Q2 Wheeler chapter 2 3 and 6 2023 with 100% correct questions and answers

stress trauma continuum mild stressors at one end and trauma at the other with increasing learned helplessness as we move towards trauma. adaptive information processing model The brain has innate self-healing and tries to control its environment through dynamic regulation. The goal is to store memory in a way where it is connected to other adaptive networks learning changes the pattern of receptors in our brain through two methods top down or cortical to subcortical to organize impulses and emotions from the limbic and brain stem or Left right to put emotions into words and integrate negative and positive emotions adaptive processing means that the neur al connections are associated that allow experiences to be integrated into positive emotional schemas Psychopathology results from events that are not fully processed due to their perception as emotionally intense or overwhelming key neurotransmitters in psychopathology norepinephrine in distressing events and dopamine in highly positive events both lead to the memory not being integrated into adaptive networks or in other words being isolated from change through learning Reminders of these experiences by either internal or external factors trigger and continue to activate specific neurobiologicalresponses that then drive behavior and the symptoms of most mental healthproblems and psychiatric disorders. sequential acquisition brain development occurs from the bottom up. neural connections form templates starting primitive regulation like breathing to motor to limbic to thought The cortex is the last area to develop and is the most plastic neuroplasticity refers to areas of the brain that can change in response to the environment acetylcholine function in the brain connects limbic to cortex a decrease leads to memory and cognitive impairments while an increase is associated with Alzheimer's cortisol function in the brain potentiation of adrenaline release of energy stores cell atrophy growth immune and inflammatory suppression dopamine function in the brain associated with motor and mood as well as reward produced in substantia niagra endorphin function Pain reduction Feelings of well-being calm reduces anxiety is involved in self-harm and stress addiction GABA function a major inhibitory neurotransmitter deficit in anxiety disorders Glutamate A major excitatory neurotransmitter; involved in memory and brain development too much is toxic to cells immune messengers can lead to mild anxiety lethargy avoidance and sleepiness Norepinephrine stress response, learning too much results in anxiety vigilance and aggression Oxytocin results in uteral contractions during childbirth and orgasm enhances monogamous relationships and social interactions Early stress leads to a lifelong decrease Serotonin A neurotransmitter that affects hunger,sleep, arousal, and mood. temperature regulation and pain control anxiety and affective disorders deficit leads to depression Vasopressin (ADH) enhances sexual arousal Early stress produces lifelong increase critical times for brain development include first three years of life where neural networks are laid down by age 5 when brain triples in size due to myelination which increases speed of information processing with a three year old tantrum remember that their cortical development does not allow advanced regulation yet long-term potentiation gradual strengthening of the connections among neurons from repetitive stimulation use it or lose it Pruning the degradation of synapses and dying off of neurons that are not strengthened by experience arborization the elaborate growth and branching of the dendrites in response to a stimulating environment memories formed at age 3 and under are difficult to change because they're formed in the brainstem midbrain and limbic area state-dependent learning memories formed during a particular physiological or psychological state will be easier to remember while in a similar state REM sleep is essential for memory consolidation of semantic/ explicit/ declarative memories or in other words facts and knowledge gained from study implicit memory procedural motor emotional or somatic memory includes emotional state memory formed early in life for example if a child was left alone frequently, they may experience agitation for sadness when alone as an adult defense mechanisms are implicit templates developed through interpersonal interactions to protect ego and prevent discomfort May have been productive during childhood but dysfunctional in adulthood primitive defense mechanisms such as projection and denial are associated with what age adolescent ego strength can be determined by the category of someone's defense mechanisms. primitive/narcissistic defense mechanisms indicate a weak ego conscious awareness of one's defense mechanism weekends up and leads to experiencing the emotion defended against limbic resonance refers to the fact that emotions are contagious and a powerful driver of our feelings, thoughts, and behaviors dyadic states of consciousness learning through attachment Attunement a parent's recognition, acceptance, and reciprocation of a person's emotions infant attachment categories 1. secure: secure and autonomous upon Mom's return 2. avoidant dismissive 3. resistant ambivalent preoccupied 4. disorganized Neuroception non-conscious evaluation of safety or threat conservation withdrawal A Parasympathetic Survival pattern that is a persistent or frequent state of withdrawal due to early trauma parasympathetic dominance conversely, if sympathetic dominates it is a state of arousal mirror neurons Frontal lobe neurons that fire when observing another's action in the same pattern as if we were doing it. this allows us to feel what others are feeling without experiencing it ourselves The hippocampus is smaller in those who have been traumatized through physical or sexual abuse during high states arousal the amygdala and hippocampus become disconnected so that learning is difficult glucocorticoids shut down hippocampus and make it impossible to learn The hippocampus is unique in that it is one of the few places where new neurons can be generated medication and therapy increase hippocampus size limbic system includes hippocampus, amygdala, hypothalamus, OMPFC, thalamus, anterior cingulate The amygdala regulates REM sleep and REM eye movements as well as fear kindling effect neurons that are repeatedly fired require less stimulation to activate and will fire more easily in the future Allostasis process by which the body achieves stability through physiological change allostatic load the long-term negative impact of the stress response on the body components of stress response physiologic HPA access which regulates cortisol limbic system fight or flight vasopressin oxytocin response leading to ACTH release leading to increased vasopressin and decreased oxytocin--increased sexual arousal and decreased fulfillment self-harm those in a parasympathetic state of withdrawal, received the rush of neurochemicals