Evidence-Based Treatment for Posttraumatic Stress Disorder: Preparing for the Aftermath of Disaster
|
|
- Jeffry Harrington
- 5 years ago
- Views:
Transcription
1 Evidence-Based Treatment for Posttraumatic Stress Disorder: Preparing for the Aftermath of Disaster Shawn P. Cahill, Ph.D. Center for the Treatment and Study of Anxiety University of Pennsylvania
2 The Problem of PTSD
3 PTSD A. Exposure to a traumatic event as defined by both A1 and A2 A1. Person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or threat to the physical integrity of self or others A2. Person s response involves intense fear, helplessness, or horror
4 PTSD (cont d) B. Traumatic event is persistently reexeperienced (need at least one) (1) Recurrent, intrusive, distressing recollections; (2) recurrent distressing dreams; (3) flashbacks; (4) psychological distress in response to reminders; (5) cued physiological reactivity
5 PTSD (cont d) C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (need at least three) (1) Avoiding thoughts, feelings, conversations about trauma; (2) avoiding activities, people, places, or people that arouse recollections of the trauma; (3) Inability to recall important aspects of the trauma; (4) marked diminished interest or participation in significant activities; (5) feelings of detachment or estrangement from others; (6) restricted range of affect; (7) sense of foreshortened future
6 PTSD (cont d) D. Persistent symptoms of increased arousal (need at least two) (1) Difficulty falling or staying asleep; (2) irritability or outbursts of anger; (3) difficulty concentrating; (4) hypervigilance; (5) exaggerated startle response E. Duration of disturbance is more than one month Acute PTSD: Duration is 1-3 months Chronic PTSD: Duration is > 3 months Specify if delayed onset: Symptom onset > 6 months after trauma
7 Lifetime Prevalence Of Trauma Percent (%) Any One Multiple Men Women Kessler et al., 1995
8 Lifetime Prevalence Of PTSD In The Community 20 Percent (%) Davidson et al., 1991 Breslau et al., 1991 Kessler et al., 1995
9 Prevalence of PTSD by Gender 20 Percent (%) Breslau et al., 1991 Kessler et al., 1995 Resnick et al., 1993 Males Females
10 Rate of PTSD is Influenced by the Nature of the Trauma Percent (%) Disaster Accident Assault Molestation Combat* Rape Trauma PTSD Kessler et al., 1995
11 Natural Recovery: Percentage of Victims with PTSD as a Function of Time 100 Percent (%) Weekly Assessment Rape Victims Non-Sexual Assault
12 Percentage of Victims with PTSD 100 Percent (%) Wk 1 Mo 2 Mos 3 Mos 6 Mos 12 Mos Assessment Rape Victims Non-Sexual Assault
13 Comorbidity with PTSD MD Dys Phobia Soc Anx Agora GAD PD Alc Drug Any Kessler et al., 1995 Women Men
14 PTSD Impairs Quality of Life 60 Percent (%) Not Working Fair or Poor Health Reduced Well Being Physical Limitations Violent Behavior Past Year PTSD Non-PTSD
15 Predictors of PTSD from Meta-analyses analyses Brewin et al. (2000) Trauma severity Lack of social support Additional life stress Gender Age at trauma Race Education Prior trauma Psychiatric history Ozer et al. (2003) Prior trauma Prior psychological adjustment Family history of psychopathology Perceived life threat Posttrauma social support Peritraumatic emotional response Peritraumatic dissociation
16 Epidemiology of 9/11
17 Immediate Reactions Random Digit Dialing, nationally representative sample of 560 US adults between 9/14/01 9/16/01 44% of adults had a substantial stress reaction Predictors: Gender (female), race/ethnicity (non-white), prior mental health problems (yes), distance from WTC (closer), hours of TV viewing (more) Schuster et al., 2001
18 Acute Reactions Random Digit Dialing, representative sample of 1008 adults living south of 110 th St. in Manhattan between 10/16/01 11/15/01 Overall incidence of PTSD was 7.5%, but 20% for those living south of Canal St. Predictors: Gender (female), race/ethnicity (non-white; trend), stressors in past year (more), social support (less), distance of residence from WTC (closer), directly witnessed events (yes), loss of possessions (yes), involved in rescue (yes), lost of job (yes), symptoms of panic attack during or soon after event (yes) Galea et al., 2002
19 Natural Recovery National probability sample of 3496 US adults received Web-based survey 9-23 days after 9/11; a random subsample of 1069 participants living outside of New York City received a second survey two months following 9/11, and third wave (n = 787) was completed six months after 9/11 17% of participants had PTSD two months after 9/11, compared to 5.8% at six months Predictors: Gender (female), prior physician diagnosis of depression or anxiety disorder (yes), marital status (separated), physical illness (yes), severity of exposure to attacks (greater severity), early disengagement of coping efforts (yes) Silver et al., 2002
20 Acute Stress Disorder and the Prediction of PTSD
21 Acute Stress Disorder (ASD) A. Exposure to a traumatic event B. Dissociation either while experiencing or after experiencing the trauma (at least 3): Numbing, detachment, absence of emotional responsiveness Reduction in awareness of one s surroundings Derealization Depersonalization Dissociative amnesia
22 ASD (cont d) C. Reexperiencing the trauma through recurrent images, thoughts, dreams, illusions, flashbacks, distress upon exposure to reminders of the trauma (at least 1) D. Marked avoidance of stimuli that arouse recollections of the trauma E. Marked symptoms of anxiety or increased arousal F. Disturbance causes functional impairment G. Lasts a minimum of 2 days, a maximum of 4 weeks, and occurs within 4 weeks of the trauma
23 Why ASD? Recognize posttraumatic stress can occur in the acute trauma phase Permit the prediction of chronic PTSD ASD emphasizes the role of dissociative symptoms in preventing long-term recovery
