Treatment for PTSD

Cognitive-behavioral therapy (CBT) 
Cognitive-behavioral therapy for PTSD have been found to be very successful in reducing peoples' symptoms and improving their quality of life.
Some of CBT therapies  that are regularly used to treat PTSD include:
1. Exposure Therapy
2. Stress-Inoculation Training
Exposure Therapy
People with PTSD may develop fears of reminders of their traumatic event. The goal of exposure therapy is to help reduce the level of fear and anxiety connected with these reminders, thereby also reducing avoidance. This is usually done by having the client confront or be exposed to the reminders that he fears without avoiding them. This may be done by actively exposing someone to reminders (for example, showing someone a picture that reminds him of his traumatic event) or through the use of imagination.
By dealing with the fear and anxiety, the patient can learn that anxiety and fear will lessen on its own, eventually reducing the extent with which these reminders are viewed as threatening and fearful.
Stress-Inoculation Training

The basic goal of this therapy is to help the person suffering from PTSD gain confidence in his ability to cope with anxiety and fear stemming from trauma reminders. The therapist helps the patient become more aware of what things are the reminders of fear and anxiety. In addition, patients learn some of the coping skills that are useful in managing anxiety, such as muscle relaxation and deep breathing.
The therapist helps the patient learn how to detect and identify the reminders as soon as they appear so that the patient can put the newly learned coping skills into immediate action. In doing so, the patient can tackle the anxiety and stress early on before it gets out of control.

Medical or Drug Treatment

Medication is sometimes prescribed to people with PTSD to relieve secondary symptoms of depression or anxiety. No medications have been specifically designed to treat the symptoms of PTSD, although some medications commonly used to treat anxiety disorders and depression have been found to be effective in helping people manage their symptoms. Antidepressants such as Prozac and Zoloft are the medications most commonly used for PTSD. While antidepressants may help you feel less sad, worried, or on edge, they do not treat the causes of PTSD. Basically they just bring you to the state of mind where you are able to continue with the treatment by for example CBT. 

CBT in combination with Medications

Medications are often paired with cognitive-behavioral therapy because by using both of these the effectiveness of them is boosted. The medications are usually used to improve the physical symptoms such as hyperarousal whilst CBT is usually used to improve the psychological symptoms such as avoidance and sadness. If only medications are used, it does not cure the patient completely because he still might be suffering from some psychological problems. If only CBT is used, it might take a longer time and the symptoms of hyperarousal might never completely disappear. When are these two treatments combined, PTSD can be treated faster and in a much more effective way. 

Post Traumatic Stress Disorder (PTSD)

What is PTSD?

PTSD is an emotional illness that that is classified as an anxiety disorder and usually develops as a result of a terribly frightening, life-threatening, or otherwise highly unsafe experience such as war or any other storngly emotional event. People who suffer from PTSD re-experience the traumatic event in some way, tend to avoid places, people, or other things that remind them of the event. They are also exquisitely sensitive to normal life experiences (hyperarousal). PTSD has been recognized as a formal diagnosis since 1980. PTSD has also been called "battle fatigue" and "shell shock".

• In the past year alone the number of diagnosed cases in the military jumped 50%– and that’s just diagnosed cases.
• Studies estimate that 1 in every 5 military personnel returning from Iraq and Afghanistan has PTSD.
• 70% of adults in the U.S. have experienced some type of traumatic event at least once in their lives. That’s 223.4 million people. Up to 20% of these people go on to develop PTSD. As of today, that’s 31.3 million people who did or are struggling with PTSD.

What are the symptoms?

After many years of research, 17 PTSD symptoms have been identified. These symptoms develop following the experience of a traumatic event and are divided into three separate categories.

1. Re-experiencing symptoms

• Frequently having upsetting thoughts or memories about a traumatic event.
• Having recurrent nightmares.
• Acting or feeling as though the traumatic event were happening again, sometimes called a "flashback."
• Having strong feelings of distress when reminded of the traumatic event.
• Being physically responsive, such as experiencing a surge in your heart rate or sweating, to reminders of the traumatic event.

     2. Avoidance symptoms

• Making an effort to avoid thoughts, feelings, or conversations about the traumatic event.
• Making an effort to avoid places or people that remind you of the traumatic event.
• Having a difficult time remembering important parts of the traumatic event.
• A loss of interest in important, once positive, activities.
• Feeling distant from others.
• Experiencing difficulties having positive feelings, such as happiness or love.
• Feeling as though your life may be cut short.

