Trauma and PTSD

SAMHSA Definition of Trauma

event/series of events/set of circumstances experienced by an individual as physically or emotionally harmful or life threatening

Three Es of Trauma (SAMHSA, 2014)

Event (Type 1 or 2) Experience (event experienced as emotionally harmful, extent of which influenced by various factors) and Effects (lasting effect on functioning and mental/physical/social/emotional/spiritual wellbeing)

Terr (1991) 2 Types of Trauma

Type 1 - Single incident, typically out of the blue

Type 2 - Complex trauma, events occuring repeatedly over time in the context of close relationships breaching your trust. Often occurs at developmentally vulnerable times, but sometimes adulthood

Trauma to PTSD Statistic (WHO)

70% will experience trauma, but only 5.6% will have it develop into PTSD

Factors inceasing PTSD Development (Davey et al., 2021)

Nature of the event (type/severity/did you participate), individual risk factors (personality/previous history/health difficulties), experience during the event (belief of death/dissociation) and experience after (no support, extreme guilt)

Protective Factors from PTSD (Carr et al., 2016)

Safe and supportive relationships, having strong internal personal resources, having positive physical and emotional wellbeing, and having socioeconomic security and resources

Key Features of PTSD (DSM5 AND ICD11)

Exposure to extremely threatening event/series of events, resulting in hyperarousal, avoidance and consistent re-experiencing

Differences between types of Trauma/PTSD

Type 1 tends to lead to PTSD, with events causing more vivid memories and more likely to lead to classic intrusive ideation; quicker recovery than type 1

Type 2 leads to complex ptsd due to being from intentional human design, memories are fuzzy due to dissociation, altered view of self and world and characterlogical problems, more negative coping mechanisms

PTSD on the Brain

Disruptive effects on memory, such as involuntary vivid sensory images that are re-experienced. Changes in medial prefrontal cortex, hippocampus and amyglada

Foa and Rothbaum on PTSD

Intensity of traumatic event interferes with encoding processes of attention and memory, leading to disjointed and fragmented narration that is relatively simplistic and poorly articulated

How do CPs work with Trauma

Assesing level of PTSD and finding treatments, focusing on those in high risk groups, developing support systems, pathways and interventions

Ehlers and Clark (2000) Cognitive Model

PTSD is derived from individual processing trauma in a way that maintains threatened state, a consequence from constant negative appraisals of the trauma, poor autobiographical memory from poor contextualisation, and maintained by bad behaviour and coping mechanisms

Ehlers and Clark targets for Treatment

Trauma memory needs to be integrated into the context of the event and combined as an integrated whole, rather than remaining an aimless sensory memory

Problematic appraisals need to be modified, and negative coping strategies preventing reassessment of appraisals and memory elaboration need to be dropped

Types of recommended treatments for PTSD

PTSD based CBT or EMDR

Eye Movement Desensitation and Reprocessing (Shapiro, 2000)

Package of CBT treatments focusing on exposure by having client bring to awareness components of traumatic memory in short doses whilst undergoing bilateral stimulation

PTSD Intervention

Assessment and formulation built collaborative, provision of psychoeducation to improve physical wellbeing, increase awareness of triggers and symptoms and identify and work with remaining beliefs. Exposure to memory with mechanisms like EMDR or imaginal exposure. Evaluation and next steps