Post Traumatic Stress Disorder

Diagnostic Criteria for PTSD

• The causal event specified as part of the diagnostic criteria – threatening death, serious injury or sexual violence 

  • Directly experience the traumatic events 

  • Witnessing the event

  • Learning that the traumatic event occurred to close family or friend 

  • Repeated extreme exposure 

Outcomes of PTSD

• Continued exposure to trauma leads to the development of several intrusion symptoms 

  • Recurrent, involuntary, and intrusive distressing memories

  • Recurrent distressing dreams

  • Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring.  

  • Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble the event.

  • Marked physiological reactions to internal or external cues that symbolize or resemble the event.

• Individuals exposed to a traumatic event demonstrate avoidance of experiences associated with the event

  • Avoiding thinking about the event 

  • Avoid external reminders that elicit thoughts, memories or feelings about the event  

• Cognitive and mood changes regarding their life and the traumatic event 

  • Inability to remember event 

  • Exaggerated negative beliefs about oneself, others or the world 

  • Distorted beliefs about the causes or consequences of the event that lead to the individual blaming themself 

  • Persistent negative emotional state 

  • Significant reduction in interest and participation 

  • Feelings of detachment and estrangement from others 

  • Persistent inability to experience positive emotions 

• Hyperarousal - alterations in arousal and reactivity associated with the traumatic events beginning or worsening after the traumatic event occurs; evidenced by two or more of the following for more than 1 month

  • Irritable behaviour and angry outbursts

  • Reckless or self-destructive behaviour

  • Hypervigilance – to similar events 

  • Exaggerated startle response

  • Problems with concentration

  • Sleep disturbance

Continued exposure to trauma leads to the development of several intrusion symptoms

• Recurrent, involuntary, and intrusive distressing memories

• Recurrent distressing dreams

• Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring.  

• Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble the event.

• Marked physiological reactions to internal or external cues that symbolize or resemble the event.

Individuals exposed to a traumatic event demonstrate avoidance of experiences associated with the event

• Avoiding thinking about the event 

• Avoid external reminders that elicit thoughts, memories or feelings about the event

Cognitive and mood changes regarding their life and the traumatic event

• Inability to remember event 

• Exaggerated negative beliefs about oneself, others or the world 

• Distorted beliefs about the causes or consequences of the event that lead to the individual blaming themself 

• Persistent negative emotional state 

• Significant reduction in interest and participation 

• Feelings of detachment and estrangement from others 

• Persistent inability to experience positive emotions

Hyperarousal

alterations in arousal and reactivity associated with the traumatic events beginning or worsening after the traumatic event occurs

Hyperarousal - alterations in arousal and reactivity associated with the traumatic events beginning or worsening after the traumatic event occurs; evidenced by two or more of the following for more than 1 month

• Irritable behaviour and angry outbursts

• Reckless or self-destructive behaviour

• Hypervigilance – to similar events 

• Exaggerated startle response

• Problems with concentration

• Sleep disturbance

Prevalence for PTSD

• Variance due to changes in the diagnostic criteria, demographics of sample group 

• Large-scale epidemiological (incidence) studies 

  • Just over 1% 

High-risk individuals 

• Combat-related jobs – dramatic increase 

  • 15.2% of US servicemen who served in Vietnam

  • 8.5% of US servicewomen who served in Vietnam

• Individuals exposed to traumatic events have a DSM-IV= 9.2% chance of developing PTSD 

• PTSD is an abnormal response to an abnormal event

Course for PTSD

• Onset at any age 

• Symptoms usually have onset within 3 months of traumatic event 

• Acute stress disorder may be the initial reaction to a traumatic event - precursor to PTSD

• Approx 50% remit (reduced symptoms or resolve) within 3 months of offset

• Others experience chronic fluctuating course 

• 33% don’t recover despite professional treatment

History of PTSD

• Long recognition of trauma as a psychological illness 

• Battlefield related symptoms

  • Shell shock - ww1 

  • Battle fatigue - ww2

•  Vietnam war → massive progression of PTSD

Risk factors of PTSD

• Severity of trauma 

• Past history of stress, abuse or trauma 

• History of behavioural or psychological problems 

• Comorbid psychopathology 

• Cognitive factors 

• Genetic factors 

• Subsequent exposure to reactivating environmental events 

• Lack of social support

Classical conditioning PTSD

Operant conditioning PTSD

Outcomes of PTSD

• Stimulus generalisation occurs – an increasing number of stimuli elicit the fear response 

• Deficits in specific behavioural skills

  • Interpersonal skills

  • Help-seeking behaviour

• Recent cognitive behavioural models of PTSD expand on the basic two-factor model

  • Ehlers & Clark’s Cognitive Model

    • PTSD sufferers show a wide range of negative appraisals

      • “I am a victim”

      • “I deserve for bad things to happen to me.”

      • “I’ll never be able to relate to people again.”

      • “Others think I was a coward.”

      • “I’m a psychological wreck!”

Treatment of PTSD

Psychological 

• Psychoeducation

• Cognitive Restructuring

• Behavioural Experiments

• Exposure 

  • Prolonged Imaginal: Therapist guides client through traumatic event 

    • Through prolonged exposure, they no longer need to avoid it as it doesn't hold the same value 

  • In vivo: confronting feared objects, situations, or places in real life

  • Functionally focussed: Targets the avoidance behaviors that interfere with a person's ability to function in daily life

• Cognitive Defusion

• Mindfulness

Pharmacological 

• Antidepressants

• Beta-Blockers

• Anxiolytics

Psychological treatment of

• Psychoeducation

• Cognitive Restructuring

• Behavioural Experiments

• Exposure 

  • Prolonged Imaginal: Therapist guides client through traumatic event 

    • Through prolonged exposure, they no longer need to avoid it as it doesn't hold the same value 

  • In vivo: confronting feared objects, situations, or places in real life

  • Functionally focussed: Targets the avoidance behaviors that interfere with a person's ability to function in daily life

• Cognitive Defusion

• Mindfulness

Prolonged Imaginal

•  Therapist guides client through traumatic event 

  • Through prolonged exposure, they no longer need to avoid it as it doesn't hold the same value 

In vivo

confronting feared objects, situations, or places in real life

Functionally focussed

Targets the avoidance behaviors that interfere with a person's ability to function in daily life

Pharmacological treatment for PTSD

• Antidepressants

• Beta-Blockers

• Anxiolytics