Psychopathology, Exam 2

Myths about depression

sad, weak personality, personal flaw, lazy, selfish

DSM-5 definitions of major depression

• Must include (at least one):

  • Sad/low mood

  • Anhedonia - Loss of interest or pleasure in usual activity

    • Used to like it, but don’t like it anymore

• May include:(5+ depressive symptoms, including sadness and/or anhedonia)

  • Changes in sleep

    • Too much or too little

  • Change in appetite or weight

  • Psychomotor agitation or retardation

  • Loss of energy

  • Feelings of worthlessness or excessive/inappropriate guilt

  • Difficulty concentrating, thinking, decision making

    • Hard to be present in class 

    • Hard to study or make decisions 

  • Recurrent thoughts of death or suicide

Persistence in depression

• Persistence: Symptoms most of the day nearly every day, for 2+ weeks

Impairment in depression

Impairment: Causing significant impairment / distress

Grief, stressors, and depression diagnoses

• Grief is just another life stressor

• We shouldn’t exclude it from diagnoses

• Grief should be recognized as a significant factor in the diagnosis of depression, acknowledging that it can coexist with other stressors.

Persistent Depressive Disorder

A chronic form of depression characterized by the presence of depressive symptoms lasting for at least 2 years in adults. It may involve periods of major depressive episodes but is distinct due to its long-lasting nature.

Major Depressive Disorder

A common and severe form of depression that significantly impairs daily functioning. It is characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in most activities, lasting at least two weeks.

Differences between MDD and PDD

MDD

-5 or more symptoms including sadness or anhedonia

-at least 2 weeks duration, all day, nearly every day

PDD

-2 or more symptoms including depressed mood

-at least 2 years duration, more days than not

Course and frequency of depression 

• Average age of onset is in early 30s, however this has decreased over past 50 years 

• % of children/teens with depression rose dramatically during COVID 

• ~50% recover within 6 months

Patterns of depression 

• Some experience a single depressive episode, most have repeated episodes 

  • Accounts for 10% of disability worldwide 

  • ~16% to 20% of population experience major depression 

Depression Prevalence and Incidence statistics

• Women are almost 2* as likely as men to be diagnosed with depression 

  • Difference in rates by gender peaks during adolescence

What causes depression?

• Biological factors 

• Psychological factors 

  • Cognitive theories 

    • Thoughts create feelings → feelings create behavior → behavior reinforces thoughts

Automatic negative thoughts

• fast, involuntary, and habitual mental evaluations or stream-of-consciousness ideas that pop into your head automatically without conscious control.

• Persistent and pervasive focus on negative thoughts influence our current mood and our thoughts on the future → depression

Attributions theory

The way we explain causes of events

Depression associated with a tendency to view the causes of negative life events as being internal (“my fault”), stable (“always going to happen”) and global (“affects everything in my life”)

External attribution

Describing negative events as stemming from external factors rather than internal ones, which can mitigate feelings of helplessness and depression.

“This was beyond my control”

Unstable attribution

Attribution that suggests causes of events can change and are not permanent in nature, influencing feelings and behavior differently according to the context.

“This job was just too demanding for me right now but I will do better in another one”

Local/ specific attribution

Attributing negative events to specific, changeable circumstances rather than permanent traits or external factors.

“My next job will be better for me”

Internal attribution

Describing negative events as resulting from internal characteristics or traits, which can increase feelings of helplessness and depression. "I failed because I am not good enough."

Stable attribution

Attribution that views causes of events as fixed and unchanging, often leading to feelings of resignation or hopelessness. For example, "I always mess things up because I am just bad at this."

