W4: PTSD

What is trauma?

Exposure to actual or threatened death, serious injury or sexual violence

What are the 4 ways that can constitute the above?

1. Direct exposure

2. Witnessing, in person

3. Learning about it (from a closed relative/friend)

4. Repeated or extreme indirect exposure

What are the 4 symptom cluster of PTSD (DSM-5)?

1. Intrusion symptoms

2. Persistent avoidance of trauma-related stimuli

3. Negative alterations in cognition or mood

4. Alterations in arousal or reactivity

What do intrusion symptoms consist of?

• Recurrent, involuntary and intrusive memories

• Traumatic nightmares

• Flashbacks

• Psychological distress and physiological reactivity to reminders

What is the lifetime prevalence of PTSD?

7-8%

What is the trend of PTSD based on gender?

Higher % of women develops PTSD (20.4%) compared to men (8.2%)

Among the possible causes of traumatic events, what events induce the highest % of developing PTSD, and why?

Rape and childhood abuse, because they are human-induced, interpersonal traumatic events

It is normal for stress and symptoms to fade over time, how long must these symptoms persist for it to be considered as a disorder?

More than 1 month

Which trend of PTSD course do majority people share?

Green line graph

What is the criteria for Acute Stress Disorder?

One must experience 9/14 symptoms from these 5 categories:

1. Intrusions

2. Negative mood

3. Dissociative symptoms

4. Avoidance

5. Arousal

What are the 4 vulnerability factors that can make someone more at risk to develop PTSD?

1. Gender

2. Prior trauma

3. Past psychiatric illness

4. History of abuse

What are the 3 theoretical models used to explain PTSD?

1. Two-factor theory (Mowrer, 1947)

2. Lang’s information-processing theory (Lang, 1977)

3. Cognitive model of PTSD (Ehlers & Clark, 2000)

What are the two factors in Mowrer’s theory?

1. Classical conditioning

2. Operant conditioning

How do the two factors give rise to PTSD?

1. Factor 1 (Classical Conditioning): A neutral stimulus is paired with the trauma, creating a conditioned fear response.

2. Factor 2 (Operant Conditioning): The person escapes or avoids the conditioned stimulus, and the resulting anxiety relief negatively reinforces the avoidance, maintaining the disorder

What is the limitation of this model?

It doesn’t explain intrusive memories and nightmares

What is the mechanism behind Lang’s information-processing theory?

Mental fear structure that is made up of stimulus (acts as reminders), meaning and response elements

What characteristic of the fear network contributes to PTSD?

The fear network is stable, broadly generalised and easily accessed

What are the two components of the cognitive model of PTSD?

1. The trauma memory

2. Negative appraisals

Why is it both difficult to remember traumatic memories deliberately, yet easily triggered?

The trauma memory is poorly elaborated and poorly integrated with other memories

What are appraisals of the event and its aftermath focused on?

1. Self

2. World

3. Trauma

Together, what do they produce?

A sense of serious, current threat

What are the 2 types of early intervention for PTSD treatment?

1. Psychological debriefing

2. Psychological first aid

What are the downsides of these methods?

1. Not effective and may be harmful

2. Little research has evaluated psychological first aid

What are the 3 core components of trauma-focused treatment?

1. Prolonged exposure (PE)

2. Cognitive Processing Therapy (CPT)

3. Cognitive Therapy for PTSD (CT)

What are the 5 types of trauma-focused treatment?

1. Psychoeducation

2. Cognitive reappraisal

3. Imaginal exposure

4. In vivo exposure

5. Relapse prevention

What does psychoeducation involve?

1. Informing common responses to trauma

2. Normalising symptoms

3. Outlining the treatment

What does cognitive reappraisal involve?

Identifying and changing unhelpful trauma-related beliefs (“it was my fault this car accident happened”, “the person who did this to me must be punished”)

What are the 3 steps to challenging these thoughts?

1. Identify maladaptive thoughts

2. Scrutinise the evidence for and against them

3. Develop alternative, more realistic or helpful thoughts

What does imaginal exposure involve?

“Relieving” the traumatic event, with a focus on sensory detail

How does it reduce anxiety over time?

Repeated recounting of the traumatic memory aloud will lead to a spike in anxiety at the start, but gradually falls as it reduces distress and builds emotional resilience over time

What does in vivo exposure involve?

Approaching avoided situations in real life

What are the 4 general steps in in vivo exposure?

1. Build a hierarchy

2. Approach gradually

3. Stay until anxiety reduces

4. Facilitate cognitive change

What is the difference between a lapse and a relapse?

• Lapse: a temporary return of symptoms e.g., around an anniversary or new stressor

• Relapse: a sustained return to old patterns of avoidance and distress