5.2 Anxiety Disorder

Post Traumatic Stress Disorder (14 min)PTSD

Pages 157 - 161

Affective:

anhedonia; emotional numbing Behavioral:

Hypervigilence Passivity Nightmares flashbacks

Cognitive: intrusive memories inability to concentrate hyperarousal

Somatic: headaches, stomach aches, lower back pain, digestive problems,

insomnia, regression (children)

Symptoms PTSD

Development of PTSD is associated with the

tendency to take personal responsibility for failures And to cope with stress by focusing on the emotion

rather than the problem. Victims of child abuse who are able to see that the

abuse was not their fault, but the problem of the abuser were able to overcome symptoms of PTSD.

Sutker et al., (1995) Gulf war veterans who had a sense of purpose and commitment to the military had less chance of suffering from PTSD than other veterans.

Etiology

Twin research (Hauff and Vaglum, 1994) – genetic

predispostion Noradrenaline (neurotransmitter) – role in emotional

arousal. Secreted by adrenal medulla. High levels of NA cause people to express emotions more

openly. Geracioti (2001) individuals with PTSD showed higher NA

levels than average. Stimulation of the adrenal system induced panic attack in

70% if patients and flashbacks in 40%, Increased sensitivity of NA receptors in patients with PTSD

(Bremner 1998) NA as a stress hormone affects the amygdala

BLOA

How Does PTSD Affects Brain Function?

(11:03)

The differences in which an individual processes

information and their attribution styles contribute to the understanding of PTSD.

Common PTSD traits Feeling of lack of control, world is unpredictable Guilt regarding the trauma (example – rape victim,

sole survivor of a crash) Intrusive memories: flashbacks that come to

consciousness Triggered by sounds, smells, sight Brewin et al, (1996) – ‘cue-dependent’ memory

similar stimuli to the original event may trigger sensory and emotional aspects of the memory → panic

CLOA

Virtual Reality – a tool to treat PTSD.

Albert Rizzo - ‘Virtual Iraq’ – the ability for PTSD war veterans to re-experience the trauma in a controlled setting where cognitive tactics can be applied.

Based on the concept of flooding (i.e. over exposure to stressful events)

Stress reactions will eventually fade out due to habituation. power of the cues diminish gradually

Exposure – response preventative:

CLOA cont.,

Suedfeld (2003) examined the attribution patterns of

Holocaust survivors: External factors – luck, God, fate When asked why someone survived the Holocaust

survivors were more likely to mention help from others. Survivors have a low trust in others and a skeptical view

of the world. This Suggests that a specific attribution may be linked

to Holocaust survivors. The question remains, did the Holocaust create this

attribution or did the Jewish culture?

Attribution and Cognition

Experiences with racisms and oppression are

predisposing factors for PTSD. Roysircar (2000), meta analysis

20.6 % Black fit profile for PTDS after 27.6% Hispanic the Vietnam war 13% white

Dyregrov studying Rwanda children: Threat of death was the driving factor for the

intrusive thoughts and avoidance of behavior that trigger anxiety or panic.

SCLA

Bosnia 1998 - Sarajevo

73% girls & 35% boys suffered PTSD Higher rate in girls was due to the fear of rape.

SLOA cont.,

Silva (2000) indicated the children may

develop PTSD by observing domestic violence.

Social Learning and PTSD

According to DSM – somatic symptoms are

atypical in PTSD

Cultural Considerations PTSD

Breslau et al. (1991) longitudinal study of

1007 young adults who had been exposed to community violence found PTSD in: 11.3% women 6% men

Horowitz et al (1995) women have up to 5X greater risk than males after a violent or traumatic event.