24 Criticisms of ASD Insufficient evidence to support the necessity of dissociation in the acute trauma response Questionable practice to introduce a new diagnosis in order to predict another diagnosis Concern about pathologizing transient stress reactions Questionable practice to distinguish between two diagnoses with similar symptom clusters on the basis of duration Harvey & Bryant, 2002
25 ASD and Chronic (6 mos) PTSD Following MVA Percent ASD Chronic PTSD 20 0 Harvey & Bryant, 1998 Full Partial None *Partial ASD and PTSD: Meets criteria for all but one symptom cluster
26 Relationship Between ASD and Chronic PTSD Percent Full PTSD Partial PTSD* None 0 Full ASD Partial ASD* None Harvey & Bryant, 1998 (Table 1) *Partial ASD and PTSD: Meets criteria for all but one symptom cluster
27 Relationship Between ASD and Acute PTSD in College Students Following 9/11 Percent Acute PTSD ASD No ASD Blanchard et al., 2004
28 ASD, PTSD, and Depression in College Students Following /11 Percent ASD PTSD Depression 0 Albany, NY Augusta, GA Fargo, ND Blanchard et al., 2004
29 Predictive Model of PTSD and Depression in College Students Following 9/11 Gender PTSD TV Hours Past Dep ASDS Knew Died Depression Traumas Blanchard et al., 2004 Rep Acts
30 Breakdown of Model: Step 1 PTSD ASDS Depression Rep Acts
31 Breakdown of Model: Step 2 Gender PTSD Past Dep ASDS Depression Traumas Rep Acts
32 Breakdown of Model: Step 3 Gender PTSD TV Hours Past Dep ASDS Knew Died Depression Traumas Rep Acts
33 Breakdown of Model: Step 4 Gender PTSD TV Hours Past Dep ASDS Knew Died Depression Traumas Rep Acts
34 Full Model Gender PTSD TV Hours Past Dep ASDS Knew Died Depression Traumas Rep Acts
35 Conclusion Reaction to mass trauma (e.g., 9/11) similar to reactions to other types of traumas (e.g., rape, physical assault, motor vehicle accidents, etc.) Effect of media exposure and reparative acts
36 Treatment of PTSD
37 Empirically Supported Treatments for PTSD Medications with FDA indication for PTSD Sertraline (Zoloft) Paroxetine (Paxil) Cognitive Behavior Therapy Exposure therapy Stress inoculation training (SIT) Cognitive therapy (CT, CR, CPT) Combinations of exposure therapy with SIT and/or CR EMDR
38 Efficacy of Sertraline Brady et al., 2000 Davidson et al., CAPS CAPS Wk 0 Wk Wk 0 Wk 12 SERT PBO SERT PBO
39 Efficacy of Medication: Paroxetine: Marshall et al., Tucker et al., 2001 CAPS CAPS Wk 0 Wk Wk 0 Wk 12 PAROX (20 mg) PAROX (40 mg) PBO PAR PBO
40 Summary of Medication Substantial placebo effect Significant medication effect Residual symptoms Many non-responders Many responders still experience significant symptoms
41 Cognitive-Behavioral Treatment Anxiety management or stress inoculation training (SIT) Cognitive therapy (CT) Exposure therapy As primary intervention Combined with SIT or CT EMDR
42 Anxiety Management A set of techniques that helps patients manage their anxiety Relaxation training Controlled breathing Positive self-talk and guided imagery Social skills training Distraction techniques (e.g., thought stopping)
43 Cognitive Therapy A set of techniques that help patients change their negative, unrealistic cognitions by: Identifying dysfunctional, unrealistic, or unhelpful cognitions (thoughts and beliefs) Challenging these cognitions Replacing these cognitions with more functional, realistic, or helpful cognitions
44 Exposure Therapy A set of techniques designed to help patients confront their feared objects, situations, memories, and images (e.g., systematic desensitization, prolonged exposure [PE], flooding).
45 EMDR Components Access trauma images and memories Evaluate their aversive qualities Generate alternative cognitive appraisal Focus on the alternative Sets of lateral eye movements while focusing on response
46 Efficacy of CBT for PTSD Marks et al., 1998 Foa et al., 1999 Percent Good End-State Functioning* Post-Tx Percent Good End-State Functioning* Post-Tx FU PE CR PE/CR RLX * > 50% decrease on PSS, BDI < 7, STAI-S < 35. PE SIT PE/SIT WL * PSS-I < 20, BDI < 10, STAI-S < 40.
47 Efficacy of CBT for PTSD (cont d) Resick et al., 2002 Rothbaum et al., 2005 Percent Good End- State Functioning* Post- Tx 6-Mo FU 9-Mo FU Percent Good End- State Functioning* Post-Tx 6- Mo FU PE CPT WL PE EMDR WAIT * PSS < 20, BDI < 10. * > 50% decrease on CAPS, BDI < 10, STAI-S < 40.
48 Efficacy of Treatment for PTSD: Change in PTSD Status Condition N Conditions Mean Completers 95% CI All active Tx % CBT % EMDR % EX % EX+CBT % SC % WL % Bradley et al., 2005
49 Paroxetine vs. PE/SIT CAPS Wk 0 Wk 12 Frommberger et al., 2004 PAR PE/SIT
50 Efficacy of CBT: Summary Several forms of CBT are efficacious Treatment gains generally maintained at follow-up (up to 1 year) Some patients show only a partial or no response (residual symptoms) Combined treatments (PE/SIT, PE/CR) not significantly more efficacious than individual treatments (PE, SIT, CR) CBT and SSRI of comparable efficacy
51 Improving Treatment Outcome
52 Strategies for Improving Treatment Outcome Combining treatments within the same treatment modality (i.e., psychotherapy or medication) Adding SIT or CR to PE (hasn t worked very well) What about combining medications? Extending duration of treatment Combining treatments across treatment modalities SSRI+CBT (e.g., adding CBT to medication)
53 Sertraline Continuation CAPS Open label continuation treatment Double blind acute treatment Wk 0 Wk Londborg et al., 2001
54 Response Status after 36 Weeks of Sertraline Percent Wk 36 Continuous Responder Relapser Eventual Responder Non-Responder
55 Time to Discontinuation Due to Relapse or Clinical Deterioration Kaplan-Meier Survival Probability Weeks Sertraline Placebo Davidson, Pearlstein et al., 2001.
