1. Cognitive and
Neurobiological Models of
Post Traumatic Stress
Disorder

2. Mechanics of PTSD
What mechanisms are involved in PTSD symptoms?
Mechanisms
 Neurobiological
 Cognitive

3. Neurobiological
 Neurochemical sensitization
 Use-dependent activation
 Neuro-cognitive development
 Cognitive organization in the developing
brain.
Perry, B. D., Pollard R. A., Blakley T. L., Baker, W. L., and Vigilante, D. (1995). Childhood trauma, the neurobiology of adaptation, and "use-dependent" development of the brain: how
"states" become "traits". Infant Mental Health Journal, 16(4), 271-291.

4. Neurochemical Sensitization
“Once sensitized, the same neural activation can be
elicited by decreasingly intense external stimuli.”
“Sensitization may result when experience activates
neurosensory apparatus, altering the pattern and
quantity of neurotransmitter release throughout
neuronal systems responsible for sensation,
perception, and processing of that specific experience.”
“[M]ay cause sensitization of neurotransmitter
receptor/effectors to similar future neurotransmitter
stimulation in all interconnected neural systems.”
Perry, B. D., Pollard R. A., Blakley T. L., Baker, W. L., and Vigilante, D. (1995). Childhood trauma, the neurobiology of adaptation, and "use-dependent" development of the brain: how
"states" become "traits". Infant Mental Health Journal, 16(4), 271-291.

5. Neurochemical Sensitization
In English…
 The effects of a traumatic experience, on
a neurological level, can influence future
brain functioning.
 The threshold of the limbic activation is
lowered, such that a lower degree of
stimulus is required to elicit a panic
response
• This would explain the exaggerated acoustic
startle response

6. Use-dependent Activation
 Fear states become traits
 “(find quote) The more a pathway is activated,
the more primed it is for activation.”
 We were designed to respond appropriately to
our environment. If there is a frequency of
occurrences in our environment, we will
increase the use of the neuro-cognitive
pathways that respond to the input.

7. Neuro-cognitive Development
 “The brain develops in a sequential and
hierarchal fashion.”
• Limbic to cortical, brainstem to neocortex
 “Disruption of experience-dependent
neurochemical signals during these
periods may lead to major abnormalities
or deficits in neurodevelopment.”
• Plasticity of the brain is higher in children;
therefore, children are more susceptible to
“variance of experience”
Perry, B. D., Pollard R. A., Blakley T. L., Baker, W. L., and Vigilante, D. (1995). Childhood trauma, the neurobiology of adaptation, and "use-dependent" development of the brain: how
"states" become "traits". Infant Mental Health Journal, 16(4), 271-291.

8. Cognitive Development
 “Experience literally provides the organizing
framework for an infant and child…In early
childhood, the child is most vulnerable to
variance of experience during this time.”
 Maintenance of PTSD symptoms can lead to
diminished functioning across social,
academic, and personal dimensions.
Perry, B. D., Pollard R. A., Blakley T. L., Baker, W. L., and Vigilante, D. (1995). Childhood trauma, the neurobiology of adaptation, and "use-dependent" development of the brain: how
"states" become "traits". Infant Mental Health Journal, 16(4), 271-291.

9. Cognitive Organization in the
Developing Brain
•“Experiences, including traumatic,[…]
will, during development, determine functional
capacity of the human brain.”
•States can become traits when all new
experiences are interpreted through
traumatic responses
Perry, B. D., Pollard R. A., Blakley T. L., Baker, W. L., and Vigilante, D. (1995). Childhood trauma, the neurobiology of adaptation, and "use-dependent" development of the brain: how
"states" become "traits". Infant Mental Health Journal, 16(4), 271-291.

10. Adaptive Responses to Threat

11. Child’s Response to Trauma
 The child may either move along a hyperarousal
continuum or a disscociative continuum.
Perry, B. D., Pollard R. A., Blakley T. L., Baker, W. L., and Vigilante, D. (1995). Childhood trauma, the neurobiology of adaptation, and "use-dependent" development of the brain: how
"states" become "traits". Infant Mental Health Journal, 16(4), 271-291.

12. Hyperarousal
 Adaptive response
 Males tend to use hyperaroused responses.
 Linked to the “fight-or-flight” response from
the limbic system.
 During adolescence, when a child is
physiologically able to defend
himself, hyperarousal responses are
exhibited, while disscociative responses are
diminished.
 Can look like ADHD, CD, ODD
Perry, B. D., Pollard R. A., Blakley T. L., Baker, W. L., and Vigilante, D. (1995). Childhood trauma, the neurobiology of adaptation, and "use-dependent" development of the brain: how
"states" become "traits". Infant Mental Health Journal, 16(4), 271-291.

13. Child’s Response to Trauma
 The child may either move along a hyperarousal
continuum or a disscociative continuum.
Perry, B. D., Pollard R. A., Blakley T. L., Baker, W. L., and Vigilante, D. (1995). Childhood trauma, the neurobiology of adaptation, and "use-dependent" development of the brain: how
"states" become "traits". Infant Mental Health Journal, 16(4), 271-291.

