PTSD Theory and Assessment Practice Flashcards

Vocabulary-style flashcards covering the history, DSM-5 diagnostic criteria, assessment tools, and the cognitive model of PTSD as presented in the lecture.

Shell-shock

A term used during the First World War to recognize traumatic stress disorders in soldiers.

Criterion A (DSM-5)

Exposure to actual or threatened death, serious injury, or sexual violation through direct experience, witnessing, learning of a close friend/family member's violent/accidental death, or repeated exposure to aversive details.

Criterion B (DSM-5)

Intrusion symptoms, including recurrent and distressing memories or dreams (flashbacks and nightmares) and re-living or re-experiencing the trauma.

Criterion C (DSM-5)

Avoidance symptoms, specifically avoiding distressing memories, thoughts, feelings, or external reminders associated with the traumatic event.

Criterion D (DSM-5)

Negative alterations in cognition and mood, characterized by poor memory, negative self-concept, detachment, and a loss of positive emotions.

Criterion E (DSM-5)

Alterations in arousal and reactivity, including hypervigilance, poor concentration, irritability, sleep disturbances, and an exaggerated startle response.

Criterion F (DSM-5)

Duration requirement where the persistence of symptoms (Criteria B, C, D, and E) must last for more than one month.

Criterion G (DSM-5)

Functional Significance, requiring that the symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning.

Criterion H (DSM-5)

Attribution, specifying that the disturbance is not due to medication, illicit substances, or other medical conditions.

Flashback

A vivid experience where an individual relives aspects of a traumatic event or feels as if it is happening in the 'here and now,' often involving sensory qualities like images, sounds, or smells.

Body memories

Physiological arousal or physical pain related to a traumatic event that is re-experienced as part of the clinical presentation of PTSD.

PTSD Checklist for DSM-5 (PCL-5)

A 20-item questionnaire based on DSM-5 symptoms used to supplement clinician interviews for assessment.

Impact of Events Scale

A 22-item questionnaire that examines the impact of difficulties experienced after a specific stressful life event.

Amygdala

Part of the 'threat system' that alerts the body to danger and triggers the adrenaline 'fight or flight' response; it cannot easily discriminate between real and perceived danger.

Hippocampus

A brain structure that processes and stores memories with a 'timestamp' in an organized way; its function is often impaired during traumatic events.

Ehlers & Clark (2000) Cognitive Model

A model proposing that PTSD is maintained because individuals process the trauma in a way that suggests a serious current threat, either external or internal.

Negative appraisals

Problematic interpretations of a trauma (e.g., 'Nowhere is safe') or its sequelae (e.g., 'I am going mad') that maintain a sense of current threat.

Thought suppression

A dysfunctional strategy where an individual tries to avoid thoughts or keep their mind busy, which paradoxically maintains PTSD symptoms.

Rumination

A cognitive strategy involving repeatedly thinking about how a traumatic event could have been prevented.

Safety behaviours

Behaviors intended to control threat, such as repeatedly checking that a door is locked, which prevent change in negative appraisals.

Trauma Memory Elaboration

A treatment aim in the Ehlers & Clark model where the trauma memory is integrated into the individual's preceding and subsequent experience to reduce intrusive re-experiencing.

Interpersonal Trauma

Traumatic events involving types of human-to-human harm, such as rape, torture, or terrorism, which carry an increased risk of developing PTSD.

PTSD Prevalence (Kessler et al., 2005)

A study of 9282 adults showed lifetime prevalence ranges from $6.1 - 9.2 \%$ in the US and Canada.

Required reading

Features and Symptoms of PTSD

• PTSD can develop after experiencing or witnessing trauma.

• Symptoms include:

  • flashbacks and intrusive memories

  • nightmares

  • hypervigilance

  • avoidance of trauma reminders

  • anxiety, guilt, shame, and emotional distress

Complex PTSD (C-PTSD)

• Usually linked to prolonged/repeated trauma (e.g. abuse or neglect).

• Includes PTSD symptoms plus:

  • emotional dysregulation

  • negative self-concept

  • relationship/interpersonal difficulties

  • chronic shame and mistrust

Psychological Models/Theories

• Ehlers & Clark Cognitive Model: PTSD is maintained by negative appraisals and a continuing sense of threat.

• Behavioural Theory: Avoidance reduces anxiety short term but maintains PTSD long term.

• Emotional Processing Theory (Foa & Kozak): Trauma memories must be emotionally processed for recovery.

Treatment Approaches

• Trauma-Focused CBT (TF-CBT): Uses cognitive restructuring and exposure to trauma memories.

