Traumatic Stress Disorders: Causes & Treatments

TRAUMATIC STRESS DISORDERS
CAUSES AND TREATMENTS
CONTRIBUTORY CAUSAL FACTORS

  • Individual Factors

    • Psychological Factors: These include pre-existing mental health conditions, coping styles, and the individual's resilience or vulnerability to stress.

    • Biological Factors: Genetics play a significant role in susceptibility to PTSD. Hormonal responses to stress and the functionality of neurotransmitters like serotonin and norepinephrine are critical in the onset of PTSD.

    • Sociocultural Factors: Factors such as socio-economic status, cultural background, and exposure to violence or trauma can impact the likelihood of developing PTSD.

    • Post-Traumatic Stress Disorder (PTSD): PTSD can arise after experiencing or witnessing a traumatic event, characterized by intrusive thoughts, heightened arousal, avoidance behaviors, and negative shifts in mood.

GENETIC VULNERABILITIES

  • Serotonin Transporter Gene

    1. Study on Female Undergraduates: Conducted on those who witnessed a shooting on campus.

      • Finding: Individuals with a specific variation of the serotonin transporter gene exhibited a markedly increased probability of developing stress disorders, highlighting genetic predispositions in trauma response.

    2. Hurricane Exposure Study (Florida, 2004):

      • Finding: Individuals with the genetic variant had a notably higher probability of developing stress disorders post-hurricane. Statistics revealed that while 3.2% of the overall sample developed stress disorders, this figure rose to 14.8% among those with the specific gene type.

      • Insight: The impact of this genetic predisposition was significantly magnified in contexts with low social support, suggesting that genetics and environmental factors interact in complex ways to influence mental health.

PSYCHOLOGICAL AND SOCIO-CULTURAL FACTORS

  • Mowrer’s Two-Factor Model of Conditioning:

    • PTSD may be acquired through classical conditioning (associating traumatic events with certain stimuli) and maintained through operant conditioning (reinforcement of avoidance behaviors). This model elucidates how environmental cues can perpetuate PTSD symptoms.

  • Social Factors:

    • Strong social support has been consistently linked to reduced risk of PTSD onset and persistence. Social networks can provide emotional support, practical help, and a sense of belonging.

    • Pre-trauma family instability increases vulnerability to PTSD by negatively impacting coping mechanisms and emotional regulation during and after a trauma.

    • Higher pre-trauma cognitive abilities appear to equip individuals with better coping strategies and a greater capacity to derive meaning from trauma, potentially reducing the risk of PTSD.

HPA AXIS

  • Definition: The Hypothalamic-Pituitary-Adrenal (HPA) axis is crucial in the body’s response to stress, activating the release of cortisol, a hormone that prepares the body for fight or flight.

  • Chronic Stress and HPA Activity:

    • Chronic stress can lead to dysregulation of HPA axis activity, resulting in altered cortisol levels.

    • Excessive HPA axis activity can cause structural and functional damage to brain regions such as the hippocampus, which is essential for memory and learning.

STRUCTURAL DIFFERENCES IN BRAIN

  • Research Findings:

    • Studies indicate that individuals with war-related PTSD and adult survivors of childhood sexual abuse exhibit smaller hippocampal volumes. These structural differences may underlie challenges in learning and memory, severe in the aftermath of trauma.

  • Twin Studies:

    • Findings suggest that smaller hippocampal volume may serve as a pre-existing vulnerability factor for developing PTSD, highlighting the interplay of genetic and environmental influences.

    • Additionally, trauma and stress have been found to negatively impact brain structures, leading to reduced hippocampal volume over time, which complicates recovery from PTSD.

TREATMENT OF PTSD: EXPOSURE THERAPY

  • Prolonged Exposure Therapy:

    • This form of therapy focuses on processing trauma memories and reminders, helping patients confront their fears in a controlled manner.

    • Involves constructing an exposure hierarchy, where patients gradually face increasingly challenging stimuli.

    • Types of exposure include:

      • Direct (In Vivo): Confronting feared stimuli in real life (e.g., visiting a site of trauma), assigned as homework.

      • Imaginal Exposure: Patients vividly recount their traumatic experiences during sessions in the present tense, which helps to process the memories.

      • Virtual Reality: Utilizes advanced technology to immerse patients in trauma-related contexts for exposure therapy.

    • Duration: Treatment typically spans 8 to 15 sessions, with each session lasting about 90 minutes, aiming to extinguish the fear response tied to trauma reminders.

TREATMENT OF PTSD: COGNITIVE THERAPY

  • Cognitive Therapy (Example: Cognitive Processing Therapy (CPT)):

    • This therapeutic approach involves psychoeducation to enhance awareness of the connection between thoughts and feelings, fostering understanding of emotional responses.

    • Patients are encouraged to write detailed accounts of their traumatic experiences, which facilitates the challenge of negative thoughts and self-blame associated with the trauma.

    • Goal: To reshape negatively skewed interpretations of the trauma, enabling a healthier reconceptualization and adaptation to life post-trauma.

VIDEO ADVANCED PTSD THERAPY (COMBAT)

  • Prolonged Exposure (PE): Recommended viewing for deeper understanding and patient application.

EXPOSURE THERAPY/VIRTUAL REALITY

  • Consult recommended resources for practical application and case examples.

EYE MOVEMENT DESENSITIZATION AND REPROCESSING (EMDR)

  • Definition: EMDR is a well-established, evidence-based trauma therapy designed to reprocess distressing memories.

  • Efficacy: Strong evidence supports EMDR's effectiveness for PTSD and related trauma symptoms, although evidence for its efficacy in conditions like anxiety, grief, and chronic pain is still being explored.

EMDR PROCESS

  • Therapist's Role: The therapist guides the patient in pinpointing specific distressing memories that evoke emotional discomfort.

  • Bilateral Stimulation Techniques: While the patient is focused on the identified memory, the therapist may employ methods of bilateral stimulation:

    • Eye movement following the therapist's fingers back and forth.

    • Listening to alternating sounds or tones in each ear.

    • Receiving alternating taps on the hands.

  • Reprocessing of Memory: This therapeutic method assists the brain in reframing and consolidating the memory with diminished emotional intensity.

  • Positive Cognitions: Following the reprocessing of traumatic memories, the therapist supports the patient in integrating positive cognitions, aiding in the recovery process.

  • Benefits: Particularly advantageous for clients experiencing difficulty discussing their trauma or completing homework assignments, facilitating healing in a supportive environment.