MANAGEMENT OF POST TRAUMATIC STRESS DISORDER

The story of PTSD is the tale of the indomitable and indefatigable human spirit to survive and adapt.
Dr. Donald Meichenbaum

Psychological Constructs After Trauma

Fear stucture
Trauma memory

Early trauma stucture

Early PTSD symptoms Recovery processes

FEAR STRUCTURE
A fear structure is a program for

escaping danger
It includes information about:
The feared stimuli The fear responses The meaning of stimuli and responses

Trauma Memory
Is a specific fear structure that includes

representations of:

Stimuli present during the trauma Physiological and behavioral responses that

occurred during the trauma Meanings associated with these stimuli and responses

Associations among stimulus, response, and

meaning representations may be realistic or unrealistic

Schematic Model of a Memory Shortly After the Rape

Afraid
I - Me

Uncontrollable

Rape
Alone
Scream

Man
Shoot Tall Gun

Say I love you Freeze

Suburbs Home

Bald

PTSD Symptoms

Confused

Incompetent

Dangerous

Characteristics Of Early Trauma Structure

Large number of stimuli Excessive responses (PTSD symptoms)

Erroneous associations between stimuli and danger

Erroneous associations between responses

and incompetent Fragmented and poorly organized relationships among representations

Early PTSD Symptoms

Trauma reminders in daily life activate the

trauma memory and the associated perception of danger and self incompetence. Activation of the trauma memory is reflected in re-experiencing symptoms and arousal Re-experiencing and arousal motivate avoidance behavior.

Recovery Processes
Repeated activation of the trauma memory

(emotional engagement) Incorporation of corrective information about world and self Activation and disconfirmation occur via confronting trauma reminders (e.g., thinking about, and contact with trauma reminders) Corrective information consists of the absence of the anticipated harm

Schematic Model of a Recovered Rape Memory

Afraid I - Me
Say I love you Freeze Alone
Scream

Uncontrollable

Rape
Suburbs
Home

Man

Shoot Gun

Tall

Bald

Confused

Incompetent

Dangerous

Source: Edna Foa, PE for PTSD

Emotional Processes After Trauma

Schematic Model of Emotional Processing

Pre-Trauma Records Traumatic Event Trauma Records Self Schema Post-Trauma Events World Schema

Schemas

PostTrauma Records

Recovery
Source: Edna Foa, PE for PTSD

Pathology

Schematic Model of Recovery Following Trauma

Pre-Trauma Records
Balanced, flexible premises about self and world

Traumatic Event Trauma Records

It was not my fault; I handled it as well as could be expected.

Schemas

Post-Trauma Events World Schema

Self Schema
I am mostly competent.

The world is mostly safe.

PostTrauma Records
Some but not all people can be trusted; PTSD symptoms are normal and temporary.

Recovery
Source: Edna Foa, PE for PTSD

Schematic Model of Developing Pathology Following Trauma

Pre-Trauma Records
Rigid premises about self and world

Traumatic Event

Schemas Self Schema

I am entirely incompetent.

Post-Trauma Events

Trauma Records
It is my fault.

World Schema
The world is entirely dangerous.

PostTrauma Records
People are untrustworthy; PTSD symptoms are dangerous.

Pathology

1038

Vulnerabilities to PTSD

Pre-Trauma Factors

A history of prior traumatization Underdeveloped protective skills Personality negative thought patterns Biology/hereditery factor Family characteristics Recent life stressors Initial distress at the time of trauma

Post-Trauma Factors
Recovery environment lack of support

from family, friends and community Secondary victimization Conspiracy of silence Ineffective coping Lack of treatment or ineffective treatment

TREATMENT OF PTSD

CBT Treatments for PTSD

Promote safe confrontations (via exposure,

discussions) with trauma reminders (memories, situations)

Aim at modifying the dysfunctional cognitions

underlying PTSD

Cognitive-Behavioral Treatment

Exposure Procedures
Anxiety Management Procedures Cognitive therapy

EXPOSURE THERAPY

A set of techniques designed to help

patients confront their feared objects,

situations, memories, and images (e.g.,

systematic desensitization, flooding).

Anxiety Management Treatment

Relaxation Training Controlled Breathing

Positive Self-talk and Imagery

Social Skills Training

Distraction Techniques

(e.g., thought stopping)

Cognitive Therapy
Identifying dysfunctional, erroneous

thoughts and beliefs (cognitions) Challenging these cognitions Replacing these cognitions with functional, realistic cognitions

When circumstances dont fit our ideas, they become our difficulties -Benjamin FranklinI dont want to remember but I cant seem to forget
-PTSD Sufferer-

The Basic Principles of Cognitive Restructuring

Major PTSD treatment goal is to integrate dissociated trauma material with associated memories, so the fabric of our memory becomes like one continuous memory. Integration is facilitated by restructuring unproductive ideas that maintain emotional arousal and interfere with processing. Unproductive ideas can relate to the present, the past, or the future. Each can keep arousal dysfunctionally high.

 Cognitive therapy asserts that thoughts significantly influence our reactions to events. Cognitive therapy enables us to stop, identify unproductive thoughts, and replace them with more functional thoughts. We stop running from arousing thoughts or only partially confronting them, and begin to persistently confront and challenge them We shift from the helpless victim mode to the action mode, gaining mastery over the one thing we can consistently control our thoughts

ABC Model of Cognitive Therapy

A B C A = stand for the Activating (or upsetting) event B = is the Belief (or automatic thoughts) that we tell ourselves about A C = is the emotional and physical Consequences (or arousal) Most people think that A causes C. In reality, it is B, our self talk, that has greater influence.

Automatic Thoughts and Distortions

When upsetting event occurs, automatic thoughts (ATs) run through our minds. Although were all capable of thinking reasonably about upsetting events, sometimes our automatic thoughts are distorted or unreasonably negative. Distorted ATs occur so rapidly that we hardly notice them, let alone stop to question them. Yet these ATs profoundly affect our mood, our bodys arousal, and our ability to process clearly.

The Distortions Thoughts on PTSD

Flaw Fixation fear focus ATs 2. Dismissing the Positive 3. Assuming ; - mind reading - jumping to conclusions - fortune telling 4. Catastrophizing horrible or awful 5. All-or-none thinking think in extremes 6. Should (must/ought) rigid demands
1.

7. Making feelings facts 8. Over generalizing 9. Abusive labeling 10. Personalizing 11. Blaming 12. Unfavorable comparisons 13. Regrets

Analyzing & Processing

Step 1 : The Facts

At the top briefly describe an upsetting event from the past, present, or future and the resulting feeling. Rate the intensity of these feelings (from 1 to 10). Remember, getting in touch with disturbing feelings is a way to stop them from controlling us.

 Step 2 : Analysis of thoughts

- List of Automatic thoughts (ATs) - Identify the distortions - Try to respond, or talk back, to each distorted AT Step 3 : Result With this process, upsetting events will still probably be upsetting, though not as disturbing

The Seven Principles of Healing

1. 2. 3. 4. 5. 6. 7.

Healing starts by applying skill to manage PTSD symptoms Healing occurs when traumatic memory is processed or integrated Healing occurs when confronting replaces avoidance Healing occurs in a climate of safety and pacing Healing occurs when boundaries are intact Kind awareness and acceptance of feeling aid the healing journey Balance in our lives is necessary to heal

The life you have led doesnt need to be the only life you have
-Anna Quindlen-

thank you