Ch 6. (quiz 4) PSYC DIS

Propranolol:

a beta blocker commonly used for high blood pressure and heart conditions

Researchers became interested in Propranolol because…

stress hormones such as Adrenaline, help strengthen emotional memory consolidation

• Can block stress hormones and relieve the physical symptoms of anxiety, without affecting cognitive functions 

PTSD/Propanol process:

1. Traumatic event occurs

2. Adrenaline surges

3. Brain stores a partial emotional memory

4. Propranolol…

blocks some of adrenaline’s effects, potentially weakening the emotional “stamp” placed on the memory

Importantly, propranolol does NOT…

erase memory

• people generally still remember what happened, it just softens the emotional association to the event

What had statistically significant effect on reducing the severity of PTSD symptoms, with a moderate effect size:

propranolol

The state of stress has two components:

1. Stressor

2. Stress response

Stressor:

event that creates demands (of stress)

Stress response:

person’s reactions to the demands (the stress)

• influenced by how we judge both the event and our capacity to react to the event effectively

DSM-5-TR lists “Trauma Disorders”:

• Acute Stress Disorder

• Post Traumatic Stress Disorder (PTSD)

Acute Stress Disorder vs. Post Traumatic Stress Disorder (PTSD):

(respectivley)

• begins and ends within a month

  • at least half of cases develop into PTSD

• symptoms may begin either shortly after the event, or months or years afterwards

Acute Stress Disorder:

• Onset

• Duration

• Symptoms

• Treatment

• 0-28 days after trauma occurs

• lasts between three days and four weeks

• Depersonalization and derealization

• Short-term psychotherapy and antidepressant medication

Post-Traumatic Stress Disorder:

• Onset

• Duration

• Symptoms

• Treatment

• at least one month after the trauma occurs

• lasts a least one month and can persist for several years

• Avoidance, heightened awareness, and changes in mood or cognition

• Long-term psychotherapy, medication, and EMDR therapy (eye movement desensitization and reprocessing)

Acute Stress Disorders and PTSD are almost identical (such as the symptoms), aside from…

the differences in onset and duration

DSM-5-TR lists “dissociative disorders”: 

• Dissociative Amnesia  

• Dissociative Identity Disorder (not MPD anymore) 

• Depersonalization-Derealization Disorder 

Dissociative Amnesia??

???

Dissociative disorders, and the primary symptoms:

group of disorders also triggered by traumatic events

• severe memory and orientation problems

Dissociative disorders — features of ____ and ____ are set in the ___.

arousal and fear in the hypothalamus

Dissociative disorders — two important systems are activated:

• Autonomic nervous system (ANS)

• Endocrine system

Autonomic nervous system (ANS):

extensive network of nerve fibers that connects central nervous system (brain and spinal cord) to all other organs of the body

Endocrine system:

network of glands throughout the body that releases hormones

Fight or Flight Response: HPA Axis

• Two brain-body routes that produce arousal:

Sympathetic nervous system pathway

Hypothalamic-pituitary-adrenal pathway

Four symptoms clusters of PTSD/Diagnosis

• Intrusive symptoms (classically conditioned)

• Avoidance (operant conditioning)

• Negative cognitions and mood

• Arousal and reactivity

*must be present for more than 1 month

*significant distress or impariment/dysfunction

PTSD intrusion:

dreams, flashbacks, memories, distress

PTSD: Avoidance

• avoid memories, thoughts, feelings of trauma

• activities place, people, that arouse distress

PTSD: Cognition/Mood Alterations

more negative emotions, less positive

PTSD: Arousal & Reactivity

• sleep disturbance

• irritability, angry outbursts

• reckless behavior

• hard to concentrate/finish tasks

2/3 of veterans with PTSD are not being treated, and are …

• re-experiencing flashbacks

• re-experiencing thoughts

• Avoidance

• Arousal Guilt

Add in Ted Talk?

??

