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POST-TRAUMATIC STRESS DISORDER (Cognitive Behavioural Theory of PTSD…
POST-TRAUMATIC STRESS DISORDER
Trauma
Experience or witness of a life-threatening event (e.g., car accident, combat, natural disaster, sexual assault, physical assault, near-death experience, drowning, etc.)
Lifetime prevalence:
50-60%
- of people will be exposed to a traumatic event in their lifetime, but not all of these people develop PTSD
Traumatic grief
- symptoms of depression in response to a traumatic event
PTSD moved from anxiety disorder (fear-based) to stress & trauma disorder (trauma-based)
Epidemiology
Lifetime prevalence:
~7%
Sex difference:
3:1
ratio, women are 3x more likely, could be due to higher rates of traumatic events in women (but not in vet populations)
10% Canadian vets
from Afghanistan are receiving benefits for PTSD, though most do not seek treatment, so may be an underestimate of true prevalence (higher risk of suicide, likely closer to
50-80%
)
Comorbidity:
73%
with MDD,
38%
with GAD,
31%
with AUD,
90%
all disorders
PTSD in specific traumatized groups:
64% of BC residential school survivors
50% of rape survivors
20% 9/11 survivors
higher rates in traumatized groups
lower rates of PTSD in natural disaster survivors (fateful event) than in assault survivors (individuality of assault, being the victim)
residential school survivors, children taken from homes, abuse & neglect (chronic traumatization)
not everyone has same risk for PTSD
often can pinpoint genesis of disorder & study risk/resilience factors as they go through life's worst moments
Criteria
A. Exposure to
traumatic event
B.
Intrusion:
persistent & distressing memories, nightmares, flashbacks, intense psychological or physiological responses to trauma cues
memories are intrusive, come upon them when don't want them
flashback = being right back in the situation as if it is happening in the present
trauma cues = generalization
panic attacks are common
C:
Avoidance:
effortful avoidance of internal & external cues & reminders
avoid thinking about trauma, avoid cues, can be debilitating
D:
Negative cognition & mood:
numbing, guilt, anger, fear, negative beliefs about self, others & world
overlap with depression & anxiety
similar to anhedonia, feeling of nothingness
guilt is common regardless of trauma or if it makes sense (sense of personal responsibility)
E:
Arousal & reactivity:
sleep difficulty, concentration impairment, exaggerated startle, hyper-vigilance, irritability/aggressivity, reckless or self-destructive behaviours
severe insomnia
concentration impaired as result of thinking a lot about the trauma
hyper-vigilance = scan env't for signs of threat
Cognitive Behavioural Theory of PTSD
most widely disseminated
the way in which the traumatic memory is
processed
explains who does or doesn't develop PTSD (integration, schematics, appraisal)
nature of memory
= how they lay down the memory
people with PTSD still find current situation threatening
memories are intrusions
intense physiological arousal in response to cues
may engage in strategies to control symptoms, but paradoxically intensify symptoms, memories, negative appraisals, etc.
see model
Memory Paradox
trouble intentionally recalling complete memory of trauma
involuntary & intrusive memories (flashbacks)
Flashbacks are...
sensory impressions
experienced as if in the
present
experienced despite more recently learned contradictory info
triggered by wide range of stimuli
Nature of Traumatic Memory
poorly integrated
into
autobiographical memory base
(no clear context in time, place, subsequent & previous info, other memories)
strong S-S (stimulus-stimulus) & S-R (stimulus-response) associations
(triggering cues serve as strong perceptual primes)
to treat, ask to write story about trauma to turn into integrative narrative, develop contextual features
Maladaptive Strategies
thought suppression
safety behaviours
avoidance
drugs/alcohol (high rates of comorbid substance use/abuse in PTSD)
rumination
dissociation
Appraisal Examples:
catastrophize symptoms, similar to rumination in depression
can have negative appraisals to positive responses from people that are trying to help
may have negative appraisals as a trait (pre-existing traits portend risk to many disorders (e..g, neuroticism, negative schemas) including PTSD, as they make negative appraisals about the trauma
Fact that trauma happened:
"Nowhere is safe"
"The next disaster will strike soon"
Trauma happened to me:
"I attract disaster"
"Others can see that I am a victim"
Behaviour/emotions during trauma:
"I deserve that bad things happen to me"
"I cannot cope with stress"
etc.
Acute Stress Disorder
- prevalence is higher than PTSD, diagnosed if experiencing clinically significant impairment/stress during a 1-month period, often get better over time
Meta-Analysis of Risk Factors
Brewin et al., 2000
the strongest factor was
lack of social support
(having social support could be the strongest protective factor)
next was
current env't categorized by high stress
(e.g., relationship dysfunction, financial worry, occupational stress, etc.), traumatized in an already stressful env't
low IQ
was strongest individual difference predictor
others - trauma severity, other adverse childhood events, low SES, female, family psychiatric history, previous trauma, psychiatric history, lack of education
not significant - minority status & age
Genetic Risk for PTSD
heritability index =
.30
shares
60%
of same genetic variance with
panic disorder & GAD
shares
40%
of same genetic variance with
drug dependence
FKBP5 Genotype x Env't Interaction
gene involved in the HPA axis
one of the primary genes responsible for regulating cortisol
childhood abuse is a strong risk factor for developing PTSD in face of more recent trauma
C allele = risk allele, associated with blunting of HPA axis
linear increase in risk with env'tal exposure is for those with one C allele & even more-so with 2 C alleles
see graph