PSY 350 - Trauma and Stressor Disorders

Do different types of stressors produce different reactionos?

No! They all produce a similar pattern of physiological and psychological reaction

What are the general adaptation syndrome (GAS) stages? (3)

1. Alarm reaction

- autonomic NS activates the fight-or-flight response

2. Stage of resistance

- coping mechanisms are used to defend against the continuing effects of stress

3. Stage of exhaustion

- results from the long-term effects of resistance; physical signs of exhaustion; in extreme situations, can result in death

What are the physical reactions to stress?

The alarm reaction

1. The body prepares to cope with the stressor

- fight-flight-orfreeze response

- activity in the parasympathetic division temporarily stops

- HR, blood pressure, respiration, and production of glucose increase

- pupils dilate, muscles tense, immune system slows down, analgesia

- Attention and concentration increase

- More vigilant to danger, heightened anxiety

- Release of endorphins

What are the psychological reactions to stress?

1. Coping refers to people's efforts to modify or tolerate stressors

2. Stress is the result of transactions between the individual and the environment

- Stress results when perceived demands exceed the ability to cope

3. Response to stress

- primary appraisal (can i handle this?)

- evaluate coping resources

- enact coping strategies

Resilience and stress

Most people are exposed to significant stressors in their lives, but only a minority develop PTSD

Post-traumatic growth (PTG)

- individuals surpass their pre-trauma well-being, usually after a period of post-trauma distress (this is the goal!)

PTSD

PTSD

1. fewer than a third of people exposed to horrible trauma will experience PTSD symptoms

2. Diagnosed at least one month after the traumatic event

3. Criterion A (trauma) event

- war, natural disasters, serious accidents, torture, various forms of abuse

4. Approximately 7% of people PTSD in their lives

5. Acute stress disorder is often diagnosed first

- symptoms within 1 month after trauma

- last more than 2 days but less than 1 month

PTSD in the DSM V

1. Trauma or stressor

2. Person was exposed to: death, threatened death, actual/threatened serious injury, or actual/threatened sexual violence (one required)

3. Direct exposure

4. Witnessing, in person

5. Indirectly, by learning that was a close relative or close friend was exposed to trauma

- unexpected

- violent

6. Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties

Why does PTSD NOT include TV, movies, or video games?

1. It is not real

2. You can turn it off

Intrusive symptoms

The traumatic event is persistently re-experienced in the following way (one required):

1. Recurrent, involuntary, and intrusive memories

2. Traumatic nightmares

3. Dissociative reactions, which may occur on a continuum from brief episodes to complete loss of consciousness

- flashbacks (brief break from reality) SEVERE!

4. Intense or prolonged distress after exposure to traumatic reminders

5. Marked physiologic reactivity after exposure to trauma-related stimuli

What did the movie clip about the Ledge, the marine, show?

How PTSD can change somene's mind about something they used to enjoy and how realistic it was

Avoidance symptoms

Persistent effortful avoidance of distressing trauma-related stimuli after the event (one required):

1. Trauma-related thoughts or feelings

2. Trauma-related external reminders (people, places, conversations, activities, objects, or situations)

Negative alterations in cognition & mood from PTSD

Symptoms that began or worsened after the traumatic event (two required):

1. Inability to recall key features from the event

2. Persistent negative beliefs/expectations about oneself or the world

3. Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences

4. Persistent negative trauma-related emotions

- fear, horror, anger, guilt, or shame

5. Markedly diminished interest in significant activites (pre-traumatic)

- anhedonia

6. Feeling alienated from others

- detachment, estrangement

7. Constricted affect

- persistent inability to experience positive emotions

Alterations in arousal and reactivity from PTSD

Alterations that began or worsened after the event (two required):

1. Irritable or aggressive behavior

- can be defensive

2. Self-destructive or reckless behavior

- trying to feel alive

3. Hypervigilance

- never resting

4. Exaggerated startle response

- Kraft being at a football after serving a tour

5. Problems in concentration

6. Sleep disturbance

- massive!!!