56 Flexible Dosing of Psychotherapy Patients were randomly assigned to PE, PE/CR, or WL Patients who achieved a minimum 70% reduction on self-reported PTSD severity by session 8 terminated at session 9 Others were offered additional sessions, to a total of 12 Foa, Hembree, Cahill et al., 2005
57 Effects of PE and PE/CR in Female Assault Victims 40 PTSD Severity (PSS-I) PE PE/CR WL Pre Post FU
58 Continuation Treatment for Partial Responders 40 PTSD Severity Pre S-8 S-10 S-12 Post 9 Sessions Sessions
59 Augmenting SSRI with CBT: Study Design Sertraline Only (10 weeks, open label treatment) Continue Sertraline Only (5 weeks) Sertraline + PE (5 week, 2x weekly therapy) Rothbaum, Cahill, Foa, Davidson et al. (2006)
60 Overall Effects of SSRI Augmentation by CBT 40 PTSD Severity * * ns * ns 0 Wk 0 Wk 10 Wk 15 Assessment SERT SERT/PE
61 CBT Augmentation for Medication Partial-Responders 40 Phase I Remitters Phase I Partial-Responders PTSD Severity * * ns * * * ns * * ns ns * 0 ns ns Wk 0 Wk 10 Wk 15 Wk 40 Wk 0 Wk 10 Wk 15 Wk 40 Assessment SERT SERT/PE
62 Improving Outcome: Summary Strategies that haven t worked: Combining separately effective CBT programs Strategies that have worked: Extending treatment (SSRI and CBT) Augmenting SSRI with CBT for SSRI partial responders Strategies to be investigated: Augmenting CBT with medication Augmenting SSRI with other medications
63 Treatment of ASD/ Prevention of Chronic PTSD
64 Treatment of ASD/Prevention of Chronic PTSD Little research on treatment of ASD, compared to amount of research on PTSD Extant research on CBT for ASD yields similar results/conclusions as research on CBT for PTSD
65 CBT for Treatment of ASD/ Prevention of PTSD (Bryant et al., 1998, 1999, 2003a, 2005) Percent PTSD Post 6-Mo FU CBT PE CBT+Hyp 1 MVA, IA 3 MBI: MVA, NSA MVA: Natural recovery (6 mos post-trauma) 2 MVA, NSA 4 Civilian trauma SC
66 Use of Evidence-Based Treatments
67 Survey of Psychologists Attitudes and Utilization of Exposure Therapy for PTSD Survey of 852 psychologists from New Hampshire, Vermont, and Texas (San Antonio & Austin) 58 surveys were undeliverable 217 of 794 surveys were returned (27.3%), of which 10 provided no relevant data Final n = 207 Becker, Zayfert, & Anderson (2004)
68 Do Therapists Treat PTSD? # of PTSD Patients Treated < Missing data
69 Are Therapists Trained in the Use of Exposure Therapy? 100 Percent Trained Im Exp for PTSD IV Exp for PTSD Exp for Anx DO
70 Do Therapists Use Exposure Therapy? The Effect of Training Main Sample (n = 207) No Training (n = 148) Trained (n = 59) Patients Treated with Imaginal Exposure None < 50% 50% - 80% > 80%
71 Reasons for not Using Imaginal Exposure to Treat PTSD Percent Endorsing Limited Training Prefers "Individualized" Treatment Fear of Patient Decompensation All participants (n = 207) Trained in IE but not Using (n = 27)
72 Psychotropic Treatment of PTSD: Use Patterns PTSD Depr PTSD/Depr % Usage SSRI TRAZ ATYP NEUR BZ Mellman et al, 2003
73 Stepped Care Model of Intervention for Trauma Survivors CBT Experts Psychiatrists MA therapists Primary care Drs. Drs., nurses, teachers, social workers, clerics PRE-TRAUMA EDUCATION OF THE PUBLIC
Healing after Rape Edna B. Foa. Department of Psychiatry University of Pennsylvania
Healing after Rape Edna B. Foa Department of Psychiatry University of Pennsylvania Outline of Lecture What is a trauma? What are common reactions to trauma? Why some people do not recover? How can we help
More informationPost-Traumatic Stress Disorder (PTSD) Among People Living with HIV
Post-Traumatic Stress Disorder (PTSD) Among People Living with HIV Milton L. Wainberg, M.D. Associate Clinical Professor of Psychiatry College of Physicians and Surgeons Columbia University mlw35@columbia.edu
More informationNew Criteria for Posttraumatic Stress Disorder in DSM-5: Implications for Causality
New Criteria for Posttraumatic Stress Disorder in DSM-5: Implications for Causality Paul A. Arbisi, Ph.D. ABAP, ABPP. Staff Psychologist Minneapolis VA Medical Center Professor Departments of Psychiatry
More informationCLAIMANT S FACTS ABOUT TRAUMATIC INCIDENT CAUSING PTSD These facts should be written in a narrative statement giving details about the following:
CLAIMANT S FACTS ABOUT TRAUMATIC INCIDENT CAUSING PTSD These facts should be written in a narrative statement giving details about the following: 1. The nature of the trauma such as military combat, sexual
More informationPTSD HISTORY PTSD DEFINED BY SONNY CLINE M.A., M.DIV. PA C. PTSD: Post Traumatic Stress Disorder
PTSD BY SONNY CLINE M.A., M.DIV. PA C HISTORY PTSD: Post Traumatic Stress Disorder The term was coined in the mid 70 s during the anti Vietnam war protest. The condition was more pronounced in those returning
More informationPTSD: Epidemiology, Course, Co-Morbidity and Treatments
PTSD: Epidemiology, Course, Co-Morbidity and Treatments R. John Sutherland, PhD, LP HealthEast Care System Director for Psychology Training and Certified Nat l PE Trainer for PTSD University of Minnesota
More informationPRISM SECTION 15 - STRESSFUL EVENTS
START TIME : PRISM SECTION 15 - STRESSFUL EVENTS Statement I.1: These next questions are about difficult or stressful things that can happen to people. It may be hard to remember everything about these
