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Learn about PTSD symptoms, diagnosis criteria, history, explanations, and various treatment strategies including exposure therapy, cognitive processing therapy, and stress-management techniques.
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Chapter 6 Stress Disorders
Characteristics of Stressful Events • Uncontrollable • Unpredictable • Change/Challenge capabilities or self concepts, coping ability
Adjustment Disorder • Development of clinically significant emotional or behavioral symptoms in response to identifiable stressor. • Symptoms must develop 3 months after the onset of the stressor. • May apply to stressors not meeting criteria for PTSD.
Acute Stress Disorder • Similar to PTSD, but occurs within one month of stressor, and lasts four weeks or less • Dissociative/avoidance symptoms may be prominent • At high risk of developing PTSD
Symptoms of PTSD • Criterion A: The person has been exposed to a traumatic event in which both of the following have been present: • Person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. • The person’s response involved intense fear, helpless, or horror. Examples: natural disaster, torture, sexual/physical assault, illness, motor vehicle accident
Symptoms of PTSD • Horowitz: PTSD a stress-response syndrome where an individual fluctuates between intrusion and avoidance • Criterion B: The traumatic event is persistently re-experienced • Intrusive thoughts/memories • Nightmares • Flashbacks • Emotional distress at exposure to trauma cues • Physiological reactivity on exposure to trauma cues
Symptoms of PTSD • Criterion C: Persistent avoidance of stimuli associated with the trauma and numbing • Efforts to avoid thoughts • Efforts to avoid activities, places, and people that are reminders of the event • Inability to recall aspects of the event • Diminished interest in positive activities • Feeling of detachment or estrangement from others • Restricted range of affect • Sense of foreshortened future
Symptoms of PTSD • Criterion D: Persistent arousal • Difficulty sleeping • Irritability/anger outbursts • Difficulty concentrating • Hypervigilance • Exaggerated startle response • Criterion E: Duration of symptoms for more than a month • Criterion F: Symptoms cause functional impairment
PTSD: History • Modern study of PTSD informed by observations made by psychologists and psychiatrists in WWI and WWII – “shell shock.” • The diagnosis began receiving more attention after the Vietnam War. • Characteristic symptoms of PTSD formally codified only since 1980. • Current debates: emotional numbing as a separate symptom cluster and what constitutes a “traumatic event.”
Explanations of PTSD Vulnerability No consistent evidence for demographic factors
Treatments for PTSD • At present, there is no single, prescriptive treatment. • Exposure therapy (systematic desensitization, imaginal exposure, in vivo exposure, implosive therapy) • Good therapeutic alliance • Psychoeducation about the effect of trauma and how exposure works • Validation • Removal of avoidance • Fostering facilitation of new meaning and understanding about the event
Treatments for PTSD • Stress-Management Strategies/Stress-inoculation training • Increase patient’s awareness of conditioned stimuli • Facilitate early cue detection so that coping responses can be used to decrease anxiety early in the stress response • Teaching of behavioral (relaxation) and cognitive (thoughts stopping, self-dialogue) coping strategies for dealing with anxiety
Treatments for PTSD • Cognitive Processing/Cognitive Therapy • - Based in the idea that PTSD stems from a conflict between existing beliefs about the self and world and the traumatic event “cognitive stuck points.” • - Maladaptive beliefs are addressed through cognitive restructuring • - Emphasizes trust and safety • - Addresses “shattered assumptions”