2.  5.2 Anxiety Disorder Post Traumatic Stress Disorder Post Traumatic Stress Disorder (14 min) PTSD Pages 157 - 161

3.   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

4.   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

5.   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

6.   How Does PTSD Affects Brain Function? (11:03) How Does PTSD Affects Brain Function?

7.   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, sightsounds  Brewin et al, (1996) – ‘cue-dependent’ memory  similar stimuli to the original event may trigger sensory and emotional aspects of the memory → panic CLOA

8.   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.- ‘ Virtual Iraq ’  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.,

9.   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

10.   Experiences with racisms and oppression are predisposing factors for PTSD.  Roysircar (2000), meta analysis  20.6 % Blackfit profile for PTDS after  27.6% Hispanicthe 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

11.   Bosnia 1998 - Sarajevo  73% girls & 35% boys suffered PTSD  Higher rate in girls was due to the fear of rape.fear of rape SLOA cont.,

12.   Silva (2000) indicated the children may develop PTSD by observing domestic violence. Social Learning and PTSD

13.   According to DSM – somatic symptoms are atypical in PTSD Cultural Considerations PTSD

14.   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

15.  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

16.  Relevant studies

17.   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

18.   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

19.   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?

20. Eclectic approach

21.   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)http://web.williams.edu/imput/synapse/pages/IIIA9.htm  Antidepressants are also prescribed – contributes to improvement Biomedical individual and group approaches of PTSD

22.   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

23.   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

24.  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. 4 Goals of CBT

25.   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

26.   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

27.  Evaluate the use of group approaches to treatment of one anxiety

28.  Discuss validity and reliability of diagnosis

29.  Describe the symptoms and prevalence of PTSD & Depression

30.  Discuss the interactions of biological, cognitive, and sociocultural factors in abnormal behavior

31.  Analyze etiologies of PTSD and Depression

32.  Discuss cultural and gender variations in disorders