More informationPosttraumatic Stress Disorder
Posttraumatic Stress Disorder History and Treatment June 6, 2017 Yves Newmen, Ph.D. DSM V (2013) Trauma, and Stressor-Related Disorders Reactive Attachment Disorder Disinhibited Social Engagement Disorder
More informationCognitive Processing Therapy: Moving Towards Effectiveness Research
Cognitive Processing Therapy: Moving Towards Effectiveness Research Courtney Chappuis, M.A., Chelsea Gloth, M.A., & Tara Galovski, Ph.D. University of Missouri-St. Louis Overview Brief review of trauma
More informationENTITLEMENT ELIGIBILITY GUIDELINE POSTTRAUMATIC STRESS DISORDER
ENTITLEMENT ELIGIBILITY GUIDELINE POSTTRAUMATIC STRESS DISORDER MPC 00620 ICD-9 309.81 ICD-10 43.1 DEFINITION Posttraumatic Stress Disorder (PTSD) is a condition in the Diagnostic and Statistical Manual
More informationCHILDHOOD TRAUMA AND ITS RELATIONSHIP TO PTSD.!! Andrea DuBose, LMSW
CHILDHOOD TRAUMA AND ITS RELATIONSHIP TO PTSD!! Andrea DuBose, LMSW "There are words that Never Show on the body that are deeper and more harmful than anything that bleeds" Laurel K. Hamilton, Mistral's
More informationUnderexplored Territories in Trauma Education: Charting Frontiers for Clinicians and Researchers
Underexplored Territories in Trauma Education: Charting Frontiers for Clinicians and Researchers Abigail Carter Susan Drevo Yvette Guereca Namik Kirlic Elana Newman Rachel Micol Stephen Snider Jennifer
More informationEXAMPLES OF TRAUMA AND DISASTER CONFRONT US EVERYDAY
Disclosure Virtually Better, Inc (VBI), part owner managed under Emory University's Conflict of Interest Policy Virtual Iraq created by Dr. Skip Rizzo at USC, not VBI, but VBI is selling virtual reality
More informationThe changing face of PTSD in 2013: Proposed Updates & Revised Trauma Response Checklist Quick Screener (Baranowsky, May 2013)
The changing face of PTSD in 2013: Proposed Updates & Revised Trauma Response Checklist Quick Screener (Baranowsky, May 2013) Dr. Anna B.Baranowsky Traumatology Institute http://www.ticlearn.com TRAUMATOLOGY
More informationUnderstanding the role of Acute Stress Disorder in trauma
Understanding the role of Acute Stress Disorder in trauma Dr. Trina Hall Police Psychologist Dallas Police Department Lessons Learned: Unfolding the story of PTSD NAMI 2014 Fall Conference Trauma and
More informationPTSD Defined: Why discuss PTSD and pain? Alicia Harding, RN-C, FNP-C Gretchen Noble, PsyD
Alicia Harding, RN-C, FNP-C Gretchen Noble, PsyD Why discuss PTSD and pain? The symptoms reported by your patients may represent an undiagnosed disorder. Mental health impairment may complicate physical
More informationACUTE STRESS DISORDER
ACUTE STRESS DISORDER BEHAVIORAL DEFINITIONS 1. Has been exposed to actual death of another or perceived death or serious injury to self or another that resulted in an intense emotional response of fear,
More informationPosttraumatic Stress Disorder. Casey Taft, Ph.D. National Center for PTSD, VA Boston Healthcare System Boston University School of Medicine
Posttraumatic Stress Disorder Casey Taft, Ph.D. National Center for PTSD, VA Boston Healthcare System Boston University School of Medicine Overview PTSD Overview Neurobiology of PTSD PTSD and Relationship
More informationThe Impact of Changes to the DSM and ICD Criteria for PTSD
The Impact of Changes to the DSM and ICD Criteria for PTSD Jonathan I Bisson Institute of Psychological Medicine and Clinical Neursociences Cardiff University What is PTSD? Question Diagnosing PTSD DSM-IV
More informationChapter 7 Acute and Posttraumatic Stress Disorders, Dissociative Disorders, and Somatoform Disorders. Copyright 2006 Pearson Education Canada Inc.
Chapter 7 Acute and Posttraumatic Stress Disorders, Dissociative Disorders, and Somatoform Disorders Copyright 2006 Pearson Education Canada Inc. Overview Focus: normal vs. pathological reactions to trauma
More informationTreatments for PTSD: A brief overview
Treatments for PTSD: A brief overview Dr Jasmine Pang DPsych(Clin) Snr Clinical Psychologist Psychotraumatology Service Department of Psychological Medicine Changi General Hospital, Singapore Outline Brief
More informationUnderstanding Secondary Traumatic Stress
Understanding Secondary Traumatic Stress Introduction Each year, millions of children are exposed to some type of traumatic event including physical, sexual or emotional abuse, neglect, witnessing domestic
More informationStress Disorders. Stress and coping. Stress and coping. Stress and coping. Parachute for sale: Only used once, never opened.
Stress Disorders Parachute for sale: Only used once, never opened. Stress and coping The state of stress has two components: Stressor: event creating demands Stress response: reactions to the demands Stress
More informationKari A. Stephens, PhD & Wayne Bentham, MD Psychiatry & Behavioral Sciences University of Washington. Approach for doing differential diagnosis of PTSD
IN PRIMARY CARE June 17, 2010 Kari A. Stephens, PhD & Wayne Bentham, MD Psychiatry & Behavioral Sciences University of Washington Defining and assessing Approach for doing differential diagnosis of Best
More informationWhat the heck is PTSD? And what do I do if I have it?
