Post traumatic stress disorder

PTSD 2

 Structural and functional abnormalities in PTSD
o Amygdala and insula
 Hyperactive in response to trauma and when processing fearul vs happy
faces
 Positive correlation between actovatoon and PTSD severity
 Successful exposure therapy associated with decreased amygdala activation
o Medial prefrontal cortex
o Rostral anterior cingulate
o Hippocampus
o Associated with fear conditioning and fear extinction
 PTSD therapies and treatments
o Prevention
 Law, education, coping skills, stress inoculation training, psychoeducation
o Medications
 SSRIs (not very successful)
 Other medications if in services (e.g. hypnotics and anti-psychotics)
o Trauma focused CBT
 Psycho-education
 Relaxation training and emotion regulation skills building
 Stress inoculation
 Exposure
 Behavioural techniques
 Cognitive restructuring
 Problem solving, recovery focus, relapse prevention
o Prolonged exposure
o Eye movement desensitization and reprocessing
 Therapeutic rapport
 Imagery/envisioning traumatic scenes
 Summarise thoughts of trauma
 Focus on sensations of anxiety
 Track therapists finger
 Cognitive restructuring
 Saccadic movements of eyes
 Extinguishing memory
 Specific training package
 Much debate about mechanisms of effect
 Are eye movements important??
o Emerging therapies:
 VR, combination of therapy and ‘illicit drugs’
 MDMA assisted therapy
 85% response
 15% response in placebo
 No adverse effects
 Treatment difficulties:
o Nature and duration of trauma
o Role of trauma