Global attribution

The belief that negative events result from universal and unchangeable factors, leading to a pervasive sense of hopelessness. An example would be, "I fail at everything in the future"

Social factors of depression

• Stressful life events predict depressive disorders 

• 42-67% report stressful life event in year prior to depression 

  • Longer time before remission 

  • Poorer response to treatment

Biological causes of depression

• Gene * environment is key 

• Heritability 50% 

• Neurotransmitters 

  • Serotonin – one of the leading theories -> low levels of serotonin cause depression

    • • Discovered when meds that increase serotonin were found to help mood

    • • However, increasing serotonin via meds doesn’t always work, and it takes time

    • • Research is mixed, unlikely to be the single cause

    • • Serotonin, dopamine, norepinephrine and GABA are all likely involved

    • • Variety of symptoms may suggest different involvement via neurotransmitters

Activity in brain regions associated with depression

1. decreased activity in anterior cingulate cortex (motivation, regulation) and dorsolateral prefrontal cortex (planning)

2. increased activity in amygdala and ventromedial prefrontal cortex (emotional salience and regulation)

Behavioral activation for depression

Increased activity by increasing more pleasurable events to improve depressed mood

CBT for depression

• Identifying thoughts, feelings and cognitive distortions

  • Common cognitive distortions in depression:

  • All or nothing thinking

    • “I forgot something my boss asked of me, I am now the worst worker”

  • Disqualifying the positive

    • “I was just lucky!”

  •  Catastrophizing

    • “If I fail this exam, my life is effectively over”

  • Shoulds

    • “I should’ve done that.”

• Mindfulness Based Cognitive Therapy  for depression

• Goal: recognize when start to feel sad, adopt perspective where thoughts are mental events not facts

• Observe thoughts/feelings

• Especially useful in reducing relapse of depression

• Interpersonal Psychotherapy 

is a structured, time-limited treatment that focuses on improving interpersonal relationships and social functioning to alleviate depressive symptoms. It addresses issues such as grief, role disputes, and interpersonal deficits.

Selective serotonin reuptake inhibitors (SSRIs)

are a class of medications commonly prescribed to treat depression by increasing levels of serotonin in the brain, thereby improving mood and emotional well-being.

• Block reuptake of serotonin 

• Side effects common 

  • Akathisia 

  • Weight gain 

  • Emotional blunting 

• Fairly effective 

• Take 4-6 weeks 

• Not effective for up to ⅓ of people

Serotonin and Norepinephrine reuptake inhibitors (SNRIs)

are a class of antidepressant medications that work by increasing the levels of serotonin and norepinephrine in the brain. They are used to treat major depressive disorder and other anxiety disorders, helping to improve mood and emotional balance.

Combining psychotherapy and antidepressant medications

• increases odds of recovery over either alone by 10–20%

  • Medications quicker, therapy longer-lasting effects

  • CBT as effective as medication for severe depression

  • CBT more effective than medication at preventing relapse

Other treatments of depression

• Electroconvulsive Therapy (ECT)

• Transcranial Magnetic Stimulation (TMS)

  • Applies a magnetic pulse

  • Approved by FDA for treatment resistant depression

  • 30-40% remission rates

• Exercise 

  • Research in MDD suggests walking predicts more positive emotion, less negative emotions 

• Ketamine and Esketamine 

  • Anesthetic used in surgeries / hallucinogen effects

  • Theory: Acts to suppress neurotransmitter activity, alters brain activation patterns and connectivity 

  • Seems to require higher doses -> associated with more side effects

  • Not as much research as other treatments

Bipolar 1 Disorder definition DSM

A mental health disorder characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). According to the DSM, to qualify for Bipolar 1 Disorder, an individual must have experienced at least one manic episode lasting at least one week, which may be preceded or followed by hypomanic or major depressive episodes.

Bipolar 2 Disorder definition DSM

A mental health disorder characterized by at least one major depressive episode and at least one hypomanic episode, but no history of manic episodes. The depressive episodes in Bipolar 2 Disorder can be severe and are often more disruptive than the milder hypomanic episodes.

