Post Traumatic Stress Disorder (PTSD)

1. Post Traumatic Stress Disorder(PTSD) Erica Blasier Karina Chavez Carlos Ferrer Ashley Galicia Jade Hall Matthew Lewis Selena Morales Kim Niemiec Alyssa Reck Contrell Smith

2. PTSD Symptoms • PTSD can be related to are depression, substance abuse, problems of member and cognition, and other physical and mental disorders. This is why diagnoses of PTSD can be hard. • PTSD is associated with a persons inability to function in daily life from family life such as divorce, parenting difficulties, and job problems • Some other common symptoms include: • Affective: Anhedonia- loss of the ability of feel pleasure, emotional numbering • Hyper vigilance- enhanced sensibility to the senses, Passivity, Nightmares, Flashbacks, Exaggerated startle response (behavioral) • Intrusive memories, inability to concentrate, hyper arousal- nervous system is in constant state of alert (cognitive). • Lower back pain, headaches, stomach ache and digestion problems, regression in some children- maturity, insomnia, losing skills the person already has- speech and toilet training (Somatic).

3. Biological Etiologies • (Etiologies- the cause or the origin of the disease. ) • Twin Research has shown a possible genetic predisposition for PTSD (Hauff and Vaglum 1994) • It is shown in studies that people who have developed PTSD have an increased level of noradrenaline. • Noradrenaline is a neurotransmitter that plays a role in emotional arousal. • The high level of noradrenaline causes a person to express more emotions on a certain situation or topic more than a normal person, this was found by Geracioti(2001). • The high levels of Noradrenaline often lead to people having flash back and panic attacks. • Bremner 1998 • There is evidence for increased sensitivity of noradrenaline receptors in patients with PTSD

4. Cognitive Etiology • Researchers took a look into how the person perceives the traumatic situation. If the person tries to blame themselves and takes responsibility for the situation then they will suffer significantly. • When the person feels this way they also beginning to feel they have a lack of control over their surroundings and the world. • Development of PTSD is associated with a tendency to take personal responsibility for failures and to cope with stress by focusing on the emotion, rather than the problem. • People who have been diagnosed with PTSD often develop something called intrusive memories. These memories come to mind randomly and are triggered by sounds, sight, and smells that the person associates with the event.

5. Cognitive Continued • Sutker et al. (1995) • Found that Gulf War veterans who had a sense of purpose and commitment to the military had less of a chance of suffering from PTSD than other veterans. • Cognitive theorists have also found that victims of child abuse who are able to see that the abuse was not their fault, but a problem with the perpetrator, are able to overcome the symptoms of PTSD.

6. Cognitive Continued • Links to schema processing and attribution. • Suedfeld (2003) • Examined attributional patterns in Holocaust survivors. Suedfeld found that the attributional style of Holocaust survivors tends to be much more external (Fate, God, Luck, etc.) When asked why someone survived the Holocaust, survivors were more likely than a Jewish control group to mention help from others- including help from Gentiles. Although help from others was prominent in the study, survivors nevertheless have low trust in others and demonstrate a skeptical view of the world. • This study shows that a specific attribution may be linked to Holocaust survivors. However, it is relevant to ask if this attributional style was the result of the Holocaust or particular to the Jewish community, which could perhaps be more about sociocultural factors than cognitive ones.

7. Sociocultrual Etiology • The majority of research on PTSD focuses on sociocultural explanations. Research suggests that experiences with racism and oppression are predisposing factors for PTSD. • Dyregrov • Research on PTSD in Rwandan children. • Argued that death was the factor evidencing the strongest influence on intrusive thoughts and avoidance of behavior, which simply means avoiding situations can trigger anxiety and panic. • This appears to have support in Bosnia, where in 1998 close to 73 % of girls and 35% of boys in Sarajevo suffered from symptoms of PTSD.

8. Gender • Research has found that there is a significant gender difference in the prevalence of PTSD • Breslau et al. (1991) did a longitudinal study of 1007 young adults who had been exposed to community violence and found a prevalence rate of 11.3% in woman and 6% in men. • Horowitz et al. (1995) reviewed a number of studies and found that woman have a risk up to 5 times greater than males to develop PTSD after a violent or traumatic event.

