5.2 anxiety disorder
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5.2 Anxiety Disorder
Post Traumatic Stress Disorder (14 min)PTSD
Pages 157 - 161
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
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
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
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, sight Brewin et al, (1996) – ‘cue-dependent’ memory
similar stimuli to the original event may trigger sensory and emotional aspects of the memory → panic
CLOA
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.
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.,
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
Experiences with racisms and oppression are
predisposing factors for PTSD. Roysircar (2000), meta analysis
20.6 % Blackfit profile for PTDS after 27.6% Hispanic the 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
Bosnia 1998 - Sarajevo
73% girls & 35% boys suffered PTSD Higher rate in girls was due to the fear of rape.
SLOA cont.,
Silva (2000) indicated the children may
develop PTSD by observing domestic violence.
Social Learning and PTSD
According to DSM – somatic symptoms are
atypical in PTSD
Cultural Considerations PTSD
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
Symptoms and gender
differencesMales
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
Relevant studies
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
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
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?
5.3 Treatment PTSD
Eclectic approach
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)
Antidepressants are also prescribed – contributes to improvement
Biomedical individual and group approaches of PTSD
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
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
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 time4. 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
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
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
Evaluate the use of group approaches to treatment
of one anxiety
Discuss validity and reliability of diagnosis
Describe the symptoms and
prevalence of PTSD & Depression
Discuss the interactions of biological, cognitive,
and sociocultural factors in abnormal behavior
Analyze etiologies of PTSD and Depression
Discuss cultural and gender variations in
disorders
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