9_PSYC_301_Trauma_and_Related_Disorders .ppt
- 1. TRAUMAAND RELATED DISORDERS Cyprus International University Department of Psychology Fall Semester
- 2. Outline ■ PTSD&ASD: Sypmtoms and epidemiology ■ Clinical features, comorbidity and etiology ■ Treatments
- 4. Clinical Description and Epidemiology of PTSD and ASD ■ Entails an extreme response to a severe stressor, including increased anxiety, avoidance of stimuli associated with the trauma, and symptoms of increased arousal ■ In DSM-5, the symptoms for PTSD are grouped into four major categories: • Intrusively re-experiencing the traumatic event • Avoidance of stimuli associated with the event • Other signs of mood and cognitive change after the trauma • Symptoms of increased arousal and reactivity
- 8. DSM-5 vs DSM-IV-TR Criterion that a person experience intense emotion at the time of the trauma is removed in the DSM-5 (Many people report they were detached from their self or emotions) The DSM-IV-TR criterion for trauma has been criticized for being overly broad (exposure to media accounts does not qualify as trauma) Many of the symptoms described in the DSM-IV-TR criteria, such as difficulty concentrating, difficulty sleeping, and diminished interest in activities, are also criteria for major depressive disorder. (DSM-5 specify that these symptoms must begin after the trauma) Avoidance and numbing are distinct symptoms
- 10. ASD ■ Diagnosed when symptoms occur between 3 days and 1 month after a trauma ■ The duration is shorter than PTSD ■ Dissociative symptoms criteria is removed 2 major concerns: It could stigmatize short-term reactions to serious traumas, even though these are quite common (Harvey & Bryant, 2002) Most people who go on to meet diagnostic criteria for PTSD do not experience ASD in the first month after the trauma (Bryant, Creamer, O’Donnell, et al., 2008).
- 11. Comorbidity and Etiology ■ Anxiety disorders ■ MD ■ Substance related disorders ■ Behavioral disorders Women (2 as much) Tendency to become chronic Suicidal ideation or self harm
- 12. Etiology of PTSD ■ Overlap with the risk factors for other AD’s Genetic risk factors, High levels of activity in areas of the fear circuit such as the amygdala, Childhood exposure to trauma, Tendencies to attend selectively to cues of threat, Neuroticism and negative affectivity Two-factor model of conditioning
- 13. ■ Among people who experience traumas, does everyone develop PTSD? ■ May certain kinds of traumas be more likely to trigger PTSD than other types?
- 14. Nature of the Trauma: Severity and the Type of Trauma Matter • Natural disasters • Traumas caused by humans (war, torture etc.) • Accidents • Unexpected deaths • Terminal illness
- 15. Neurobiological Factors ■ PTSD appears to be related to greater activation of the amygdala and diminished activation of the medial prefrontal cortex (Shin, Rauch, & Pitman, 2006): ■ Regions that are integrally involved in learning and extinguishing fears ■ PTSD appears uniquely related to the function of the hippocampus. ■ The hippocampus is known for its role in memory, particularly for memories related to emotions ■ Hippocampal volume and PTSD may be related (Gilbertson, Shenton, Ciszewski, et al., 2002).
- 16. Coping ■ Avoidance – PTSD ■ Dissociation – PTSD Protective/Adaptive Factors: ■ High intelligence ■ Strong social support
- 17. PTG ■ What doesnt kill you, makes you stronger? ■ Can trauma awaken an increased appreciation of life, renew a focus on life priorities, and provide an opportunity to understand one’s strengths in overcoming adversity? ■ “Percieved benefits”, “Stress-related growth” or “Posttraumatic growth” ■ Resilience, hardiness, optimism and sense of coherence
- 19. ■ Antidepressants (SSRI’s) ■ Exposure (In vivo/in vitro) ■ Healthy coping ■ VR ■ EMDR ■ Cognitive interventions (Self blame) ■ Critical situation-stress evaluation
- 20. Questions that remain about the syndrome itself include: ■ What is the clinical course of untreated PTSD? ■ Are there other subtypes of PTSD? ■ What is the distinction between traumatic simple phobia and PTSD? ■ What is the clinical phenomenology of prolonged and repeated trauma?
