3. A month later…
Flashbacks and
nightmares
about the car
crash
Easily aroused
by loud noises
Avoiding
neighborhood
where she
experienced the
crash
Avoiding
driving in her car
Hasn’t been
going to
McDonalds
because one was
on the road
15. Onset of PTSD
Directly after
Trauma
Acute stress
disorder
Not PTSD time will
often heal
Acute if symptoms
last less than 3
months
Better prognosis
Chronic if persists 3
months or mother
Delayed onset
More guarded
prognosis
At least 6 months
Reason for delayed
onset is unknown
16. Traumatic event
Intense fear and
anxiety
surrounding cars
Avoid using your
car on highway
You temporarily
suppress your
anxiety and fear
Thoughts becomes
more intrusive and
common
Significant
dysfunction and
distress
Bike to the doctors
office
20. E
X
P
O
S
U
R
E
Traumatic event
car crash
Intense fear and
anxiety
surrounding cars
Avoid using your
car on highway
Expose patient to
the fear
Overcome fears
Reduce avoidance
and withdrawal
Allow you to drive
your car
Coping strategies
+ CS, control
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Bremner, J., Randall, P., Vermetten, E., Staib, L., Bronen, R. A., Mazure, C.,
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hippocampal volume in posttraumatic stress disorder related to
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Breslau, N., Davis, G. C., & Andreski, P. (1995). Risk factors for PTSD-
related traumatic events: A prospective analysis. The American
Journal of Psychiatry, 152(4), 529-535.
References
27. Foa, E. B., Keane, T. M., Friedman, M. J., & Cohen, J. A. (Eds.). (2009).
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et al. (1993). Do gnenes influence exposure to trauma? A twin study
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Tarrier, N., Sommerfield, C., & Pilgrim, H. (199). Relatives; espressed
emotion (EE) and PTSD treatment outcome. Psychological Medicine,
29, 801-808.
29. Van Etten, M. L., & Taylor, S. (1998). Comparative efficacy of treatments for
post-traumatic stress disorder: A meta-analysis. Clinical Psychology
and Psychotherapy, 5(3), 126-144.
Widows, M. R., Jacobsen, P. B., & Fields, K. K.,. (2000). Relation of
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Hinweis der Redaktion
Although Patricia’s physical injuries have healed, a month after this life-threatening accident, she still refuses to go to McDonalds because there was one near the site of her accident, she avoids driving her car, she avoids the neighborhood where the accident took place, she is easily aroused by loud noises, and she experiences persistent flashbacks and nightmares about her traumatic car crash
Slide 6: In order to be diagnosed with PTSD, a patient must have been exposed to a traumatic event, 1 month must have passed since the trauma, and a patient must display other symptoms
Common misconception of PTSD is that the only cause is a traumatic event; however, if this were the case many more individuals would have developed the disorders. While we know exposure to a traumatic event plays a role in development of PTSD we must use a multidimensional approach to best understand the etiology of PTSD. While there is not a single “cause” for PTSD research suggests that in addition to the experience of a traumatic event other factors such as Generalized biological vulnerabilities, generalized psychological vulnerabilities, and Environmental Factors all of which play a role in the development of PTSD.
General Biological Vulnerabilities include Genetics, a difference in the serotonin transporter gene, damage to the hippocampus, and dysfunction in the HPA axis. One twin study on male-male twins who fought during the Vietnam War found a stronger correlation in monozygotic twin pairs developing PTSD than dizygotic twins suggesting a genetic basis for PTSD. The Monozygotic twins had a .41 correlation coefficient for development of PTSD while dyzygotic twins only had a .24 correlation coefficient. Another study researching PTSD and non PTSD patients found that PTSD patients were much more likely to have two short alleles in the serotonin transporter gene. Another study’s results comparing individuals with PTSD to individuals with out the disorder suggested that those with PTSD more commonly have a smaller hippocampus. However, researchers still do not know if the loss volume in the hippocampus is a cause or an effect of PTSD. Finally, research indicates that an individual with PTSD do not have a normal functioning HPA axis which is the circuit responsible to control the body’s reaction to stress.
Unlike other disorders there is not one typical courseOnset can take various forms
Avoidance – short term solves the problem but can cause enhanced distress and dysfunction in future, less you will desensitize, caused increased fear and anxiety Avoidance maintains the disorder
Alcohol abuse – men: 52% women: 28% (source 1) Drug abuse – men: 35% women: 27% (source 1)Used often to cope with distress an individual is suffering can actually intensify symptoms of PTSD
Slide 20:Studies have found the most successful treatment for PTSD is Prolonged Exposure. I will give you an example of various steps you might go through if you were to use this treatment method. In prolonged exposure, you will not avoid fears associate with the traumatic event. Instead, you will be exposed to these fears. Exposure helps patients’ overcome these fears rather then suppressing them. This reduces symptoms of PTSD such as withdrawal and avoidance and allow you to drive your car. This treatment also includes education before the exposure so patients can learn positive coping strategies. This treatment also has two main components: imaginable and in vivo. Imaginable exposure is when a patient re lives their traumatic event through remembering it while in vivo implies a direct confrontations of fears associated with the traumatic event. For example, you might go back to the site of your car crash. During prolonged exposure, patients should go at their own pace so they feel a sense of control because a sense of control is often taken away by trauma. This treatment often takes multiple sessions but studies indicate it is the most successful way to treat PTSD
Slide 21: Another treatment method is Cognitive-processing Therapy. This therapy involves repeatedly talking about the event to a psychiatrist. Through these sessions a psychiatrist aims to change the way an individual thinks about the traumatic event for example he or she will try to change feelings of self-blame or guilt. Cognitive processing therapy depends on the principle that if you can change and individuals thoughts it will change their behavior.
Slide 22: Medication can also be used in treatment however there is more evidence that Prolonged exposure and cognitive processing therapy are more effective treatments than medication. Medication will hide the symptoms rather than permanently reduce and eliminate them. The most common medication are SSRIs, which reduces anxiety by inhibiting the reuptake of serotonin
Slide 23: There are also other treatments for PTSD. Various studies indicate that strong social support plays a large role in determining the success of a treatment. Eye Movement Desensitization and Reprocessing is a controversial treatment for PTSD. While studies have suggested the treatment has been successful many argue that the success is due to the exposure part of the treatment rather than the eye movement. Research has also shown that Virtual Reality can be used as another form of exposure to reduce PTSD symptoms.