Mania

• Distinctly elevated or irritable mood

• Abnormally increased activity or energy

  • At least 3 of the following:

    • Increased goal-directed activity or psychomotor agitation

    • Talkative; rapid speech

    • Flight of ideas or racing thoughts

    • Decreased need for sleep

    • Increased self-esteem / grandiosity

    • Distractibility

    • Excessive risky behavior (e.g., reckless spending/sexual behavior/driving)

  • Lasts at least a week most of the day nearly every day, or requires hospitalization

Hypomania

• Last at least 4 days, clear changes in functioning but impairment isn’t as significant from typical functioning. It includes symptoms similar to mania, such as elevated mood, increased energy, and goal-directed activities, but to a lesser degree. Hypomanic episodes may also precede or follow depressive episodes.

Course, Outcome, and Frequency of Bipolar Disorder 

•  Prevalence - ~1% for Bipolar I; ~4% for Bipolar Disorders combined

  • Average age of onset between 18-22 years of age

  • No gender differences in prevalence

• Women report more depressive episodes

• About 3x as many days depressed as manic/hypomanic

• Most have more than one episode

  • More than ½ with the disorder have 4+ episodes across their life

Suicide in bipolar disorder

• ~ 15% of people with diagnosis die by suicide

• 25% report suicide attempt, >50% report suicidal ideation in past 12mos

Biological causes of Bipolar Disorder

• Estimates of heritability range from 70-90% heritability 

• Share genetic risk factors with schizophrenia with MDD 

• Some evidence of reduced brain volume in prefrontal, limbic structures

• Increased activation in amygdala and striatum (limbic system) – increased response to high rewards / goal achievement

• Hypersensitivity to dopamine receptors → mania

MDD and BD genetic comparisons

1. Genetic contribution

   1. High for BD, moderate for MDD

2. Neurotransmitter implication

   1. Mixed evidence

3. Changes in activation of regions in the brain in response to emotion stimuli

   1. Present

4. Activation of the striatum and amygdala in response to emotion stimuli

   1. Diminished in MDD

   2. Elevated in BD

Reward sensitivity

• How motivated a person is to obtain a reward 

  • Increase response to reward cues or pursuing rewards in those with Bipolar disorder and those at risk 

  • Reward sensitivity predicts onset of disorder and more severe symptoms over time 

Goal Striving – setting, pursing and committing to goals in BD

• Improbable goal striving predicts future mania symptoms & onset of BD

• Increase pursuit of extreme goals:

  • “You will have 100 million dollars or more.”

  • “Someone will write a book about your life.”

Med for BD

• First line of treatment is medication 

  • Mood stabilizers, antipsychotics, anticonvulsants 

    • Lithium 

      • Mood stabilizer 

      • Side effects may be severe with lithium toxicity 

      • ⅓ show dramatic response to lithium; another ⅓ show some response 

      • Protective effect against suicide 

  • Bipolar disorder treatment and medication 

    • What about antidepressants? 

      • Paired with mood stabilizer to prevent triggering mania 

    • Medication non-compliance is high 

      • Side effects 

      • Desire to stop mania

• Social rhythms therapy for BD

• Develop daily rhythms; sleep and daily routines; identify patterns and predictors of mood episodes

• Life Charting – the identify personal patterns and triggers

• Goal regulation  BD

• 
  

  • Not doing away with high goals -> focus on breaking down goals into smaller steps

  • Checking in with others on goal pacing

• Creativity and BD 

• Unaffected first-degree relatives of those with BD show enhanced creativity and professional success

Fear

• Present focused (response to immediate danger or a threat) 

• Intensity builds quickly 

• EX: Seeing a bear 

Anxiety

• Future-focused (anticipate and prepare) 

• General diffuse emotional reaction 

• EX: thinking about an upcoming project

Benefits of fear and anxiety

• Help alert us to flee dangerous situations 

• Encourage them to prepare for future events 

• Keep us alert and vigilant

Yerkes–Dodson Law

The Yerkes–Dodson Law states that there is an optimal level of arousal for performance; too little or too much arousal can impair performance. It suggests that moderate anxiety can enhance performance, while high anxiety can hinder it.

