N332 - Module 3 Part 1: Caring for persons experiencing trauma and anxiety disorders fully solved questions with 100% accurate solutions 2025-2026

How does DSM-5 define a "traumatic stressor"?

Any event(s) that may cause or threaten death, serious injury, or sexual violence to oneself, a close family or a close friend

What are the 2 key points of trauma

1. We do not want to re-traumatizing patients

2. Trauma is based on how the person experiences/perceives it

Through what pathways can trauma effects be transmitted to offspring?

1. Psychological

- parental appraisals influence children's coping, impairing ability to provide a supportive environment

2. Biological/neurochemical

- inherited reactivity to stress

3. Social/economic/cultural:

- external factors that shape lived experience

Is intergenerational transmission of trauma inevitable?

No - protective factors (assets, resources, resilience) can buffer negative outcomes

What are risks of intergenerational trauma transmission?

- Increased risk of further stressor exposure

- Heightened psychological and neurochemical reactivity

- Greater likelihood of poor mental and physical health outcomes

What is collective trauma? Examples?

Trauma experienced by a large social group (political, racial, cultural, religious)

Examples

- natural disasters

- war

- genocide

What are the consequences of collective trauma?

- erosion of trust

- silence

- moral breakdown

- poor leadership

Key concept of collective trauma?

It modifies group norms, dynamics, and functioning beyond individual trauma

What is historical trauma?

Cumulative trauma experienced by a social group across generations, often becoming part of a single traumatic trajectory when adversities outweigh resilience

ex:

- colonizations of Indigenous Peoples

- suppression of traditions

- residential schools

What are the outcomes of historical trauma?

- psychological distress

- suicide risk

- intergenerational "soul wounding"

When is the risk of historical trauma greater?

When trauma spans multiple generations

e.g., parent and grandparent both in residential schools

What are community responses to collective and historical trauma?

- Public awareness campaigns

- grassroots training

- traditional practices/rituals

- strengthening family/community ties

- rehabilitation

- networking with organizations

What are specific approaches for Indigenous Peoples?

- Multilevel interventions (individual, family, community)

- culturally responsive and community-driven programs

- restoration of healing traditions and knowledge transmission

What is trauma-informed care (TIC)?

An approach that recognizes the prevalence of trauma and diverse responses, aiming to avoid re-traumatization and foster compassion and trust

What are the four principles of trauma-informed care?

1. Trauma awareness

2. Safety and trustworthiness

3. choice, collaboration, and connection

4. strength-based, skill-building approach

What is the key concept of TIC?

"Do no further harm" — avoid re-traumatization, foster compassion, and build trust

How do cultural considerations affect TIC?

1. Racism & inequities influence trauma care

2. Cultural competence: finite skill set (risk of stereotyping)

3. Cultural humility: ongoing reflection, critique, respect, partnership

4. Cultural safety: addresses colonial and systemic power imbalances → essential for equitable, trauma-informed care

What is toxic stress?

the body's prolonged activation of the stress response system d/t strong, frequent, or chronic stress without adequate support from caring adults or protective factors

ex:

- abuse

- neglect or abandonment

- chronic poverty, violence, discrimination

- caregiver substance abuse or mental health issues

- exposure to repeated medical trauma

How toxic stress contribute to trauma?

Toxic stress overwhelms a person's ability to cope/self-regulate --> traumatic experiences

The brain encode these experiences as threats --> which can form the foundation for trauma

How does toxic stress and anxiety relate?

Prolonged cortisol/adrenaline exposure rewires the brain

1. hyperactive (heightened fear, vigilance, worry)

2. function is reduced (harder to reason, calm down or feel safe)

3. Impaired memory (difficulty distinguishing past from present danger

This imbalances makes a person prone to chronic anxiety, panic attacks and increase fear responses

Toxic stress and PTSD?

PTSD develops when trauma responses become chronic and intrusive

Toxic stress primes the brain and body for this

- constantly on edge

- intrusive memories/flashbacks

- avoidance/numbing

- negative beliefs about self/world

What is adaptive coping?

