Trauma Focused Therapy For Comorbid Ptsd/mdd
The effects of trauma-focused CBT are not confined to PTSD symptoms, with trauma-focused therapy consistently producing significant reductions in depressive symptoms . For instance, Resick et al. found that at pretreatment, 51% of treatment completers had an MDD diagnosis, whereas 16% continued to meet the diagnosis at post-treatment and only 13% at the 6-month follow-up. However, the question still remains as to whether a single focus on PTSD is the most effective means of treating comorbid PTSD/MDD. Although no study to date has explored whether a single focus on PTSD is superior to a treatment program that also focuses on MDD, this has been examined in non-PTSD comorbidities , and findings suggest that treatments focused on principal diagnoses may reduce comorbidity severity.
Trauma-focused therapy may have positive effects on comorbidity for numerous reasons. For instance, individuals may apply core CBT strategies to comorbid symptoms, or such treatments may target and improve emotion processes that are shared across emotional disorders . Further, trauma-focused CBT may be effective in reducing MDD symptoms as the treatment shares much in common with typical MDD treatments. For instance, CPT and cognitive therapy both target maladaptive cognitions.
Helping Someone Cope With A Traumatic Event
Its tough trying to help when a friend or loved one doesnt want to talk about what happened. It can be hard to keep making the effort to get the person to respond, especially if you feel youre being pushed away. But youre in a good place to help when you:
- Understand the definition of a traumatic event
- Can identify some of the signs
- Are willing to keep offering help even if it’s not accepted at first
Remember, your caring support after a traumatic event may make a big difference in how well and how fast the traumatized person recovers.
Rates Of Ptsd Among Veterans By War
Some research suggests that rates of PTSD differ among veterans who served in different military conflicts. Indeed, there is;compelling statistical evidence;that military personnel who served in certain wars were somewhat more likely to develop PTSD symptoms.
- Vietnam War Veterans: The National Vietnam Veterans Readjustment Study, conducted from 1986 to 1988, found that 15.2% of men and 8.1% of women who served in Vietnam met diagnostic criteria for PTSD. Additionally, the estimated lifetime prevalence of PTSD was 30.9% among men who served in Vietnam and 26.9% among women. In a;more recent study, researchers also found that PTSD was more prevalent among Vietnam veterans who had served in the theater of combat.
- Gulf War Veterans: In;a study;of over 11,000 Gulf War veterans conducted from 1995 to 1997, researcher Han K. Kang and his colleagues found that 12.1% had PTSD at the time they were surveyed.
- Iraq and Afghanistan Veterans:;In a 2008 study, researchers at the RAND Corporation analyzed the psychological health of 1,938 veterans of Operation Enduring Freedom and Operation Iraqi Freedom . OEF commenced in Afghanistan in 2001, whereas OIF launched in 2003. Among these veterans, 13.8% met criteria for PTSD at the time they were assessed.
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Can You Get Ptsd From Narcissistic Abuse
Psychological trauma from their abuse will not just go away. In fact, this type of abuse can cause long lasting post-traumatic stress disorder, or PTSD. The abuse from a narcissist is overwhelming. It is hard to identify and sufferers tend to blame themselves and continue to suffer long after the relationship is over.
Sex Differences In Ptsd
Researchers are also cautioned to consider the potential for participant sex to play a role in G × E investigations. Epidemiologic investigations have identified a markedly higher prevalence of PTSD in females relative to males in both adult samples and child/adolescent samples . A recent meta-analytic review of more than two decades of research in the area indicated that whereas females were more likely to meet criteria for PTSD, they were less likely to experience traumatic events . Although greater exposure to childhood sexual abuse and sexual assault has been proposed to explain this difference, within-trauma type analyses revealed that women were more likely than men to show PTSD following exposure to accidents, nonsexual assaults, witnessing death/injury, disaster, fire, and war. These findings suggest that the greater prevalence of PTSD in women cannot be completely explained by type of trauma.
