive, or behavioral symptoms following exposure to an extremely threatening or horrific event.

Behavioural-Ecological Model (Hovell, Wahlgren & Gehrman, 2002)

A model showing that Acute Stress and PTSD are influenced by factors 'Outside the Skin' (Society, Community) and 'Inside the Skin' (Behaviour, Physiology, Genetics) .

Acute Stress Prevalence (Bryant, 2011)

Between 7-28% of individuals will develop acute stress following trauma, which is predictive of later mental and physical health problems .

Critical Incident Stress Debriefing (CISD)

An early intervention described as convenient but having a mixed evidence-base and being "possibly harmful" . - iatrogenic

CBT for Acute Stress

An early intervention that is highly effective but resource-intensive and individual/symptom-focused .

Psychological First Aid (WHO, 2011)

Defined as "humane, supportive and practical help" to fellow human beings suffering serious crisis events.

5 Essential Principles of Mass Trauma Intervention (Hobfoll et al., 2007)

Principles that guide early post-trauma intervention: 1. Safety, 2. Calm, 3. Self/Community Efficacy, 4. Connectedness, and 5. Hope .

Cognitive Maintenance of PTSD (Foa, 1997)

Natural recovery is linked to maintaining a balanced world view; the belief that the world is "completely dangerous" is a primary dysfunctional cognition.

Trauma Reminders and Memory (Ehlers & Clark, 2000)

Traumatic memories are easily triggered and can subjectively feel as if they are occurring in the present, even if safety is restored.

"Pressure Cooker Effect" (Hobfoll & London, 1986)

Occurs when accurate info is lacking and people share rumors/horror stories, which is positively correlated with psychological distress.

The "Dose-Response Effect" of Media (Ahern et al., 2002)

There is a direct link between the frequency of televised images of a traumatic event and levels of psychological distress.

Hyperarousal and Risk Perception

Heightened emotional states following trauma can cause the environment to be perceived as harmful beyond the objective information available.

Stress Inoculation Training (SIT) (Rothbaum et al., 2000)

A type of CBT TO promote calming using education and coping training found effective for combat stress, sexual assault, and accident survivors.

Normalisation of Stress Reactions (Solomon, 2003)

A key intervention to enhance calming; pathologizing common responses can increase associated anxiety.

Self-Efficacy vs. Collective Efficacy (Bandura, 1997; Benight, 2004)

Self-efficacy is the belief one's actions lead to positive outcomes; Collective efficacy is the sense a group one belongs to will experience positive outcomes.

Conservation of Resources Theory (Hobfoll, 1988)

Suggests that self and collective efficacy are personal resources likely to be diminished following trauma.

Social Connectedness and PTSD Risk (Solomon et al., 1986)

Prior to developing severe distress, combatants often experience loneliness; a lack of social connection is a risk factor for PTSD.

Social Support Deterioration/Deterrence Model (Kaniasty & Norris, 1993)

Suggests that social support systems can quickly deteriorate under the pressure of overuse following mass trauma.

Antonovsky’s Sense of Coherence (1979)

A hopeful state defined as a pervasive feeling of confidence that one's environment is predictable and things will work out.

Learned Optimism (Seligman et al., 2005)

A positive psychology model that identifies and amplifies strengths in people at risk to enhance hope.

Decatastrophizing in CBT

An intervention critical for restoring hope by counteracting cognitive schemas that prepare for the worst.

Social-Ecological Resilience (Adler et al., 2005)

A determinant in recovery based on the ability of communities to mobilize assets, networks, and social capital.

PFA Eligibility Criteria

Suitable for those aged 18+ exposed to trauma <4 weeks ago; not for those seeking therapy for other mental health disorders like OCD .

Homerton Staff Support Pathway (Cole et al., 2020a)

A PFA protocol developed in response to Covid-19 using a screen-and-treat stepped-care model.

Social GRACES Model

A model used to guide cultural sensitivity in PFA by exploring social identity during support conversations.

7-Step Problem-Solving Cycle in PFA

1. Identify, 2. Clarify, 3. Brainstorm, 4. Pros/Cons, 5. Decide, 6. Implement, 7. Review .

The 'ABC' Wellbeing Plan

A co-created PFA structure: Awareness (review stress), Balance (action points), and Connection (prioritize social support) .

PFA Systematic Review (Hermosilla et al., 2023)

Found PFA is "evidence-informed" but not "evidence-based" due to poor methodologies and lack of rigorous RCTs.

Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) Outcomes

Service evaluations (Cole et al., 2023) showed a significant improvement from 37.88 to 49.13 after PFA.

NSESSS Acute Stress Scores after PFA

Average scores dropped from "severe" (3) before treatment to "mild" (1) after PFA.