Cognitive Behavioral Therapy (CBT) includes therapy sessions, but also involves…

homework, and work outside of therapy sessions

What triggers Acute and Posttraumatic Stress Disorder?

• Prevalence rates among groups and populations

• ratio of women to men is 2:1

• low income? — twice as likely to develop one of these disorder

—> *can not infer causality

Combat, disasters, abuse, and a victimization traumas and experiences more likely…

to cause disorders than others

Ex: military incident, sexual harassment

Why do people develop Stress Disorders?

*Likely the event (stressor) PLUS a predisposition (diathesis) that causes a stress disorder

• extraordinary trauma can cause a stress disorder

• BUT the event alone may not be the entire explanation

Multifinality:

persons challenged by similar negative variables in childhood MAY wind up with…

different clinical outcomes

Equifinality:

different predispositions, similar outcomes

Diathesis (a predisposition) —> if there is NO significant stressor, then…

no psychopathology

Explanations of PTSD Vulnerability:

• Sociocultural factors

• Psychological factors

• Biological factors

Explanations of PTSD Vulnerability: Sociocultural factors

1. Severity, duration, proximity of trauma

2. Social support

Explanations of PTSD Vulnerability: Psychological factors

1. Personal assumptions

2. Pre-existing distress

3. Coping styles

Explanations of PTSD Vulnerability: Biological factors

1. Physiological hyperreactivity

2. Genetic

Why do people develop stress disorders?

Processes — Feedback Loop

chronic or repeated traumatic stress can alter the brain and weaken regulatory systems

• Ex: “Kindling effect” — does not take much to trigger a big response

HPA Axis & Hippocampus:

• the Hippocampus acts as a…

powerful brake on the HPA (hypothalamic-pituitary Adrenal) axis

• helping your body turn off the stress response once the threat passes

About half of all cases of PTSD improve within…

6 months; the remainder may persist for years 

How are stress disorders treated?

Treatment procedures vary depending on type of trauma 

• General goals: 

• End lingering stress reactions 

• Gain perspective on painful experiences 

• Return to constructive living

PTSD Treatment — Cognitive Behavioral therapy (forms)

• Prolonged exposure

• Systematic desensitization

*Cognitive techniques to challenge irrational thought

• Virtual reality

• Stellate ganglion block (SGB)

Stellate ganglion block (SGB), may:

1. Reduce excessive norepinephrine (adrenaline-related signaling).

2. Decrease sympathetic overactivity.

3. Allow stress-response circuits to “reset” to a less activated state.

4. Improve symptoms such as hypervigilance, startle responses, irritability, and sleep disturbance.

Reliving your worst memory can be…

therapeutic OR traumatizing

Dissociative disorders are marked by…

and occurs when…

• major changes in memory that do not have clear physical causes

• one part of memory or identity become separated from other parts

Dissociative disorders can involve identity

a sense of what we are and where we fit in our environment

Dissociative disorders can involve memory

the key to this sense of identity, link between our past, present, and future

Cognitive Interview, components:

• Context reinstatement

• Report everything

• Variety of perspectives

• Temporal order

Cognitive Interview: Context Reinstatement

interviewee encouraged to mentally reconstruct physical and personal context of event

• state-dependent learning

Cognitive Interview: Report everything

no matter how small or incomplete, you report

Cognitive Interview: Variety of perspectives

sharing your own and others’ perspectives of the stressor

Cognitive Interview: Temporal Order

• From start to end

• From end to backwards

  • Pictures still — (more detail/context)

  • Moving forward or started backwards or in the middle

Eye Movement Desensitization and Reprocessing (EMDR) --

an exposure treatment in which clients move their eyes in a rhythmic manner from side to side while flooding their minds with images of objects and situations they ordinarily avoid. 

Hypothalamic-pituitary-adrenal (HPA) axis):

hypothalamus signals pituitary gland to secrete ACTH (adrenocorticotropic hormone) —> corticosteroids released to help the body cope