Yr2t2 PTSD Intervention

Re-experiencing trauma (dream and waking state), avoidance of stimuli reminders (anything associated with the event), emotional numbing, hyperarousal

Onset is usually first month after trauma however in 15% there is a delay of months/years. Natural recovery occurs for many in the intial stages, and although many trauma survivors show some symptoms most will recover without treatment

It does not decrease

severity of trauma (more significant in military), lack of social support, more subsequent life stress, peritraumatic dissociation, peritraumatic emotionality (e.g. fear, helplessness, horror, guilt, shame), perceived life threat, perceived social support. Cognitive risk factors include negative cognitions about self & world, self-blame, negative appraisals of symptoms, negative responses from others, permanent change, alienation, mental defeat (perceived loss of autonomy, giving up in one’s mind all efforts to retain one’s own identity as a human being).

Traumatic events are not adequately represented in memory (great representation of fear but little else, most trauma tends to be represented in right side of brain).

Consists of information about feared object(s), reaction(s), and stimulus-response links (such as plane = fear), the network has a low threshold for activation, and when this occurs a fear reaction results. Under this concept the fear network should be activated and new, fear-incompatible information should be introduced (through fear in a safe environment) which develops an exposure-based treatment.

Puts the person in context of fear and keeps them there until the anxiety decreases.

People with psychosis, substance abuse/dependence (should be 60 days sober), with high risk of suicide/self-injury or where PTSD symptoms relate to realistic guilt/shame.

Breathing retraining, in-vivo exposure, imaginal exposure & exposure until anxiety reduces to confront painful experiences instead of avoiding them to habituate the client and change unrealistic beliefs

Trauma memories have a more 'here and now' feel, they often have poor intentional recall but when triggered are overwhelming. They also lack adequate elaboration/conceptual processing and are thus not well integrated into autobiographical memory.

In persistent PTSD stimulus-stimulus (e.g. footsteps = predator) and stimulus-response (footsteps = fear) associations are strong as is cue driven retrieval and often outside of awareness. Thus any footstep may trigger intense fear and no connection may be made to link to original stimulus

Increases intentional retrieval - perceptual processing reduces intentional retrieval and increases involuntary retrieval (more perceptual processing occurs in persistent PTSD)

1) directly producing PTSD symptoms 2) preventing change in negative appraisals of trauma and/or sequelae 3) preventing change in nature of trauma memory.

1) the trauma memory needs elaboration and integration 2) problematic appraisals require modifying 3) dysfunctional behavioural and cognitive strategies that prevent memory elaboration and hinder appraisal modification must stop.

· Identify main cognitive themes · Explore ‘hotspots’ for meaning and thoughts accompanying them · Examine dominant emotions and what they can tell you about cognitions · Appraise problematic sequelae · Examine problematic cognitive/behavioural strategies · Assess aspects of memory by characterising nature of trauma memory/spontaneous intrusions