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Understanding the Impact of Trauma

Sequence of Trauma Reactions

1. Which of the following is NOT likely one of the factors that impact survivors’ immediate reactions in the aftermath of trauma?

A. The availability of natural supports and healers

B. Their coping and life skills and those of immediate family

C. The responses of the larger community in which they live

D. Their willingness to express emotions and process the trauma


Common Experiences and Responses to Trauma

2. In general, trauma survivors are highly resilient and develop appropriate coping strategies, and while most of them exhibit immediate reactions, these typically resolve without severe long-term consequences.

A. True

B. False


Exhibit 1.3-1: Immediate and Delayed Reactions to Trauma

3. Immediate emotional reactions to trauma include shame, feelings of fragility, sleep disturbances, depersonalization, and grief responses.

A. True

B. False


Biology of Trauma

4. Exposure to trauma leads to a cascade of biological changes and stress responses including:

A. Changes in limbic system functioning

B. Hypothalamic–pituitary–adrenal axis activity changes with variable cortisol levels

C. Neurotransmitter-related dysregulation of arousal and endogenous opioid systems

D. All of the above


Cognitions and Trauma

5. One of cognitive or thought-process changes that can occur in response to traumatic stress is demonstrating inaccurate rationalizations or justifications of the perpetrator’s behavior, particularly if he or she is a caregiver, which is known as glorification.

A. True

B. False


6. Each of the following is an accurate statement about triggers and flashbacks related to trauma EXCEPT:

A. A trigger is a stimulus that sets off a memory of a trauma or a specific portion of a traumatic experience

B. A flashback is reexperiencing a previous traumatic experience as if it were actually happening in that moment, and includes reactions that often resemble the client’s responses during the trauma

C. Flashback experiences are always initiated by a trigger, and typically last several seconds

D. Some triggers can be identified and anticipated easily, but many are subtle and inconspicuous, often surprising the individual or catching him or her off guard


Dissociation, Depersonalization, and Derealization

7. Experiences associated with dissociation include derealization, or psychologically “leaving one’s body,” as if watching oneself from a distance, or through depersonalization, which leads to a sense that what is taking place is unfamiliar or is not actually happening.

A. True

B. False


Self-Harm and Self-Destructive Behaviors

8. Self-destructive behaviors differ from self-harming behaviors in that there may be no immediate negative impact of the behavior on the individual, and they differ from suicidal behavior in that there is no intent to cause death in the short term.

A. True

B. False


9. Each age group is vulnerable in unique ways to the stresses of a disaster, with adolescents likely to exhibit symptoms such as rebellion, increased risky activities such as sexual acting out, wish for revenge and action-oriented responses to trauma, sleep and eating disturbances, and:

A. Depression and social withdrawal

B. Loss of ability to concentrate

C. Increased agitation and hypervigilance

D. Regression to child-like behavior


Specific Trauma-Related Psychological Disorders- Acute Stress Disorder

10. Acute stress disorder represents a normal response to stress and includes which of the following characteristics:

A. Symptoms develop within 2 weeks of the trauma and can cause significant levels of distress

B. Acute stress disorder is highly associated with the experience of long-term exposure to chronic traumatic stress

C. The primary presentation of an individual with an acute stress reaction is often withdrawal and refusal to discuss the traumatic event, acting as if everything is fine

D. People with ASD symptoms sometimes seek assurance from others that the event happened in the way they remember, that they are not “going crazy” or “losing it,” and that they could not have prevented the event


Posttraumatic Stress Disorder (PTSD)

11. The important feature of PTSD is that the disorder becomes an orienting feature of the individual’s life, and impacts how well the person can work, with whom he or she associates, the nature of close and intimate relationships, the ability to have fun and rejuvenate, and how the person confronts and solves problems in life.

A. True

B. False


Other Trauma-Related and Co-Occurring Disorders

12. While PTSD may exacerbate anxiety disorder symptoms, it is also likely that preexisting anxiety symptoms and anxiety disorders increase vulnerability to PTSD.

A. True

B. False


Timeframe: PTSD and the Onset of Substance Use Disorders

13. The “susceptibility” hypothesis attempts to explain the relationship between PTSD and substance abuse by suggesting that clients with PTSD are likely to use substances in an attempt to relieve or numb emotional pain or to forget the event.

A. True

B. False


Sleep, PTSD, and Substance Use

14. People with alcohol dependence report multiple types of sleep disturbances over time, including an increase in the amount of time it takes before sleep occurs, decreased overall sleep time, more nightmares, and:

A. Disruptive sleep-related events involving inappropriate actions during sleep

B. Reduced sleep efficiency

C. REM sleep disorder

D. A dread/fear of falling asleep or going to bed


Exhibit 1.3-6: PTSD and Substance Use Disorders: Important Treatment Facts

15. Clinicians must recognize and help clients understand that becoming abstinent from substances does not resolve PTSD, and some that some PTSD symptoms become worse with abstinence, while also emphasizing that both disorders must be addressed in treatment.

A. True

B. False


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