What the heck is PTSD? And what do I do if I have it? Dr. Dion Goodland, Psychologist Goodland Psychology November 2015 Outline for today What is Posttraumatic Stress Disorder (PTSD)? How do I get it?
More informationProlonged Exposure Therapy for PTSD. Kirsten DeLambo, Ph.D.
Prolonged Exposure Therapy for PTSD Kirsten DeLambo, Ph.D. To comply with professional boards/associations standards, I declare that I do not have any financial relationship in any amount, occurring in
More informationPTSD, Addictions and Veterans
PTSD, Addictions and Veterans Malcolm Battersby Head, Discipline of Psychiatry Centre for Anxiety and Related Disorders Master of Mental Health Sciences Post Traumatic Stress Disorder and comorbidities
More informationPOST-TRAUMATIC STRESS DISORDER
ISBN: 9780170999809 POST-TRAUMATIC STRESS DISORDER Grant J. Devilly (Swinburne University of Technology) & Jennifer McGrail (University of Melbourne) DSM-IV Criteria for PTSD Information detailing the
More informationPOST-TRAUMATIC STRESS DISORDER Comorbidity and Treatment
POST-TRAUMATIC STRESS DISORDER Comorbidity and Treatment Thomas A. Mellman, M.D. Kathleen T. Brady, M.D., Ph.D. R. Bruce Lydiard, M.D., Ph.D. Howard University, Washington DC and Medical University of
More informationManual for the Administration and Scoring of the PTSD Symptom Scale Interview (PSS-I)*
Manual for the Administration and Scoring of the PTSD Symptom Scale Interview (PSS-I)* Introduction The PTSD Symptom Scale Interview (PSS-I) was designed as a flexible semi-structured interview to allow
More informationClinician-Administered PTSD Scale for DSM-IV - Part 1
UW ADAI Sound Data Source Clinician-Administered PTSD Scale for DSM-IV - Part 1 Protocol Number: XXXXXXXX-XXXX a Participant #: d Form Completion Status: 1=CRF administered 2=Participant refused 3=Staff
More informationLecture Outline Trauma events, meaning Relevant concepts Diagnostic criteria Specifiers Responses to trauma Acute Stress Disorder PTSD
Posttraumatic Stress Disorder Cornelia Pinnell, Ph.D. Argosy University/Phoenix Lecture Outline Trauma events, meaning Relevant concepts Diagnostic criteria Specifiers Responses to trauma Acute Stress
More informationDSM-IV-TR Diagnostic Criteria For Posttraumatic Stress Disorder
DSM-IV-TR Diagnostic Criteria For Posttraumatic Stress Disorder PTSD When an individual who has been exposed to a traumatic event develops anxiety symptoms, re-experiencing of the event, and avoidance
More informationAnxiolytics and anxiety disorders. MUDr. Vítězslav Pálenský Dept. of Psychiatry, Masaryk University, Brno
Anxiolytics and anxiety disorders MUDr. Vítězslav Pálenský Dept. of Psychiatry, Masaryk University, Brno Anxiety disorders 1. Panic disorders and agoraphobia 2. Specific phobia and social phobia 3. Obsessive
More informationPTSD Definition. Page 1. Posttraumatic Stress Disorder. Depression and Anxiety Disorders: Prevalence (lifetime, of 200M adults in U.S.
Posttraumatic Stress Disorder Randall D. Marshall MD Associate Professor of Clinical Psychiatry, Columbia University College of Physicians and Surgeons Director of Trauma Studies and Services, New York
More informationPost-Traumatic Stress Disorder
Post-Traumatic Stress Disorder Teena Jain 2017 Post-Traumatic Stress Disorder What is post-traumatic stress disorder, or PTSD? PTSD is a disorder that some people develop after experiencing a shocking,
More information7/3/2013 ABNORMAL PSYCHOLOGY SEVENTH EDITION CHAPTER SEVEN CHAPTER OUTLINE
ABNORMAL PSYCHOLOGY SEVENTH EDITION Oltmanns and Emery PowerPoint Presentations Prepared by: Ashlea R. Smith, Ph.D. This multimedia and its contents are protected under copyright law. The following are
More informationComorbidity Rates. Comorbidity Rates. Males: Females:
Comorbidity Rates Males: Any Diagnosis: 88% Alcoholism 52% Depression 48% Conduct Disorder 43% Drug Abuse 35% Phobia 31% Kessler, et al. (1995) Comorbidity Rates Females: Any Diagnosis 78% Depression 49%
More informationTreating Children and Adolescents with PTSD. William Yule Prague March 2014
Treating Children and Adolescents with PTSD William Yule Prague March 2014 In the beginning. When DSM III first identified PTSD, it was thought that children would rarely show it Why did professionals
More informationA Family s Guide to Posttraumatic Stress Disorder
A Family s Guide to Posttraumatic Stress Disorder Department of Veterans Affairs and Department of Defense (DoD) employees who use this information are responsible for considering all applicable regulations
More informationMODULE IX. The Emotional Impact of Disasters on Children and their Families
MODULE IX The Emotional Impact of Disasters on Children and their Families Outline of presentation Psychological first aid in the aftermath of a disaster Common reactions to disaster Risk factors for difficulty
More informationSecondary traumatic stress among alcohol and other drug workers. Philippa Ewer, Katherine Mills, Claudia Sannibale, Maree Teesson, Ann Roche
Secondary traumatic stress among alcohol and other drug workers Philippa Ewer, Katherine Mills, Claudia Sannibale, Maree Teesson, Ann Roche Trauma and PTSD among clients AOD clients Dore et al. (2012).
More informationPTSD does trauma ever really go away? Trauma. Is Trauma Common? 9/29/2010. These types of events can cause Post traumatic Stress Disorder (PTSD).