9. Culture • According to DSM, somatic symptoms of PTSD are atypical. • Kleinmen (1987) argues that it is irrational and ethnocentric to assume that non-western forms of this disorder are atypical- the form commonly seen in the West being assumed to be the norm. • Non-western survivors exhibit what is called body memory symptoms • Ex. The dizziness experienced by a woman which was found to be a body memory of her repeated experience of being forced to drink large amounts of alcohol and then being raped (Hanscom 2001)

10. Treatment • Pros of Treatment • Educating people with PTSD about the disorder • may help them cope with having the disorder. • Exposure therapy can work at helping the survivor • of a traumatic experience get over their anxiety • developed from it. • Giving a per suffering from PTSD the correct medicines • may help cure them. (e.g. Antipsychotics, Antidepressants or Anti-anxiety medications) • Individual treatment can allow the doctor to gain one • on one personal relationships with the patient allowing • them to be more open to sharing what they are thinking. • Cons of Treatment • Some people may deny they have the disorder • and resist treatment more. • Using exposure on a person suffering from PTSD • may cause them to freak out and forget about the • coping mechanisms they learned, do to panic. • If a person suffering from PTSD is prescribed • too many different medicines they may become • addicted or dependent on the drugs. • You may not know how well the treatment worked • until how the patient reacts around more than one • person.

11. Examine biomedical, individual and group treatment • Contemporary abnormal psychology adopts a number of different approaches to treatment depending on the disorder (such as biomedical, individual and group therapy). • It’s believed that multifaceted treatment is the best treatment and this is called the biopsychosocial approach to treatment. • This may include drug treatment, individual therapy and group therapy as well as handling risk factors in the environment.

12. Continued • People who suffer from PTSD often take antidepressants and tranquillizers to help cope with their disorder. • Valium and Xanax are tranquillizers that modulate the neurotransmitter GABA in order to regulate anxiety levels. • Antidepressants are often prescribed because most people who suffer from PTSD have depression; those will improve with depression also will improve with PTSD (Marshall, 1994).

13. Continued • At a traumatic event psychiatrists come to help survivors/witnesses and try to prevent them from having PTSD. Mayou et. el (2000) claims that crisis intervention may do more harm than good. The argument is that psychiatrists lay down more concrete memories of the event and make it more difficult to forget. • Foa (1986) treats individuals suffering from PTSD by having them talk about their experience. The four goals of treating a person suffering from PTSD are: • Create a safe environment. • Show that remembering is not equivalent to experiencing the event again. • Show anxiety is alleviated over time. • Acknowledge that experiencing PTSD symptoms does not lead to loss of control.

14. Continued • Friedman and Schnurr (1996) looked at the role of group therapy on Vietnam War veterans. They had a total of 325 war veterans as participants. • There was a group that held trauma-focused therapy which had three components: exposure to traumatic memories, cognitive restructuring, and coping skills development. Compared to a controlled group who only talked about current life issues, the group that had trauma-focused therapy had a better improvement rate. • However, the trauma-focused group had a very high attrition rate (participants dropping out).Attrition rate was 27 percent compared to 17 percent

15. Eclectic Approaches • Antipsychotics. Are prescribed to relieve severe anxiety and/or related problems. • Ex. difficulty sleeping or emotional outbursts.

16. Continued • Antidepressants. Can be used to help symptoms of both depression and anxiety. They can help improve sleeping issues and improve concentration. • Medication related: selective serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) and paroxetine (Paxil)

17. Continued • Anti-anxiety medications. Can improve feelings of anxiety and stress. • Prazosin(Minipress) . For symptoms that include insomnia or recurring nightmares. It is also used for the treatment of hypertension and blocks the brain's response to adrenaline-like brain chemical called norepinephrine

18. Psychotherapy • Cognitive therapy. • Vocal therapy lets the person recognize ways of thinking or cognitive patterns that keep the patient stuck. This method can be used along with behavioral therapy also known as exposure therapy. Ex. negative or inaccurate ways of perceiving normal situations.

19. Continued • Exposure therapy. • Behavioral therapy safely lets the patient face the very thing that is found frightening, and helps them learn to cope with it effectively. Another way of doing this is by using "virtual reality" programs that allow you to re-enter the setting in which you experienced trauma -Ex. a "Virtual Iraq" program.