- Positive

- constructive strategies that reduce stress

- promote growth

- improve functioning and well-being

Examples of adaptive coping strategies?

- Problem-solving

- Seeking social support

- Positive reframing

- Mindfulness/relaxation techniques

- Exercise/healthy lifestyle choices

- Time management and goal setting

What is the outcome of adaptive coping?

- Builds resilience

- strengthens mental health

- promotes emotional regulation

- supports long-term recover

What is maladaptive coping?

Negative or harmful strategies that temporarily relieve stress but worsen long-term well-being and functioning

Examples of maladaptive coping strategies?

- substance use

- avoidance/withdrawal

- denial or suppression of feelings

- self-harm

- overeating or under-eating

- aggression or lashing out

What is the outcome of maladaptive coping?

- Increase distress over time

- worsens mental and physical health

- perpetuates negative cycles

- interferes with problem-solving

Define PTSD (DSM-5)

A psychiatric disorder that can occur after experiencing or witnessing a traumatic event involving actual or threatened death, serious injury, or sexual violence

Core Feature: The traumatic event gets "stuck" in the nervous system — the brain continues to respond as if the danger is still present

What is the DSM-5 criteria for PTSD?

1. Exposure to a traumatic event through:

- direct experience

- witnessing the event

- learning it happened to a close family/friend

- repeated/extreme exposure to details (eg. first responders)

2. Response involved:

- Intense fear, helplessness, and/or horror

3. Symptoms

- >1 month

- Symptoms: re-experienced, avoidance, negative mood, arousal changes

4. exclusions

- Symptoms must not be due to medication, substance use, or another illness

5. Impairment

- disturbances causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

What must PTSD symptoms cause to meet diagnostic criteria?

Clinically significant distress or impairment in social, occupational, or other important areas of functioning

What is Criterion B (Intrusion symptoms) for PTSD?

The traumatic event is persistently re-experienced through intrusive memories, flashbacks, nightmares, or distress at reminders.

What is Criterion C (Avoidance symptoms)?

Persistent avoidance of stimuli associated with trauma (memories, thoughts, feelings, people, places, activities)

What is Criterion D (Negative alterations in cognition & mood)?

Persistent negative beliefs, guilt, blame, detachment, inability to feel positive emotions, and memory gaps related to trauma

What is Criterion E (Arousal & reactivity symptoms)?

Marked alterations such as irritability, anger outbursts, hypervigilance, exaggerated startle response, poor concentration, or sleep disturbance

What criteria must be met for a PTSD diagnosis?

Exposure (direct or witnessing) to severe threat of death, injury, or sexual violence plus symptoms of:

- Intrusion (intrusive memories/images)

- Avoidance (emotional/behavioral)

- Altered arousal (hyperarousal, hypervigilance, poor concentration)

- Negative impacts (disrupted sleep, impaired relationships, isolation)

What disorders overlap with PTSD (differential diagnoses)?

- panic disorder

- generalized anxiety disorder

- depression

How is suicidality related to PTSD?

PTSD is associated with an increased risk of suicide

What are common PTSD assessment tools?

- PTSD Checklist

- Impact of Events Scale

What are common PTSD triggers?

- Witnessing killing/injury

- life-threatening accidents

- precarious immigration status

What percentage of people experience trauma, and how many develop PTSD?

~50% experience trauma; most do not develop PTSD

What is more common after trauma: resilience or psychopathology?

Psychological resilience is more common

Define psychological resilience.

A dynamic process of effective coping and positive adaptation in the face of adversity, supported by bio/psycho/social/spiritual factors

What promotes resilience?

1. Positive appraisal style (looking on the bright side)

2. Perceived social support

3. coping strategies

- focus on small steps

- maintain competence/self-view

- focus on present implications vs past regrets

What are risk factors for PTSD?