     3. Hyperarousal symptoms

• Having a difficult time falling or staying asleep.
• Feeling more irritable or having outbursts of anger.
• Having difficulty concentrating.
• Feeling constantly "on guard" or like danger is lurking around every corner.
• Being "jumpy" or easily startled.

To be diagnosed with PTSD, a person does not need to have all of these symptoms. However, a person with PTSD usually has at least some of the symptoms from each category. 

What causes PTSD?

PTSD is caused by experiencing any trauma, defined as an event that is life-threatening or that severely compromises the physical or emotional well-being of an individual or causes intense fear. Such events can be for example: seeing or being victim of violence, death or serious illness of someone very close to you, war, car accidents, natural disasters (hurricanes, fires, tornadoes, etc.), robbery, shooting, seeing somebody dying in front of your eyes, etc. People can also be diagnosed with PTSD in reaction to events that may not qualify as traumatic but can be devastating life events such as divorce or unemployment.

Briefly explain how memory and emotion relate to PTSD.

Memory and emotion are closely related to PTSD because first of all, PTSD is caused by experiencing a strongly emotional traumatic event and second of all, memory is the one that is responsible for bringing back the emotional event to the mind of  person suffering from PTSD. Therefore, we can see that memory, emotion, and PTSD are all very closely related to each other. 

Flashbulb Memory - Talarico & Rubin (2003)

Procedure: The day after the terrorist attack on September 11, they gave to 52 students a questionnaire about their memory of September 11 and an ordinary event of their choosing from the preceding few days. Then they divided the participants into three groups, and had each group return for a follow-up questionnaire session after a different amount of time such as: 7 days, 42 days, and 224 days. In the follow-up session they were asked the same questions about their memories about both the ordinary event (typically this was something like a party or a sporting event) and the flashbulb memory of September 11.
Findings: The number of details remembered about September 11 and the everyday event were statistically very similar and sometimes even identical. Most memories were consistent, and over time, the number of consistent details participants were able to recall declined, but there was no difference in the decline for ordinary memories and for memories of September 11. The number of inconsistent details (e.g. "I was with Fred" changing to "I was with Mary") increased similarly for both ordinary events and September 11. However, participants were more likely to believe their memories of September 11 were accurate than their ordinary memories. They reported the ordinary memories becoming less and less vivid and reliable, even though objectively they could remember no more details about September 11.
Conclusion: The rate of forgetting of flashbulb memories is the same as the rate of forgetting of ordinary memories. Talarico & Rubin suggested that flashbulb memories and ordinary autobiographical memories differ not in their rate of forgetting, but in the confidence with which they are held, with confidence in flashbulb memories remaining high, even as the memories are forgotten. Confidence in ordinary autobiographical memories declines as the memories are forgotten.
Weakness: They only tested retention intervals of eight months or less.

Flashbulb Memory - Neisser & Harsch (1992)

Procedure: Participants were asked about the Challenger space ship one day after the disaster and 2.5 years later. They asked questions such as: where they were, what they were doing, who told them, what time it occurred etc.  

Findings: The findings showed that memories had in fact dimmed. 40% of the participants had distorted memories in the final reports they made. Interestingly participants were not aware of this fall off in performance, being highly confident in their ability to recall accurately.

Conclusion: This represents how memories have deteriorated significantly during the two and half years, suggesting that Flashbulb Memories (FBMs) are not reliable and that FBMs may be ordinary memories. The results suggest that what is different is the confidence that people have in their memories associated with significant events.

Flashbulb Memory - Brown & Kulik (1977)

Brown & Kulik (1977) described flashbulb memories, suggesting that dramatic events can imprint a powerful impression in peoples' memories, and argued that there may be some physiological process involved in encoding such a memory. Such events as the Kennedy assassination, or Princess Diana's death are examples of events which bring us flashbulb memories.
Aim: The aim of this study was to investigate whether dramatic, or personally significant events can cause "flashbulb" memories.

Procedure: Participants were asked a series of questions about their memories of ten major events, such as the assassination of President John F. Kennedy in 1963. They were asked questions such as where they were when they heard the news, what were they doing, etc. 

