Download POSTTRAUMATIC STRESS DISORDER

POSTTRAUMATIC
STRESS DISORDER
CHARITY HAMMOND, PH.D.
PSYCHOLOGIST
MICHAEL E. DEBAKEY VA MEDICAL CENTER
OBJECTIVES
• Describe the history of PTSD
• Define the diagnostic criteria of PTSD
• Identify risk factors for developing PTSD
• Give a brief overview of biological aspects of PTSD
• Review evidence based treatment approaches for treating
PTSD
• Provide resources for learning more about PTSD
History of PTSD
Shakespeare in Henry IV:
Tell me, sweet lord, what is’t that takes from thee
Thy stomach, pleasure, and thy golden sleep?
Why dost thou bend thine eyes upon the earth,
And start so often when thou sit’st alone?
Why hast thou lost the fresh blood in thy cheeks,
And given my treasures and my rights of thee
To thick-eyed musing and cursed melancholy?
History of PTSD
•
•
•
•
•
•
•
•
•
•
•
Soldiers heart
Da Costa’s syndrome
Traumatic neurosis
Shell shock
Combat fatigue
Neurocirculatory asthenia
Railway spine
Rape trauma syndrome
Concentration camp syndrome
Battered woman’s syndrome
Child abuse syndrome
History of PTSD
• DSM I (1952): Gross stress reaction
• DSM II (1968): Situational reaction
• DSM III (1980): Posttraumatic stress disorder
• DSM IV (1994): Posttraumatic stress disorder
• DSM V (2013): Posttraumatic stress disorder
6
What is traumatic stress?
7
Trauma exposure is common.
8
How common is PTSD?
Diagnostic criteria for PTSD
Person exposed to actual or threatened death, serious injury, or
sexual violence in one of the following ways:
• A) Direct exposure
• B) Witnessing in person
• C) Indirectly, by learning of a close friend or relative exposed to
trauma.
• D) Repeated or extreme indirect exposure to aversive details of
events, usually in the course of professional duties.
Diagnostic criteria for PTSD
• Intrusion symptoms:
• Recurrent, involuntary, and intrusive memories
• Traumatic nightmares
• Dissociative reactions (flashbacks) ranging from brief to
prolonged
• Intense or prolonged distress after exposure to traumatic
reminders
• Physiological reactivity after exposure to trauma related stimuli
Diagnostic criteria for PTSD
http://www.ptsd.va.gov/apps/AboutFace/veterans/andrewreeves/how-i-knew-i-had-ptsd.html
http://www.ptsd.va.gov/apps/AboutFace/veterans/guillermosanchez/how-i-knew-i-had-ptsd.html
Diagnostic criteria for PTSD
• Avoidance symptoms
• Avoidance or efforts to avoid distressing memories, thoughts, or
feelings about the trauma
• Avoidance or efforts to avoid external reminders that lead to
thoughts of trauma
Diagnostic criteria for PTSD
http://www.ptsd.va.gov/apps/AboutFace/veterans/tiachristopher/how-i-knew-i-had-ptsd.html
http://www.ptsd.va.gov/apps/AboutFace/veterans/wandapegues/how-i-knew-i-had-ptsd.html
Diagnostic criteria for PTSD
• Changes in mood and beliefs
• Inability to remember parts of the event
• Exaggerated negative beliefs about oneself, others, and the world
• Persistent, distorted cognitions about the cause and
consequences of event leading to self-blame
• Persistent negative emotional state
• Diminished interest in participating in significant activities
• Feeling detached or estranged from others
• Inability to experience positive emotions
Diagnostic criteria for PTSD
http://www.ptsd.va.gov/apps/AboutFace/veterans/rickcollier/how-i-knew-i-had-ptsd.html
http://www.ptsd.va.gov/apps/AboutFace/veterans/andrewreeves/how-i-knew-i-had-ptsd/2.html
Diagnostic criteria for PTSD
• Changes in arousal and reactivity:
•
•
•
•
•
•
Irritable behavior and angry outbursts
Reckless or self-destructive behavior
Hypervigilance
Exaggerated startle response
Problems with concentration
Sleep disturbance
Diagnostic criteria for PTSD
• http://www.ptsd.va.gov/apps/AboutFace/veterans/josesanchez/how-i-knew-i-had-ptsd/2.html
• http://www.ptsd.va.gov/apps/AboutFace/veterans/johnangell-jr/how-i-knew-i-had-ptsd.html
Diagnostic criteria for PTSD
• Symptoms last for more than 1 month
• Symptoms cause distress and impairment in functioning
• Subtypes:
• With dissociative symptoms
• With delayed expression (more than 6 months after the event)
19
Why do some people get PTSD
while others do not?