- Female gender

- type/severity of trauma (esp. interpersonal violence)

- history of trauma (childhood abuse)

- lack of support at time of event

When are women at higher risk of PTSD?

During the perinatal period (due to exacerbation of pre-existing PTSD symptoms)

How does PTSD affect children under 10?

They are less likely to develop PTSD, but adverse childhood experiences (ACEs) are strongly linked to later depression, anxiety, and substance use

What are evidence-based treatments for PTSD?

1. Cognitive-behavioral therapy (CBT)

2. psychotherapy

3. EMDR (Eye Movement Desensitization and Reprocessing)

4. medications (e.g., SSRIs)

Is PTSD treatment always short-term?

No — some individuals experience chronic symptoms (e.g., Vietnam veterans decades later

What is the DSM-5 exposure criterion for Acute Stress Disorder (ASD)?

Exposure (direct or witnessing) to a life-threatening or injury-threatening event

What ongoing effects must be present for ASD diagnosis?

Disturbances in arousal, intrusive memories, behavior, and overall functioning

How does ASD symptomology compare to PTSD?

ASD involves the same diagnostic criteria and symptom clusters as PTSD (intrusion, avoidance, negative mood, and arousal changes)

What is the key difference between ASD and PTSD in terms of time?

ASD: Symptoms last 3 days to 1 month after trauma.

PTSD: Symptoms last > 1 month

What phrase is sometimes used to describe ASD?

Psychological shock

Why is diagnosing ASD clinically important?

It is a risk factor for developing PTSD if symptoms persist beyond 1 month

What are the goals of care for clients with acute stress?

- eliminate or moderate the stressor

- reduce harmful effects of stress

- develop positive coping mechanism

What are the four factors to focus on for treatments for PTSD?

1. Biologic

2. Psychological

3. social

4. Spiritual

What psychological factors should be assessed - Treatment for PTST?

1. Behavior, affect, psychomotor changes

2. Mood changes (anxiety, anger, depression)

3. Cognitive impairments (ruminations, poor concentration, suicidal ideation)

4. Appraisal of traumatic/life events

5. Day-to-day functioning & responsibilities

6. Coping strategies/resources

What psychological interventions are used - Treatment for PTST?

1. CBT:

- identify triggers

- restructure thinking

- build coping skills

- talk through trauma

2. Trauma counseling:

- psychoeducation

- relaxation therapy

- assertiveness training

3. Specific therapies: Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), EMDR

What biologic factors should be assessed in PTSD individuals - Treatment for PTST?

- Autonomic responses (sympathetic/parasympathetic)

- Vegetative changes (sleep, appetite, energy, sex)

- Stress-related chronic illness (HTN, IBS, migraines)

- Immune suppression (frequent infections)

- Substance use (Rx, OTC, alcohol, tobacco, illicit)

What biologic interventions are recommended - Treatment for PTST?

1. Establish regular routines (sleep, eating, hygiene)

2. Exercise for physical & psychological benefit

3. Relaxation techniques (yoga, meditation, breathing, progressive muscle relaxation)

4. Referrals (biofeedback, hypnosis, EMDR)

5. Health teaching (nutrition, sleep hygiene, medication management)

What are the medications/therapy for treatment for people with PTSD?

1. Usually polypharmcy (bc one doesn't work)

2. Types of meds

- venlafaxine (SNRI)

- sertraline (SSRI)

- paroxetine (SSRI)

- topiramate (Anti-epileptic)

- prazosin (alpha-adrenergic antagonist)

- anxiolytics

- Antipsychotics

3. Therapy

- Tx for SU (if applicable)

- Psychedelic-assisted therapy (PAT)

- Electroconvulsive Therapy (ECT) - in rare cases

What social factors should be assessed - Treatment for PTST?

- Social network (size, quality, functions, reciprocity)

- ethnic/cultural influences

What are social interventions for stress - Treatment for PTST?

- Family education/support, respite care, and family therapy

- use of support networks/groups/community

- time management and lifestyle stress

- occupation/hobbies

What spiritual questions can nurses ask clients - Treatment for PTST?