such as endorphins that result in comfort they are in a parasympathetic disassociated state this cycle can be called addiction to trauma this association at the time of trauma is suggestive of future diagnosis ptsd in PTSD the brain may be hypersensitive to cortisol causing overreaction to minor events and underreaction to major problems. they may function well in an emergency but if something is spilled or they are startled they overreact and exaggerate the significance of the event mindfulness and EMDR changed the brain through bottom up theory starting at the limbic system moving up to the cortex improves attention and tolerance of unpleasant feelings or thoughts CBT changes the brain through top down theory from cortex to limbic system strengthen s inhibitory control and self-regulation through talking and journaling about experiences The brain is able to integrate them into a sensical narrative for adaptive learning and connect the past present in future as well as integrate both positive and negative events together additionally these actions increase prefrontal activity in the brain and decrease negative emotional activitivation The narrative, in tandem with experiencing emotional components of the memory, allows processing and change to occur. Identifying emotions correlates with decreased amygdala response and an increase in prefrontal activity Highly emotionally arousing memories become powerfully linked in our brain and are mediated by amygdaloid functioning without connecting to the frontal cortex. this means that Language and reason cannot change or access these memories. This is important for psychotherapists to understand, because intellectual understanding can take the patient only so far mindful meditation increases the size of the prefrontal cortex interceptive awareness Heightened awareness of internal cues without becoming overwhelmed. mindfulness with trauma what happened is not as relevant as how people make sense of their lives Alexithymia A learned difficulty identifying and expressing emotions and they instead manifest as physical symptoms- somatization suspect with chronic pain Psychotherapy is about helping people to make sense of their inner lives,emotions, and interpersonal experience Integration is accomplished through adaptive processing ofdysfunctional information broad goals of clinical assessment as follows: 1. To effectively engage the patient in the data-gathering process 2. To collect information and form a valid database 3. To develop an evolving and compassionate understanding of the patient 4. To develop an assessment from which a differential diagnosis can be made 5. To use the diagnosis as a guide to the choice of an appropriate treatment plan 6. To effect some decrease in the patient's anxiety 7. To instill hope and ensure that the patient will return for the next appointment validity refers to the accuracy of the database, whether the information sought is actually being obtained trust can be built early in the psychiatric interview by giving control to the patient through a non-directive stance and open questions in the holistic nursing model instead of chief complaint we can say patient identified problem if the patient denies any need to be there or reason for coming in, ask can you tell me what led to the person who suggested you come in, making that suggestion? or nothing may be wrong but since we're here anyway perhaps there's something else I could help with HPI components order 1. patient's baseline functioning or last period of stability 2. previous diagnoses of psychiatric disorder and treatment 3. onset of the first symptom and its precipitant 4. A chronology of one to three key symptoms, including when they worsened and the precipitant events that caused them to worsen 5. Associated symptoms related to the one to three key symptoms 6. Documentation why the patient presents for treatment now 7. Repetition of components 3, 4, and 5 if there is more than one diagnosable disorder 8. A list of pertinent negative symptoms 9. A list of additional stressors not mentioned extreme difficulty with Affective regulation alexithymic Assessing Interpersonal Relationships: impairment clues 1. insistent emphasis on the patient's feelings and views about the person, rather than on that person's independent attributes 2. An extreme and affectively charged verdict, rather than a balanced account that permits mixed feelings toward the person described 3. inability to see independent motivations in other EMDR stages 1. history and treatment plan 2. preparation with education surrounding EMDR and trust building resource development and installation 3. assessment identify negative cognition NC and picture the worst part of it identify positive cognition that one desires to have of self and rate validity of cognition VOC 1 to 7 based on how true it feels about oneself presently. then emotions associated with NC rated as subjective units of disturbance SUD 1 to 10 and identified where in body they are felt 4. Desensitization begin sets of BLS with eye movements, sound, and/or tapping and continue until the SUD is 0 or 1 5. Installation—install PC with bilateral stimulation 6. Body Scan—note tension and sensations in body for any residual 7. Closure—instruct about keeping a log and educate about disturbances that mayoccur postsession 8. Re-evaluation—reassess and review targets that were processed at the beginning ofthe next session EMDR Signs that the person is stabilized include no current life crisis,acceptance of the diagnosis, an ability to set and adhere to limits,the ability to identify triggers, ability to self-soothe and to reach out tosupportive people, and the ability to communicate honestly with the clinician.In terms of mood stability, the person's mood may be depressed but not labile Abreaction Psychoanalytic term for reliving an experience with all the same thoughts and emotions. BLS in EMDR bilateral stimulation treat change permanent personality change state change temporary change in current emotions processing should take place only in which part of the session the middle. The beginning should establish safety and trust and the end should establish safe and trust THE PATIENT MUST LEAVE IN A CALM STATE before the patient leaves the EMDR session, inform them that processing may continue between sessions processing has been achieved when SUD subjective units of disturbance successful processing has occurred after relationships are adaptive, work is productive, self-references are positive, there are nosignificant affect changes on exposure to trauma triggers, affect is proportionate to events, and there is congruence among behavior, thoughts, and affect future oriented before starting EMDR assess DES for disassociation. A scale of 30 or higher indicates caution since EMDR will break down disassociative defense mechanism seizure and eye pain contraindicate EMDR EMDR certification is available to clinicians with two years of experience 50 hours, 25 patients, 12 hours of continuing education, 20 hours of consultation with an approved consultant