Relative to men, women have been found to show greater fear-potentiated startle when presented with a predictable aversive event . Female biological response patterns are further complicated by differences in patterns of biological response over the course of the menstrual cycle . Moreover, cortisol circadian release has been shown to be related to developmental stage .
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Rationale For Investigating Impaired Hippocampal Function As Putative Susceptibility Factor
Although PTSD symptoms suggest stronger and longer-lasting encoding of emotion-influenced information , PTSD patients often have fragmented recollections of the traumatic event which lack integrated environmental perceptions , even to the degree of trauma-related amnesia . This apparent discrepancy can be explained by the fact that during a behavioral experience the brain acquires different types of memories, explicit/declarative and implicit, supported by different brain systems .
Assessing whether impaired hippocampal function is a susceptibility or sequalae factor can be accomplished with the help of animal models. Although it has been argued that declarative memories are uniquely human , a large body of evidence exists to support the notion that essential aspects of declarative memory, specifically episodic memories, exist in rodents and depend on the hippocampal system . Therefore, we have employed the RISP model to test the hypothesis that impaired hippocampal function is a susceptibility factor.
Extent Of Functional Impairment
It is important that clinicians recognize the breadth of functioning impacted by complex trauma and that acquisition, not just restoration, of some modes of functioning may be necessary. Especially when dating back to childhood, complex trauma can entail developmental deficits in self-organization that are seldom encountered in single-incident PTSD when prior underlying trauma is absent. Developmental and attachment deficits require additional treatment focus and make treatment goals more extensive than those directed at PTSD symptoms alone .
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Intrusion Of Thoughts Memories Flashbacks And Dreams
This category, sometimes called re-experiencing symptoms, describes any kind of repeated, unwanted recollection of the traumatic events in question. These intrusive forms of thinking include memories and dreams, which can often be quite vivid. In some cases, individuals with a diagnosis of PTSD experience flashbacks in which they feel as if they are witnessing or reliving the traumatic event again.
For veterans, intrusive thoughts might include memories, dreams, or flashbacks of distressing combat experiences. Similarly, disturbing recollections of injuries or fatalities might repeatedly or unpredictably intrude on their thoughts.
What Is The Root Cause Of Narcissism
Although the cause of narcissistic personality disorder isnt known, some researchers think that in biologically vulnerable children, parenting styles that are overprotective or neglectful may have an impact. Genetics and neurobiology also may play a role in development of narcissistic personality disorder.
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Learning And The Development Of Ptsd
; ;PTSD learning models suggest that some symptoms are developed and maintained through classical conditioning. The traumatic event may act as an unconditioned stimulus that elicits an unconditioned response characterized by extreme fear and anxiety. Cognitive, emotional, physiological, and environmental cues accompanying or related to the event are conditioned stimuli. These traumatic reminders evoke conditioned responses similar to those caused by the event itself . A person who was in the vicinity of the Twin Towers during the 9/11 terrorist attacks and who developed PTSD may display excessive hypervigilance and distress when planes fly overhead; this behavior constitutes a conditioned response to the traumatic reminder . Differences in how conditionable individuals are help to explain differences in the development and maintenance of PTSD symptoms . Conditioning studies demonstrate facilitated acquisition of conditioned responses and delayed extinction of conditioned responses in people with PTSD .
Do I Have Ptsd From Emotional Abuse
Emotional abuse doesnt always lead to PTSD, but it can. PTSD can develop after a frightening or shocking event. Your doctor may make a PTSD diagnosis if you experience high levels of stress or fear over a long period of time. These feelings are usually so severe that they interfere with your daily functioning.