- 21. ■ PTSD has also been criticized from the perspective of cross-cultural psychology and medical anthropology, especially with respect to refugees, asylum seekers, and political torture victims from non- Western regions. ■ Some clinicians and researchers working with such survivors argue that since PTSD has usually been diagnosed by clinicians from Western industrialized nations working with patients from a similar background, the diagnosis does not accurately reflect the clinical picture of traumatized individuals from non-Western traditional societies and cultures. ■ There is substantial cross-cultural variation and the expression of PTSD may be different in different countries and cultural settings, even when DSM-5 diagnostic criteria are met.
- 22. Eye Movement Desensitization and Reprocessing ■ In 1989, Francine Shapiro began to promulgate an approach to trauma treatment called eye movement desensitization and reprocessing (EMDR). ■ In this procedure, the person imagines a situation related to the trauma, such as seeing a horrible automobile accident.
- 23. ■ Keeping the image in mind, the person visually tracks the therapist’s fingers as the therapist moves them back and forth about a foot in front of the person’s eyes. ■ This process continues for a minute or so, or until the person reports that the image is becoming less painful. ■ At this point, the therapist tells the person to say whatever negative thoughts he or she is having, while continuing to track the therapist’s fingers.
- 24. ■ Finally, the therapist tells the person to think a positive thought (e.g., “I can deal with this”) and to hold this thought in mind, still tracking the therapist’s fingers. ■ This treatment, then, consists of classic imaginal exposure techniques, along with the extra technique of eye movement.
- 25. ■ Studies in which EMDR was used to treat people with PTSD have reported dramatically rapid symptom relief (van der Kolk, Spinazzola, Blaustein, et al., 2007). ■ EMDR proponents argue that the eye movements promote rapid extinction of the conditioned fear and correction of mistaken beliefs about fear- provoking stimuli (Shapiro, 1999). ■ The claims of dramatic efficacy have extended to disorders other than PTSD, including attention-deficit/hyperactivity disorder, dissociative disorders, panic disorder, public-speaking fears, test anxiety, and specific phobias (Lohr, Tolin, & Lilienfeld, 1998).
- 26. ■ Despite the remarkable claims about this approach, several studies have indicated that the eye movement component of treatment is not necessary. ■ For example, one researcher developed a version of EMDR that included all its techniques except eye movement and then conducted a study in which people were randomly assigned to receive either a version without eye movement or a version with eye movement (Pitman, Orr, Altman, et al., 1996). ■ The two groups achieved similar symptom relief.
- 27. ■ Since the time of this study, findings from a series of studies have found that this therapy is no more effective than traditional cognitive behavioral treatment of PTSD (Seidler & Wagner, 2006). ■ Some have argued that EMDR should not be offered as a treatment because the eye movement component is not supported either by studies or by adequate theoretical explanations (Goldstein, de Beurs, Chambless, et al., 2000).
- 28. Critical Incident Stress Debriefing ■ Critical incident stress debriefing (CISD) involves immediate treatment of trauma victims within 72 hours of the traumatic event (Mitchell & Everly, 2000). ■ Unlike cognitive behavioral treatment, the therapy is usually limited to one long session and is given regardless of whether the person has developed symptoms. ■ Therapists encourage people to remember the details of the trauma and to express their feelings as fully as they can
- 29. ■ Therapists who practice this approach often visit disaster sites immediately after events—sometimes invited by local authorities (as in the aftermath of the World Trade Center attack) and sometimes not; they offer therapy both to victims and to their families. ■ Like EMDR, CISD is highly controversial ■ A review of six studies, all of which included randomly assigning clients to receive CISD or no treatment, found that those who received CISD tended to fare worse (Litz, Gray, Bryant, et al., 2002).
- 30. ■ No one is certain why harmful effects occur, but remember that many people who experience a trauma do not develop PTSD. ■ Many experts are dubious about the idea of providing therapy for people who have not developed a disorder. ■ Some researchers raise the objection to CISD that a person’s natural coping strategies may work better than those recommended by someone else (Bonanno, Wortman, Lehman, et al., 2002).