Trauma and Stress Disorders

Risk vs. Resilience

 Risk factors:
o Any variable that increases the likelihood that negative outcomes will occur
 Protective factors:
o Any variable that decreases the likelihood that a disorder will emerge
The Response to Trauma
 Important to note that not everyone has the same reactions to traumatic events
o Emotional and behavioral responses
 Denial, confusion, anger, fear, guilt, anxiety, depression, flashbacks to the
event, difficulty concentrating
o Physical responses
 Insomnia or disrupted sleep, fatigue, muscle tension, headaches, chest
pain, chronic unexplained pain and health challenges
 What factors could influence the development of some of these symptoms?
Stress Reactions
 Exposure to repeated and/or intense stressors early on lead to higher rates of developing
mental illness later in life
 Stress alters both out physiological and psychological reactions to the world around us
o Psychological: changes the way we think about the world
o Developmental: alters how our brains form
o Biological: epigenetic modifications to genome
o Social: can alter how others see/treat you; how you interact with others
Toxic Stress
 Three types of stress reactions:
o Positive – a normal and essential part of development
 Brief increases in heart rate, mild elevations in stress hormone levels
o Tolerable – activation of the body’s alert system as a result of more intense,
longer-lasting stressors
 Serious, temporary stress responses, buffered by supportive relationships
o Toxic – exposure to strong, recurrent stressors without adequate support to
process events
 Prolonged activation of stress response systems in the absence of
protective relationships
Three Inter-Related Systems
 Cognitive
o Thoughts of being scared or hurt
o Worry
o Thoughts of incompetence/inadequacy
 Physical
o Increased heart rate/respiration
o Upset stomach/headaches
o Muscle tension
o vomiting
 Behavioral
 o Avoidance
o Crying/screaming
o Nail biting
o Trembling voice
o Tantrums

Understanding Trauma
 Traumatic responses have often been viewed through the lens of anxiety disorders
o Ex. WWI and “shell shock”
 Modern research efforts have focused on seeing trauma as its own unique antecedent(s)-
response relationship
o Looks at larger picture (ecological systems)
Trauma in the Time of COVID
 How do you think the past 2+ years has had an impact on people’s response to traumatic
events?
Post-Traumatic Stress Disorder (PTSD)
 Persistent symptoms following exposure to an overwhelmingly traumatic event
(experienced or witnessed) that includes actual or threatened death, serious injury, or
sexual violence
o Can be through direct exposure (witnessing in person) or learning about it
occurring to others you know (family, close friend)
o Can also occur through repeated or extreme exposure to aversive details of the
traumatic event (first responders, police officers)
 Core features:
o Intrusion symptoms such as re-experiencing (nightmares, memories) and/or
dissociative reactions (flashbacks)
o Persistent avoidance of associated stimuli (internal or external)
o Alterations in cognition (failure to remember event, distorted thoughts) and mood
(emotional numbing, exaggerated negative mood, detachment)
o Alterations in arousal and reactivity (exaggerated startle response, hypervigilance)
 Onset of symptoms can occur any time following trauma
 Symptoms must last for at least one month
Prevalence
 Estimated that 60% of all men and 50% of women will experience a serious threat to their
life or that of another close to them during their lifetime
o Of these, approximately 8.7% develop PTSD during their lifetime
 12-month prevalence: 3.5%
o Diagnosis more common in women than men
o Females report longer duration of symptoms of PTSD than men
 Culture
o Rates of PTSD are higher in US than other countries (averaging around 1%, with
some exceptions)
 Veterans
o Vietnam veteran’s lifetime prevalence is/was 30.9% (men) and 26.9% (women)
 o Gulf war – 10 to 12%; Iraqi war – around 13.8%
Complex PTSD
 *Does not exist (yet) as a stand-alone diagnostic label*
 Complex trauma has potentially different symptom patterns
o May include problems attaching to others, emotion dysregulation, behavioral
problems, disassociation, distorted self-concept, etc
o Potential increases in self-harm and/or self-destructive behaviors
 Potential causes of C-PTSD:
o Early trauma (likely perpetuated by a caregiver)
o Extended exposure/experience of the trauma(s)
 Ongoing contact with person who perpetuated trauma (if applicable)
 C-PTSD also is unique in that it may take years for symptoms to manifest and, when they
do, are often not immediately associated with trauma
Acute Stress Disorder
 Not “simple PTSD” – it is a short-term stress disorder
 Requires the same criteria point for PTSD (exposure to trauma)
 Symptoms cluster around the following categories
o Intrusion, negative mood, dissociative symptoms, avoidance behaviors,
heightened arousal responses
 PTSD requires symptoms to be present in ALL categories, whereas Acute Stress Disorder
only requires nine total symptoms across all domains
 The other major distinction is duration (3 days to one month)
o If symptoms persist longer, then a diagnosis of PTSD is considered
Adjustment Disorders
 Not “PTSD-lite”
 The development of emotional or behavioral symptoms in response to an identifiable
stressor(s)
o Symptoms must manifest within 3 months of stressor(s)
 Impairment/distress is a requirement
 Symptoms aren’t “normal” responses to situations (bereavement)
Treatment for Stress Disorders
 Management of any associated medical and/or physical issues resulting from the trauma
itself
o Physical and occupational therapy
o Adherence to medical treatment routines
 Medication
o Highly dependent on symptom presentation
 Treatment ranges from antidepressants, anti-anxiety medication
(anxiolytics)
 Psychotherapy
o Cognitive processing therapy (CPT)
o Prolonged exposure therapy (PET)
o Trauma-focused cognitive behavioral therapy (TF-CBT)
Trauma-Informed Care
  A framework for understanding and relating to individuals
o Not a specific manualized treatment
o Draws heavily on “soft skills”
Exposure Therapy (CPT, PET)
 Involves using imagery to help a person reduce their anxiety/distress to stimuli (thoughts,
environments)
o Guided by clinician, following developmental of skills (deep breathing,
progressive muscle replication
o Depending on client and the traumatic event, in vivo exposure can help the person
learn to reduce their reactions in real-world settings
 Exposure to aversive stimuli helps clients to re-learn (cognitive processing) how to see
the trauma and its impact on their functioning
o “This doesn’t have power over me…” “I am not my trauma…”
Trauma-Focused CBT
 TF-CBT is the most studied version of exposure therapy
o Draws from cognitive-behavioral, attachment, humanistic, empowerment, and
family-based models of treatment
o Skill-based – client courses on one component at a time
o Clients develop a “trauma narrative” that helps the cope with their experience(s)