Abnormal Terms/Theories

trauma

emotionally painful, shocking, stressful, sometimes life-threatening experience (could include physical injuries or witnessing distressing events)

what are the 8 criteria to diagnosing PTSD

1. EXPOSURE to actual/ threatened death, serious injury, or sexual violence

2. changes in REACTIVITY or arousal

3. AVOIDANCE symptoms

4. INTRUSTIVE symptoms

5. negative changes in MOOD and cognition

6. disturbances last a MONTH

7. cause significant distress or IMPAIRMENT in social/occupational areas

8. disturbance not attributed to other physiological effects or medical CONDITIONS

describe the first 5 critera to diagnosing PTSD, include # of symptoms required, and examples

EXPOSURE to actual/ threatened death, serious injury, or sexual violence

• ex. through: direct experience or witnessing

changes in REACTIVITY or arousal (2 or more)

• irritable behaviour/ angry outbursts

• startle response

AVOIDANCE symptoms (1 or more)

• avoid interal stressors (memories, feelings)

• avoid external reminders (places, objects)

INTRUSTIVE symptoms (1 or more)

• distressing nightmares

• dissociative reactions (flashbacks)

negative changes in MOOD and cognition (2 or more)

• inability to remember aspects of trauma

• persistent neg. emotional state

definition of biological treatments for disorders

methodology of helping to improve/reduce symptoms based on the assumption that phsiological factors (such as neurochemical imbalance) are infolved in psychological fisorders (like PTSD)

• includes drug therapy, electroconvulsive therapy (ECT), psychosurgery

drug therapy

used to treat disorders based on theories of brain chemistry and neurotransmitters

• doesn’t work for all, and not fully known why individuals react differently to the same drug (why it works vs doesn’t)

• used to alleviate (physiological) symptoms to make other forms of therapy possible

• SSRIs and beta blockers

what are SSRIs and how do they work

SSRI = selective serotonin reuptake inhibitors, serotonin agonist

works on the pre-synatpic neuron, and blocks the reuptake of serotonin so that serotonin remains in the synapse for longer, able to continue to be used

serotonin

an inhibitory neurotransmitter

• physically constricts blood vessels, brings on sleep, helps with temp regulation

• imbalances associated with depression, suicde, impulsive behaviour, aggression

agonist

amplifies the effect of a neurotransmitter by…

1. mimicking the neurotransmitter

2. preventing it from being removed from synapse (either from enzymes or reuptake)

3. increasing production of neurotransmitters

what are the strengths and limitations of SSRIs as PTSD treatment

strengths

• helps alleviate symptoms, allows for use of other treatments (in conjunction with psychological therapies)

limitations

• negative side effects (nausea, weight gain, insomnia)

• not sure why/how they work, why not effective for some

• reductionist (rely too heavily on drug treatments, neglects importance of psychological/ social factors)

what are beta blockers and how do they work

block the transmission of norepinephrine (excitatory neurotransmitter), norepinephrine antagonist

• works with post-synaptic neuron and causes norepinephrine to not transmit a signal from pre →post-synaptic neuron

• (norepinephrine either reuptaken or broken down)

norepinephrine

an excitatory neurotransmitter

• linked to memory consolidation, recall of emotional events

• released in stress response (fight/flight/freeze)

antagonist

substance that inhibits/reduces the effect of a neurotransmitter by…

1. blocking receptor sites

2. increasing removal of neurotransmitters from synapse

3. decreasing production of neurotransmitters

strengths and limitations of beta blockers

strengths

• rate that drug impacts past memories (instead of just future)

limitations

• short time frame: most effective within 6 hours of event

• side effects (sedation, difficulty paying attention)

• may reduce consolidation of positive emotional memories

• don’t know if those who DIDNT develop PTSD would’ve had the same outcome WITHOUT drug

what is electroconvulsive therapy (ECT) and how does it work

treatment of electrical stimulation of the brain while the patient is under general anesthesia

1. before, patient is given general anaesthetic and musicle relaxant

2. electrodes attached to specific locations on scalp

3. brain is stimulated with brief controlled electrical pulses (causes 1 min seizure)

believed to make serotonin receptors in postsynaptice neuron more sensitive, influence transmissioon of other neurotransmitters BUT mechanism not fully understood

what are the strengths and limitations of ECT

strengths

• short duration (ex. 3 weeks)

• may have higher rentention rate

• short treatment with potentially long-term treatments

• lessens severe symptoms to allow other therapies to work

limitations

• not approved by APA for PTSD treatment

• may only be effective in severe cases to reduce severity

• side effets (nausea, headaches, fatigue)

