Trauma and Stressor Related Disorders

Cognitive Processing Therapy (CPT)

Involves discussion of key themes, including challenges to safety, trust, power, and self-esteem

Exposure to memory through written accounts

Characteristics of Trauma

Single event vs. sustained/chronic exposure

Expected vs. unexpected events

direct vs. indirect experiences

Perpetrator identity/relation (who the perpetrator is) and intentionality

Trauma can create significant losses (trust, control, sense of self, stability) which also negatively affect functioning

Differences in trauma

History of prior traumas (includes cumulative effects)

History of mental disorders (think of diathesis stress model)

Men have greater risk for ______

trauma exposure

Women are at greater risk for ______

PTSD

Women experience ______ and ______ assault

psychical and sexual

Men are more likely to experience _________ and _________ victimization

combat and crime

Men’s traumas are more likely to occur in ________, women’s in _______

public, private (by intimate partner)

How do diverse ethnic, racial, and cultural (minority) groups differ in their experiences with trauma?

They are more likely to experience adverse effects from various traumas

Individuals of minority sexual orientation and gender identity are at higher risk of _______, _______, and __________

assault, hate crimes, and laws of exclusion

__________ orientation is a risk factor for women (for sexual orientation)

Heterosexual

Adverse Childhood Experiences (ACEs)

Child Abuse (sexual, physical emotional, neglect)

Substance-dependent parent

Incarcerated, mentally ill, or suicidal household member

Spousal abuse between parents

Divorce or separation that meant one parent was absent during childhood

About ____% of adults across 25 states reported they had experienced at least ___ type of ACE

61%, one

Nearly x/x reported they had experienced ____ or more ACES

1/6, 4

Tragedies that occur outside of developmental sequence

Child dying before parent

life-threatening illness diagnosed in young adulthood

Cumulative Trauma

Repetitive exposure to traumas over the lifetime

Complex trauma

Chronic, sustained trauma experiences (ex: child abuse)

multiple, prolonged, and repeated trauma in childhood

What can complex trauma disrupt?

Developmental processes

attachment

emotion regulation

life assumptions

Cognitive interpretations of later experiences

The lifetime prevalence of PTSD in women is ____% in women and ____% in men

10.4% and 6.8%

There are higher rates of PTSD reported among these ethnic groups

US Latinos, African Americans, American Indians

There are lower rates of PTSD among this ethnic group

Asian Americans

____% of men and ____% of women with a Dx of PTSD at some point in their lives had at least one other mental disorder

88%, 79%

In men, the prevelance of comorbid alcohol abuse or dependence is ___% and conduct disorders are ___%

51.9%, 43.3%

Traumatic stressors are common, with a lifetime prevalence of trauma being ___% for men and ____% for women in a US sample

60.7%, 51.2%

Not all stressors confer the same…

degree of conditional risk for the development of the disorder

Being a prisoner of war, combat, and rape confer a much higher risk of ____ than witnessing an event or experiencing a natural disaster

PTSD

Psychopathology does not reflect the presence of trauma reactions, rather…

the persistence of these reactions

Trauma and stressor-related disorders

Adjustment

Acute Stress

PTSD

Reactive Attachment

Disinhibited Social Engagement

Essential Criteria for PTSD

“exposure to a threatened death, serious injury, or sexual violation” (direct experience, witnessing, learning about stressor)

4 clusters

Sx last at least 1 month

Cause clinically significant distress or impairment

4 Clusters of PTSD criteria

Intrusions

Avoidance

Negative alteration in cognitions and mood

Arousal and reactivity

Cluster 1

Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s)

recurrent distressing dreams

dissociative reactions (flashbacks/feels as if it’s reoccuring)

intense/prolonged psychological distress at exposure to internal/external cues

Cluster 2

Persistent avoidance of stimuli associated with the event (avoiding memories, thoughts, feelings associated with events

Avoidance of external reminders

Cluster 3

Negative alterations in cognitions and mood associated with traumatic events

inability to remember aspect of event

persistent and exaggerated negative beliefs or expectations about self, others, and world

persistent, distorted cognitions about cause/consequences of traumatic events (blame self/others)

persistent negative emotional state

markedly diminished interest or participation in significant activities

feelings of detachment or estrangement from others

Cluster 4

Alterations in arousal and reactivity

irritability

reckless/self-destructive behavior

hypervigilance

exaggerated startle response

sleep disturbances

Acute Stress Disorder

Similar to PTSD EXCEPT

Sx last 3 days to 1 month follow exposure to events(s)

Approximately ___-___% of variance in PTSD is attributed to genetic and heritability factors after a trauma

33-70%

Brain structures/regions of
interest in trauma/stressor disorder

decreased medial prefrontal cortex activation

increased amygdala

HPA Axis

Hypothalamus releases hormone while tells Pituitary gland to release hormone which tells Adrenal gland to produce cortisol

Long-term: Too much cortisol “shuts body down” (feeling like you’re under chronic attack)

Psychosocial models: Classical Conditioning in trauma disorders

Experience of danger or perceived danger leads to development of learned danger signals

Previously neutral stimuli (ex: car) becomes pared with the traumatic/stressful event (crash

Leads to development of persistent anxiety-based reaction

Cognitive model of trauma disorders

Shock from the trauma shatters previously held beliefs about safety and worthiness of self

individual’s maladaptive beliefs about the traumatic event, the world, and self are questioned

Maladaptive Coping

Avoid, safety behaviors, rumination

Eye movement desensitization and reprocessing (EMDR)

Visual or auditory tracking during activation of the trauma memory, a variant of exposure therapy

Prolonged exposure therapy

In vivo experiences and imaginal exposure

Trauma-focused cognitive therapy

New, adaptive information is introduced via cognitive restructuring and behavioral experiments to update the trauma memory

Witnessed traumatic events included

direct observation and indirect exposure

_________ does not qualify as an indirect exposure to trauma

death due to natural causes

Brain structures/regions related to trauma/stressor disorders

decreased medial and prefrontal cortex activation

increased amygdala