1. Anushka Pai Tyler Davis Darrell Worthy Cindy Stappenbeck
PTSD
Anushka Pai
Tyler Davis
Darrell Worthy
Cindy Stappenbeck

2. Clinical Factors of PTSD
Rexperiencing symptoms
Intrusive memories
Nightmares
Protective reactions
Emotional numbing
Amnesia
Cognitive avoidance
Arousal symptoms
Startle response
Hyper vigilance
Negative emotions & cognitions
Sadness
Anger
Guilt

3. Typical characteristics
Typically characterized by an alternation between re-experiencing and avoiding
Re-experiencing is rapid and spontaneous, vivid, and arousing
Different than normal LTM retrieval in that emotions are felt in original intensity
May be able to dispassionately discuss traumatic experience, but still experience trauma related emotions when cued
Occurs in 25-30% of the population given a traumatic experience
Decreases over time, but can last up to 40 years

4. PTSD and Stress Responses
Can be explained somewhat in terms of stress responses within the normal range of human experience
Bereavement
Bowlby’s Attachment Theory
Parkes Psycho-Social Transitions
Does not account for all aspects of PTSD such as negative flashbacks, startle responses, and high physiological arousal. Can’t explain individual differences.
Do you think that the differences between PTSD and these general models of responses to stressful events could be related to differences between the stress inducing stimuli, rather than differences in cognitive architecture for handling different types of stress?

5. Influences on the development and time course of PTSD
Object exposure (how close were you to the trauma?)
Levels of social support
Locus of control (internal vs. external)
Do you think the locus of control is another example of how our authoritarian ego is actually a safety mechanism?

6. Comorbidity 80% of PTSD sufferers have a comorbid disorder
Commonly
Somatization
Psychosis
Anxiety disorder
Depression
Shares features of comorbid disorders, but cannot be explained by them

7. Cognitive Biases in PTSD
Increased skin conductance for combat related words in PTSD vets vs controls
Are normal people appropriate controls for this?
Slower in stroop task with trauma related words with personal relevance
Difficulty retrieving specific memories to cues
Judge negative events as more probable in the future than controls
PTSD itself cannot be explained by comorbid disorders, however do you think that most or all of the cognitive biases can be?

8. Trauma Processing and Dual Representation Theory

9. Dual Representation Theory

10. Conscious Processing
Verbally Accessible Memories (VAMs) – can be consciously retrieved from the store of autobiographical knowledge
E.g. – “I remember losing a finger in the hot-dog cooker”
Conscious processing of the accident
May have selective recall – anxiety increases attentional selectivity and decreases short-term memory capacity

11. Non-conscious processing
Situationally Accessible Memories (SAMs)- not accessed consciously; may be accessed automatically when the person is in a context where the physical features or meaning are similar to that of the trauma situation
Hormonal effects of trauma may diminish neural activity in areas associated with conscious processing – motor aspects represented in analogical codes

12. SAMs
This picture could induce a situationally induced memory in a person who has suffered hot dog machine trauma
The four finger hands could make SAMs even more likely to be activated

13. Emotional Processing
Activation of SAMs to aid the process of readjustment
Conscious attempt to search for meaning and make judgments about cause and blame
Editing of VAMs to bring perceptions of the event into line with prior expectations
Need to consciously reassert perceived control
Need to prevent the continued automatic activation of SAMs
This processing is necessary for overcoming trauma

14. Endpoints of Emotional Processing
How can completion/integration be distinguished from premature inhibition of processing?
How can we be certain that traumatic memories will not resurface in the future?

15. Premature inhibition
Dual representation theory distinguishes between verbally and situationally accessible knowledge
Authors propose that trauma processing can be prematurely inhibited
What is the right amount of processing?
Should patients dwell on what happened to them – could it make things worse?
Are these good recommendations?

16. Overview of persistent PTSD
Pre-trauma Variables
Cognitive processes during Trauma
Memory for Trauma
Appraisals-perception of current threat
Strategies to control threat and symptoms

17. Ehlers and Clark (2000)

18. Pre-trauma Variables Prior Beliefs (Positive or Negative)
Previous traumas
Coping style

19. Cognitive processes in trauma
Conceptual vs. Data driven
Influenced by
High arousal and fear
Duration and predictability
Perception of control
State factors
Low intellectual ability

20. Memory for trauma Reexperiencing Strong S-S and S-R associations
Strong perceptual priming
Poor elaboration and incorporation

21. Appraisals of traumatic event
Overgeneralize from event
FEAR
Overestimate probability of another trauma
How they felt/behaved during trauma
SHAME

22. Appraisals of trauma sequelae
Interpretations of common symptoms
Interpretations of others’ reactions
Interpretations of consequences in other domains

23. Maladaptive strategies
Strategies are meaningfully linked to appraisals
Maladaptive because
Directly produce PTSD symptoms
Prevent change in negative appraisals
Prevent change in the nature of trauma memory

24. Maladaptive Strategies Cont.
Thought Suppression
Selective Attention to threat cues
Safety Behaviors
Trying not to think about the trauma
Avoidance of reminders
Rumination
Dissociation when reminded of trauma
Alcohol or substance use

25. PTSD Treatment

26. Putting Trauma in the Past
Memory needs to be integrated into person’s experience to reduce problematic reexperiencing
Appraisals of the trauma need to be modified
Avoidance techniques and safety behaviors need to be eliminated

27. Assessment & Treatment Rationale
Attempt to assess coping strategies, what they avoid, how they deal with intrusions, what their fear is about dwelling on trauma
These identified to use in later treatment
Reexperiencing symptoms are isolated memory fragments triggered by matching cues
Experienced as if happening in the “here and now” because they are not integrated into other autobiographical info

28. Treatment Components
Thought suppression causes more of the unwanted thoughts
Instructed to accept intrusive thoughts
Education
Reclaim one’s former life

29. Treatment Components Reliving Trauma
Make image realistic including thoughts and feelings as well as what was happening
Verbally describe event in present tense
Therapist uses questions to keep client focused on feelings and thoughts
Patients rate distress at different points
Cognitive restructuring used to change problematic thoughts & beliefs about event

30. Treatment Components Reliving (cont.)
As therapy progresses, narrative tends to become more coherent
Memory loses the “here and now” quality
Works by facilitating elaboration of the trauma memory
Facilitates retrieval of elements of the trauma memory difficult to otherwise access
Verbalization of visual and sensory cues may make it more difficult to retrieve original sensory impressions from memory

31. Treatment Components In vivo exposure Imagery Techniques
Revisiting the site of event
Engage in feared/avoided behaviors to obtain disconfirming evidence
Imagery Techniques
Useful in changing meaning of the trauma memory
Allows patients to explore consequences of actions not taken

32. Treatments Not Covered in Article
Eye Movement Desensitization
Stress Inoculation Training
Muscle relaxation
Breathing control
Role Playing
Thought Stopping