20
Personal Factors
21
Traumatic Event
22
Recovery Environment
23
Other Co-occurring Problems
Biological aspects of PTSD:
HPA Axis
Biological aspects of PTSD:
Neurotransmitters
Biological aspects of PTSD:
Structural changes
Treatments for PTSD
• Cochrane review (2013)
• VA/DoD guidelines (2010)
• International Society for Traumatic Stress Studies guidelines
(2005)
• Institute of Medicine (2007)
Evidence-based Psychotherapy
Treatments
Cognitive Behavioral Therapy (CBT): build new cognitive skills
and engage in new behaviors, or change existing ones
• Prolonged Exposure (PE): In PE you confront situations you have
been avoiding until distress decreases.
• Cognitive Processing Therapy (CPT): In CPT you examine and
challenge thoughts about the trauma until you can change the
way you feel.
28
• First line psychotherapies
Evidence-based Psychotherapy
Treatments
• Stress Inoculation Training (SIT): By teaching coping skills, SIT can help
you find new ways to deal with PTSD symptoms. These skills can also
help you manage other stressful situations or event in your life.
• Eye Movement Desensitization and Reprocessing (EMDR): EMDR helps
you process upsetting memories, thoughts, and feelings related to
trauma. In EMDR, you’ll pay attention to a back-and-forth movement or
sound while you think about the upsetting memory long enough for it to
become less distressing.
29
• Other VA/DoD Clinical Practice Guideline first line
psychotherapies include:
Treatments for PTSD:
Psychotherapy
• Exposure therapy
http://www.ptsd.va.gov/apps/AboutFace/questions--whattreatment-was-like-for-me--2.html
http://www.ptsd.va.gov/apps/AboutFace/questions--whattreatment-was-like-for-me--3.html
http://www.ptsd.va.gov/apps/AboutFace/questions--whattreatment-was-like-for-me--8.html
• Cognitive behavioral therapy (CBT/CPT)
http://www.ptsd.va.gov/apps/AboutFace/therapies/cpt.html
Evidence-based Pharmacological
Treatments
• First line medications
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• E.g., paroxetine (Paxil), sertraline (Zoloft)
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
• E.g., venlafaxine (Effexor)
• Warning: Benzodiazepines (e.g., Xanax, Valium, Klonopin)
• Limited efficacy
• Increased safety concerns
• Not recommended for PTSD
Resources
National Center for PTSD
www.ptsd.va.gov
International Society for Traumatic Stress Studies
www.istss.org
National Child Traumatic Stress Network
www.nctsnet.org
Center for Deployment Psychology
www.deploymentpsych.org
• NCPTSD developed
toolkits for various
professionals who have
contact with Veterans
or those with PTSD in
their line of work.
• Toolkits offer
information and
networking resources.
33
Toolkits
PTSD Basics
• Understanding PTSD and PTSD Treatment is a
booklet that explains basic information about:
• What can cause PTSD?
• What are the symptoms of PTSD?
• What do I do if I have symptoms?
• How do I know if I have PTSD?
• Why get treatment for PTSD?
• Common questions about treatment
• What happens during PTSD treatment?
• How do I choose a mental health provider?
• Where can I go to get help?
34
• What is PTSD?
Animated Whiteboard Videos
• NCPTSD created a series
of whiteboards, including
one for professionals
about PTSD and effective
treatments.
• Short (~3 minute),
engaging videos that are
easily shared via email or
Facebook.
36
AboutFace
• NCPTSD has partnered with a
number of organizations to
develop a variety of mobile apps.
• Apps are focused on PTSD,
related health problems (e.g.,
insomnia, alcohol use, etc.), or
general well-being.
• There are apps for patients,
providers, and for use with
patient-provider dyads.
37
Mobile Apps
Thank you.
Questions?
Contact information:
Charity Hammond, Ph.D.
[email protected]