PTSD does trauma ever really go away? Ch.5 Anxiety Disorders Trauma These types of events can cause Post traumatic Stress Disorder (PTSD). Is Trauma Common? Yes more than two-thirds of people experience
More informationAnnual Insurance Seminar. Tuesday 26 September 2017
Annual Insurance Seminar Tuesday 26 September 2017 Dublin Dublin London London New New York York San San Franscisco Francisco Welcome Emer Gilvarry, Chairperson Dublin Dublin London London New New York
More informationIntroduction into Psychiatric Disorders. Dr Jon Spear- Psychiatrist
Introduction into Psychiatric Disorders Dr Jon Spear- Psychiatrist Content Stress Major depressive disorder Adjustment disorder Generalised anxiety disorder Post traumatic stress disorder Borderline personality
More informationAdded meanings. A Cognitive Approach to the Understanding and Treatment of Posttraumatic Stress Disorder
A Cognitive Approach to the Understanding and Treatment of Posttraumatic Stress Disorder POSTTRAUMATIC STRESS DISORDER (PTSD) Reexperiencing Avoidance Anke Ehlers Institute of Psychiatry, London, UK DGVT,
More informationPosttraumatic Stress Disorder
Posttraumatic Stress Disorder Amanda Smith, Ph.D., & Gretchen H. Wilber, Psy.D. Staff Psychologists, PTSD Program Albany Stratton VAMC Roadmap/Outline for Today s Talk PTSD incidence, symptoms, etiology
More informationMENTAL HEALTH FOLLOWING TERROR: FROM INDIVIDUAL RESPONSES TO MASS DISASTER CARE PLANS
MENTAL HEALTH FOLLOWING TERROR: FROM INDIVIDUAL RESPONSES TO MASS DISASTER CARE PLANS Sara Freedman, PhD, School of Social Work, Bar Ilan University. Dept of Psychiatry, Hadassah University Hospital Jerusalem
More informationAnxiety Disorders. Dr. Ameena S. Mu min, LPC Counseling Services- Nestor Hall 010
Anxiety Disorders Dr. Ameena S. Mu min, LPC Counseling Services- Nestor Hall 010 Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18
More informationPost-Traumatic Stress Disorder (PTSD): Best Treatment Options for the Military. Workforce. Morgan M. Harden. Auburn University School of Nursing
Running head: PTSD: BEST TREATMENT OPTIONS 1 Post-Traumatic Stress Disorder (PTSD): Best Treatment Options for the Military Workforce Morgan M. Harden Auburn University School of Nursing PTSD: BEST TREATMENT
More informationNeurology and Trauma: Impact and Treatment Implications Damien Dowd, M.A. & Jocelyn Proulx, Ph.D.
Neurology and Trauma: Impact and Treatment Implications Damien Dowd, M.A. & Jocelyn Proulx, Ph.D. Neurological Response to a Stressor Information from the senses goes to the thalamus which sends the information
More informationIndividual Planning: A Treatment Plan Overview for Individuals with PTSD Problems.
COURSES ARTICLE - THERAPYTOOLS.US Individual Planning: A Treatment Plan Overview for Individuals with PTSD Problems. Individual Planning: A Treatment Plan Overview for Individuals with PTSD Problems. Duration:
More informationPsychological and Pharmacological Treatments for Adults with Posttraumatic Stress Disorder (PTSD)
1 Psychological and Pharmacological Treatments for Adults with Posttraumatic Stress Disorder (PTSD) This continuing education monograph examines the results of a comparative effectiveness review to assess
More informationPosttraumatic Stress Disorder (PTSD) Louise Burkhart Jaime Hamm Jessica Mungro Erin Schultz
Posttraumatic Stress Disorder (PTSD) Louise Burkhart Jaime Hamm Jessica Mungro Erin Schultz Overview Posttraumatic stress disorder (PTSD) is an anxiety disorder that a person may develop after experiencing
More informationNational Center for PTSD CLINICIAN-ADMINISTERED PTSD SCALE FOR DSM-IV
National Center for PTSD CLINICIAN-ADMINISTERED PTSD SCALE FOR DSM-IV Name: ID # : Interviewer: Date: Study: Dudley D. Blake, Frank W. Weathers, Linda M. Nagy, Danny G. Kaloupek, Dennis S. Charney, & Terence
More informationPTSD: Armed Security Officers and Licensed Operators. Peter Oropeza, PsyD Consulting Psychologist
PTSD: Armed Security Officers and Licensed Operators Peter Oropeza, PsyD Consulting Psychologist History of PTSD 1678 Swiss physician Johannes Hofer coins the term nostalgia. to describe symptoms seen
More informationAnxiety Disorders. Fear & Anxiety. Anxiety Disorder? 26/5/2014. J. H. Atkinson, M.D. Fear. Anxiety. An anxiety disorder is present when
Anxiety s J. H. Atkinson, M.D. HIV Neurobehavioral Research Center University of California, San Diego Department of Psychiatry & Veterans Affairs Healthcare System, San Diego Materials courtesy of Dr.
