Discover the concept of cumulative impact PTSD, how prevention is vital to helping first responders deal with the stresses they experience on a daily basis and how to identify early warning signs of burnout and ptsd
Discover the concept of cumulative impact PTSD, how prevention is vital to helping first responders deal with the stresses they experience on a daily basis and how to identify early warning signs of burnout and ptsd
Somatic Experiencing - Savera Noriega (TouchStudio) op CoachCafé GentYourCoach BVBA
Op donderdagavond 24 november ontvingen we Savera Noriega van TouchStudio, die ons op geheel eigen wijze duidelijk maakte wat Somatic Experiencing is. Ze maakte er een leuk en tegelijk diepgaande ervaring van, waar achteraf nog veel over viel te bespreken. Hier is de presentatie over Somatic Experiencing
ASSESSING THE EFFICACY OF SOMATIC EXPERIENCING FOR REDUCING SYMPTOMS OF ANXIE...Michael Changaris
This study was assesses the impact of Somatic Experiencing on symptoms of depression and anxiety in homeless adults. It is a non-blinded match control group study.
Trauma and the Twelve Steps: Clinical Keys to Recovery Enhancement Jamie Marich
Course Description:
Some of the toughest clients presenting for therapy are plagued by issues of co-occurring trauma and addiction. Although the popular 12-step approaches to addiction treatment are still appropriate for clients with posttraumatic stress disorder (PTSD) and other trauma-related diagnoses, rigid application of the disease model and 12-step principles may prove more harmful than helpful for clients in need. In this workshop, participants will learn how to blend traditional knowledge about the disease of addiction and 12-step approaches to recovery with the latest research and practice knowledge on trauma. As a result, participants will find that they will be able to better connect with addicted clients who struggle with trauma, and deliver the help that they so desperately need in a way that honors their experience. In this workshop, participants will learn how to blend traditional knowledge about the disease of addiction and 12-step approaches to recovery with the latest research and practice knowledge on trauma. As a result, participants will find that they will be able to better connect with addicted clients who struggle with trauma, and deliver the help that they so desperately need in a way that honors their experience.
Objectives:
Describe how certain 12-step approaches, slogans, and customs may be counterproductive when working with a traumatized client
Explain how certain features of 12-step recovery are productive for working with addicted survivors of trauma stress and identify how these features can be implemented into treatment
Develop a plan for working 12-step recovery strategies alongside appropriate treatment for the traumatic stress issue(s)
A critique of outcome research in psychotherapy, and a proposal that more weight should be put on the ability fo therapists and clients to continue in relationships for as long as therapy remains active and mutative
This is lecture 1 of a 10 week Lecture series for Level 6 students Introducing them to Complex Trauma. This module is based on Courtis & Ford (2013) Treatment of Complex Trauma : A sequenced relationship based approach.London. Guildford Press.
Utilizing clips from the feature films "Ali" and "Magnolia," Dr. Tobin emphasizes the importance of regret in adult development. When pursued in psychotherapy, regrets a patient experiences serve as a bridge into vital aspects of emotional development, mourning, and self-integration. Further, Dr. Tobin introduces the notions of "otherness" and "non-meaning" and characterizes their relevance for personal and existential experience.
EMDR & Mindfulness: Interventions for Trauma, Anxiety, Panic, and Mood Jamie Marich
Course Description (From www.pesi.com):
Attend this seminar and gain a deeper understanding of both Mindfulness and EMDR. Learn how and why they can be powerful tools for healing, and with whom and when it is suitable to use each. Experience various practices of Mindfulness, and leave with skills to teach Mindfulness to your clients. Increase your knowledge of how trauma affects the brain, and how Mindfulness and EMDR can improve patient outcomes. Clinicians not trained in EMDR: gain an overview of EMDR, how and why it works. Clinicians already trained in EMDR: update your skills and enhance your ability to use Mindfulness to deepen your sessions.
Dr. Jamie Marich is not only an EMDR expert, author, speaker and practicing clinician, she is the creator of ‘Dancing Mindfulness’, a powerful community-based practice that teaches people mindfulness principles through creative expression. She is known for her natural way of presenting the “complex” in very relatable terms that translates into your having real-life, effective tools to take back to your offices!
In addition to the seminar, you will take home a manual with dozens of specific strategies along with numerous recent citations from scientific literature attesting to the efficacy of EMDR and Mindfulness.