Gender Considerations PTSD

Symptoms and gender differences

Males Irritability Impulsiveness Substance abuse Externalize their

Symptoms

Females Numbing Avoidance Anxiety and affective

disorders. Internalize their symptoms

Types of trauma may carry different risks for developing PTSD

Rape is experienced more by women and has one of the highest risks for PTSD;Other forms of sexual abuse and interpersonal violence as opposed to accidents or Natural disasters

Relevant studies

UNICEF, 1997,

65,000 families headed by children aged 12 years or younger

300,000 children were growing up in households without adults

Dgrov found that living in the community (rather than in centers) was associated with higher rates of intrusive memories. Children were living within the stimulus zone without any

cognitive assistance Resilience in children is intimately linked to family and

community resources. Cognitive assistance was being administered to the centers.

PTSD in post genocidal societies: the case of

Rwanda

1995 UNICEF conducted a survey of 3000 Rwandan

children, aged 8-19 95% witnessed violence 80% suffered death in their immediate family 62% had been threatened with death 60% did not care if they grew up

Des Forges (1999) elimination of the Tutsi children was seen as the critical dimension in eliminating the Tutsi people from Rwanda.

Geltman and Stover (1997) – trauma occurs when a child cannot give meaning to dangerous experiences.

PTSD in post genocidal societies: the case of

Rwanda

To what extent do the symptoms exhibited by

Rwandan children correspond to what you have read in this unit?

Which factors could promote resilience in these children?

What surprised you most about this case?

5.3 Treatment PTSD

Eclectic approach

Antidepressants and tranquilizer Benzodiazepine – modulates GABA (gamma-

aminobutyric acid) – (Inhibitory neurons) Valium, Xanax

Mode of action: GABA receptors open channels for negative chloride ions, making it less likely that action potentials can be generated in output neurons in the amygdala. These output neurons will then stop sending signals from the amygdala in the limbic system to the frontal cortex. (http://

web.williams.edu/imput/synapse/pages/IIIA9.htm)

Antidepressants are also prescribed – contributes to improvement

Biomedical individual and group approaches of PTSD

Behavioral therapy – based on the idea that

fear is learned response based upon a stimulus, and that this association with the stimulus can be broken through different approaches. Systematic desensitization – process of imagery

and muscle relaxation working up to the real phobia (i.e. fear of flying)

Cognitive therapy – works to correct the faulty thinking. reconstruction

Individual Therapy

Foa (1986) expert in PTSD.

Exposure therapy and psycho-education. Provide information about PTSD then ask the

individual to relive the event through memory and discuss.

The goal is to help separate the idea that, “Talking about trauma” is not the same as experiencing the trauma.

Cognitive Treatment

1. Create a safe environment that shows that the

trauma cannot hurt them.2. Show that remembering the trauma is not

equivilent to experiencing it again.3. Show that anxiety is alleviated over time4. Acknowledge that experiencing PTSD symptoms

does not lead to a loss of control.

PTSD is very raw in emotion – patients may become initially worse in the initial stages of therapy – this is difficult for both the patient and the therapist.

4 Goals of CBT

Traumatology: the onset of school shootings and

terror has triggered the adoption of a new line of intervention based management.

Crisis intervention – objective is to prevent the onset of PTSD Effectiveness is questioned

Does intervening do more harm than good? Is it better sometimes for social support and family to

attend to certain issues? The procedures used in crisis management may help

to lay a more concrete memory, rather than remove one

A New World

Weine (1998) Bosnia: use of testimonial

psychotherapy to aid Bosnian refugees Recognizes collective traumatization's to be a

significant as individual traumatization's. Collective way of life Create an oral history to study survivors memory Give meaning and purpose to the experience of the

survivor. Time to reflect on previous individual attitudes

concerning ethnic identity, forgiving and violence. PTSD decreased up to 56% after 6 month of

testimonial psychotherapy.

Testimonial Psychotherapy

Evaluate the use of group approaches to treatment

of one anxiety

Discuss validity and reliability of diagnosis

Describe the symptoms and

prevalence of PTSD & Depression

Discuss the interactions of biological, cognitive,

and sociocultural factors in abnormal behavior

Analyze etiologies of PTSD and Depression

Discuss cultural and gender variations in

disorders