Atypical anxiety

• Involves excessive avoidance 

• Pervasive and persistent symptoms of anxiety and fear 

• Causes significant distress and impairment

What’s common across anxiety disorders?

• Persistence and distress 

• Comorbidity is associated with greater severity and poorer outcomes 

• 75% met the criteria for another psychological disorder 

• 60% also have depression 

• 50% of those with 1 anxiety disorder meet the criteria for another anxiety disorder 

Anxiety disorders stats

• Most common disorders 

• 25% of people who qualify for an anxiety disorder actually seek treatment 

  • Specific phobia is the highest 

  • Social anxiety is one of the highest 

  • OCD is the lowest

Social Anxiety Disorder myths

• People with this disorder are just shy

• People with this disorder are happier alone

• People with this disorder just need to avoid the spotlight 

Social Anxiety

• Common to feel anxious when meeting people or going to social events 

• For some, that tension does not go away

Social anxiety disorder in DSM 5

A mental health condition characterized by an intense fear of social situations and being judged by others. Individuals with this disorder often experience significant distress and avoidance behavior, impacting daily functioning.

• Fear or anxiety specific to social settings (noticed, observed, or scrutinized) 

• Fear that others will notice their anxiety and experience social rejection 

• Social interaction consistently results in distress 

• Social interaction is avoided or endured with intense anxiety/distress 

• The fear and anxiety are disproportionate to the situation 

Worry

• Negative emotional thoughts 

• Uncontrollable 

• Concerned with possible future threats/dangers 

• Becomes GAD when 

  • Frequent 

  • Range of topics 

  • Impairing 

• DSM-5: Generalized anxiety disorder (GAD) 

• Excessive worry for at least 50% of the day about a number of events

• Trouble controlling these worries 

• At least 3 of the following: 

  • Restlessness or feeling “keyed up” or on edge 

  • Easily fatigued 

  • Difficulty concentrating or mind going “blank”

  • Irritability 

  • Muscle tension 

  • Sleep disturbance

GAD vs MDD 

• GAD 

  • Worry 

  • Trouble controlling worry 

• MDD 

  • Sad mood 

  • Anhedonia 

• Must have evidence that GAD exists outside of depressed episodes 

• Panic disorder 

• A sudden onset of intense apprehension, terror, and/or feelings of impending doom, peaks quickly (10 minutes)

• Physical symptoms 

  • Shortness of breath

  • Heart palpitations

  • Nausea

  • Upset stomach

  • Chest pain

  • Feelings of chocking/smothering

  • Dizziness, lightheadedness, faintness

  • Sweating

  • Chills

  • Heat sensations

  • Numbness or tingling

  • Trembling

• Psychological symptoms 

  • Depersonalization—feel like outside body

  • Derealization—feel like world isn’t real

  • Fear of losing control/going “crazy”

  • Fear of dying

Panic attack/panic disorder

•  First attack frequently experienced after high stress situation

• Many adults who experience attack, never go on to develop Panic Disorder

• ~ 20% of college students have a panic attack but most don’t have more than one.

• It is response to panic attack that dictates whether one develops panic disorder

  • Recurrent, unexpected panic attacks

    • Unrelated situation 

  • Persistent worry about having more attacks or the consequences of attacks (losing control, having heart attack, “going crazy,” etc.)

  • Significant change in behavior related to attacks (e.g., behaviors designed to avoid having panic attacks such as avoidance of exercise or unfamiliar situations)

Agoraphobia DSM-5 criteria 

• Panic Disorder can occur with or without Agoraphobia

• Criteria for agoraphobia:

  • Fear or anxiety about being in situations difficult to escape or receive help

  • These situations are avoided or endured with intense fear/anxiety

• Note: Often portrayed as being house bound, but it’s not necessarily the case

Specific phobia

• Intense fear of an object or situation that is excessive or unreasonable

• Exposure to phobic stimulus = immediate fear response (may be panic attack)