More informationPTSD Guide for Veterans, Civilians, Patients and Family
PTSD Guide for Veterans, Civilians, Patients and Family Overview There are a variety of PTSD booklets available, so with ours we wanted to hand-pick the content we felt our audience could use most. We
More informationCALIFORNIA STATE UNIVERSITY, SACRAMENTO
COLLEGE OF EDUCATION DEPARTMENT OF SPECIAL EDUCATION, REHABILITATION AND SCHOOL PSYCHOLOGY CALIFORNIA STATE UNIVERSITY, SACRAMENTO School Psychology Diagnostic Clinic 6000 J Street Sacramento, California
More informationSECTION I: D Yes D No If no diagnosis of PTSD, check all that apply: Name of patient/veteran: SSN:
Name of patient/veteran: SSN: This form is for use only by VHA, DoD, and VBA staff and contract psychiatrists or psychologists who have been certified to perform Initial PTSD Evaluations. VA will consider
More informationStopped at a red light, Mr. O glances in the rearview
For mass reproduction, content licensing and permissions contact Dowden Health Media. p SYCHIATRY Treating posttraumatic stress in motor vehicle accident survivors Lessen anxiety s impact with proven CBT
More informationDeconstructing the DSM-5 By Jason H. King
Deconstructing the DSM-5 By Jason H. King Assessment and diagnosis of PTSD and skin-picking disorder I am enjoying the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
More informationPost-traumatic Stress Disorder
Parkland College A with Honors Projects Honors Program 2012 Post-traumatic Stress Disorder Nicole Smith Parkland College Recommended Citation Smith, Nicole, "Post-traumatic Stress Disorder" (2012). A with
More informationChapter 5 - Anxiety Disorders
Chapter 5 - Anxiety Disorders I. PANIC DISORDER A. Description - with &without Agoraphobia 1. PD w/o Agora - panic attacks - feeling of imminent death - numerous symptoms (racing heart, sweating, dizziness)
More informationPTSD Criterion B REEXPERIENCING
Emory Medicine: Strategic Treatment Repositioning of Posttraumatic 213-217 Stress Disorder: From Pharmacotherapy to Psychotherapy to Virtual Reality Barbara Olasov Rothbaum, Ph.D., ABPP Paul A. Janssen
More informationClinical Relevance of Biological Alterations in PTSD. Rachel Yehuda, PhD Mount Sinai School of Medicine New York, NY
Clinical Relevance of Biological Alterations in PTSD Rachel Yehuda, PhD Mount Sinai School of Medicine New York, NY New developments in PTSD Conceptual shift New findings of prevalence, longitudinal course,
More informationA Quiet Storm: Addressing Trauma & Addiction through a Trauma Informed Lens
A Quiet Storm: Addressing Trauma & Addiction through a Trauma Informed Lens P R E S E N T E D B Y : B R E N D E N A. H A R G E T T, P H. D., L P C, L C A S, N C C, M A C A L G R E E N E A D D I C T I O
More informationReview of Research on Post-Traumatic Stress and Current Treatments. published in The San Francisco Psychologist, June 2005 issue, pp 6-7
Review of Research on Post-Traumatic Stress and Current Treatments published in The San Francisco Psychologist, June 2005 issue, pp 6-7 By Shelley F. Diamond, Ph.D. On May 6 th, 2005, approximately 20
More informationPost-traumatic Stress Disorder: a Response to Abnormal Circumstances
36 Post-traumatic Stress Disorder: a Response to Abnormal Circumstances 1-! Michael I. ' Simpson. :,,.,..,.,.,.. * i-ivri?w^-invmisr-r-i, ; A i r -; : l'wii*i.n; ;., It has long been recognised that psychological
More informationEffects of Traumatic Experiences
Effects of Traumatic Experiences A National Center for PTSD Fact Sheet By Eve B. Carlson, Ph.D. and Josef Ruzek, Ph.D When people find themselves suddenly in danger, sometimes they are overcome with feelings
More informationPTSD & Stress Responses After Individual and Mass Injury Trauma. Trauma Survivors Outcomes & Support (TSOS) Trauma Survivors Outcomes & Support (TSOS)
PTSD & Stress Responses After Individual and Mass Injury Trauma Douglas Zatzick, MD Professor Department of Psychiatry & Behavioral Sciences Research Faculty Harborview Injury Prevention & Research Center
More informationA Patient s Guide: Understanding Posttraumatic Stress Disorder and Acute Stress Disorder
A Patient s Guide: Understanding Posttraumatic Stress Disorder and Acute Stress Disorder Department of Veterans Affairs and Department of Defense (DoD) employees who use this information are responsible
More informationPOST TRAUMATIC STRESS DISORDER
POST TRAUMATIC STRESS DISORDER Authors: Dr Janis Carter, MB BS DPM FRANZCP, Psychiatrist, Brisbane, Australia. Therapy with Yoga. www.therapywithyoga.com email: janiscarter@onaustralia.com.au Assoc. Prof.
More informationPTSD Reacting to the London Bombings
PTSD Reacting to the London Bombings Dr. Howard Fine Aims To develop an understanding of the effect of traumatic events To explore developmental considerations of PTSD in children Outline Normal Post-Traumatic
More informationDefinitions of primary terms and acronyms of trauma and shame disorders. [Draft ]
Definitions of primary terms and acronyms of trauma and shame disorders. [Draft 7-23-2014] I welcome suggestions. Please email wteague@verizon.net Acronym Definition DSM- ACE Adverse Childhood Experiences
More informationPTSD and TBI. Rita Wood, Psy.D. Assistant Chief of VA Police Aaron Yoder
PTSD and TBI Rita Wood, Psy.D. Assistant Chief of VA Police Aaron Yoder Outline Prevalence of Post Traumatic Stress Disorder What is a traumatic event? Acute Stress Disorder (ASD) Risk Factors for PTSD
More informationInformation about trauma and EMDR Eye Movement Desensitization & Reprocessing Therapy Felisa Shizgal MEd RP
Information about trauma and EMDR Eye Movement Desensitization & Reprocessing Therapy Felisa Shizgal MEd RP what is emotional trauma People experience many challenging and painful emotions including fear,
More informationPosttraumatic Stress Disorder in the Occupational Context, Including Military Service
Posttraumatic Stress Disorder in the Occupational Context, Including Military Service John R. McQuaid, PhD Associate Chief of Mental Health, SFVAHCS Professor of Clinical Psychology, UCSF Disclosures I
More informationPost-traumatic stress disorder A brief overview
THEME: Trauma and loss Post-traumatic stress disorder A brief overview Simon Howard, Malcolm Hopwood BACKGROUND Post-traumatic stress disorder (PTSD) is an anxiety disorder which occurs following exposure
More informationA Content Analysis of 9 Case Studies
PSYCHOSOCIAL FACTORS ASSOCIATED WITH SEPARATION TRAUMA IN A Content Analysis of 9 Case Studies Presenter Talli Ungar Felding, Cand. Psych., Clinical Psychologist, Specialist and Supervisor in Psychotherapy
More informationPost-traumatic stress disorder
IN-DEPTH REVIEW Occupational Medicine 2007;57:399 403 doi:10.1093/occmed/kqm069... Post-traumatic stress disorder Jonathan I. Bisson Abstract Post-traumatic stress disorder (PTSD) is an increasingly recognized
More informationPSYCHOLOGY. Chapter 15 PSYCHOLOGICAL DISORDERS. Chaffey College Summer 2018 Professor Trujillo
PSYCHOLOGY Chapter 15 PSYCHOLOGICAL DISORDERS Chaffey College Summer 2018 Professor Trujillo 15.1 WHAT ARE PSYCHOLOGICAL DISORDERS? A psychological disorder is a condition characterized by abnormal thoughts,
More informationAnd Cognitive Therapy. Grant J. Devilly. Department of Criminology, University of Melbourne, Parkville, Victoria Australia. and. Edna B.
