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5.2 Anxiety Disorder

5.2 Anxiety Disorder. Post Traumatic Stress Disorder (14 min) PTSD Pages 157 - 161. Symptoms PTSD. Affective: anhedonia ; emotional numbing Behavioral: Hypervigilence Passivity Nightmares flashbacks Cognitive: intrusive memories inability to concentrate hyperarousal Somatic:

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5.2 Anxiety Disorder

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  1. 5.2 Anxiety Disorder Post Traumatic Stress Disorder (14 min) PTSD Pages 157 - 161

  2. Symptoms PTSD • 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)

  3. Etiology • 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. • Sutkeret 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.

  4. BLOA • 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

  5. How Does PTSD Affects Brain Function? (11:03)

  6. CLOA • 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 • Brewinet al, (1996) – ‘cue-dependent’ memory • similar stimuli to the original event may trigger sensory and emotional aspects of the memory → panic

  7. CLOA cont., • 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:

  8. Attribution and Cognition • 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?

  9. SCLA • Experiences with racisms and oppression are predisposing factors for PTSD. • Roysircar (2000), meta analysis • 20.6 % Black fit 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.

  10. SLOA cont., • Bosnia 1998 - Sarajevo • 73% girls & 35% boys suffered PTSD • Higher rate in girls was due to the fear of rape.

  11. Social Learning and PTSD • Silva (2000) indicated the children may develop PTSD by observing domestic violence.

  12. Cultural Considerations PTSD • According to DSM – somatic symptoms are atypical in PTSD

  13. Gender 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.

  14. Symptoms and gender differences Males Females Numbing Avoidance Anxiety and affective disorders. Internalize their symptoms • Irritability • Impulsiveness • Substance abuse • Externalize 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

  15. Relevant studies

  16. PTSD in post genocidal societies: the case of Rwanda • 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.

  17. 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.

  18. 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?

  19. 5.3 Treatment PTSD Eclectic approach

  20. Biomedical individual and group approaches of PTSD • 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

  21. Individual Therapy • 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

  22. Cognitive Treatment • 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.

  23. 4 Goals of CBT • Create a safe environment that shows that the trauma cannot hurt them. • Show that remembering the trauma is not equivilent to experiencing it again. • Show that anxiety is alleviated over time • 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.

  24. A New World • 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

  25. Testimonial Psychotherapy • 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.

  26. Evaluate the use of group approaches to treatment of oneanxiety

  27. Discuss validity and reliability of diagnosis

  28. Describe the symptoms and prevalence of PTSD & Depression

  29. Discuss the interactions of biological, cognitive, and sociocultural factors in abnormal behavior

  30. Analyze etiologies of PTSD and Depression

  31. Discuss cultural and gender variations in disorders

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