• Phobic situation is avoided or endured with intense anxiety/distress

• Persists: 6 months or more

• Interferes significantly with daily routines / activities

Anxiety Disorder statistics

Phobia has highest lifetime prevalence 

Women are more likely to be diagnosed 

• SAD happens near adolescence, the rest can be spontaneous

Biological underpinnings for anxiety disorders

• Heritability 

  • Modest 30-50% 

• Genetic vulnerability for anxiety and depression may overlap 

• Neurobiological correlates

  • Limbic system 

  • Heightened activity in the amygdala/insula

• Neurotransmitters 

  • Serotonin, GABA, norepinephrine 

  • The sympathetic nervous system is involved 

    • Physical symptoms

    • Anxiety thoughts 

• Psychological factors for anxiety disorders

• Attention to threat 

  • Tendency to notice negative environmental cues and selective attention to signs of threat 

• Positive feedback loop 

  • Physical anxiety symptoms → thoughts/cognitions → physical anxiety → repeat 

    • Catastrophizing 

environmental factors for anxiety disorders

• Stressful life events often precede anxiety and depression 

cognitive factors for anxiety disorders

• Sustained negative beliefs about the future 

  • Bad things are likely to happen → engage in safety behaviors

    • Like canceling an event, if you avoid that situation it will maintain the negative beliefs

• Phobias 

  • Classical conditioning 

Medications for anxiety

• Benzodiazepines (anti-anxiety medications) 

• SSRI

  • GAD and Social Anxiety Disorder 

• Psychological treatments are considered the preferred treatment of most anxiety disorders 

  • Long-term treatment 

  • No side effects 

• Cognitive behavior treatment for anxiety

• Exposure: effective for 70-90% of clients 

• Role playing: practice social communication for social anxiety 

• Challenging worry/anxious thoughts 

In vivo exposure

• Exposed to fear in real life 

• Highly effective and quick 

  • Dog phobia 

    • Do a fear hierarchy 

Imaginal exposure

• Imagining a fear vividly 

Virtual reality exposure

• Exposed to the fear in VR 

Interoceptive exposure

• Triggering physical sensations to show they are not harmful 

Identify, track, and challenge worries

• Beliefs about worry and prediction 

  • Worried that you would look stupid during the presentation

  • Intensity: 75% 

  • What can you do to test this? 

    • Practice with a friend 

  • What was the outcome?

    • They did not think they were stupid

Attention Bias Modification Training for anxiety

• The most common format displays two stimuli side-by-side (such as a threatening face and a neutral face), which are then replaced by a neutral target probe like the letter "E" or "F".

• By consistently placing the probe behind neutral or positive images rather than negative ones, the program trains the participant's brain to shift attention away from threat cues.

• Repeated sessions aim to weaken the automatic cognitive pull toward negative information and alleviate symptoms of anxiety, depression, or addiction.

Misconceptions about OCD

• Personality quirk or trait 

• Being clean or organized 

• DSM-5 criteria  for OCD

• Obsessions

  • Recurrent, persistent and unwanted thoughts, impulses or images

  • Experienced as intrusive, inappropriate and often nonsensical

  • Not just excessive worries about real life problems

  • Try to suppress / ignore thoughts or try to neutralize with some other thought /action (i.e., compulsion)

• Compulsions

  • Repetitive behaviors or mental acts that person feels driven to perform in response to an obsession or according to rules that must be applied rigidly

  • Acts are aimed at reducing anxiety or distress or preventing obsessive thought, but they are excessive or aren’t realistically connected

    • Obsession: I caused COVID outbreak

    • Compulsion: Wash hands 15 times in a row every time → a momentary reduction in anxiety

common themes in OCD

Common themes in OCD include contamination fears, fears of harming others, perfectionism, and intrusive sexual or religious thoughts.