1. What sustains you now?

2. Are there spiritual acts/rituals helping you?

3. What can you take from this experience?

What is the nurse's role in the spiritual domain - Treatment for PTST?

- Address feelings of alienation/estrangement

- support hope, minimize fear

- encourage spiritual activities (medications, mindfulness, religion, etc)

How are anxiety and the mind-body-brain connected?

Anxiety involves bidirectional influence - physiologic responses shape behavior, and thoughts influence physiology

Difference between fear, anxiety, and worry?

1. Fear: present-oriented, immediate threat (e.g., snarling dog)

2. Anxiety: future-oriented, apprehension about potential threats

3. Worry: persistent thoughts/images about adverse outcomes

Normal vs abnormal anxiety?

1. Normal:

- transient

- adaptive

- motivates action

2. Abnormal / Anxiety disorder:

- excessive

- chronic

- impairs functioning

- often comorbid with other disorders

Define allostasis and allostatic load.

1. Allostasis:

- adaptive stress response maintaining homeostasis

2. Allostatic load:

- cumulative wear/tear from chronic stress → increased risk for physical disorders

Lifetime prevalence and risk factors of anxiety disorders?

1. Lifetime prevalence ~31% globally

2. Often begin in childhood/adolescence

3. Risk factors:

- genetics

- parental modeling

- stressful life events

4. Higher prevalence in females

5. Comorbidities: depression, substance misuse, chronic medical conditions

Key features of Generalized Anxiety Disorder?

Persistent excessive anxiety across life situations (most anxiety is exogenous situations - ex: rent)

1. perceived lack of control

2. functional impact

3. physical symptoms include

- fatigue

- muscle tension

- sleep disturbance

- GI upset

4. onset early in life

5. often comorbid with depression

What is the symptom requirement for Generalized anxiety disorder?

3 or more symptoms of:

- Restlessness/on edge

- Being easily fatigued

- Irritability

- Sleep disturbance

- Muscle tension

- Poor concentration

What is the typical onset and course of GAD?

Onset is often early in life and follows a chronic course, with severity fluctuating depending on life events and stressors

Treatment for GAD?

1. First-line psychotherapy

- CBT, including bibliotherapy and self-help

2. First-line pharmacologic treatment

- SSRI and SNRIs

3. Second-line pharmacotherapies (short term, common, withdrawal)

- Buspirone

- Benzodiazepines

- Pregabalin

4. Third line pharmacotherapies (old, overdosing rate is high)

- Antipsychotics

- tricyclic antidepressants (imipramine, nortiptyline, clomipramine)

- MAOIs

Why are SSRIs and SNRIs considered first-line for anxiety?

They are effective, have fewer side effects, and are safer in overdose compared to older agents

Why are tricyclic antidepressants (TCAs) not considered first-line?

They have significant side effects and are used when SSRIs/SNRIs are ineffective

What is the advantage of benzodiazepines compared to antidepressants?

They have a rapid anxiolytic effect (hours vs. weeks)

Why are benzodiazepines recommended for short-term use only? What are the risks of benzodiazepines in older adults?

Risk of withdrawal, rebound anxiety, and sleep disturbance with long-term use

Increased risk of falls and memory difficulties

How are short-acting benzodiazepines typically dosed? How are long-acting benzodiazepines typically dosed?

Short acting

- Multiple small doses during the day, with a higher dose at bedtime

Long acting

- Less frequent dosing with lower rebound risk

Key features of Social Anxiety Disorder?

Marked fear of social situations or performance situations due to fear of negative evaluations (humiliation, embarrassment, rejection, offending others)

1. low self-esteem

2. impaired quality of life

3. subtypes: generalized vs specific

4. lifetime prevalence ~4%

5. protective: supportive relationships.

6. Anxiety is more often a secondary/co-morbid disorder

- frequently co-occur with other psychiatric problems

- frequently co-occur with depressive disorders

- substance use to medical (maladaptive)

7. Cognitive distortions common

How do individuals typically respond when exposed to the feared situation in Social anxiety disorder?

