Understanding PTSD: Types and Symptoms

• 80% of people experience a traumatic situation, and 20% of those people go on to develop PTSD
• Trauma is exposure to actual or threatened death, serious injury, or sexual violence

Phenomenology of PTSD

• PTSD has five diagnostic criteria
• A: Exposure
• B: Intrusions (nightmares, reliving the trauma, triggers)
• C: Avoidance (avoiding reminders of the event, or thoughts, or people, external or internal reminders)
• D: Negative Moods (hopelessness, depression type symptoms)
• E: Hyper arousal (fight, being jumpy, snapping)
• PTSD can look different for everyone, therefore there are many possible combinations of symptoms

Trauma Type

• Symptoms for some people don't improve for one main reason
• Non-interpersonal traumas are those not inflicted by another person, such as natural disasters or car accidents
• Interpersonal traumas are those inflicted by another person, such as sexual or physical assault or robbery
• People who experience non-interpersonal traumas are more likely to recover
• Experiencing non-interpersonal traumas are more likely to lead to recovery, where individuals tend to think the world is balanced, hence when those individuals inflict trauma on someone it effects core beliefs

Heterogeneity

• All individuals diagnosed with PTSD have different symptom patterns
• There are over 2000 symptom combinations

PTSD Diagnostics

• PTSD diagnosis requires exposure to actual or threatened death, serious injury, or sexual violence
• Intrusion requires at least one symptom from the cluster of memories, dreams, distress at reminders, or physical and emotional symptoms
• Avoidance requires at least one symptom from the cluster of avoiding distressing internal and external reminders
• Negative alteration in thoughts or mood requires at least two symptoms from the cluster of inability to remember aspects of event, exaggerated beliefs for self or others, distorted cognitions about the cause or consequences of the event (blaming themselves or others), hopelessness, detachment from others, or inability to experience positive emotions
• Hyperarousal and reactivity requires at least two symptoms from the cluster of irritability, angry outbursts, self-destructive behavior, hypervigilance, startled responses, issues focusing, or sleep disturbances unrelated to nightmares
• Symptoms must be present for at least a month and must cause distress

Manifestation

• The lifetime prevalence of PTSD is 8%, with 72% of the 80% that experience trauma developing PTSD
• Women are twice as likely to experience PTSD as men, with a sex ratio of 2:1
• Women are more likely to experience interpersonal trauma, but also more likely to seek help, influencing these numbers
• A developmental subtype of PTSD exists

Recovery

• Individuals without PTSD symptoms improve over time, but individuals with PTSD symptoms do not
• Natural recovery should not be interrupted
• General risk factors include trauma intensity and peritraumatic fear, where high levels of fear during the event increase the likelihood of developing PTSD, a post-trauma psychological environment and low social support

Etiology

• An individual must have trauma exposure
• Classical conditioning creates a "fear network" where many conditioned stimuli bring a fear response
• It is important to teach individuals that stimuli connected to trauma do not always mean trauma is coming
• Operant conditioning involves avoidance of internal and external trauma reminders
• Avoidance prevents exposure to stimuli, inhibiting new extinction learning
• Negative and positive reinforcement
• This means fear is maintained
• Disrupted schemas can cause an individuals to disrupt the idea of how we expect the world to work like "just-world" beliefs
• "Meaning-making" can impact someones beliefs or how we bring meaning to things that happen.
• Internal Cognitive can cause accommodations or schema changes, and assimilation

Memory

• Having issues with encoding and retrieval of event can look like:
• Problematic encoding and retrieval of the event.
• Hippocampus- responsible for laying down memories and being able to put them back out there.)
• Encoding- having a hard time laying down the memory. Retrieving-struggles to find it correctly (in acute stress)
• Stories change because they are struggling to put the pieces back together.
• "Losing their mind.” Memory may come back.

Emotion Regulation in PTSD

• Genes play a role, but it's not exactly heritable because of trauma
• PTSD patients have overactive defensive systems, where the amygdala produces emotional responses and activates the SNS, and an overactive amygdala with Pre-Frontal Cortex "Brake"
• The HPA axis releases cortisol as a stress hormone, having a healthy HPA-Axis that utilizes a Negatice Feedback Loop and Fight or Flight response can lead to dysregulation from before trauma exposure.

