Transcript 5.2 Anxiety Disorder PTSD

5.2 Anxiety Disorder
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Post Traumatic Stress Disorder (14 min)
PTSD
Pages 157 - 161
Symptoms PTSD
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 Affective:
 anhedonia; emotional numbing
 Behavioral:
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Hypervigilence
Passivity
Nightmares
flashbacks
 Cognitive:
 intrusive memories
 inability to concentrate
 hyperarousal
 Somatic:
 headaches, stomach aches, lower back pain, digestive problems,
insomnia, regression (children)
Etiology
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 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.
BLOA
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 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
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 How Does PTSD Affects Brain Function? (11:03)
CLOA
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 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 cont.,
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 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:
Attribution and
Cognition
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 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?
SCLA
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 Experiences with racisms and oppression are
predisposing factors for PTSD.
 Roysircar (2000), meta analysis
 20.6 % Black
 27.6% Hispanic
 13% white
fit profile for PTDS after
the Vietnam war
 Dyregrov studying Rwanda children:
 Threat of death was the driving factor for the intrusive
thoughts and avoidance of behavior that trigger
anxiety or panic.
SLOA cont.,
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 Bosnia 1998 - Sarajevo
 73% girls & 35% boys suffered PTSD
 Higher rate in girls was due to the fear of rape.
Social Learning and PTSD
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 Silva (2000) indicated the children may develop
PTSD by observing domestic violence.
Cultural Considerations
PTSD
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 According to DSM – somatic symptoms are atypical
in PTSD
Gender Considerations PTSD
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 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.
Symptoms and gender
differences
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Males
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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
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PTSD in post genocidal
societies: the case of Rwanda
 UNICEF, 1997,
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 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
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 1995 UNICEF conducted a survey of 3000 Rwandan
children, aged 8-19
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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.
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 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?
Eclectic approach
Biomedical individual and
group approaches of PTSD
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 Antidepressants and tranquilizer
 Benzodiazepine – modulates GABA (gammaaminobutyric 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
Individual Therapy
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 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
Cognitive Treatment
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 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.
4 Goals of CBT
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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 time
4. 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.
A New World
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 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
Testimonial Psychotherapy
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 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.
Evaluate the use of group
approaches to treatment of
one anxiety
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Discuss validity and
reliability of diagnosis
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Describe the symptoms
and prevalence of PTSD
& Depression
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Discuss the interactions of
biological, cognitive, and
sociocultural factors in
abnormal behavior
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Analyze etiologies of
PTSD and Depression
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Discuss cultural and
gender variations in
disorders
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