They experience anxiety (sometimes panic attacks) that is out of proportion to the actual threat

What is the time duration for SAD diagnosis?

Symptoms must persist for > 6 months

What is the behavioral pattern of SAD?

Feared situations are avoided or endured with intense distress

What type of impairment does SAD cause?

Significant impairment in social, occupational, or other important areas of functioning

What are common life impacts of SAD?

Difficulty speaking in crowds, dating, or forming sexual relationships

How is SAD different from being introverted?

SAD involves clinically significant anxiety and impairment, not just personality preference

What is the first-line psychotherapy for SAD?

CBT, especially exposure therapy

What medications can help in SAD?

1. Low-dose beta-blockers (propranolol):

- help manage anxiety, panic, stress in performance situations

2. Benzodiazepines: sometimes used short-term

What are the risk factors/etiology for anxiety disorder?

1. Biologic factors

- genetic theories

- fear conditioning (eg. bullying)

2. Psychodynamic theories

- traumatic life events

3. Sociocultural factors

- culture bound syndromes

How do genetics contribute to anxiety disorders?

Diathesis-stress model: genetic predisposition + environmental stressors → vulnerability

- heritability 20-60%

- multiple genes

- protective factors: adaptive coping, self-efficacy

Key neurobiologic mechanisms in anxiety?

1. Fear conditioning: neutral stimulus paired with aversive stimulus → conditioned fear

2. Brain structures: hippocampus (memory), amygdala (fear response)

3. Neurotransmitters: 5-HT, NE, GABA, CRH, CCK, oxytocin/AVP

Structural/functional changes in anxiety disorders?

1. PD: grey/white matter reductions

2. PD/GAD/SAD: increased amygdala activity

3. SAD: precuneus dysfunction

4. PFC-amygdala connectivity differs by disorder

How do psychodynamic theories explain anxiety?

1. Early trauma, separation, loss shape anxiety

2. integrates with diathesis-stress;

3. positive coping reduces vulnerability.

What assessment is needed for Anxiety disorder?

1. Self Report

2. Can rate on scale 0-10 (as with pain)

3. Degrees of anxiety: Mild, Moderate, Severe, Panic

4. Complete psychological assessment

What is in the psychological assessment for Anxiety disorder?

1. Patterns of anxiety (before feeling anxiety; coffee, etc)

2. Characteristic symptoms

3. The person's emotional, cognitive, and behavioral responses

4. Presence of suicidal tendencies and thoughts

5. Present and past coping strategies

What are the nursing interventions for mild anxiety?

- learning is possible

- assist the patient to use the energy that anxiety provides to encourage learning

What are the nursing interventions for moderate anxiety?

1. nurse needs to check their own anxiety so that the patient do not empathize with it

2. encourage the patient to talk:

- focus on one experience

- describe it fully

- formulate the patient's generalizations about that experience

What are the nursing interventions for severe anxiety?

1. learning is less possible

2. allow relief behaviours to be used but do not ask about them

3. encourage the patient to talk

- ventilation of random ideas is likely to reduce anxiety

- when anxiety is reduced -- proceed with interventions from moderate/mild anxiety

What are the nursing interventions for panic anxiety?

1. Learning is impossible/no content inputs to the patient's thinking should be made by the nurse

2. Nurse needs to stay with patient

3. Allow pacing and walk with the patient

4. Talking/response

- pick up on what the patient say

- short phrases by the nurse-direct, to the point of the patient's comment

- match the current attention span of the patient in panic --> more likely to be heard

5. Do NOT touch the patient

- patients experiencing panic --> concerned about survival and usually distort intentions of all invasions of their personal space

Settings for anxiety treatment?

- Outpatient clinics

- primary care/private practitioners

- hospitalization only for acute exacerbations or comorbid disorders

- holistic bio-psycho-social-spiritual assessment