PTSD and Heritability

• The heritability coefficient for PTSD is 0.4, meaning 40% is accounted for genes

Comorbidity

• There are over 2000 combinations for PTSD
• Women are twice as likely to develop PTSD and are more likely to experience interpersonal trauma

PTSD Treatments

• Prolonged Exposure ("PE") treatment helps form extinction learning and new inhibitory distinctions
• The goal is to activate each node of the fear network
• Imaginal exposure where individuals imagine themselves at the scene of trauma
• Audio recorded narratives of event. In Vivo exposures- in real life
• Both allow one to extinguish fear response and create new inhibitory responses
• Cognitive Processing Therapy ("CPT") targets thoughts, schemas, and beliefs about the world after the event
• It processes "Stuck points", or distorted cognitions or beliefs about intimacy, trust, power or control and shame
• The goal is to focus on memory assimilation and accommodations, impact statement,
• 8-12 week program to target stuck points and make them rewrite it again to see if they stuck point have gone away
• "CBT-I" can be used for targeting co-morbidity
• Medications should not be the first line of treatment. SSRIs treat depression and anxiety disorders, and also helps treatment engagement

PTSD Treatment Options

• In terms of the development of PTSD, one treatment is to lay out the idea of a fear network Fear network: many stimuli that lead to one response. Extinction learning- expose client to end=tire fear network
• Use the gene-environment (rGE) correlation to explain the empirical observation that traumatic event exposure appears to be heritable. Genes influence the environments we select. And if you are predisposed to disorders you will let those decide the environment you pick (impulsivity- skydiving, anger- fights.)

Diagnosing Anxiety

• Fear is an emotional and immediate response to a present danger while anxiety concerns potential threats in the future
• Pathological anxiety is defined as excessive and impairing

Panic Disorder

• Panic disorder is TRANSDIAGNOSTIC and occurs across many disorders
• The Diagnostic criteria of a panic attack is: Abrupt surge of intense fear/discomfort peaks within minutes (imminent threats) peak within minutes/ very short Has to experience at least 4: Ο Heart palpations, sweating, trembling, short of breath, chest pain/tightness, tingling, hot flashes/chills, dizzy/lightheaded and/or fear of losing control

Diagnosing Panic Disorder

• For Panic Disorder you must have: Recurrent (happen more than once), unexpected, panic attacks. Uncued (perceived as “out of the blue") 1+ month of: Ο Worry about another Panic Attack occurring. Avoidance of bodily arousal (working out because of increased Heart Rate) and Functional Impairment.

Diagnosing Anxiety

• In Internal cues (bodily feelings) Client thinks they come out of nowhere, The Client doesn't realize the internal bodily sensations cue PA.
• Diagnosing specific phobias needs: Having External cues (or situations)-Not same as social. One specific thing in environment- bugs, clowns, animals. Anxious-Misery disorders need different sets of symptoms.

Diagnosing Generalized Anxiety Disorders

• Worry all of the time, no good time. No trigger just something that could happen Pathological Worry- is Excessive- often "meta-worry" and Difficult to control- can't fix it
• There is usually Physical muscles tension- neck and shoulders
• Have to have: Pathological worry more days than not for 6+ months,difficult to control and meet 3+ symptoms: Restlessness, Easy fatigued, Difficulty concentrating Irritability, Muscles tension and/or Sleep disturbance

Diagnosing Anxiety Disorders

• The overlap of symptoms can occur, some being-overlap with Major Depressive Disorder.
• GAD is co-morbid with PTSD, SAD, MDD, etc., as GAD video shows
• Video: Intense worry that interferes with everyday tasks Financial, bad things happening, health or safety of others, Cognitive Behavioral Therapy, Difficult to control, constant.