Findings: Memories for such events were particularly vivid, detailed and long lasting. People usually remembered where they were when they heard of the news, how they heard it, what they and others were doing at the time, and the emotional impact of the news on themselves and those around them.

Conclusion:  Dramatic events can cause a physiological imprinting of a memory of the event

Weaknesses: 1. Data collected through questionnaires, so it is impossible to verify the accuracy of memories reported

2. It could be that dramatic events are rehearsed more than usual, making memories more durable, rather than any "imprinting" process causing flashbulb memories

Seneca's Philosophy compared to Lazarus Theory

Lazarus Theory states that a thought comes before every emotions or physiological arousal. His theory basically says that first you have to think about the event and just then experience the emotion. For example, when somebody announces that something sad happened, first you think about it and just then you experience the emotion of sadness and an physiological arousal such as crying.
                                          EVENT ---> THOUGHT ---> EMOTION
                                                                                   ---> AROUSAL

He expects the computer would work
 properly but it doesn't
 so he gets angry

Seneca's Philosophy on Anger says that anger is a philosophical problem and can be treated philosophically. He believes that the anger is caused by our high expectations because when the things don't go the way we want them to go, we get angry. Whereas when we have lower expectations we don't get angry because we do not really expect that it will go that well either. Seneca also says that poor people are less angry than rich people because they have less expectations on life and they got used to the hardships of life. On the other side, rich people have really high expectations and get angry whenever something doesn't go as they want it to go. Seneca also thinks that we should just accept some things that we cannot change. He compared us to a dog tied to a moving chariot because in order to maximize the its happiness, the dog has to follow the chariot. This relates to humans because if we want to be happy we should sometimes just follow and accept something that we are not able to change. If we were going to resist to follow, it would just bring hassles if we would resist to follow something that we cannot change.
Seneca's Philosophy relates to Lazarus Theory because both of them are about how thought can bring an emotion. In Seneca's Philosophy, the thought about how good it should have been brings the emotion of anger. If we did not have high expectations for something we would not get upset when it goes the other way we want it to go. In Lazarus Theory, the thought is involved in the process of feeling emotion because it says that first you have to think about the situation that happened and just then you  can experience the emotion. 

Facial Expressions Of Emotion Are Innate, Not Learned

The article in the ScienceDaily  claims that according to a new study, facial expressions of emotion are 'hardwared' into our genes which means that instead of learning how to express the emotion, we are already born with the ability to do so. The study is the first of its kind to demonstrate that sighted and blind individuals use the same facial expressions, producing the same facial muscle movements in response to specific emotional stimuli. Matsumoto compared the facial expressions of sighted and blind judo athletes at the 2004 Summer Olympics and Paralympic Games. He found out that both the blinded and the sighted athletes manage their expressions of emotion in the same way according to social context. For example, both the blinded and the sighted athletes that lost showed the same emotion. This shows that the facial expressions are innate because the blinded athletes did not have a chance to observe and learn to express the emotions and still showed the same facial expression as the sighted athletes did. 

I chose this article over the others because I think that it is really interesting that the facial expressions of emotion are innate. To be honest, I have always thought that you learn how to express the emotions from the others but this study clearly shows that I was mistaken. 

I think that this article relates to one of the evolutionary theories which suggests that the emotions are natural and innate. One of the main reasons why are they innate is because they are meant to help us survive and back then they could even save our lives. 

How Do Culture and Gender Affect Expressing Emotions?

All of us have emotions. However, there have been conducted studies that show that Gender and Culture play a big role in expressing the emotions. For example, in some cultures they consider smiling as a sign of weakness so the people from these cultures do not smile that often because they have learned that they should eliminate smiling to be considered to be strong characters. There are also some differences between males' and females' form of expressing the emotions.

Gender Differences

Men are able to control their
emotions

The modern psychological researches show that males and females possess different skills of sending and receiving the emotions. Generally, women are more emotionally expressive (Miller, 1976), whereas men are able to conceal or control their displaying of emotions (Buck, Miller,& Caul, 1972). Moreover, women tend to express emotions through facial expression and interpersonal communication, whereas men generally express emotions through actions such as engaging aggressive, dangerous, or distracting behavior.