OCD Course, Outcome, and Frequency

• Prevalence - about 1-2% of the population

• Fairly equal between genders

  • Males more commonly affected in childhood, earlier onset, possibly more chronic course

• Average age of onset = 19.5 years

  • 25% of cases start by 14 years

OCD biology

• Chronic condition, can be extremely severe and debilitating

  • Moderate genetic influences; concordance for MZ twins = .57, for DZ twins = .22

  • Comorbid with mood and substance use disorders

• Medication/Medical Treatment

  • Antidepressants (SSRIs) – Benefit about 60%

  • Relapse is common with medication discontinuation and no therapy

  • Transcranial Magnetic Stimulation (TMS)

  • Deep brain stimulation

    • Not widely used 

ERP for OCD

• Cognitive-behavioral therapy – Most effective for OCD

• Heavy emphasis on behavioral element

• Exposure and response prevention

  • ⅓ drop out of ERP 

  • Very effective

• Exposure and response prevention

• Set up situations that will trigger compulsions and help the individual confront their fears without engaging in compulsive behaviors. Cognitive restructuring may also be included to challenge distorted thoughts.

SSRI + ERP

Combined treatment approach for OCD that utilizes Selective Serotonin Reuptake Inhibitors (SSRIs) alongside Exposure and Response Prevention (ERP) therapy. This dual strategy aims to address both the biological and behavioral aspects of the condition, improving treatment efficacy.

etology of OCD

• Heritability in range of .40-.50

•  Frontal-striatal circuitry

  • Overactivity when shown stimuli that provoke obsessions

  • Successful treatment of OCD with ERP related to reduced activation of OFC and caudate

OCD Psychological models: cognitive

• The white bear experiment proves that trying to suppress a thought only makes it return more frequently and intensely. 

  • In the original 1987 study by social psychologist Daniel Wegner, participants were seated in a room and asked to verbalize their stream of consciousness into a tape recorder for five minutes. Wegner gave them one strict rule: "Try not to think of a white bear." Every time the participant thought of a white bear, or said the words out loud, they had to ring a physical bell on the desk. Despite their best efforts to distract themselves, participants still blurted out the phrase or rang the bell more than once per minute on average.

  • Immediately following this five-minute suppression period, the rule was reversed, and participants were told they were now allowed to think about the bear. Wegner discovered that this group experienced a massive rebound effect, thinking about the white bear far more frequently than a control group that had been allowed to think about the bear from the very beginning. This simple test proved that the human brain cannot consciously force a specific thought away without simultaneously checking to see if it is gone, which ironically cements the thought into your immediate awareness.

Ironic rebound effect

• In OCD, this phenomenon—called the ironic rebound effect—fuels the loop of obsessions because a person's brain splits into two tasks: one trying to find a distraction, and an unconscious monitor constantly checking to see if the forbidden thought has returned. This monitoring ironically keeps the distressing thought highly active and loud, which is why effective treatments like Exposure and Response Prevention (ERP) focus on accepting and allowing intrusive thoughts to exist without fighting them.

  • Thought suppression is hard 

  • Paradoxical effect 

OCD psychodynamic model

The OCD psychodynamic model suggests that obsessive-compulsive symptoms arise from unresolved internal conflicts and anxiety stemming from unconscious processes. This model posits that the compulsive behaviors serve as mechanisms to manage anxiety and provide temporary relief from the distress associated with these conflicts.

PTSD

• Definition is unique within DSM: it is the only disorder that gives a cause to the symptoms 

  • Cause = exposure to trauma 

• Symptom domains: 

  • Intrusive memories 

  • Avoidance symptoms 

  • Negative changes in mood and thoughts 

  • Changes in physical/emotional reactions 

What is trauma

• Debate about what trauma is – 

  • Does it require first-hand experience? 

  • Does it have to be life-threatening? 

  • Exposure to trauma through media?