Comments On Tarrier et al s (1999) Study And The Investigation Of Exposure And Cognitive Therapy. Grant J. Devilly Department of Criminology, University of Melbourne, Parkville, Victoria 3010. Australia.
More informationPosttraumatic Stress Disorder (PTSD) for West Virginia Nurses
Continuing Education (CEU) course for healthcare professionals. View the course online at wildirismedicaleducation.com for accreditation/approval information, course availability and other details, and
More informationAssessment and Treatment of PTSD. Learning Objectives. Disclaimer. 1. Discuss issues of under and over reporting of
Assessment and Treatment of PTSD Center for Deployment Psychology Uniformed Services University of the Health Sciences 2 Disclaimer Learning Objectives This project is sponsored by the Uniformed Services
More informationPost Traumatic Stress Disorder (PTSD) (PTSD)
Post Traumatic Stress Disorder (PTSD) (PTSD) Reference: http://www.psychiatry.org/military Prevalence of PTSD One in five veterans of the Iraq and Afghanistan wars is diagnosed with PTSD. (http://www.psychiatry.org/military
More informationPosttraumatic Stress Disorder: Tomas Yufik, Ph.D
Posttraumatic Stress Disorder: Tomas Yufik, Ph.D. 2014-15 PTSD for Municipal Judges Outline A. Define Posttraumatic Stress Disorder Notes a. Controversies in defining trauma b. Legal implications for defining
More informationThe ABC s of Trauma- Informed Care
The ABC s of Trauma- Informed Care AGENDA What do we mean by trauma? How does trauma affect people? What can we learn from listening to the voices of people who have experienced trauma? Why is understanding
More informationMICHELE BEDARD-GILLIGAN, PH.D. ASSISTANT PROFESSOR DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL SCIENCES UNIVERSITY OF WASHINGTON
Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences PTSD IN PRIMARY CARE MICHELE BEDARD-GILLIGAN, PH.D. ASSISTANT PROFESSOR DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL
More informationAcknowledge the depth of the pain that your affair brought to your marriage
Acknowledge the depth of the pain that your affair brought to your marriage We ve already talked some about the pain and trauma that your spouse has experienced, but for a very long time most cheaters
More informationPost-Traumatic Stress Disorder
Post-Traumatic Stress Disorder "I was raped when I was 25 years old. For a long time, I spoke about the rape as though it was something that happened to someone else. I was very aware that it had happened
More informationPost-traumatic Stress Disorder following deployment
Post-traumatic Stress Disorder following deployment Fact Sheet Introduction A substantial majority of the Dutch population (approximately 80%) will at some point experience one or more potentially traumatic
More informationGetting the Informed in Trauma Informed Care right
WELCOME! Getting the Informed in Trauma Informed Care right David S. Prescott, LICSW Welcome! PLEASE BE PATIENT WITH ME We live in troubled times I am going to be very provocative I am going to be highly
More informationADJUSTMENT DISORDERS AND PTSD
ADJUSTMENT DISORDERS AND PTSD Page 1 1. Introduction Acute Stress Reaction, Post-Traumatic Stress Disorder (PTSD) and Adjustment Disorders arise as a consequence of acute severe stress or continued psychological
More informationPTS(D): The Invisible Wound
PTS(D): The Invisible Wound Julie Rake, MS, PA C Fellow, Integrative Medicine The intelligent combination of conventional and evidence based alternative medicine. It aims to restore the focus of medicine
More informationPRIMUM NON NOCERE (FIRST DO NO HARM): SYMPTOM WORSENING AND IMPROVEMENT IN FEMALE ASSAULT VICTIMS AFTER PROLONGED EXPOSURE FOR PTSD
Research Article DEPRESSION AND ANXIETY 31:412 419 (2014) PRIMUM NON NOCERE (FIRST DO NO HARM): SYMPTOM WORSENING AND IMPROVEMENT IN FEMALE ASSAULT VICTIMS AFTER PROLONGED EXPOSURE FOR PTSD Nuwan Jayawickreme,
More informationUnderstanding Posttraumatic Stress Disorder
Understanding Posttraumatic Stress Disorder Have you or a loved one: Been through combat? Lived through a disaster? Been assaulted or raped? Experienced any other kind of traumatic event? Are painful memories
More informationPSYCHOLOGICAL DISORDERS Abnormal Behavior/Mental Disorders. How do we define these?
PSYCHOLOGICAL DISORDERS Abnormal Behavior/Mental Disorders How do we define these? Abnormality is identified from three vantage points: 1. That of society 2. That of the individual 3. That of the mental
More informationTreating adults with acute stress disorder and post-traumatic stress disorder in general practice: a clinical update
emja Journal of Australia The Medical Home Issues emja shop MJA Careers Contact More... Topics Search Login Buy full access Clinical Update Treating adults with acute stress disorder and post-traumatic
More information