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Post traumatic stress disorder
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covers therapies and treatments including difficulties in treatment
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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
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