What are the causes of PTSD?

1. Intensity of the trauma and response to it

2. Learn alarms --> direct conditioning and observational learning

- growing up

- what triggers their stress response?

3. Biological vulnerability

- excessive surges of NTs such as NE

- excessively strong adrenergic response to the traumatic event

- heightened autonomic reactivity

- limbic system involvement

4. Uncontrollability and unpredictability

What reduces risk of PTSD?

Social support post-trauma

- ASAP!!!

What are the psychological causes of PTSD?

Impairment of the hippocampus can result in aberrant memory formation

1. Isolated fragments of memory

2. Amnesia for the autobiographical context of stressful events

3. Stronger than normal recall of emotional memories

What is the two-factor conditioning model?

Previously neutral stimuli become conditioning emotional stimuli through their association with fear and pain

- Victim tries to avoid these stimuli (operant conditioning)

- Getting attacked at a bus stop --> not feeling safe at a bus stop --> bus stop didnt change

What are fear networks?

Memory networks that interconnect all the fear stimuli and response elements associated with the trauma, as well as the meaning of the event to the person

- When any part of the fear network is accessed and activated, escape and avoidance programs are set in motion

What are some pre-trauma experiences of PTSD?

1. Younger age

2. Lower socioeconomic status

- Correlated? Access to care?

3. Risk-taking behavior

4. Past trauma history (100%!!!)

- esp. untreated!!

5. Previous psychiatric history

What are peri-trauma experiences of PTSD?

1. Crime-related trauma

2. Extent of injury

3. Greater emotional distress and physical pain

4. Physiological arousal

5. Psychological perceptions of the trauma

6. Belief that one's life is in danger

7. Helplessness

What post-traumatic events of PTSD?

1. Lack of social support

2. Continued life stressors

What are the treatments for PTSD?

1. Cognitive-behavioral therapy (CBT)

- highly effective!

2. Cognitive processing therapy

- "Stuck points" that need to be broken down

- "What if?" questions??

3. Prolonged exposure

- Have the patient retell the story over and over again

- Stress goes down the more you sit in your thoughts

4. EMDR

- Eye Movement Desensitization and Reprocessing

*All 3 evidence-based treatments that work for the extinction of the event through exposure

Why don't we say PTSD is cured?

Triggers in the future can still cause PTSD to come back

What is the medication for PTSD?

Meds effective against anxiety and panic

1. SSRIs

- most common

- two are FDA-approved

2. Sleep Aids

- Many patients have sleep disturbances

-

3. Off-label

- other SSRIs

- beta-blockers for lower HR???

4. Benzodiazepines

- Black box warning (mostly dangerous!)

- do not work

What is acute?

May be diagnosed 1 to 3 months post trauma

What is chronic?

DIagnosed after 3 months post trauma

What is delayed onset?

Onset 6 months or more post-trauma

What is acute stress disorder?

Symptoms occur immediately post-trauma (up to one month)

What are adjustment disorders?

1. Anxious or depressive reactions to life stress

- DIRECTLY related to a stressor in their life, resolved once it is removed

2. Milder than PTSD/acute stress disorder

3. Occur in reaction to life stressors like moving, new job, divorce, etc

- can be chronic or acute

4. Clinically significant distress or impairment

What are the 5 subtypes of adjustment disorder?

1. With anxiety

2. With depressed mood

3. With disturbance of conduct

4. With mixed disturbance of mood and conduct

5. With mixed anxiety and depressed mood

What is the treatment for adjustment disorders?

1. Most mild adjustment disorders resolve themselves without formal treatment

2. Even serious cases have a generally favorable prognosis

3. Use of psychotropic drugs is not supported

4. Psychotherapies are most supported by evidence

- CBT

- focus on enhancing factors that reduce stress

- problem-focused coping, emotion-focused coping, social support