Problem 3 2.6
The war within
Source 1 – Psychological theories of PTSD (Brewin & Holmes)
Abstract
Early approaches of PTSD:
1. Social-cognitive model
2. Conditioning model
3. Information processing model
4. Anxious apprehension model
3 theories:
1. Emotional processing theory (Foa and Rothbaum)
2. Dual representation theory (Brewin, Dalgleish, and Joseph’s)
3. Cognitive theory (Ehlers and Clark)
Psychological processes and PTSD
Memory and PTSD
In patients with PTSD there tends to be a bias towards enhanced recall of trauma-
related material and difficulties in retrieving autobiographical memories of specific
incidents
- There is a contradictory pattern of recall related to the traumatic material itself -
sometimes memories are more vivid and long lasting whereas others are vague
and lacking in detail
Flashbacks - memories dominated by sensory detail such as vivid visual images and
include sounds and other sensations
- The reliving of these memories is reflected in a distortion in the sense of time
such that the traumatic event seems to be happening in the present rather than
belonging to the past
- they are triggered involuntarily by specific reminders that relate in some way to
the circumstances of the trauma
Individuals with a greater working memory capacity are better at suppressing
unwanted thoughts when instructed to do so
- explains why low intelligence is strongly related to PTSD due to a low working
memory capacity
- low levels of working memory capacity may also predict a less successful
outcome in therapy
attention and PTSD
While attentional bias is clearly important in PTSD research does not provide
evidence that the effects are unique to PTSD
The available evidence on whether PTSD is associated with deficits in sustained
attention is inconsistent
dissociation and PTSD
, Dissociation - any kind of temporary breakdown in what we think of as the relative
continuous, inter-related processes of perceiving the world around us, remembering
the past, or having a single identity that links our past with our future
Symptoms most commonly encountered in trauma include emotional numbing,
derealization, depersonalisation, and out of body experiences
- Reflects a defensive response related to immobilisation in animals (freezing)
- causes a decrease in heart rate
cognitive-affective reactions and PTSD
A requirement of a diagnosis of PTSD according to the DSM 4 is to experience
intense fear, helplessness, or horror at the time of the trauma
- There is a strong relationship between each of these specific reactions in victims
of violent crime and the risk of PTSD six months later
- Sometimes however people report high levels of anger or shame during the most
intense moments of the traumatic event
mental defeat - the perceived loss of all autonomy, a state of giving up in one's own
mind all efforts to retain ones identity as a human being with a will of one’s own
Posttrauma - cognitive appraisal of the cause of, responsibility for, and future
implications of the trauma which provide numerous opportunities to generate
negative emotions
- Lots of evidence that feelings of guilt, shame, sadness, betrayal, humiliation, and
anger frequently accompany PTSD
Evidence has shown that both the victims who had been abused as children and the
victims who felt more shame after being assaulted as adults tended to recover more
slowly from PTSD
- being abused as a child made victims more likely to report experiencing shame
beliefs and PTSD
Traumatic events shattered peoples’ basic beliefs and assumptions
- A general increase in negative beliefs about the self, others, and the world has
been found in trauma victims with PTSD
Higher levels of anger with others reported by PTSD patients are also consistent with
the loss of belief in the good intentions of other people
Trauma victims often believe that the trauma has brought about a negative and
permanent change in the self and in the likelihood of achieving goals
Cognitive coping strategies and PTSD
Attempts to suppress unwanted thoughts are usually doomed to failure and
afterwards, the thoughts return even more strongly
- deliberate avoidance of intrusive thoughts and memories will similarly be
unhelpful for the majority of victims
Avoidance and thought suppression are related to a slower recovery of PTSD
- rumination and increased use of safety behaviours is also associated with a
greater risk of PTSD
Social support and PTSD
The war within
Source 1 – Psychological theories of PTSD (Brewin & Holmes)
Abstract
Early approaches of PTSD:
1. Social-cognitive model
2. Conditioning model
3. Information processing model
4. Anxious apprehension model
3 theories:
1. Emotional processing theory (Foa and Rothbaum)
2. Dual representation theory (Brewin, Dalgleish, and Joseph’s)
3. Cognitive theory (Ehlers and Clark)
Psychological processes and PTSD
Memory and PTSD
In patients with PTSD there tends to be a bias towards enhanced recall of trauma-
related material and difficulties in retrieving autobiographical memories of specific
incidents
- There is a contradictory pattern of recall related to the traumatic material itself -
sometimes memories are more vivid and long lasting whereas others are vague
and lacking in detail
Flashbacks - memories dominated by sensory detail such as vivid visual images and
include sounds and other sensations
- The reliving of these memories is reflected in a distortion in the sense of time
such that the traumatic event seems to be happening in the present rather than
belonging to the past
- they are triggered involuntarily by specific reminders that relate in some way to
the circumstances of the trauma
Individuals with a greater working memory capacity are better at suppressing
unwanted thoughts when instructed to do so
- explains why low intelligence is strongly related to PTSD due to a low working
memory capacity
- low levels of working memory capacity may also predict a less successful
outcome in therapy
attention and PTSD
While attentional bias is clearly important in PTSD research does not provide
evidence that the effects are unique to PTSD
The available evidence on whether PTSD is associated with deficits in sustained
attention is inconsistent
dissociation and PTSD
, Dissociation - any kind of temporary breakdown in what we think of as the relative
continuous, inter-related processes of perceiving the world around us, remembering
the past, or having a single identity that links our past with our future
Symptoms most commonly encountered in trauma include emotional numbing,
derealization, depersonalisation, and out of body experiences
- Reflects a defensive response related to immobilisation in animals (freezing)
- causes a decrease in heart rate
cognitive-affective reactions and PTSD
A requirement of a diagnosis of PTSD according to the DSM 4 is to experience
intense fear, helplessness, or horror at the time of the trauma
- There is a strong relationship between each of these specific reactions in victims
of violent crime and the risk of PTSD six months later
- Sometimes however people report high levels of anger or shame during the most
intense moments of the traumatic event
mental defeat - the perceived loss of all autonomy, a state of giving up in one's own
mind all efforts to retain ones identity as a human being with a will of one’s own
Posttrauma - cognitive appraisal of the cause of, responsibility for, and future
implications of the trauma which provide numerous opportunities to generate
negative emotions
- Lots of evidence that feelings of guilt, shame, sadness, betrayal, humiliation, and
anger frequently accompany PTSD
Evidence has shown that both the victims who had been abused as children and the
victims who felt more shame after being assaulted as adults tended to recover more
slowly from PTSD
- being abused as a child made victims more likely to report experiencing shame
beliefs and PTSD
Traumatic events shattered peoples’ basic beliefs and assumptions
- A general increase in negative beliefs about the self, others, and the world has
been found in trauma victims with PTSD
Higher levels of anger with others reported by PTSD patients are also consistent with
the loss of belief in the good intentions of other people
Trauma victims often believe that the trauma has brought about a negative and
permanent change in the self and in the likelihood of achieving goals
Cognitive coping strategies and PTSD
Attempts to suppress unwanted thoughts are usually doomed to failure and
afterwards, the thoughts return even more strongly
- deliberate avoidance of intrusive thoughts and memories will similarly be
unhelpful for the majority of victims
Avoidance and thought suppression are related to a slower recovery of PTSD
- rumination and increased use of safety behaviours is also associated with a
greater risk of PTSD
Social support and PTSD