20. Continued • Eye movement desensitization and reprocessing (EMDR). • This combines exposure therapy with a series of guided eye movements that can help process traumatic memories.

21. Relationship between etiology and therapeutic approach in relation to one disorder. • Etiology: to find out why people suffer from a disorder; this way is more difficult to establish for a psychological disorder, than for physical illness in general. • Therapeutic: treating or curing of the disease.

22. Therapy • Therapy is the most effective approach to try to cure PTSD. • Therapy will help one have a good relationship between the person suffering from PTSD and the therapist. • The goal of therapy is to provide a nonjudgmental environment that allows the person suffering from PTSD and the therapist to work together to achieve certain goals. • The sooner one addresses the symptoms of PTSD, the less likely that person will become worse with their PTSD and will increase the risk of depression. • Symptoms can vary depending on the sex of the patient. Most men develop aggression, become irritable, and violent while women are more prone to anxiety, avoidance of social situations, and depression

23. Therapy (Cont.) • During therapy, the therapist and the patient work on the triggers that make the PTSD more difficult. • The patient and therapist develop techniques to help relieve the triggers that can cause an onset of PTSD responses. • The therapeutic approach and the relationship with etiology become more clear once the patient can identify the triggers sooner and implement the techniques to help relieve the symptoms of PTSD. • Some therapists recommend that the PTSD patient work with a dog that is trained to know when the patient is starting to feel the symptoms of PTSD. • The patient can use the techniques developed faster when they have a dog to help identify that symptoms are starting.

24. Etiology • The patient usually suffers a traumatic experience that leads the patient to suffer from PTSD. • Some traumatic experiences include: fighting in a war and having to kill someone, being involved in a car accident, being raped, etc. • Patients that suffer from PTSD learn with help from a therapist what can trigger the symptoms of PTSD. • Some triggers can include: a gun shot or a firecracker going off, a person following too closely, or acting aggressively towards a raped victim, etc. • Another trigger is having nightmares about the traumatic experience and feeling like the patient is reliving the experience over and over again.

25. Achenbach (1991) • Research for PTSD shows that gender plays a role in symptoms. • Males are more likely to experience externalization symptoms such as aggression and delinquency. • Females are more likely to experience symptoms internally such as anxiety and depression.

26. Diagnostic criteria for Posttraumatic Stress Disorder • Criteria A: The person has been exposed to a traumatic event in which both of the following were present: • The person experience, witnessed, or was confronted with an event of 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, helplessness, or horror. NOTE: In children, this may be expressed instead by disorganized or agitated behavior.

27. Criteria Cont. • Criteria B: The traumatic event is persistently reexperienced in one (or more) of the following ways: • Recurrent and instrusive distressing recollections of the event, including images, thought, or perceptions. NOTE: In young children, repetitive play may occur. • Recurrent distressing dreams of the event. NOTE:In children. There may be frightening dreams without recognizable content.

28. Criteria B Cont. • Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucination, and associative flashback episodes, including those that occur on wakening or when intoxicated. • Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. • Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

29. Criteria C • Persistent avoidance of stimuli associated with the trauma and numbering of general responsiveness (not present before the trauma), as indicated by three (or more) of the following: • Efforts to avoid thoughts, feelings or conversations associated with the trauma • Efforts to avoid activities, places, or people that arouse recollections of the trauma • Inability to recall an important aspect of the trauma • Markedly diminished interest or participation in significant activities • Feeling of detachment of estragement from others • Restricted range of affect (e.g., does not expect to have a career, marriage, children, or a normal life span)

30. Criteria D • Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following: • Difficulty falling or staying asleep • Irritability or outbursts of anger • Difficulty concentrating • Hyper vigilance • Exaggerated startle response

31. Criteria E • Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.

32. Criteria F • The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

33. Statistics of PTSD • In the US, PTSD has a prevalence rate of 1-3 percent and an estimated lifetime prevalence of 5 percent in men and 10 percent in women. • Studies by Davidson (2007) and Breslau (1998) estimate that PTSD affects 15-24 percent of individuals who are exposed to traumatic events.