Women are very emotionally
expressive 

There has been also some studies that were investigating smiling of men and women. Over 90% of the studies showed more females than males smiling, and over 50% found this difference to be statistically significant. It was also found that the smiling difference was greatly reduced in less social situations for females. Furthermore, research has uncovered fairly reliable sex differences in the experience and expression of sadness. Substantial evidence shows that women are more likely to be sad and engage in more interpersonal communication about their problems.
Cultural Differences

One of the biggest differences between cultures in expressing emotions are the cultural display rules. These rules say what emotions expressions are appropriate and which are not. Every culture has slightly different rules than the other cultures. One useful distinction in these rules is made between cultures which are considered generally 'collectivist' such as the Japanese and cultures considered 'individualist' such as Americans. Collectivist cultures tend to cherish 'fitting in' and homogeneity and getting along with others, while individualist cultures tend to emphasize the importance of individual autonomy and power.

 Studies have found that those from collectivist cultures are more likely to mask negative emotions with smiles - but only do this when in the presence of others, not when they are alone which means that they are just showing off to 'fit in'. There are also big differences in controlling emotions among different cultures. There have been conducted a study where they found that it is Russians who most tightly control the display of their emotions, closely followed by the Japanese and South Koreans. On the other side, Americans displayed the least control over their facial expressions (Matsumoto, 2006).

Introduction to Emotions

The basic definition of emotion says that an emotion is a feeling state involving thoughts, physiological changes, and an outward expression or behavior. Emotions are very important because they influence our everyday lives, affect the choices we make and shape our lives. There are many theories that attempt to examine why and how we experience emotions. One of them is James-Lange Theory which argues that an event causes a physiological arousal first and then an interpretation of this arousal. 

 Only after our interpretation of the arousal we can experience emotion. If the arousal is not noticed or is not given any thought, then we will not experience any emotion based on this event. EXAMPLE: You are walking down a dark alley late at night. You hear footsteps behind you and you begin to tremble, your heart beats faster, and your breathing deepens. You notice these physiological changes and interpret them as your body's preparation for a fearful situation. You then experience fear.

Another example is Cannon-Bard Theory which argues that we experience physiological arousal and emotion at the same time, but give no attention to the role of thoughts or outward behavior. EXAMPLE: You are walking down a dark alley late at night. You hear footsteps behind you and you begin to tremble, your heart beats faster, and your breathing deepens. At the same time as these physiological changes occur you also experience the emotion of fear.

One of the main roles of emotions is to allow humans to survive and be successful in the world. Nature developed our emotions over millions of years of evolution. By showing emotions we reveal our needs and wants. Our emotions also have the potential to serve us as a delicate and sophisticated internal guidance system. Our emotions alert us when natural human need is not being met. For example, when we feel lonely, our need for connection with other people is unmet. When we feel afraid, our need for safety is unmet. When we feel rejected, it is our need for acceptance which is unmet. Fear is an example of emotion which is important for our survival. Back then, being afraid was important for survival of our species because our distant ancestors could see when it was needed to run away - otherwise they might have been killed. Fear signals to your brain that your survival is under threat upon which chemicals and hormones are released to prepare your body for the needed action.

Alzheimer's Disease

   Alzheimer's disease is a physical disease of the brain. During the course of the disease plaques and tangles develop in the brain leading to the death of brain cells. Alzheimer's always starts in the median temporal lobe, so it affects the memory first. In its early stages memory loss is mild but in its late- stages it causes loss of ability to carry on a conversation and respond to the environment. Alzheimer's Disease is the most common form of dementia. Dementia is a general term for loss of memory and other abilities that may interfere with normal daily life. Alzheimer's Disease accounts for about 50 to 80 % of all dementia cases. Alzheimer's disease symptoms become worse over time. It is a lethal disease, meaning that there is no way out and it will eventually end your life. Alzheimer's was discovered in 1906 by German neurologist Alois Alzheimer, but it was only recently brought up how widespread this disease actually is. 

