Post Traumatic Stress Disorder or PTSD, is defined as an anxiety disorder that develops in those who have experienced an extremely traumatic event such as war, crime, a car accident, a natural disaster, and/or any physical or sexual abuse.
Before its discovery PTSD was known as ‘shell shock’ and ‘combat fatigue’, present in many soldiers during World War I and after World War II. However, PTSD does not only occur in soldiers. It is said to affect men and women of any ethnicity, nationality and age. It affects approximately 3.5% or 7.7 million US adults and around 5% of people subjected to life threatening trauma.
A diagnosis of PTSD requires exposure to a traumatic event, but this traumatic event doesn’t have to be experienced first hand. For example, a person who learns about a family member who has died in a natural disaster could develop PTSD. In addition, not everyone who experiences trauma develops PTSD, and not everyone who develops PTSD requires psychiatric treatment.
There are four main categories in which the symptoms of PTSD fall and any other specific symptoms can vary in severity and length.
1. Intrusive Thoughts:
a. Repeated, involuntary memories of the event.
b. Nightmares and insomnia.
c. Flashbacks. These can be so vivid that patients feel as though they are reliving the event or watching it happen right in front of them.
2. Avoiding Reminders:
a. Avoiding people, places, activities, objects, and situations that trigger distressing memories related to the event.
b. Patients also avoid remembering, thinking or talking about the event and addressing how they feel about their trauma.
3. Negative Thoughts and Feelings:
a. Ongoing and distorted beliefs about oneself and others. (“I’m a horrible person,” “No-one can be trusted” etc.)
b. Consistent fear, anger, horror, guilt (survivor’s guilt), or shame.
c. Reduced interest in activities that were previously enjoyed.
d. Feeling detached or estranged from friends and family.
4. Arousal and Reactive Symptoms:
a. Irritability and having random angry outbursts.
b. Becoming reckless or self-destructive.
c. Being easily startled.
d. Having problems concentrating on tasks as well as trouble sleeping.
Those who are exposed to a traumatic event show symptoms in the days after the event while those who are diagnosed with PTSD can have symptoms that last for months and sometimes years following the event. Often times, individuals develop the symptoms within three months of the trauma but sometimes they can appear later.
These symptoms cause significant distress and trouble functioning, resulting in increased anxiety and a reduced quality of life. In addition, PTSD is often presented with other related conditions such as depression, substance abuse and memory problems. For some people, symptoms of PTSD subside or disappear over time; others get better with the help of family or friends. However, many people with PTSD need professional treatment in order to recover.
Both psychotherapy (talk therapy) and medication are effective treatments used for PTSD. A subcategory present in psychotherapy is Cognitive Behavioral Therapy (CBT). Cognitive processing therapy, prolonged exposure therapy and stress inoculation therapy are types of CBT used to treat PTSD.
Cognitive Processing Therapy
This form of CBT focuses on modifying and altering painful negative emotions and beliefs that have resulted from the trauma by directly addressing them. Feelings like shame and survivor’s guilt, as well as thoughts like “I have failed,” “The world is dangerous,” “I’m a bad person” are targeted for modification as PTSD patients write or read about their traumatic experience. This therapy occurs in around 12 group or individual sessions and helps the person confront their feelings and memories of the event.
Prolonged Exposure Therapy
This therapy uses repeated detailed imaging of the trauma, or consistent progressive exposures to symptom triggers in a safe controlled environment, to help the PTSD patient confront and gain control of their fear and distress. For example, war veterans are put in virtual reality programs in order to re-experience the battlefield in a therapeutic manner. The patient engages with the symptom triggers in order to promote the processing of the traumatic memory rather than the avoidance of it, decreasing the uncomfortable feelings associated with the memories when they are triggered.
Stress Inoculation Therapy
This is another form of CBT that involves a variety of methods to manage anxiety such as education about stressful situations and symptoms, muscle relaxation training and biofeedback. Social skills training, role-playing, distraction techniques, positive thinking and self-talk are all very useful techniques. They are intended to help patients prepare themselves in advance, to handle stressful events successfully and with minimum distress. At the conclusion of the therapy, patients should feel confident in their ability to anticipate negative feelings and how to treat them.
For those who don’t want to expose themselves to reminders of their traumas, there are interpersonal, supportive, and psychodynamic therapies that focus on the emotional and interpersonal aspects of PTSD.
This is another treatment option that can help control symptoms. Antidepressants such as SSRIs and SNRIs (selective serotonin re-uptake inhibitors and selective norepinephrine re-uptake inhibitors) are used to treat the core symptoms of PTSD, either alone or alongside psychotherapy. These antidepressants regulate the amount of serotonin or norepinephrine in the brain, helping with symptoms of depression and anxiety as well as sleep problems and concentration.
This type of therapy encourages PTSD patients to share their experiences and reactions in a comfortable environment with those who have experienced a similar situation. It helps build a sense of community and family therapy and is also useful as the PTSD symptoms of one person can affect the entire family. Support groups for family members are helpful as well.
Complementary & Alternative Therapy
These may include acupuncture, animal assisted therapy, virtual reality, and stellate ganglion block technique (anesthesia of nerves in the neck). Alternative therapy is increasingly being used, helps provide treatment outside of a mental health clinic, and requires less talking and disclosure than psychotherapy.
Written By Subhaga Laxman