• EMDR: Uses bilateral stimulation while processing traumatic memories.

• Exposure Therapy: Gradual exposure reduces avoidance and fear responses.

• Compassion-focused/stabilisation approaches: Particularly useful for complex PTSD and emotional regulation difficulties.

Key Point

• PTSD is maintained by avoidance, maladaptive beliefs, and difficulties processing trauma memories, so treatment focuses on processing trauma safely and reducing fear/avoidance.

What are the key points and evidence relating to PTSD and Complex PTSD?

Key Points

• PTSD can develop after experiencing or witnessing traumatic events.

• Symptoms include flashbacks, nightmares, hypervigilance, avoidance, and emotional distress.

• Complex PTSD includes additional difficulties such as emotional dysregulation, shame, negative self-concept, and relationship problems.

• Complex PTSD is often linked to prolonged or repeated trauma.

Key Research Studies Herman (1992)

• Proposed the concept of Complex PTSD following prolonged interpersonal trauma.

• Highlighted symptoms beyond standard PTSD, including identity and relationship difficulties.

• Argued traditional PTSD diagnosis did not fully capture chronic trauma effects.

Cloitre et al. (2013)

• Examined evidence for Complex PTSD symptoms across trauma survivors.

• Found strong support for emotional regulation and interpersonal difficulties as distinct trauma responses.

• Supported recognition of Complex PTSD as separate from standard PTSD.

Evaluation

• PTSD diagnosis has strong empirical support and clear symptom patterns.

• Critics argue trauma responses vary across cultures and individuals.

• Complex PTSD has improved understanding of chronic trauma experiences.

Cognitive and Behavioural Models of PTSD

Key Points

• PTSD is maintained by negative appraisals, trauma memories, and avoidance behaviours.

• Individuals experience an ongoing sense of threat after trauma.

• Avoidance reduces anxiety short term but maintains PTSD long term.

• Trauma memories may be fragmented and easily triggered.

Key Research Studies Ehlers & Clark (2000)

• Developed the cognitive model of PTSD.

• Proposed PTSD is maintained by maladaptive appraisals and poorly processed trauma memories.

• Found negative interpretations increase feelings of current threat.

Foa & Kozak (1986)

• Developed Emotional Processing Theory.

• Suggested trauma creates a “fear structure” maintained through avoidance.

• Argued exposure helps modify trauma-related fear responses.

Evaluation

• Cognitive and behavioural models have strong research support.

• Successfully explain the role of avoidance and negative beliefs in PTSD.

• Criticism: may not fully explain complex trauma or social/cultural influences.

EMDR for PTSD

ey Points

• EMDR involves recalling traumatic memories while engaging in bilateral stimulation (e.g. eye movements).

• Aims to reduce emotional distress linked to trauma memories.

• Commonly used for PTSD treatment.

• Recommended in several clinical guidelines.

Key Research Studies Shapiro (1989)

• First major study examining EMDR for traumatic memories.

• Found significant reductions in trauma-related distress.

• Helped establish EMDR as a PTSD treatment approach.

Rasines-Laudes & Serrano-Pintado (2023)

• Reviewed randomized controlled trials of EMDR for PTSD.

• Found EMDR reduced PTSD, anxiety, and depression symptoms.

• Noted some methodological weaknesses in the evidence base.

Evaluation

• EMDR has strong support for reducing trauma symptoms.

• Often effective relatively quickly.

• Criticism: debate remains about whether eye movements themselves are necessary for improvement.

Trauma-Focused CBT (TF-CBT)

Key Points

• TF-CBT is a structured treatment for PTSD.

• Uses cognitive restructuring and exposure to trauma memories.

• Aims to reduce avoidance, fear, and maladaptive trauma beliefs.

• Recommended in clinical treatment guidelines.

Key Research Studies Bisson et al. (2007)

• Meta-analysis examining psychological treatments for PTSD.

• Found Trauma-Focused CBT highly effective in reducing PTSD symptoms.

• Identified TF-CBT as one of the strongest evidence-based PTSD treatments.

Hoppen et al. (2023)

• Reviewed 157 randomized controlled trials on PTSD therapies.

• Found trauma-focused CBT produced strong short- and long-term symptom reduction.

• Supported TF-CBT as more effective than many non-trauma-focused approaches.

Evaluation

• Strong evidence base and widely used clinically.

• Effective for flashbacks, avoidance, and hyperarousal.

• Criticism: exposure work can feel distressing and lead to dropout.