34. Research (When?) • Careful research and documentation of PTSD began after the Vietnam War. The National Vietnam Veterans Readjustment Study estimated in 1988 that the prevalence of PTSD among veterans was 15.2 percent at that time, and that 30 percent had experienced the disorder at some point since returning from Vietnam

35. Rwanda Genocide (PTSD Study) • Study of the Survivors of the Rwandan Genocide. (Occurred soon after the genocide). • 1995 UNICEF conducted a survey of 3000 Rwandan children, aged 8—19 years of these: • 95 percent had witnessed violence • 80 percent had suffered a death in their immediate family • 62 percent had been threatened with death.

36. Study Cont. • Des Forges (1999) argued that eliminating Tutsi children was seen as a critical dimension in eliminated the Tutsi presence in Rwanda. • According to a UNICEF survey (1999), 60 percent of children surveyed did not care if they grew up.

37. Dyregrov (2000) argues that the extent of loss and trauma which affected all levels of society throughout Rwanda may have rendered the traditional coping mechanisms and collective support less viable, and the whole adult community less receptive to children’s needs, as adults coped with their own traumas and grief.

38. According UNICEF, in 1997 there were 650,000 families headed by children aged 12 years or younger. • Over 300,000 children were growing up in households without adults.

39. The children lived in the community in which the atrocities occurred. This community has a higher opportunity of intrusive memories.

40. Biological factors in PTSD Twin research has shown a possible genetic predisposition for PTSD (Hauff and Vaglum 1994), but most biological research focal point is on the role of noradrenaline. Noradrenaline- is a neurotransmitter which plays an important part in emotional arousal When people express emotions more openly than normal is because they have higher levels of noradrenaline. Geracioti (2001) found that PTSD patients have higher levels of this neurotransmitter than a common person has. In 70 percent of patients, stimulating the adrenal system in PTSD patients causes a panic attack, and flashbacks in 40 percent of patients. These symptoms are not experience by any of the control group members. Bremner (1989), there is no proof found for increased sensitivity of noradrenaline receptors in patients.

41. Cognitive factors in PTSD Can an individuals cognitions make a difference to people who develop PTSD. There may be differences in the way an individuals cognitive process experiences and the other may be a difference in attributional styles. What cognitive therapists often note is that PTSD patients tend to feel that that have very little control over their lives and that the world is unpredictable. Example: A survivor of a car accident or a victim of rape often experience guilt regarding this trauma. These intrusive memories that seem to come to consciousness at random are often triggered by sight, sounds, and smells related to the traumatic event. Example: Flashbacks may be experience while watching a fireworks display to a war veteran. Brewin (1996) These flashbacks occur as a result of cue- dependent memory, where stimuli similar to the original even may activate sensory and emotional aspects of the memory, thus causing extreme fright.

42. Cognitive factors in PTSD Cont. Albert Rizzo professor at the University in Southern California. Rizzo was trying to develop a tool to treat PTSD patients by using virtual reality. In Virtual Iraq these traumatized soldiers can re- experience these horrors of the war while therapist manipulated variables that would be appropriate to each individual. This was based on the concept of flooding. An example of this is over- exposure to stressful events. When the stress reaction finally fades is due to what is called habituation. Rather than focusing on the problem, development of PTSD is associated with a tendency to cope with stress by focusing on the emotion and to take personal responsibility for failures Sutker (1995) found that Gulf War veterans had a less chance of suffering from PTSD than other veterans. Cognitive Theorists have found that victims of child abuse that see that the abuse was not their fault, tend to overcome the symptoms of PTSD

43. Sociocultural factors in PTSD A large amount of the research on PTSD focuses on sociocultural explanations. Some predisposing factors for PTSD are experiences with racism and oppression. Roysircar (2000) researched Vietnam War veterans. His results were that 20.6 percent of black and 27.6 percent of Hispanic veterans met the criteria for a diagnosis on PTSD and only 13 percent of white veterans met this criteria. Dyregrov goes a step further, when it came to Rwandan children, arguing that threat of death was the strongest influence on intrusive thoughts and avoidance of behavior. Research in Bosnia seemed to support this, because in 1998 close to 73 percent of girls and 35 percent of boys in Sarajevo suffered from symptoms of PTSD. Kaminer (2000) was credited to have the highest rate of PTSD in fear of rape in girls. A role in PTSD is social learning. Silvia (2000) studies indicated that children may develop PTSD by observing domestic violence.