Somatic Experiencing - Savera Noriega (TouchStudio) op CoachCafé GentYourCoach BVBA
Op donderdagavond 24 november ontvingen we Savera Noriega van TouchStudio, die ons op geheel eigen wijze duidelijk maakte wat Somatic Experiencing is. Ze maakte er een leuk en tegelijk diepgaande ervaring van, waar achteraf nog veel over viel te bespreken. Hier is de presentatie over Somatic Experiencing
ASSESSING THE EFFICACY OF SOMATIC EXPERIENCING FOR REDUCING SYMPTOMS OF ANXIE...Michael Changaris
This study was assesses the impact of Somatic Experiencing on symptoms of depression and anxiety in homeless adults. It is a non-blinded match control group study.
Trauma and the Twelve Steps: Clinical Keys to Recovery Enhancement Jamie Marich
Course Description:
Some of the toughest clients presenting for therapy are plagued by issues of co-occurring trauma and addiction. Although the popular 12-step approaches to addiction treatment are still appropriate for clients with posttraumatic stress disorder (PTSD) and other trauma-related diagnoses, rigid application of the disease model and 12-step principles may prove more harmful than helpful for clients in need. In this workshop, participants will learn how to blend traditional knowledge about the disease of addiction and 12-step approaches to recovery with the latest research and practice knowledge on trauma. As a result, participants will find that they will be able to better connect with addicted clients who struggle with trauma, and deliver the help that they so desperately need in a way that honors their experience. In this workshop, participants will learn how to blend traditional knowledge about the disease of addiction and 12-step approaches to recovery with the latest research and practice knowledge on trauma. As a result, participants will find that they will be able to better connect with addicted clients who struggle with trauma, and deliver the help that they so desperately need in a way that honors their experience.
Objectives:
Describe how certain 12-step approaches, slogans, and customs may be counterproductive when working with a traumatized client
Explain how certain features of 12-step recovery are productive for working with addicted survivors of trauma stress and identify how these features can be implemented into treatment
Develop a plan for working 12-step recovery strategies alongside appropriate treatment for the traumatic stress issue(s)
A critique of outcome research in psychotherapy, and a proposal that more weight should be put on the ability fo therapists and clients to continue in relationships for as long as therapy remains active and mutative
This is lecture 1 of a 10 week Lecture series for Level 6 students Introducing them to Complex Trauma. This module is based on Courtis & Ford (2013) Treatment of Complex Trauma : A sequenced relationship based approach.London. Guildford Press.
Utilizing clips from the feature films "Ali" and "Magnolia," Dr. Tobin emphasizes the importance of regret in adult development. When pursued in psychotherapy, regrets a patient experiences serve as a bridge into vital aspects of emotional development, mourning, and self-integration. Further, Dr. Tobin introduces the notions of "otherness" and "non-meaning" and characterizes their relevance for personal and existential experience.
EMDR & Mindfulness: Interventions for Trauma, Anxiety, Panic, and Mood Jamie Marich
Course Description (From www.pesi.com):
Attend this seminar and gain a deeper understanding of both Mindfulness and EMDR. Learn how and why they can be powerful tools for healing, and with whom and when it is suitable to use each. Experience various practices of Mindfulness, and leave with skills to teach Mindfulness to your clients. Increase your knowledge of how trauma affects the brain, and how Mindfulness and EMDR can improve patient outcomes. Clinicians not trained in EMDR: gain an overview of EMDR, how and why it works. Clinicians already trained in EMDR: update your skills and enhance your ability to use Mindfulness to deepen your sessions.
Dr. Jamie Marich is not only an EMDR expert, author, speaker and practicing clinician, she is the creator of ‘Dancing Mindfulness’, a powerful community-based practice that teaches people mindfulness principles through creative expression. She is known for her natural way of presenting the “complex” in very relatable terms that translates into your having real-life, effective tools to take back to your offices!
In addition to the seminar, you will take home a manual with dozens of specific strategies along with numerous recent citations from scientific literature attesting to the efficacy of EMDR and Mindfulness.
As a fundraising and marketing company helping nonprofit organizations, Faircom New York knows the value of charitable thought and action. This value is confirmed by science, as well, which has documented its benefits to the giver on a personal level, such as making them a happier person.
The Ultimate Platform Hotness Smackdown: Twitter, Facebook, iPhone, the Native Web / Search (Dave McClure, David Cohen, Jeff Clavier, Howard Lindzon, Ryan McIntyre -- Startup2Startup Boulder @ TechStars, June 2009)
Moving to the right side of safety is a journey; living a true culture of safety our goal. Sometimes it may feel like hiking up Everest without preparation; however, it doesn't have to be. Join us to explore this journey and inspire a passion for safety.
122lecture2AnxietyDisorders.ppt total topicAltafBro
Anxiety
Universal human experience
Dysfunctional behavior often defends against anxiety
Legacy of Hildegard Peplau (1909-1999)
Operationally defined concept and levels of anxiety
Suggested specific nursing interventions appropriate to each of four levels of anxiety
Anxiety and grief have been described as two major, primary psychological response patterns to stress.
