CH 5: Trauma, stressor disorders, and PTSD

• • Fight

  • Flight

  • Freese

  • Fawn: appease the individual that is affecting you (do what's told of abusive parents)

• A set of physical and psychological responses that help us to respond to a threat (real or imagined) using 

• Hypothalamus starts the reaction

• Can impact us in 4 different ways

  • Somatic

  • Emotional

  • Cognitive

  • Behavior 

Where does flight/fight response start and what ways does it impact us (4)

• Hyperarousal:

• excessive activation/energy in the form of flight/fight responses (energy increase)

• Hypoarousal:

• freeze response, emotionally flat, lack of energy and response (energy decrease)

• Adjustment disorder:

• Exposure to stressor of any type of severity, begin within 3 months of exposure to stressor, lasts no longer than 6 months after termination 

• Most common in women and higher income

• Most adults recover 

• Adolescents may be at risk for other disorder

• Acute stress disorder:

• Direct or indirect exposure to traumatic stressor actual or threatened death serious injury or sexual violence

• Disturbance persists from 3 days to 1 month after exposure to trauma

• Varies according to type, 20% from most traumatic events 

• Most prevalent in women 

• Over half will later receive a PTSD diagnosis the rest will remit in 30 days

• 9 or more symptoms involving acute stress disorder include (5)

• Intrusive memories

• Avoidance of reminders of event

• Negative thoughts or emotions 

• Heightened arousal

• Dissociation or inability to remember details

PTSD

• Caused by exposure to extreme stressors SKS traumas

• Normal: dependent on lived experiences and culture/ area

• Causes:natural disasters (floods, hurricanes, fires)

• Human made disasters (war terrorism, car accidents, etc)

• Sexual assault (rape, abuse, domesti viole, harrassment)

• big huge things (big T trauma)

  • Little t (breakup, failing an exam) not as big but still impactful

• • Big T vs little t

• DSM criteria: 8 PTSD

• Exposure

• Intrusion

• Avoidance

• Negative cognition/mood

• Hyperarousal

• Duration

• DIstress

• Independent of the psychological effect of a substance or another medical or psychological condition

• Exposure:

• direct, witness, learned, repeated

• Environmental and social 

• Psychological factors

• Biological factors: 

• Factors influence PTSD

• • Duration

  • Severity

  • Proximity 

  • Social support

• Environmental and social factors affecting PTSD

• Psychological factors affecting PTSD

• Prior mental health concerns

• Poor interpersonal relationships

• Coping skills

• Biological factors affecting PTSD

• Genetically predisposed

  • SS genotype

• Intergenerational trauma

• Fear extinction response time

• Biofeedback

• • Women more likely than men

  • LGBTQIA folks more likely to experience PTSD than straight

  • Sexual abuse tend to come with more stigma so less social support

  • African Americans have higher risks than white hispanic etc

  • People of color less likely to seek treatment 

• Biological sex and cross cultural differences for PTSD

• Cognitive behavior therapy (REBT, CPT, DBT, etc) 

• Stress inoculation therapy/exposure therapies 

• biological options 

• Yoga medication/mindfulness

• Eye movement desensitization and reprocessing

• Equine assisted psychotherapy 

• Treatment for PTSD

• Cognitive behavior therapy (REBT, CPT, DBT, etc) 

• Think feel do

• Can be more structured

• Systematic desensitization

• Stress inoculation

• • Relax

  • Stimulus

  • Relax

  • Rate

  • Repeat 

• Systematic desensitization

• • SSRIs

    • Sleep medications

    • Decrease nightmares

  • Use of psychedelics 

• biological options 

• SSRIs

• Improved mood 

• More energy/better sleep 

• Increased appetite

• Yoga medication/mindfulness

• Trauma can be a very physical response, helps people reclaim their bodies

• helps create sense of calm in the mind

• helps you bring awareness to what is causing problems

• Eye movement desensitization and reprocessing

• Re experiencing trauma

• Using stimulus to release trauma

• Change the narrative surrounding the trauma

• Requires intense training to be certified in this treatment 

• Light bar, tapping, hand buzzers

• Equine assisted psychotherapy 

• MH/ES partnership and process

• Horses are social and require connections like us

• Horses mirror human behavior and body  language

• Horses are brutally honest- dont know guilt/shame

• Horses can teach us self awareness, boundaries

• Communications kills patience assertiveness and more

• Intrusion:

• memories, dreams, flashbacks, psychological physical distress

• Avoidance:

• internal or external trauma memories

• Negative cognition/mood:

• amnesia,bad beliefs, inappropriate blame, persistent bad emotions, loss of activities, detached from others

• Hyperarousal:

• irritability, outbursts. reckless behavior, hypervigilance startle easily, concentration difficulties, sleep disturbances

• longer than one month

• Duration to be considered DSM criteria

• DIstress:

• clinically significan dysfunction, social occupations. Other important functioning impairment

• Fear is a response to objectively threatening events

• Fear may be somewhat unrealistic 

• Fear is moderately unrealistic (potentially meets diagnostic criteria) - well after event has passed

• Fears are completely unrealistic 

• Function to Dysfunctional:

• Fear and anxiety on a continuum

fear

• can become maladaptive when it arises in situations that most people would find threatening

• becomes anxiety when it persists long after the threat has subsided 

• can become an anxiety disorder when a person engages in maladaptive behaviors in response to a threat 

GAD

• Excessive anxiety and worry occurring more days than not for at least 6 months

• The individual finds it difficult to control the worry 

• The worry causes significant distress in social occupations or other important areas 