14. Dissociation
 Adaptive response
 Females tend to utilize dissociative
responses.
 Younger children tend to dissociate more
than older children.
 Tends to look like internalizing disorders:
depression, anxiety, or dissociative
disorders.
Perry, B. D., Pollard R. A., Blakley T. L., Baker, W. L., and Vigilante, D. (1995). Childhood trauma, the neurobiology of adaptation, and "use-dependent" development of the brain: how
"states" become "traits". Infant Mental Health Journal, 16(4), 271-291.

15. Adaptive Style
Perry, B. D., Pollard R. A., Blakley T. L., Baker, W. L., and Vigilante, D. (1995). Childhood trauma, the neurobiology of adaptation, and "use-dependent" development of the brain: how
"states" become "traits". Infant Mental Health Journal, 16(4), 271-291.

16. Cognitive
“Cognitive factors may play as significant a role in these aspects of the time course
of PTSD as do pretraumatic and peri-traumatic experiences.”
 Secondary emotions
 The traumatic memories
 Thought control and suppression
 Rumination
 Negative self-evaluations
 Anxiety sensitivity
Meiser-Stedman, R. (2002). Towards a cognitive-behavioral model of PTSD in children and adolescents. Clinical Child and Family Psychology Review, 5(4), 217-230.

17. Maintenance of PTSD
 Secondary emotions
• Feelings of guilt, anger may interfere with processing the traumatic memories
 The traumatic memories bring back the same physiological
effects experienced during the initial trauma.
 Thought control and suppression seems to increase the
frequency of disruptive and intrusive memories.
 Rumination
• Thinking about how the incident could have been prevented, changed, or
avoided.
• Thoughts about justice or revenge when dealing with man-made trauma.
• Females tend to use rumination as a coping strategy more than males.
 Negative self-evaluations both “enhance a sense of current
threat” and promote thought control strategies.
 Anxiety sensitivity
• Once a pathway is activated, the activation threshold is lowered across the
system.
Meiser-Stedman, R. (2002). Towards a cognitive-behavioral model of PTSD in children and adolescents. Clinical Child and Family Psychology Review, 5(4), 217-230.

18. “Onset of posttraumatic sympomatology may be strongly related to
the quality of the memory laid down during the traumatic event.”
Yerkes-Dodson Law
 Accuracy of memory
•With high arousal, the accuracy
and efficiency of memory decreases.
•During a traumatic experience,
physiological arousal is very high.
Quote: Meiser-Stedman, R. (2002). Towards a cognitive-behavioral model of ptsd in children and adolescents. Clinical Child and Family Psychology Review, 5(4), 217-230.
Graph: Yerkes, R.M. & Dodson, J.D. (1908) The relation of strength of stimulus to rapidity of habit-formation. Journal of Comparative Neurology and Psychology, 18, 459-482

19. Clinical Applications
 A better understanding of the underlying
cognitive mechanisms can inform Cognitive-
Behavioral Therapy (CBT) and make it much
more effective by specifically focusing on the
cognitive mechanisms involved in PTSD
symptoms.
 Development of other techniques that aid in
cognitive restructuring, such as EMDR, can
result.

20. Critical Analysis
 Positive:
• The studies in this field are consistent with
findings in cognitive psychology and
neuropsychology
• High effecacy in application
 Negative:
• Most studies in this field are meta-analyses
• Lack of controlled studies

21. Making Connections
• Victims of child abuse who do not meet full
diagnostic criteria can display symptoms of
PTSD
• Investigation into a neuro-cognitive model can be used
to lessen disruptions in functioning
• Prevention and relief of chronic symptoms of
anxiety can be facilitated with early intervention
can be done with a better understanding of the
underlying cognitive mechanisms
• Many pathways are shared with PTSD

22. Developmental Context
• PTSD specific manifestations may
change from childhood for adulthood
• CBT and cognitive restructuring will help
patients avoid the cognitive state from
becoming a trait
Ferry, N. C., Foa, Edna B., March, John, Treadwell, and Kimberli R. H. (2004). Posttraumatic stress disorder in youth: a critical review of the cognitive and behavioral treatment outcome
literature. Professional Psychology: Research and Practice, 35(5), 466-476.

23. List of References
• Meiser-Stedman, R. (2002). Towards a cognitive-behavioral model of ptsd
in children and adolescents. Clinical Child and Family Psychology Review,
5(4), 217-230. SECONDARY
• Perry, B. D., Pollard R. A., Blakley T. L., Baker, W. L., and Vigilante, D.
(1995). Childhood trauma, the neurobiology of adaptation, and "use-
dependent" development of the brain: how "states" become "traits". Infant
Mental Health Journal, 16(4), 271-291. SECONDARY
• Yerkes, R.M. & Dodson, J.D. (1908) The relation of strength of stimulus to
rapidity of habit-formation. Journal of Comparative Neurology and
Psychology, 18, 459-482. PRIMARY
• Ferry, N. C., Foa, Edna B., March, John, Treadwell, and Kimberli R. H.
(2004). Posttraumatic stress disorder in youth: a critical review of the
cognitive and behavioral treatment outcome literature. Professional
Psychology: Research and Practice, 35(5), 466-476. SECONDARY