9_PSYC_301_Trauma_and_Related_Disorders in the psychopathology .ppt

trauma and related disorders

1. TRAUMA AND 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).