E1 - PTSD

variability in trauma types

big ‘t’ - life-threatening events the pose significant danger to self or others

little ‘t’ - distressing life experiences that may not be life-threatening, but change how one views oneself, others, or the way the world work

Diagnosing PTSD

NEED: exposure to actual or threatened: death, serious injury, or sexual violence

direct exposure, witnessing trauma, learning that a loved one was exposed

Diagnosing PTSD

traumatic event is re-experienced in some way. Avoidance of internal or external trauma reminders. Onset (or worsening) of negative thoughts/feelings after trauma. Trauma-related arousal and reactivity that began or worsened after the trauma. Last for more than 1 month

inability to recall key features of trauma

overly negative assumptions about self or world

blaming self for causing trauma

feelings of isolation

heightened startle reaction

irritability or aggression

hypervigilance

difficulty concentrating or sleeping

Nature of Trauma

the following factors make any event more stressful and influence the likelihood of developing PTSD

human intent

degree of direct exposure

degree of unpredictability or uncontrollability

length and frequency of event

individual factors

low social support, greater neuroticism (personality trait associated with maladaptive coping responses to stress), pre-existing mental health problems, maladaptive appraisal of early symptoms, s/s allele of the 5HTT gene, not identifying with the reasons for combat

Prevention of PTSD

debriefing after the event

critical incident stress debriefing (CISD)

3-4 hour individual/group session

Usually 2-4 days after event

Participants encouraged to talk about their experiences

CISD conclusions

debriefing is intuitively appealing, no convincing evidence that’s helpful, at early stage - group format can be detrimental, debriefing may impede natural recovery

Psychological First Aid - 8 steps

contact & engagement

safety & contact

stabilization

information gathering

practical assistance

connection w/social support

Information on coping

Linkage with Collaboration Services

Acute Stress Disorder

acute response to traumatic (Criterion A) event

Similar criteria to PTSD, except for the time criteria (response lasts from 3 days to 1 month), individuals with ASD are at a greater risk of developing PTSD, but symptoms may remit over the month for some

Treatment for PTSD

medication (SSRIs, antipsychotics) - benzodiazepines (cannot be recommended as monotherapy for PTSD due to increased risk of substance abuse and interference with extinction learning)

Therapy (Prolonged Exposure & Cognitive Processing Therapy)

CPT Overview

targets the meaning of the traumatic event, in terms of its impact on one’s beliefs about themselves, other, and the way the world works

using classic cognitive restructuring strategies, CPT helps patients re-evaluate their ‘stuck points’ using evidence

preferable PTSD treatment?

there are common processes across treatments that seem to contribute to favorable outcomes, like: organizing one’s understanding of the trauma, and processing the aversive event in a safe environment with a compassionate and non-judgmental clinician

additional data is needed to determine whether individual characteristics (type of trauma, patient age, number of comorbidities) are associated with better response rates in one treatment vs. another