A variety of thoughts, feelings, and behaviors are associated with each of these response patterns.
Adaptation is determined by the extent to which the thoughts, feelings, and behaviors interfere with an individual’s functioning.
Generalized and phobic anxiety disordernabina paneru
This slide contains information regarding Generalized and phobic anxiety disorder. This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
What is Anxiety Disorders?
1. ANXIETY
DISORDERS
Anxiety vs. Anxiety Disorder
Biological pathways
Major anxiety disorders:
development & treatment
Post Traumatic Stress Disorder
2. When does anxiety become a
disorder?
Anxiety is a normal human response to objects,
situations or events that are threatening
Anxiety is different from fear due to its cognitive
component (i.e. fear of the future)
Anxiety can be helpful and adaptive (e.g. anxiety
about giving lectures!)
Anxiety becomes a disorder when out of
proportion or when it significantly interferes with
life.
3. Anxiety disorders…
Highly treatable yet also resistant to
extinction
Often begins early in life
Reported more by women than men
Reported more in Western countries
Often comorbid both with other anxiety
diagnoses and with other disorder groups
(e.g. Mood disorders, psychoses)
4. Sensory Input 2. Amygdala
registers
danger
3. Amygdala
triggers fast
response
4. More considered
response based on
cortical processing1. Thalamus
receives stimulus
and sends to both
amygdala and
cortex
• Parts of the brain involved in fear response = thalamus, amygdala,
hypothalamus, which then instruct the endocrine glands and autonomic nerv.sys.
• Evolved fear module (pink) versus considered response (green) = “fight or flight”
versus “feel the fear and do it anyway (or do it differently)”!
5. Specific Phobias
Selective, persistent and out of proportion
Includes cognition that leads to behavioural
response, whether or not the threat is present
May be genetically, neurologically or
experientially based
Maintained through the processes of
classical and operant conditioning.
6. Social Phobia
A more pervasive, highly cognitive type of
phobia
Distinguishing feature is the fear of doing
something in front of others
May be situation or context (e.g. performance
versus interaction anxiety) specific
Fear of one’s own behaviour causing
negative attention from others
7. Therapeutic Treatment of
Phobia
Mainly behavioural or cognitive behavioural
techniques are used
Systematic Desensitisation (with or without relaxation training)
Flooding (with or without relaxation training)
Modelling
Cognitive restructuring, skills training, gradual exposure
[Relaxation not recommended for blood phobia where fainting is a risk]
• Hypnosis
• Medication (mainly social phobia)
MOAIs
SSRIs
8. Panic Disorder
Two major types: with or without agoraphobia
Consists of a pattern of recurring panic attacks
Emotional, physical, cognitive and behavioural
components
Main fear is of losing control (consequence = dying,
going crazy, embarrassment, not being able to get help)
The fear of having a panic attack becomes a
problem of itself, possibly leading to
agoraphobia (fear of open spaces, crowds etc. Any place where
escape or finding help is difficult or embarrassing) or other phobias
9. Treatment of Panic Disorder
Debate about the extent to which Panic
Disorder is biological versus psychological
(most likely both)
Genetic and medication studies support
biological view
Cognitive strategies - reality testing, psycho
education, cognitive restructuring, graded
exposure - all may add to effectiveness of
treatment supporting psychological argument
10. Obsessive Compulsive
Disorder
Classified as anxiety disorder, but with unique
presentation
Characterised by obsessions and compulsions (in
most cases)
Compulsions may be physical or mental
Types of presentation: contamination fear;
doubt/checking; magic thinking; symmetry; hoarding
Severity = frequency + capacity to resist +
interference with normal functioning
11. Aetiology of OCD
Psychoanalytical theories: attempt to
suppress instinctual drives – sexual and
aggressive – arising from the anal stage
Biological theories: Brain injury/trauma/acute
disease and/or neurochemical (serotonin);
Genetic factors
Behavioural and Cognitive theories:
conditioning; modelling; memory deficits
12. Treatment of OCD
Medical: particularly high doses of SSRIs
Psychoanalysis
Cognitive-behavioural therapy
Exposure and response prevention
Thought-stopping not generally effective alone
13. Generalised Anxiety Disorder
Characterised by persistent and global worry:
worry about “everything”, “worry about worry”
Distinguished from normal worry by severity,
interference, irrationality
Common problem but little is known
Resistant to change
A product of Western society?