Individual State Nursing Approvals
In addition to states that accept ANCC, NetCE is approved as a provider of continuing education in nursing by: Alabama, Provider #ABNP0353, ; Arkansas, Provider #50-2405; California, BRN Provider #CEP9784; California, LVN Provider #V10662; California, PT Provider #V10842; District of Columbia, Provider #50-2405; Florida, Provider #50-2405; Georgia, Provider #50-2405; Kentucky, Provider #7-0054 through 12/31/2021; South Carolina, Provider #50-2405; South Carolina, Provider #50-2405. West Virginia RN and APRN, Provider #50-2405.
Veterans With Ptsd: Associated Health Risks
While the symptoms of PTSD can prove overwhelming in their own right, the condition is closely linked to other health risks in epidemiological research. Veterans who experience PTSD are at elevated risk for several related physical and psychological challenges. In some cases, the connection between these health problems is well understood; in others, the basis of the relationship requires further exploration.
Some of the health problems linked to PTSD, either in research pertaining specifically to veterans or among individuals with PTSD more generally, are as follows:
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Alterations In Cognition And Mood
Traumatic experiences can produce a complex mix of cognitive and emotional consequences. Veterans with PTSD can experience some or all of the following disruptions in their moods and thinking patterns, and these symptoms may combine to reinforce one another.
- Difficulty remembering certain details of the traumatic event
- Negative beliefs about oneself, others, or the world more generally, such as Im a bad person,Im a weak person, or People cant be trusted
- Inaccurate, self-loathing, or self-blaming thoughts about the cause or nature of the traumatic event, such as I could have prevented this,I caused this,I should have been able to save him, or I should have died instead
- Feelings of guilt, shame, fear, or horror in connection with the negative thoughts and beliefs noted above
- Feelings of detachment or estrangement from others
- An inability to experience positive emotions such as contentment or happiness, even when circumstances would seem to warrant them
Assessment And Management In The Intermediate Post
When psychologic distress severe enough to interfere with important areas of psychosocial functioning persists during the four weeks after trauma exposure, the post-trauma reaction is no longer a normal adaptive response and the patient is considered to have ASD. Assessment should be performed to identify persons who meet the criteria for ASD, sub-threshold yet clinically significant distress and impairment, or incapacitating acute psychologic or physical symptoms .
Following exposure, some persons will develop a diagnosable disorder, many will experience sub-threshold symptoms, and others will not develop clinically significant symptoms. Stepped care may be employed to help individuals receive care that matches the severity and complexity of need. This is performed by assessment to identify symptom severity and complexity of need. Triage allows patients with great serious immediate need to be rapidly identified and linked to appropriate resources; others with less severe symptoms and impairment are also identified for care. All patients should be assessed for ASD .
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Biological And Neurological Factors
Two risk factors that have been shown to possibly influence the development of PTSD after trauma are IQ and neuroticism. Those who tend to score lower on IQ tests have been shown to be more susceptible to developing PTSD.
In addition, people who have greater;neuroticism;have shown to be more likely to have PTSD.
Neuroticism is a personality trait of people who are more likely than average to experience anxiety, feelings of guilt, worry, fear, anger, frustration, and sadness.
As mentioned previously, there is an increasing number of research studies dedicated to exploring the role of genetics in the development of PTSD. Being that PTSD does not occur in everyone who experiences a traumatic event, these continued findings help to better determine who may be at greatest risk so that interventions and treatments can be of the most help.
Post-traumatic stress disorder, along with other conditions such as major depression, is associated with decreased brain volume, particularly in the prefrontal areas. Research has shown that this decreased volume was associated with greater self-reports of anxiety in participants.
Understanding that the emotional impact of trauma can have a cumulative effectit can be easier to understand how past traumatic experiences can be a risk factor for someone developing PTSD after a marked traumatic event.
Individual State Behavioral Health Approvals
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The Dsm Definition Of A Traumatic Event
Compared to previous editions of the Diagnostic and Statistical Manual of Mental Disorders , the 5th edition more clearly details the elements of a traumatic event, particularly within the framework of diagnosing PTSD.