The video we watched in class, "The Forgetting", was about Alzheimer's Disease and its explanation in depth. They estimated the number of people with this disease to five million and that the number is still increasing. There were also mentioned experiments on animals and how are the scientists trying to develop drugs that will cure the disease. There were also introduced some stories of the people with this disease. In the video they said that Alzheimer's Disease affects the relatives more than the person with the disease because the person with the disease eventually forgets who are his or her relatives and it can be quite traumatic for their loved ones.
       There is so many new things I have learned about Alzheimer's Disease in the class. Personally, I don't know anybody who has this disease so I was never really interested in it and therefore I didn't know a lot about the disease. After we covered this topic in class, I finally became aware of how widespread it is and how awful are the consequences of it. From the video "The Forgetting" I learned that Alzheimer's Disease can "tear all the memories that form who you are." Some of the patients in the video say that they "lost themselves"  because memories form who we are. I also learned that relatives of the person suffering from this disease are affected really badly because the person that they knew and loved is slowly disappearing.

The Case Study of H.M.

The case study of Henry Molaison (H.M.) has been one of the biggest contributions to neuropsychology. Henry Gustav Molaison banged his head after being by a bicycle rider when he was nine and after that developed severe seizures. The scientists did not see into his head and were not even sure if the seizures had to do something with the accident. After 18 years, Molaison went to see Dr. William Beecher Scoville, a neurosurgeon at Hartford Hospital because he was blacking out frequently, had devastating convulsions and the quality of his life radically worsened. Dr. Scoville decided that the best option to help H.M. would be to surgically remove a portion of his temporal lobes, in particular hippocampus. After the surgery, seizures abated but there still were some other consequences, especially on his memory. A number of scientists were trying to figure out what were the consequences by giving H.M. memory tests and studying him thoroughly. After some tests, the scientist found out that H.M.'s short-term memory was completely fine; he could hold thoughts in his head for about 20 seconds. However, since it was impossible for him to hold onto these short-term memories, scientists concluded that hippocampus is responsible for forming and maintaining long-term memories. Yet H.M. was able to recall some of the earlier memories, he still had obstacles with placing them into the correct place in time. He was also unable to move memories from short-term to long-term stores so therefore he no longer had the ability to create new memories that could be later recalled. There were a lot of things learned on this case. He helped scientists understand the biology of learning, memory and physical dexterity, as well as the fragile nature of human identity. Before H.M. case, scientists believed that memory was widely distributed throughout the whole brain and that it was not dependent on any particular neural organ or region. However after this case they found out that there is a part in our brain that is responsible for forming long-term memories. This part is called hippocampus and it is located in the medial temporal lobes. Therefore, the case study of H.M. was really essential to development of neuroscience and to understanding the biological concept of memory.            “The study of H. M. by Brenda Milner stands as one of the great milestones in the history of modern neuroscience,” said Dr. Eric Kandel, a neuroscientist at Columbia University. “It opened the way for the study of the two memory systems in the brain, explicit and implicit, and provided the basis for everything that came later — the study of human memory and its disorders.”

Limitations of Memory - Schema Theory

According to schema theory, the knowledge we have stored in memory is organized as a set of schemata which incorporates all the knowledge of a given object or event that we have acquired from past experience. In other words, our experiences are organized into different categories based on our previous knowledge. For example, when you go to doctor and he or she takes a blood sample from you, after that you automatically put it into a category in your memory and when you go to doctor next time you will know what to expect there. People can quickly organize new perceptions into schemata and act effectively without effort. Schema theory emphasizes the fact that what we remember is influenced by what we already know. Schemata also represent an active process and can change over time as a result of new experiences and learning. Many psychologists examined schema theory by conduting studies such as Bartlett, 1932, Loftus & Palmer, 1974, French & Richards,1993, and Ronald Cotton legal case study.

The concept of schemata was firstly introduced in 1932 by Frederic Barlett. He conducted a famous study called “War of the Ghosts” where he showed that memory recall is influenced by pre-existing knowledge, also known as schema, which is influenced by many different factors such as cultural background. Barlett had the participants to read an Indian folk tale called “War of the Ghosts” and then tested their recall of it on several occasions. Individuals mangled the story more with each attempt to remember it, notably by changing elements of the legend to match their own expectations, and sometimes even adding a moral to it. This experiment proves that people use frameworks of knowledge that they already have to remember and interpret the new memories that they obtained.

