2 16 Posttraumatic Stress Disorder Key Question 1 How do fear and anxiety develop Example Hiking through the woods and you run into a bear what will you feel like What will you do FEAR One aspect we might feel is physiological sensations Increase in heart rate faster breathing sweating increased muscle tension Decreased stomach acid decreased salivation Cognitive Increased focus on the threat Judging your ability to cope Prediction of the future Behaviors Freeze Flee Fight All of these aspects influence each other What will happen next time you go hiking ANXIETY Increased heart rate and muscle tension Physiological Cognitive Behaviors What if there s a bear Check for signs of a bear Stay close to friends Key takeaway Fear is in the present moment anxiety is about the future unknown Fight Flight Freeze response Threat sends message to the amygdala which sends messages to the hypothalamus The hypothalamus then sends messages to two systems 1 Sympathetic nervous system Prepares your body for the threat 2 Pituitary Adrenal glands Creates the HPA axis Release of cortisol stress hormone Has negative feedback to stop activation when levels get too high it stops producing for a moment Anxiety and Related Disorders Frequent persistent intense anxiety fear Significant distress impairment In class Activity 3 The Case of Diego Think back to when we talked about behavioral theories of psychological disorders How does the concept of classical conditioning apply to Diego Identify one conditioned stimulus Key points from the case of Diego Was brutally attacked by a group of young men late at night Has intrusive memories of the attack Feels anxious whenever near the area where he was attacked or whenever he encounters a group of young men Avoids leaving house late at night avoids place where attack happened avoids people that remind him of the attackers Feels detached from other people withdrew from his friends blames himself Trouble sleeping trouble concentrating and easily startled Diego experienced an unconditioned stimulus the attack which produced an unconditioned response fear Nighttime groups of men area where he was attacked became conditioned stimuli as a result Led him to avoid these stimuli the immediate reduction in anxiety leads to negative reinforcement makes him even more likely avoid situation in the future Mowrer s Two factor Model Classical conditioning develops the fear Operant conditioning maintains the fear Key Question 2 What is post traumatic stress disorder PTSD Post Traumatic Stress Disorder PTSD Can develop following extreme stressors experience witness trauma actual threatened death serious injury or sexual violence Learn about trauma to someone close Repeated or extreme exposure to details of trauma 4 main categories of symptoms Re experiencing ie intrusive memories dreams nightmares Avoidance Altered mood cognitions guilt blame loss of interest in activities feeling distant arousal reactivity panic sensations in response to conditioned stimuli hypervigilant intense startle response Symptoms all have to be present for more than one month and patient has to have significant distress and or impairment to meet criteria for diagnosis Prevalence of PTSD About 7 lifetime prevalence 70 90 exposed to one or more traumatic events Nearly all of trauma exposed have some symptoms following trauma 10 of trauma exposed develop PTSD PTSD Risk Factors Trauma type Severity and proximity Duration of trauma Sexual assault Environment Lack of social support society culture Women Black African American Gender or sexual minority Individual Dissociation Avoidant coping Past anxiety or depression Protective factors Social support Ethnic identity Supportive friends family educators