14. Treatment of GAD
Medication (SSRIs used more for GAD than other
anxiety disorders)
Psychoanalysis: GAD is caused by conflict between the
ego and id impulses. The ego fears punishment but id
cannot be extinguished = constant anxiety and conflict
(has not been displaced as with phobia)
Behavoural Techniques: difficult to implement due to
global nature of GAD. May choose themes or priorities
Cognitive Therapy: apparently most useful but still shows
limited success
Others: Rational Emotive Therapy, Existential Therapy,
Gestalt Therapy, Narrative Therapy
15. Post Traumatic Stress
Disorder
Is it an anxiety disorder?
Main diagnostic criteria:
Witness or experience of an event that (a) involved
actual or threatened death or injury, and
Feelings of intense fear, horror, or helplessness
Person must relive the event in some way (e.g.
dreams, “flashbacks”, internal distress, physiological
reactions)
Avoidance (subconscious and/or conscious)
Hyperarousal or mood instability
Usually persisting for at least three months
16. PTSD contd…
Inclusion in DSM-III due to awareness of symptoms
in Vietnam veterans
Control and helplessness often key factors
Severity most determined by perceived threat
Unexpectedness?
Typified by delayed onset and lack of insight
Past experience may increase vulnerability (e.g. past
trauma, psychological issues, personality)
No good data to suggest some more likely to
develop than others, although prognoses may differ
17. Types and Aetiology
Acute versus Chronic (< 3 mths vs. > 3 mths)
May be caused by personal encounters, war,
natural event/disaster, extreme events
[outside normal human experience]
May develop slowly or rapidly, acutely or after
a long time
Can be difficult to recognise or diagnose
18. Therapeutic Treatment of
PTSD
Medication (treats the symptoms, but
minimally effective)
Exposure Therapy
Critical Incident Stress Debriefing
Supportive psychotherapy
Eye Movement Desensitisation and
Reprogramming (EMDR)
Rapid saccadic eye movements coupled with
exposure and positive thought
Huge movement but has attracted much criticism due
to its secrecy and lack of controlled studies
19. Complex PTSD
(Judith Herman: “Trauma & Recovery” 1992)
Argument for a new PTSD classification
Current criteria and understanding do not ‘fit’
with those in situations of chronic, ongoing
abuse or subjugation
Controversial: history of PTSD and lack of
recognition of abuse
Symptoms are entrenched, prognosis tends
to be poorer
Often present as other ‘disorders’ (e.g.
personality, mood, dissociative, other anxiety)
20. Complex PTSD contd.
A history of subjection to totalitarian control over a
prolonged period (months to years). Examples include
hostages, prisoners of war concentration-camp survivors
and survivors of some religious cults. Examples also
include those subjected to totalitarian systems in sexual
and domestic life, including survivors of domestic battering,
childhood physical or sexual abuse, and organized sexual
exploitation.
1. Alterations in affect regulation, including
persistent dysphoria (a state of anxiety, dissatisfaction,
restlessness or fidgeting)
chronic suicidal preoccupation
self-injury
explosive or extremely inhibited anger (may alternate)
compulsive or extremely inhibited sexuality (may alternate)
21. 2. Alterations in consciousness, including
amnesia or hyperamnesia for traumatic events
transient dissociative episodes
depersonalization/derealization (depersonalization - an
alteration in the perception or experience of the self so that the
usual sense of one's own reality is temporarily lost or changed;
derealization - an alteration in the perception of one's
surroundings so that a sense of the reality of the external world
is lost)
reliving experiences, either in the form of intrusive post-
traumatic stress disorder symptoms or in the form of ruminative
preoccupation
22. 3. Alterations in self-perception, including
sense of helplessness or paralysis of initiative
shame, guilt, and self-blame
sense of defilement or stigma
sense of complete difference from others (may include sense of
specialness, utter aloneness, belief no other person can
understand, or nonhuman identity)
4. Alterations in perception of perpetrator, including
preoccupations with relationship with perpetrator (includes
preoccupation with revenge)
unrealistic attribution of total power to perpetrator (caution:
victim’s assessment of power realities may be more realistic than
clinician’s)
idealization or paradoxical gratitude
sense of special or supernatural relationship
acceptance of belief system or rationalizations of perpetrator
23. 5. Alterations in relations with others, including
isolation and withdrawal
disruption in intimate relationships
repeated search for rescuer (may alternate with isolation and
withdrawal)
persistent distrust
repeated failures of self-protection
6. Alterations in systems of meaning
loss of sustaining faith
sense of hopelessness and despair
24. Treatment of Complex PTSD
Ongoing concern of how best to deal
therapeutically with this type of presentation
Very difficult cases to work with: complexity,
severity, disturbance to sense of self
Long term treatment probably best, although
may be delivered in short courses
Difficult to study outcomes based on current
research methodology
25. PTSD Issues
The same disorder?
Danger of both minimising and maximising
with diagnosis of Complex PTSD
Political and legal consequences of
diagnostic category
Social consequences