PTSD and ASD

PTSD AND ASD
Dr. Dawn-Elise Snipes, PhD, LMHC, CRC, NCC

Copyright 2008-2012 AllCEUs.com, a subsidiary of
CDS Ventures, LLC

PREVALENCE
50 to 90% of the population have been exposed to

traumatic events during their life
 Most individuals do not develop PTSD

 Resilience is the ability to negotiate psychosocial
and emotional changes after trauma exposure

Copyright 2008-2012 AllCEUs.com, a
subsidiary of CDS Ventures, LLC

INITIAL ASSESSMENT
Screen for

Recent and remote exposure

 Availability of basic resources

For each exposure

Proximity

 Similarity
 Helplessness
 Social Support
 6-month stressors
 Hx of mental illness


INITIAL INTERVENTIONS
Stabilizing


 Supportive medical care

 Supportive psychiatric care

 Ensure availability of basic resources
Provide information verbally and in writing to the patient

and support persons
Assessment



DIAGNOSTIC EVALUATION
Waits until patient is stable


 Premature evaluation can overwhelm

 Clinical evaluation requires assessment of
reexperiencing, avoidance/numbing, hyperarousal
 ASD occurs within four weeks and must last for a
minimum of 2 days
 PTSD occurs 1 month or more after exposure


DISSOCIATIVE SYMPTOMS
a subjective sense of numbing, detachment, or

absence of emotional responsiveness
 a reduction in awareness of his or her surroundings

 derealization

 depersonalization

 dissociative amnesia


REEXPERIENCING SYMPTOMS
recurrent and intrusive distressing recollections


 recurrent distressing dreams of the events

 acting or feeling as if event were recurring

 intense psychological or physiological distress at
exposure discriminitive stimuli


AVOIDANT SYMPTOMS
avoid thoughts, feelings, or conversations

associated with the trauma
 avoid activities, places, or people that arouse
recollections of the trauma
 inability to recall an important aspect of the trauma

 feeling of detachment or estrangement from others


HYPERVIGILENCE SYMPTOMS
difficulty falling asleep or staying asleep


 irritability or outbursts of anger

 difficulty concentrating

 hypervigilence

 exaggerated startle response


GRIEF
Grief Stages

Denial

Anger

Bargaining

Depression

Acceptance


During the first 48 to 72 hours after a traumatic

event, some individuals may be very aroused,
anxious, or angry while others may appear
minimally affected or numb


ONGOING TREATMENT
establishing a therapeutic alliance


 Increasing understanding of and coping with the
psychosocial effects of the trauma
 evaluating and managing physical health and
functional impairments
 coordination of care


EFFECTS OF A TRAUMA
Emotional


 Mental

 Physical

 Social

 Spiritual

 Environmental

 Financial

 Occupational


EFFECTIVE TREATMENTS
Supportive Interventions


 Psychoeducation

 Case management

 Psychopharmacology
SSRIs

 Benzodiazepines
 Opiates for physical complaints

Preventative: CBT beginning 2-3 weeks post-

exposure


SSRIS
Ameliorate all three PTSD symptom clusters


 Are effective treatments for comorbid disorders

 May reduce clinical symptoms

 Have relatively few side effects


CHOOSING TREATMENTS
The patient’s age and gender


 Presence of comorbid medical and psychiatric
illnesses
 Propensity for aggression or self-injurious behavior

 Recency of the precipitating traumatic event

 Severity and pattern of symptoms

 Presence of distressing target symptoms

 Development of problems in psychosocial
functioning
 Preexisting developmental or psychological issues


DEBRIEFING
Psychological debriefing or single session

techniques
are not recommended

 may increase symptoms in some settings
 appear to be ineffective in treating individuals with ASD
and PTSD

Triage assessments in a group setting may identify

those in need of intervention, but should avoid
detailed discussion of distressing memories and
events


SUPPORTIVE INTERVENTIONS
Encourage acutely patients to rely on

their inherent strengths

 their existing support networks
 their own judgments of the need for further intervention


TREATMENT GOALS
Reducing the severity of symptoms


 Preventing or treating related comorbid conditions

 Improving adaptive functioning

 Restoring a sense of safety and trust

 Protecting against relapse

 Restore normal developmental progression

 Integrate the trauma into a constructive schema of
risk, safety, prevention, and protection


TREATMENT PLAN
Observable, measurable goals and objectives


 Interventions and their rationale


CBT
Targets the distorted threat appraisal process in

order to desensitize the patient to trauma related
triggers
 Stress inoculation training involves
breathing exercises

 relaxation training
 thought stopping
 cognitive restructuring


PSYCHODYNAMIC PSYCHOTHERAPY
Focus on the meaning of the trauma in terms of

prior psychological conflicts and development
 Address developmental, inter and intrapersonal
issues that relate to
Nature

 Severity
 Symptoms

Assure patients that they will decide how deeply to

explore the difficult events/feelings
 Normalize their distress


COUNTERTRANSFERENCE
The therapists reaction can make ongoing attention

to countertransference of particular importance


PSYCHOEDUCATION
the expected physiological and emotional

responses
 strategies for decreasing secondary or continuous
exposure to the trauma
 stress reduction techniques

 the importance of remaining mentally active

 the need to concentrate on self-care tasks

 recommendations for early referral


TREATMENT PLACEMENT
Considerations

symptom severity

comorbidity

suicidal or homicidal ideation or behavior

level of functioning

available support systems


Internet based therapies show some effectiveness



OTHER INFORMATION
Patients with serious mental illness have higher

rates of abuse
 Depression, substance abuse, panic attacks and
severe anxiety are associated with increased risk
for suicide
 PTSD has demonstrated the strongest association
with suicidal behaviors
 Family members of victims are not only secondary
victims but also one of the major buffers



AGGRESSION
aggressive behavior in patients with PTSD results

from the anticipatory bias caused by the trauma
 Occurs in the context of reexperiencing symptoms

 Techniques targeting symptoms may reduce
aggression


PERSONALITY DISORDERS
Childhood trauma associated with development of

PD
 Features of PTSD and PDs overlap

 PTSD may be masked by PD symptoms


OTHER RELATED DISORDERS
Traumatic Grief

Sudden unanticipated loss

 Patient requires stabilization
 Distressing thoughts, longing
 Duration at least 2 months

Adjustment Disorder

Identifiable stressor within 3 months

 Depression, anxiety, conduct


SUMMARY
There are many causes for PTSD


 Early intervention may be key to preventing later
developmental issues in children
 Strengths-based, supportive interventions are the
best first-line treatments


PTSD and ASD

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