PTSD

Etiologies - Bio , Cog and

Socio cultural
What is PTSD
Biological Etiologies - Abnormalities of brain
structures
● The Hippocampus: low function and volume in the hippocampus is commonly correlated with PTSD
symptoms
● The amygdala: Decreased volume but hyper-responsivity (i.e. increased activity) in the amygdala is a
common finding in people with PTSD
● The vmPFC: Decreased volume and hypo-responsivity in the vmPFC have been correlated with symptoms
of PTSD
● Fear conditioning: These three areas of the brain are also involved in the process of fear conditioning and
fear extinction
Meta-analysis of MRI studies on patients with
PTSD (Karl et al. 2006):
● 50 different studies
● correlations between PTSD and brain regions (23 hippocampal studies and 27 other,
including 18 amygdala studies)
● the results showed that the strongest correlation was between reduced hippocampal
volume and PTSD
● correlation between reduced amygdala volume and PTSD symptoms, although the
effect size was smaller
Meta-analysis of hippocampal volume and PTSD
by Smith (2005)
● reduced volume in the hippocampus - PTSD
● amnesia of the traumatic event and/or events after the
traumatic event
● meta-analysis of 13 studies
● significant differences in volumes of patients with PTSD when
compared with healthy controls: on average the left
hippocampus was 6.9% smaller and the right was 6.6%
smaller.
Cognitive Etiologies - Cognitive appraisals (and
re-appraisals)
● Thinking about traumatic experiences and getting triggered
● Appraisal - how threatening something is, how it will affect them and whether or not they have the
resources to cope with it.
● Negative cognitions - > negative cognitive appraisal
● Negative cognitive appraisal = avoidance
● Ehler and Clark’s cognitive model of PTSD (2000): “PTSD becomes persistent when
individuals process the trauma in a way that leads to a sense of serious, current threat.”
● 2 factors - 1) negative appraisals of the trauma and its effects on the person, and
(2) effects on memory, including those related to fear conditioning (associative
memory)
Cognitive appraisal as a predictor of PTSD
(Hitchcock et al. 2015)
● correlations between negative appraisals after experiencing a traumatic event
and the development of PTSD symptoms
● 7-17 years who were admitted to hospital because they had experienced a
one-off traumatic event
● Their symptoms of PTSD were measured within one month of the trauma and
again after six months using the CAPS
● Negative appraisals measured by 25-item self-report questionnaire - CPTCI
● Moderate but statistically significant correlation between negative appraisals
and PTSD symptom severity after six months
Cognitive reappraisal and top-down processing
of the vmPFC and amygdala activation (Urry et
al., 2006):
● 19 participants (without PTSD) - exposed to a range of emotional stimuli that
were flashed on a screen while they were in an fMRI machine.
● cognitively reappraise the stimuli by either increasing, decreasing or attending.
● negative correlation between vmPFC and amygdala activation – the higher the
vmPFC activity, the lower the amygdala activation.
● hypofunction and reduced volume in the vmPFC in patients with PTSD
Etiology – Socioeconomic status
● negative correlation between socioeconomic status and the risk of developing
PTSD after a traumatic event
● Socioeconomic status and appraisals
Correlations between income and PTSD (Irish et
al. 2011):
● Aim - to understand gender differences in the development of PTSD
● 356 participants who had been in a series car accident
● women were more at risk for developing PTSD.
● differences in income between men and women had a significant effect on the
risk of developing symptoms of PTSD.
Comparison of PTSD after a natural disaster
(Garrison et al.’s (1995):
● Aim of this study - investigate cross-cultural differences in the US after Hurricane
Andrew in Florida
● 350 black, Hispanic and white teenage participants six months after the hurricane
● Structured interview
● Young women were more than three times as likely to develop PTSD than men (9%
and 3%, respectively)
● Higher levels of PTSD for black (8.3%) and Hispanic (6.1%) than for white participants.
● stressful events experienced after the hurricane had a stronger correlation with PTSD
than those experienced during the Hurricane itself.
● explained by the differences in economic resources available to different racial groups
PTSD Treatments - Biological
Davidson et al. (2001) -
● SSRI - for mood stabilisation
● 208 patients with moderate to severe PTSD to test the effectiveness of Zoloft,
an SSRI
● Double blind study
● Zoloft group or placebo group
● 12 week treatment
● Post treatment, Zoloft group - better improvement
● Self-reported improvement rates were 60% for the Zoloft group and 38% for
the placebo group
● Negative side effects for the Zoloft group, including insomnia, diarrhea, nausea
and decreased appetite
● 9% of Zoloft group - withdrawal symptoms at the end of the study
PTSD Treatments - Biological
Mithoefer et al. (2011)
● MDMA - controversial drug
● Conducted clinical trial of MDMA with 20 patients with chronic PTSD
persisting for an average of over 19 years
● Randomly allocated - MDMA group or placebo group
● Both groups received psychotherapy
● Combination of MDMA + Psychotherapy = improvement of symptoms
● 80% of MDMA group no longer met the criteria for PTSD
● 25% of placebo group no longer met the criteria for PTSD
PTSD Treatments - Psychological
Weine (1998)
❏ Testimonial therapy or narrative exposure therapy - helping individuals cope
with the trauma that has led to their PTSD symptoms.
❏ Habituation
❏ To test testimonial therapy using PTSD symptom scale translated to Bosnian
❏ Testimonials translated back to english
❏ Final doc given back to survivor to test for credibility
❏ Rate of PTSD decreased from 100 percent at pre-testimony to 75 percent
post-testimony, 70 percent at 2-month follow up, and 53 percent at 6-month
follow-up.
PTSD Treatments - Psychological
Knaevelsrud et al (2014)
❏ 30 elderly survivors of World War II (17 females and 13 males) with PTSD
❏ Online testimonial therapy program for 6 weeks
❏ Asked to complete two 45-minute writing assignments per week during a
6-week period.
❏ Feedback from therapist to participants
❏ Significant decrease in PTSD symptoms and improvement in self-efficacy.
In a follow-up interview, all clients had maintained their level of improvement.
Only 13% of the participants dropped out of the study
PTSD Treatments - Socio cultural
➔ Indigenous psychotherapy - Morita Therapy
➔ Beliefs : Feelings are natural responses to our life circumstances and we need
not try to “fix” or “change” them.
➔ Dogmatic thinking - that is, perfectionism and high demands on oneself - hinder
recovery. Liberation from self-centeredness leads to healing.
➔ Isolation and rest, rather than verbal interaction, is essential to recovery.

Focus of therapy - recovery

PTSD Treatments - Socio cultural
Ando et al (2009)
● To test effect of mindfulness-based meditation therapy on anxiety and
depression in Japanese patients undergoing anti-cancer treatment
● 28 patients - 2 sessions of meditation therapy
● Asked to practice at home
● Pre and post test design
● Completed questionnaires before & after treatment
● Results : anxiety and depression levels decreased significantly.
PTSD Treatments - Socio cultural
Chinese Taoist cognitive psychotherapy (CTCP)

● Verses from Taoist writings that highlight main principles, such as restricting
selfish desires, learning how to be content, and learning to let go, are read and
reflected on by the client
PTSD Treatments - Socio cultural
Zhang et al (2002)
● 143 Chinese patients with Generalized Anxiety Disorder were randomly
assigned to one of three treatment groups: CTCP only, benzodiazepines only, or
a combination of the two
● Pre treatment evaluation, 1 month post and 6 months post treatment
evaluation
● After the first month, they found that benzodiazepines produced better results.