• risks associated wtih anesthesia

deep brain stimulation

newer approach, could be used in combo with other treatments

• certain areas of the brain have electrodes implanted, and connected to pacemakers

• designed to alleviate severe symptoms

psychological treatment for disorders

may be more personal than drug therapy, individualised to meet needs

focused on their life situation, and subjective understanding of their psychological problems

helps to identify unhealthy thought patterns/behaviours, suggest strategies to manage stress/symptoms

what is virtual reality exposure therapy (VRET) and how does it work

effective for treating acute PTSD (within a few months of symptoms)

theory that illusion of presence in virtual world allows for emotional processing of memories related to that event

theory that habituation (decreased reponse as event is normalised) must occur

1. partient describes even so situation is created in VR

2. equipped with VR helmet with speakers

3. in sessions, patient views multiple scenes of the event, paired with sounds

4. patients stop or proceed depending on stress response

strengths and limitations of VRET

strengths

• individualised therapy can focus on specific thinking patterns/concerns*

• creates a supportive relationship that is absent in drug therapy*

• low attrition rate (may feel like a more active approach, or a result of sampling bias [adverse just don’t sign up])

• less stigma compared to drugs or normal therapy (appears cool to younger generation)

* true for all psychological treatments

limitations

• not enough peer-reviewed studies (mostly case studies)

• ethical concerns about exposure therapy (traumatic)

• drug therapy may be needed in conjunction with VRET

• most VRET done in individualist cultures, not sure if effective in collectivist (individualist emphasises YOUR emotions)

• not applicable to all trauma (if forgotten, or about abuse, or super specific/ uncommon)

• older generations may be hesitant to use

what is present-centered therapy PCT and how does it work

(originally developed as a placebo)

non-trauma focused treatment centred around current issues, not directly processing trauma

• provides psychoeducation about the impact of trauma on them

• teaches problem-solving skills/strategies

• homework to practice adaptive solutions in response to triggers

• relies on benefits from caring therapeutic relationship

• instills hope, optimis, shared goal setting

strengths and limitations of PCT

strengths

• higher rentention rate than other psychological therapies (no stressful confrontation of trauma)

• appropriate for those who don’t want to discuss or cannot recall trauma (memory loss)

• appropriate for situations where exposure therapy doesn’t work (assault)

limitations

• may not be as effective as other therapies like cognitive behavioural therapy (CBT) that address trauma

• procedure needs to be developed with more detail, reflection needs to be applied to the process to improve

moral injury

cognitive distress resulting from acting in a way that conflicts with deeply held moral beliefs

• includes psychological symptoms (feelings of shame, grief, betrayal, guilt, rage) and spiritual symptoms (moral concerns, loss of hope)

• often ignored in secular, non-religious appraches

cognitive processing therapy

treatment that targets inaccurate beliefs (aka. stuck points) that result in guilt, shame, self-blame, that hinder recovery

• uses cog. restructuing and behavioural exercises to change the way they think about the trauma

• allow for better emotional processing

spiritually integrated cognitive processing therapy (SICPT)

developed to use religion to address moral injury in PTSD

main differences compared to CPT

1. targets MI, instead of directly PTSD (like CPT)

2. focuses on cog restructing based on spiritual resouces (beliefs, sacred writings)

3. MI /= incorrect belief, SICPT uses concepts such as compassion, forgiveness to resolve this

4. encourages support from faith community

5. spiritual struggles are normalised (angry at god, loss of faith)

12 sessions, 60 min each, over 6-12 weeks

each session has a different focus based on the readings/ prayers from different religions (christianity, judaism, islam, buddhism, hinduism)

strengths and limitations of SICPT

strengths

• useful for those who have done committed morally unacceptable actions

• can be a less stigmatised way to get mental health services (ex. in Malaysian Muslim population)

limitations

• effectiveness may be impacted by religion of therapist or individual’s religious faith intensity

• new method, still need to do more research (more experience)

  • only Christian case studies have been published (missing for the other religions, and low generalisability)

• lack of comparison against other therapies such as CPT

• may rely on homework/ independent work that is difficult to complete if struggling with severe symptoms/ comorbid depression* (true for PCT too)

cognitive restructuring

technique where participants are taught to analyses, assess, and reframe dysfunctional beliefs that result in dysfunctional behaviour

side effects of sertraline

nausea, sleepiness, headaches

risks with propranolol

increased risk of heart and blood vessel probems, changes in blood sugar

culturally informed method of disorder treatment

can help give a more holistic and individualised perspective on their cognitive distress

• can help address certain aspects such as moral injury

• can be particularly helpful in those who have done morally unaccepted things in the past