Another study that examined schema theory was Loftus& Palmer study conducted in 1974. The attempt of this study is to demonstrate that memory is not a factual recording of an event and that memories can become easily distorted by other information which occurs after the event. In this study the participants were shown short videos of car accidents. Following each video, the students were asked to answer some specific questions but the critical question had to do with the speed of the vehicles involved in the collision. The important question was 'About how fast were the cars going when they _____ each other?'. In each condition, a different word or phrase was used to fill in the blank. These words were; smashed, collided, bumped, hit, and contacted. The results are shown in the table on the left. The results of the experiment show that the way the question is asked can influence the recall of the memory.

 French & Richards Experiment (1993) also supports the idea of schema theory. In the study there were three conditions: 

• Condition One: participants were shown a clock with roman numerals and asked to draw the clock from memory
• Condition Two: the same procedure, except the participants were told before hand that they would be required to draw the clock from memory
• Condition Three: the clock was left in full view of the participants and they just had to draw the clock.

The clock used represented the number four with IIII, not the conventional IV. In the first two conditions,  the majority of participants reverted to the conventional IV notation, whereas in the third condition, the IIII notation. This shows that participants' memory was influenced by their own schema which says that number four is normally represented with IV notation. 

Lastly,  Ronald Cotton legal case study also shows that schema theory works. This case study shows that pictures that were shown to the eye-witness in the line-up significantly influenced her memory of the criminal. Since the real rapist was not presented in the line-up, the eye-witness picked the one that resembled the criminal the most and from that moment her memory was changed. In her memory, was now her rapist Ronald Cotton even though he was totally innocent. Later on even though she saw her real rapist, Bobby Poole, she did not recognize him because in her memory the rapist was now Ronald Cotton. 

All of the studies listed above show that the memory is malleable and can be changed really easily. All of the studies supports schema theory which says that memories are stored into different subcategories based on our previous experiences. Schema theory both helps and hinders the actual memory recall. It helps it because our brain can store a huge amount of information just because it is so well-organized into different subcategories. However, schema theory also hinders the memory recall because sometimes the information does not really fit into any of the categories so then our brain has to put it somewhere where it can be unfortunately easily manipulated and changed.

False Memory - Eyewitness Testimony Is Not Always Reliable

Memory is malleable, full of holes and can be easily changed. Therefore the eyewitness testimony is not always the most reliable method that can be used as evidence in court. We can see how unreliable the eyewitness memory can be on the case of Ronald Cotton. In 1984, a man broke into Jennifer Thompson’s house and raped her. She managed to remember his facial features and was intended to find this man and put him into the jail. After the assault she called the police and described the man. According to her description they put 6 men into the photo line-up. At that point she knew that it had to be one of the six men in the line-up so she picked the one that most resembled the man that raped her. She picked Ronald Cotton and then when police told her to pick one from the physical line-up she picked him up again. Unfortunately, Ronald Cotton actually wasn’t her rapist and he was totally innocent. However, she said that she is 100 percent sure that Cotton is the attacker.  Ronald Cotton then went to prison and met there a man that was very similar to him and might have been Thompson’s actual rapist. So he asked for a retrial where he and the other man called Poole would be presented to Thompson and she could again pick one of them whom she thought was her attacker. However, when Thompson saw them in the courtroom she again picked Cotton with an absolute certainty. Cotton remained in jail up until 1995 when DNA evidence got more popular and reliable way of evidence. So she asked his attorneys to make a DNA test on the one single sperm sample left from the case. Fortunately, there was enough DNA to prove Cotton was innocent and Poole was guilty. 

Now the question number one is why was Thompson so sure that she picked the right man from the line-up where the actual rapist was not even offered as an option and the question number two is why did she pick Cotton in the retrial even though she saw there her actual rapist too. The answer to the first question is that when she saw the line-up she unconsciously knew that one of the men should have been her attacker. Therefore, she picked the one that resembled the man from her memory the most. At that point, all of her previous memories about her actual rapist were changed and now she is thinking of Cotton as if he was her actual rapist. That is why she picked him in the physical line-up afterwards and that is also why she picked him in the retrial over her actual rapist (Poole) years later. Her memories of the actual rapist were changed and replaced with Ronald Cotton.

In conclusion, I think that the eyewitness testimony is not a reliable and useful type of evidence in court. I think this because there were many studies (Loftus study, French and Richard study) that proved that human memory can be very easily changed and influenced. Therefore, I am of an opinion that the eyewitness testimony should always be supported by another type of evidence such as DNA evidence.