• Disturbance is not attributable to direct psychological effects of substance

• Disturbance is not better explained by a different disorder

• Anxiety and worry with 3 or more of the following symptoms 

• Restlessness, feeling on edge

• Easily fatigued

• Difficulty concentrating

• Irritability

• Muscle tension

Sleep disturbance

How many needed for diagnosis of disorder

• Emotional Theories of generalized anxiety disorder:

• more intense negative emotions and heightened reactivity to negative events emotions are not controllable or managed 

Cogntive Theories of generalized anxiety disorder:

• maladaptive assumptions reflect concerns about  losing control lead people to respond to situations with automatic thoughts that sti up anxiety hypervigilant and lead to overreact 

biological Theories of generalized anxiety disorder:

•  heightened activity of the sympathetic nervous system and greater reactivity to emotional stimuli in the amygdala abnormalities in the GAGa neurotransmitter system

Thomas Borkovec: Cognitive avoidance model:

worry helps people avoid awareness of internal and external threats reducing reactivity to unavoidable negative events

• Michelle Newman and sandra liera cognitive avoidance model:

• worrying maintain a constant level of anxiety that is more tolerable that leaving themselves open to sudden sharp increases in negative emotions

• Biological dimension: of GAD

• some genetic influence, overactive fear network, abnormalities with GABA receptors 

• Sociocultural dimensions: of GAD

• stressful or poor living conditions, prejudice and discrimination, low SES

• Psychological dimension: of GAD

• lower threshold for uncertainty. Anxiety evoking schemes,use of worry as coping, worry about worrying

• Social dimensions: of GAD

• lack of social network, separation or loss, anxious or unresponsive parents, peer conflicts and victimization

• Specific Phobias:

12 months

• unreasonable or irrational fears of specific objects or situation (how long needed for diagnosis ) - could produce panic attacks → childhood and adolescent

• Animal type

• Natural environment

• Situational

• Blood injection injury

• Other 

• 5 categories: of specific phobias

• Agoraphobia: situational

• fear of places where you may have trouble escaping for getting help if you become anxious —> what category?

• Panic disorder:

• when panic attacks become a common occurrence and you develop worry about having them and exhibit behaviors as a result of this worry late adolescence 

• Panic attacks:

• short but intense periods of experiencing the psychosocial symptoms of anxiety (heart palpitations, trembling, feeling of choking, dizziness

• Social anxiety disorder: 

12 months

• excessive fear of being watched or judged by others

• Extreme self consciousness in group situation 

• Fear that anxiety symptoms will be humiliating or offend others 

situations are avoided or endured with intense fear 

More common in females

how long for diagnosis?

• Medications with efficacy for social anxiety disorder

  • Benzodiazepines

    • Ativan xanax valium 

    • Can price dependence

  • SSRIs 

    • Often prescribed for chronic forms of anxiety 

  • Beta blockers

  • D cycloserine

  • Exposure therapy:

  • Systematic desensitization:

  • Cognitive restructures:

  • Modeling therapy:

• Treatment of anxiety disorders

• Exposure therapy:

• gradual introduction to feared situation

• Systematic desensitization:

• exposure techniques with relaxation

• Cognitive restructures:

• identifying and changing irrational thoughts

• Modeling therapy:

• viewing another person's successful interactions with the subject of the phobia

• Obsessive compulsive disorder:

• • Presence of obsessions, compulsions or both

  • Obsessions or compulsions are time consuming (1 hour or more per day)

  • Symptoms are not attributable to psychological effects of a substance

  • Disturbance is not better explained by the symptoms of another mental disorder

• Obsessions

• : recurrent and persistent thoughts, urges or images that are experience at some time during the disturbance and unwanted and that in most individuals cause marked anxiety or distress

  • Individual attempts to ignore or suppress such thoughts urges or images to neutralize some other thought or action

• Compulsions:

• repetitive behaviors or mental acts the individuals feels driven to person in response to an obsession or according to rules that must be applied

  • Aimed at preventing or reducing anxiety or distress or preventing dreaded event or situation however these behaviors are not connected in a realistic way 

• Biological theory of OCD

• : dysfunction in specific area of the frontal cortex to areas of the basal ganglia, thalamus, and aback to the frontal cortex

  • Circuit in the brain involved in cognition and emotions

• Cognitive theories: of OCD

• negative intrusive thoughts which may include thoughts about harming others or doing something against their moral code 

• Behavioral theory: of OCD

• OCD behaviors develop because they reduce anxiety

• Biological dimension: of OCD

• Increased activity in the orbitofrontal cortex, lower activation in caudate nuclei, subgroups differ on genetic and biological involvement , reduced availability of serotonin and glutamate

• Sociocultural dimension: of OCD

• equally common in males and females, onset in childhood more common in boys, cultural differences in obsession and compulsions

• Psychological dimension: of OCD

• lack of trust in women performance , impulse control conflicts anxiety reduction, cognitive distortions

• Social dimension: of OCD

• social vulnerabilities, divorce, separation, unemployment, controlling or critical preventing

• • BIological treatments:

    • SSRI antidepressants

• Cognitive behavioral treatment

• Exposure and response prevention:

• Treatments for OCD

• Exposure and response prevention:

• repeated exposure to the focus of obsession while preventing compulsive responses

Depersonalization:

feeling detached from or as if one was an

outside observer of one's mental processes or body

Derealization:

unreality of surroundings (dream state, distant,

distorted)