The DSM-5;defines;PTSD triggers as exposure to actual or threatened:
- Serious injury
- Sexual violation
Furthermore, the exposure must result from one or more of the following situations, in which the individual:
- Directly experiences the traumatic event
- Witnesses the traumatic event in person
- Learns that the traumatic event occurred to a close family member or close friend
- Experiences first-hand, repeated, or extreme exposure to aversive details of the traumatic event
Power And Sample Size
The statistical power of a candidate gene association study refers to the probability of detecting a true genetic effect. Power in a genetic study is determined by factors similar to those that influence power in any research design: significance level, sample size, prevalence of the risk factor in controls, and the effect size conferred by the risk factor . See for a detailed discussion of power issues in candidate gene association studies.
The power to detect a G × E interaction will depend on the frequency of the risk allele and environmental factors , as well as the way in which they are measured and the actual nature of the interaction effect itself. As a consequence, the effective magnitude of the interaction effect will vary depending on whether or not continuous or dichotomous measures are used, as well as the frequencies of the genotypes, exposure to environmental stressors, and phenotype prevalence. In general, if the disease, the risk genotype, and the dichotomous environment all are rare, then power will be marginal for most achievable sample sizes; if at least two of these factors are more common, then power exceeds the 80% level much more often. These results reflect the well-known result that more power can be extracted by use of continuous measures whenever appropriate.
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Ptsd And Veterans: Breaking Down The Statistics
Because of the nature of their service, military veterans face particular risk of experiencing traumatic events and subsequently developing post-traumatic stress disorder symptoms. Drawing from the latest authoritative research, this page presents several important statistics pertaining to the incidence of PTSD among United States veterans.
Youll also find helpful information related to the nature of the disorder, the mental health problems it causes, and how it can be effectively treated. Though post-traumatic stress disorder is alarmingly common among Americas veterans, there are valuable resources, treatments, and mental health care available to those recovering from military-related trauma.
Chronic Stressor Exposure In Adolescent Rats Produces A Long
Previous studies showed that chronic stress in adult rodents produced a robust increase in circulating acyl-ghrelin measured 1 day after the last stressor exposure; this increase persisted at least 4 weeks after the last stressor exposure,. Here, we sought to extend these findings to stressor exposure beginning in adolescence using time points even more remote than those previously assessed.
Adolescent rats were exposed to two weeks of immobilization stress or daily handling starting at approximately postnatal day 50, a period corresponding to rodent adolescence. Body weights did not differ between the two groups at the start of the experiment =0.32, p=0.58). Twenty-four hours after the last stress or handling session, acyl-ghrelin was significantly elevated in the chronically stressed rats =33.00, p<0.0001), an effect similar to that reported for stress-exposed adult rats,. One hundred and thirty days following the final stress or handling session , an elapsed time corresponding roughly to 12 human years, acyl-ghrelin remained significantly elevated in the rats in the STR group =9.63, p=0.0038). Thus, chronic stressor exposure in adolescent rats produced a long-term elevation in circulating acyl-ghrelin that persisted long after the stressor was ceased.
Fig. 1: Chronic stress in adolescent rats elevates acyl-ghrelin for at least 130 days post-stressor cessation.
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Pathways To Comorbid Ptsd/mdd
Research examining the temporal order of PTSD and MDD development has suggested several potential pathways to PTSD/MDD comorbidity. Some researchers have proposed that pre-existing MDD may elevate one’s susceptibility to traumatic events . Others suggest that MDD may be a reaction to PTSD, whereby PTSD is a risk factor for the development of MDD . Recently, Stander, Thomsen, and Highfill-McRoy examined the literature regarding the development of comorbid PTSD/MDD in military samples. Although the reviewed literature generally supported the hypothesis that PTSD was a causal risk factor for the development of MDD, they acknowledged that the exact relationship between PTSD and MDD was likely to be complex, involving bidirectional causality, common risk factors, and common vulnerabilities.