Avoidance and Dissociation PDF

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Summary

Professor Adele Hayes, Trauma & Resilience, PSYC467...

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Avoidance -develops easily and rapidly after trauma -innate defense reaction to protect from danger -persists through classical and operant conditioning Mowrer’s Two-Factor Model - Base model for anxiety disorders/ anxiety disorder treatment - You have an UCS (ex. Trauma, rape), and gets connected with CS (ex. Men), so then the CR is fear o Learned (CS) to be afraid of men o Called overgeneralization - Operant conditioning and classical conditioning both keep the loop alive Avoidance Loop - Constricted Reality Feedback Loop / Downward Spiral - What SUSTAINS this feedback loop: automatic cutting off people, groups, aka AVOIDANCE behavior - Applies to all anxiety disorders (OCD, phobias) - basic learning theory - Avoidance spreads VERY quickly Types of Avoidance: Cognitive -Intrusions, flashbacks, negative thoughts Though suppression - Problem of rebound - Comes back TWICE AS HARD Distraction - Healthy distraction might help immediately after trauma, may prevent encoding (Tetris, Candy Crush) - Maladaptive forms of distraction can inhibit processing Experiential Avoidance - attempts to modify form and frequency of internal responses because of unwillingness to tolerate unpleasant emotions and body sensations o ex. Someone may avoid working out because their heart raises and that relates to fear - Numbing o With drugs, a rush (takes you away), mentally (dissociation as extreme form) - Avoidance of emotions (negative and positive) - Avoidance of body states - Acceptance and mindfulness-based treatments might be added to treatment to enhance distress tolerance How do I go about using distress tolerance for anticipating therapy later?? Bring up DBT to professor Actions to avoid trauma-related stimuli

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stimuli people objects avoidance coping strategies Why can positive emotions be bad? o Professor with depressed patient – they feel better, but have FEAR response – scared that they’ll get hurt, brace for failure o tell her how I understand that as someone who is depressed – after a fun weekend out, I feel more and more depressed and essentially miss it *positives can TRIGGER – person felt calm at yoga class, memories came up, can’t feel calm and then that’s associated with fear Extinction – what we WANT to do to break that link (of overgeneralization, etc.) - a. learning (CS-men and US-trauma) - b. extinction (CS-men – want to BLOCK and then make it unpaired with trauma) o ex. Would do exposure therapy and bring in man, then eventually learn that not ALL men rape Extinction parts: -

plasticity of memories – thought that they are always set, but now see that it is NOT the case: o Traumatic event – goes into ST memory (active state)  Then consolidates to long term memory (inactive state) o Goes into working fear memory (active state) o If not fixed, gets reconsolidated with modification o Then there is an altered fear memory (inactive state) o Then hopefully EXTINCTION by doing exposure therapy  Repeated memory reactivation without adverse consequences  Then, safe memory inactive state  Inhibition of altered fear memory and long-term memory o The new memory can INHIBIT the old one  Ex. (trauma memory comes up) but then saying “BUT, I know and learned that not all men are evil and rape.” - KNOW CONSOLDIATION PERIOD, RECONSOLIDATION THAT MAKES IT TIGHTER, AND INHIBITORY LEARNING Overgeneralization, avoidance etc. all inhibit extinction Avoidance - Do an exposure exercise and run away Overgeneralization - Do exposure and then overgeneralize it and then fear the therapist Extinction and New Learning

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Areas of the prefrontal cortex serve INHIBITORY function Activation of the vACC inhibits amygdala activity Decreased activity of the vaCC in PTSD releases amygdala activity *want to LOWER the amygdala activity (it’s the fear response), want to increase prefrontal lobe activity!!

prefrontal cortex not lighting up on FMRI before treatment, does after Prolonged Exposure for PTSD shown as best treatment (?) - have person write about things they are afraid of: o ex. Touch, men, going on a date, a park - graph is curvilinear – goes up and then back down, learn that it is a fear, not real danger or threat - short as 5 sessions, up to 12 for extinction mark** - want that natural extinction process to come back – taught and exposed, let anxiety move through you - LEARNING (for overgeneralizing and ruminating, etc) Learning that distress does NOT have to go down a ton – if you can tolerate the distress, that can also work (and that is distress tolerance) Virtual reality being used for exposure and trying to make it as real as possible – exposure is meant to counter avoidance: SIT with the emotions - Can be imaginal exposure therapy, real exposure (ex. Go back to park where incident happened), can write about it - Hard to do some things in vivo o Ex. Combat: can’t bring person back to Afghanistan; dangerous, hard and costly o Virtual reality can attempt to be exposure therapy for these situations o Will even take person’s experiences and assimilate the situation Enhancing Extinction and Inhibitory Learning - Fear activation (emotional arousal) - Reduce avoidance and maladaptive safety behaviors (ex. Always having another person around) - Fear reduction or distress tolerance Enhancing Extinction and Inhibitory Learning - Compound stimulus presentations (also multimodal) - Vary Css (types and number; virtual reality exposures do this) - Exposure in multiple contexts o Ex. Other places – not just place because the context gets learned – want to switch up from park to school to other parks to malls o Extinction in multiple contexts - Varied time intervals

o Kind of new – thought it should be once a week same time – but that is PREDICTABLE. o Mix it up: every other day, every hour, every 2 days – worked better in extinction learning because it wasn’t as predictable - New conditioned inhibitors (ex. Changing the building, room where the event happened) Promoting Inhibitory Prefrontal Cortex Functioning New directions Exposure therapy augmented with: - Methylene blue - D-cycloserine - Glucocorticoids - Yohimbine - MDMA (Ecstasy)** Some evidence that this can enhance extinction learning...