• Defining trauma will have to evolve with society 

  • DSM-5 Category A

    • Happens to the person (direct experience)

    • Witnessing, in person, occur to others

    • Learning event occurred to close family or friend

      • Vicarious trauma: Repeated exposures to aversive details

        • *can only be through media as long as it’s work related (e.g., firefighters, police)

A-E PTSD DSM

• DSM-5 Category A

  • Happens to the person (direct experience)

  • Witnessing, in person, occur to others

  • Learning event occurred to close family or friend

    • Vicarious trauma: Repeated exposures to aversive details

      • *can only be through media as long as it’s work related (e.g., firefighters, police)

• DSM-5 Category B – Intrusive memories

  • Unwanted memories of traumatic events, flashbacks or nightmares 

  • Recurring 

  • Intense distress or physiological reactivity in response to reminders of trauma

• DSM-5 Category C – avoidance symptoms 

  • Avoids reminders of the trauma 

    • Internal: memories, thoughts or feelings 

    • External: people, places or activities 

• DSM-5 PTSD Category D- negative changes in mood and thoughts 

  • Difficulty remembering important aspects of the trauma

  • Persistent negative beliefs / expectations about self, others and world

  • Persistent blame of self or others about the traumas

  • Feel disconnected from others

  • Anhedonia

  • Persistent negative emotion (e.g., fear, anger)

    • Summary: Decreased interest and pleasure (anhedonia); negative thoughts about self and others; trouble recalls aspects of trauma

• DSM-5– PTSD Cateogry E – Changes in Physical / Emotional REactions 

  • Hypervigilance

  • Exaggerated startle response

  • Irritable

  • Reckless or self-destructive behavior

  • Trouble concentrating

  • Sleep disturbance

Acute stress disorder

• Just like PTSD but 

  • Symptoms only last 3 days to one month 

• Criticisms of acute stress disorder

  • Pathologizing a common, short-term response

  • Not very predictive of PTSD development 

• PTSD facts and statistics 

• Prevalence ~7% 

• Women are about twice as likely as men 

• Commonly comorbid with other anxiety disorders, depression and substance abuse 

• 33% report symptoms 10 years later 

  • Even with treatment 

• PTSD unique risk factors 

  • Directly witnessing violence vs indirect exposure

  • Trauma caused by human vs natural disasters 

  • Prior trauma (additive effect)

• Etiology of PTSD

• Trigger = Trauma 

• Neurobiology 

  • The hippocampus 

  • blunted/diminished activation, smaller in size

  • Limbic system is important 

psychosocial risks for PTSD

• Lack of social support 

• conditioning/learning 

• avoidance/operant conditioning 

  • Avoidance initially alleviates anxiety but keeps it long term

protective factors for PTSD

• Resilience: process, capacity, or outcome of successfully adapting to difficult, stressful, or traumatic life experiences

• Resilience does not mean you don’t feel distress

  • One person can go on with their daily experience while someone else turns inward 

people with best outcomes in PTSD have

• Cognitive abilities 

  • Ability to reframe negative events without engaging in self-blame or overaccomodation 

• Emotion regulation skills 

• Social conectedness

• Active coping

• PTSD treatment  biological

• Medications 

  • SSRIs 

  • Benzodiazepines

• Prolonged Exposure  PTSD

• Build up resources – relaxation training 

• Imagery rehearsal – describing trauma in detail 

• Exposure – feared or avoided triggers 

CPT

• Identify problematic beliefs related to trauma experience

• Self blame: I’m a failure for not stopping event, it’s all my fault

• Challenge these ideas / beliefs about blame towards self

• Write about impact trauma has had on life

• Process emotions related to trauma

EMDR

• Breathing, meditation

• Recall past trauma

• Bilateral stimulation – eye movements, alternating taps from left to right

• Skill building

• controversial

Other treatments for PTSD

• Psychedelics 

  • As an addition to therapy

  • Potential mechanisms: reduce fear, increase social engagement and compassion

  • Neural changes unclear – research pending!

• Animal-Assisted Therapy 

  • Increase feelings of connectedness, reduce loneliness 

  • Decrease frequency of nightmares and sleep disturbances 

  • Increased participation in life outside the home