PTSD

CHAPTER 4: Trauma- and Stressor-Related Disorders

Learning Objectives
  • LO 4.1: Describe current diagnostic criteria for PTSD.
  • LO 4.2: Identify prevalence and course of PTSD responses.
  • LO 4.3: Compare models for PTSD development.
  • LO 4.4: Understand effective treatments and challenges for PTSD treatment.
Historical Context
  • The Odyssey: Ancient writings address psychological trauma after war.
  • World War I: Awareness of psychological effects of trench warfare.
  • Vietnam War (1980): PTSD recognized as a mental disorder by APA.
  • Australia: Increased interest in PTSD during natural disasters (e.g., Cyclone Tracy, Granville train disaster).
Diagnosis of PTSD
  • Classification: PTSD is part of 'Trauma- and Stressor-Related Disorders' in DSM-5.
  • Definition: Extreme stress reactions post-trauma, with actual/threatened harm involved.
  • Traumatic Events: Include war, natural disasters, sexual assault, car accidents, terrorism.
  • Symptom Clusters:
    • Re-experiencing: Intrusive memories, flashbacks, and nightmares.
    • Avoidance: Avoiding thoughts/ reminders of the trauma.
    • Cognitive/Mood Changes: Emotional numbing, negative beliefs about oneself/others.
    • Arousal Symptoms: Exaggerated startle response, hypervigilance, sleep/concentration difficulties.
  • Diagnosis Requirement: Symptoms must persist for at least one month.
Epidemiology of PTSD
  • Prevalence Rates:
    • 61% of U.S. adults reported traumatic exposure (National Comorbidity Survey).
    • PTSD developed in 20.4% of women, 8.2% of men post-trauma.
  • Gender Differences: Women 2x more likely to develop PTSD than men.
  • Severity Correlation: Greater trauma severity correlates with higher PTSD likelihood.
Aetiology of PTSD
  • Risk Factors:
    • Previous psychological issues.
    • Traumatic history.
    • Severe trauma exposure.
    • Low post-trauma social support.
    • Ongoing stressors.
  • Models of Development:
    • Cognitive Models: Maladaptive interpretations of trauma lead to perceived ongoing threat.
    • Learning Models: Classical conditioning links trauma to fear (conditioned stimuli).
    • Biological Models: Sympathetic arousal can strengthen fear-related memories.
Treatment and Prevention of PTSD
  • Pharmacological Treatment: SSRIs (e.g., sertraline) show effective symptom reduction.
  • Psychological Treatment: Cognitive Behavior Therapy (CBT) as the primary treatment, focusing on:
    • Psychoeducation: Understanding trauma responses.
    • Anxiety Management: Teaching coping skills.
    • Cognitive Restructuring: Modifying maladaptive thoughts.
    • Exposure Techniques: Prolonged imaginal and in vivo exposure to the trauma.
  • Acute Stress Disorder: Recognition of early intervention's role in preventing PTSD.
  • Challenges: Many patients drop out or do not respond; need for improved intervention approaches.
Current Challenges in Treatment
  • Awareness and Access: Need for evidence-based treatment for large trauma-affected populations.
  • Internet and Community Approaches: Promising avenues in providing CBT remotely, training non-specialists for delivering effective treatment strategies.
  • Evaluation of Treatment in Community Settings: Need for research on the efficacy of CBT in less controlled, community environments.
Summary
  • PTSD presents severe responses to trauma, leading to persistent distress and avoidance behaviors.
  • Understanding and treatment strategies are rooted in cognitive, learning, and biological theories.
  • Trauma-focused CBT has shown significant efficacy over pharmacological treatments for chronic PTSD.
Key Terms
  • Cognitive Behavioural Therapy (CBT): Integrates cognitive restructuring with behavioral exposure.
  • Sympathetic arousal: Physiological response to perceived threat.
  • In vivo exposure: Direct confrontation with trauma-related stimuli in real life.
  • Avoidance: Strategy that inhibits emotional processing and learning needed for recovery.
Review Questions
  • Identify types of events that can trigger PTSD.
  • Describe major symptom clusters in PTSD.
  • Discuss major risk factors associated with PTSD development.