Social Anxiety Disorders ("SAD")

Few years, moving out escalated it. Isolation prevents her from getting work- can't interact with people- Prevents her from making relationships. Social expectations stopped from putting herself out there. A person feels Scared of interaction and body language showed distress and uncomfort. Intense, persistent fear of public scrutiny (Intense: impairing or tolerated with distress.,Persistent: 6+ months)

Manifestation patterns with Anxiey

• Anxiety disorders are found to be the most common class.
• Panic Disorder is 3 %, Specific Phobia at rate of 11%,: GAD: 10%, SAD shows for 13% of the populus. Early Onset- can go be away when older or sticks around
• Puberty and “spotlight” effect- specific phobia Panic & GAD between people age 26-35. Can be Chronic (not just one panic attack)
• "Uncued" panic attacks, symptoms, or phenomena, occurs multiple disorders" and are the hallmark of panic disorder, although cued panic attacks occur in other disorders, making them transdiagnotic "uncued" panic attacks- report there is no trigger but really there are internal symptoms, "out-of-nowhere” panic Panic- with an Panic disorder- fear-based disorder which involves uncued panic attacks, and over 1 month of worry of panic attacks coming "Where do panic dieorders come from and diagnosis" Anxiety can derive from.. (Multidimensional model of psychopathology)

Factors for Anxietity

Bio-psycho-social perspective Biological Factors can impact people: Genes- heritability coefficient of .3 to .5 (psychosocial intervention first) General anxiety proneness inherited. For .4- use psychosocial intervention and for 0.8 use medication because it is mostly biologicals Neurobiology; Overactive Defensive system Amygdala; activates SNS (Synthetic Nervous system) (too many Prefrontal cortex- brake and can be from Gene-Environment Interplay

Why Does Anxiety Exist

• "Just because they have the gene- doesn't mean they will have the disorder, you have to have stressors to turn on the gene."
• Cognitive
• Psychological Factors Problematic beliefs Anxiety Sensitivity- general proneness for someone to experience anxiety symptoms and think that severe negative consequences will come. Which makes the anxiety worse

Psychology in Anxiety

• Classical Conditioning: The Stimulus learning where over may trials CS predicts the US And Learning with Domains Direct- she directly experienced that learning in Indirect Vicarious- through others like our parents. Observing others, Info transmission Responses can be operative in two-Factor with Factor 1: Classical Conditioning Dog (CS) paired with bite (US) Factor 2: Operant Conditioning Avoidance (negatively reinforced) of dogs (behavior prevents bad outcome)

Social Factors in Anxiety

• No (new) extinction learning about dogs.
• Intergenerational transmission can include symptoms: Bidirectional between parents and kids, Anxious Parents with a stressful family environment, And modeling that Anxious parents reinforce anxious behavior for Anxious Kids to Elicit overprotectiveness

Therapy and Treatment

• In Anxiety thereapeutic there is a First-line Cognitive Behavior Therapy (CBT) method that does: psychoeducation (tell client about disorder they are experiencing), Exposure (expose to symptoms to make extinction learning the condition: CS w/o US) , and then Cognitive Restructuring which will change thoughts to make them sting less
• If the First Line Treatments Fail then use: Medication" with "not"fast acting SSRI and Benzodiazepines that are fast-acting drugs (Xanax) that can be subject to abuse- easily tolerable so you increase dose"

OCD AND Compulsions

• Phenomenology- Obsessions AND/OR Compulsions/ Disturbing thoughts (if he didn't lock the door- urges can be images attempting to ignore/suppres/neutralize"
• An indication is Not "thought insertion”- aware it's their own thoughts Compulsions
• MUST BE REPETITIVE and TIME CONSUMING, also 1+ hr/ day or impairing Common where can be- Contamination Concerns (germs, excessive handwashing) Responsibility,Harm Disorders tend to lead to patterns when one is in Manifestation state

Psychological Factors

• Believes with “mental noise is a factor in all disorders” ""Thought fusion can be cause if”They believe they will act on that thought"".
• “Misinterpretation of unwanted thoughts can be cause in a diagnosis

Medical Treatment

• Stimulus- leads to obsessions and then distress and anxiety. Distress leads to ritualized behavior (compulsions) and then Reinforcement of behavior- Temporary relief from distress and anxiety

Therapy

• If the treatment in medical fails then use: Medication with SSRIS but also work to use: Exposure and Response Prevention (ERP)- Psychosocial"

What Is The Connection Between PTSDD

• Dysregulated Hypothalamic pituitary adrenal axis (HPA-Axis) Healthy HPA Fight or flight response for few minutes Negative feedback look, turns on cortisol and then turn off itself The body responds, Hypothalamus

• Anterior Pituitary-> Adrenal Cortex-> Cortisol->"