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Trauma & Post Traumatic Stress (What is stress? (appraisal of event…
Trauma & Post Traumatic Stress
What is stress?
Stressor: event
stress response: reaction
stress: physiological & emotional response
appraisal of event & our abilities determine stress level
primary: appraisal of even
secondary: what are our abilities/resources?
Effects of stress
anxiety, schizophrenia, diathesis stress, depression, sexual dysfunctions
Defining stress
Psychophysiological Responses
Fight or flight response: endocrine and autonomic systems
sympathetic nervous system -> gas
parasympathetic nervous system -> the brakes
Coping Responses
Problem-focused coping change stresses
emotion-focused coping alters internal stress
Defining Trauma
exposure to actual or threatened death or serious injury or sexual violence
direct, witness, violence or accidental trauma to friend/family repeated exposure through work
PTSD Symptoms
Re-experiencing (at least 1)
avoidance, alterations in cog or mood (2+)
alteration in arousal (2+)
For children
Trauma: self, witnessing, parent
1+ intrusion (nightmare, play, flashbacks)
1+ persistent avoidance or negative alterations in cognition
2+ alterations in arousal & reactivity
Acute Stress Disorder (as many as 80% -> PTSD)
severe trauma definition
9 of 14 sxs (intrusion, negative mood, dissociation, avoidance, arousal)
Functional Impairment
2 days, <4 wks, and within 4 weeks of event
Prevalence & Incidence
3.5% yearly prevalence
7-9% lifetime prevalence
66% seek tx
Rape
distress raises for 3 wks, plateaus for 1 mo, improves 94% ASD
War
Vietnam: 29% w/ PTSD or ASD
Factors
Social
nature of exposure
social support following trauma
spiritual alienation -> higher distress
Biological
genetic contributions
Psychological
Two-factor theory
classical condition creates fear (associate music that was playing during trauma with trauma)
operant conditioning maintains fear (avoidance
uses negative reinforcement by removing anxiety)
Cognitive
expectations, preparedness, control
Treatment
Psychological Interventions
CBT
trusting therapeutic relationship
educate about coping process
stress-management training
re-experience of trauma, integrate event into client's experience
1/3 do not respond to Tx
CBT: Imagery Rehearsal Therapy
prolonged exposure in vivo or imagination
Trauma-focused CBT: trauma narrative after coping & grounding skills
EMDR
Biological Interventions
Antidepressants -> high comorbidity of PTSD & depression
Anxiolytics not effective
Dissociative Disorders
Dissociative Amnesia
inability to recall personal info but no biological factor
functional impairment/distress
localized, selective, generalized or continuous
Dissociative Fugue
Specifier of Dissociative Amnesia
sudden travel away, inability to recall past
confusion about identity, may assume new identity
0.2% lifetime prevalence
Dissociative Identity Disorder (DID)
2+ identities control bx
inability to recall important personal info not bc of drugs, med condition, fantasy play
Subpersonalities
avg: 15 for women, 8 for men
identifying features
Etiology
Psychodynamic
repressing painful memories (abuse/trauma)
pattern of lifetime repression
Behavioral
operant conditioning, relief from mind-drifting
Self-hypnosis
Role-Enactment
Social
iatrogenesis
leading questions of therapist
Treatment
psychoeducation, family therapy, recover memories, integrate subpersonalities
Treatment
#
Psychodynamic
explore unconscious to recover memories
Hypnosis
may be etiology
recall memories while relaxed
Psychopharmacology
Sodium Amytal or Pentothal
Truth serums