Post Traumatic Stress Disorder

Post Traumatic Stress Disorder

Treating Post Traumatic Stress Disorder

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treating post traumatic stress disorder

Post Traumatic Stress Disorder: A Framework For Understanding

The experience of being devastated by a Traumatic event or events – such as combat, rape, a life-threatening illness or accident, or prolonged abuse by a parent or spouse – can leave one overwhelmed and worried that life will never go back to normal.  If one develops Post Traumatic Stress Disorder, symptoms can seem to inundate life, night and day.  This article places those symptoms into a context, a framework for understanding them.

Post Traumatic Stress Disorder involves a variety of symptoms that can be grouped into three areas:  symptoms of avoidance, symptoms of re-experiencing, And Symptoms of (central nervous system) hyperarousal.   This isn’t as technical as it sounds!  All of the familiar post-Traumatic Symptoms can be organized in this arrangement.

Symptoms of Avoidance

These symptoms are like those in any Anxiety disorder:  we seek to avoid things that scare us, or in Ptsd, things that remind us of the traumatic event.

Many times, people avoid places.  A man who was in a car accident feels unable to drive farther than a short distance from home.  A woman who was in a car accident is able to drive, but not down the street where the accident occurred.  Someone who was abused by clergy won’t go near a church.  A man who was sexually assaulted in a dark alley is afraid to shower in the locker room at the gym.

Trauma survivors might also avoid certain people.  A woman who was gang-raped avoids crowds.  A woman who was abused as a child avoids middle-aged white men.  A man who had long, painful hospitalizations as a child avoids doctors.

Still others avoid situations that remind them of the traumatic event.  A crowded elevator, a store where the salespeople are pushy, conflicts or confrontations with colleagues or family members, contact sports, dating – the list is very long.

Symptoms of Re-Experiencing

Re-experiencing symptoms include some of those that we think of as the hallmarks of Ptsd, such as nightmares and flashbacks.  The emotions were completely overrun during the traumatic event or events, and (by some theories) the mind keeps trying to make sense of it by re-experiencing.  

During a life-threatening or horrific event, the brain functions differently than at other times.  The part of the brain that remembers what groceries to buy, drives the car, and reads the newspaper receives less blood and is operating at a reduced level.  The “old brain,” which controls breathing, heart rate, and other survival requirements, is activated, and the “fight or flight” mechanism takes over.  Just as other animals do when faced with a threat, our bodies prepare to take on the threat or to run.  So the eyes are dilated, breathing and heartbeat rapid, and muscles are poised to react.

After the event is over, the memory of it is often unclear or just unfinished in the cerebral cortex, the part of the brain that reads the paper and remembers events in a narrative fashion, in stories.  The old brain remembers the sensations, the emotions continue to be overwhelming, and the cerebral cortex just tries to make sense of it.

Re-experiencing symptoms include nightmares that are related to the trauma.  Also included are intrusive thoughts, which are thoughts about the traumatic events that occur unbidden, when the individual is thinking (or would like to be thinking) of something else.  Flashbacks are episodes where the traumatic event is relived.  Sometimes these are so serious that the individual believes that the event is happening over again.  Sometimes  a partial flashback is experienced, such as seeing or hearing the event again, or feeling the same sensations in the body.

Symptoms of Hyperarousal

When emotions run high, the central nervous system rises to a high level of arousal.  In PTSD, arousal levels remain high and interfere with one’s day to day functioning.  Symptoms of hyperarousal include difficulty falling asleep, irritability, hypervigilance, an exaggerated startle response (feeling “jumpy” or jittery), and trouble concentrating.

With prolonged or repeated trauma, there is some thought that the body’s ability to regulate arousal may become permanently impaired, and the individual may not be able to sleep, for example, without medication.  Others have had success with training in relaxation using meditation, mindfulness, or other Relaxation Techniques.

Treatment for Post Traumatic Stress Disorder

There are a variety of treatment approaches used With Ptsd today.  These include behavioral approaches (exposure techniques, cognitive-behavioral therapy), trauma-informed relational techniques, and body-focused techniques (Somatic Experiencing, Sensorimotor therapy, craniosacral therapy, Eye Movement Desensitization and Reprocessing).  Exposure treatments and Cognitive Behavioral Therapy have received very strong research support, mostly addressing the needs of individuals who have experienced a single traumatic event and do not have other Mental Health Problems that complicate treatment.  

People who have undergone prolonged, repeated, sometimes sadistic traumatic events, such as children who are physically and sexually abused for years by a parent, may likely require treatment that addresses more than exposure therapy targeted at a single traumatic memory.  This kind of trauma history is the precursor of what is called “Complex Ptsd” (Herman, 1992).  Trauma-informed relational therapy focuses on supporting individuals in helping reduce their symptoms, creating safety in their lives today, and finding a way to make meaning of their experiences (Allen, 2005; Courtois & Ford, 2009; Pearlman & Saakvitne, 1995; Saakvitne, Gamble, Pearlman, & Lev, 2000.  Body-focused techniques can be an important adjunct to relational therapy.

Experimental Treatments

Because of the enormous suffering and awakening public awareness of the prevalence of abuse and trauma, a number of new treatments have recently been invented.  I recommend asking carefully about the qualifications of the treatment provider, and research into the efficacy of the approach, before trying any experimental treatments.  Beware of anecdotes masquerading as research!  Research means articles published in peer-reviewed professional journals, not glowing testimonials, no matter how persuasive they seem.  

Summary

In summary, Post Traumatic Stress Disorder has symptoms that can feel harrowing.  These symptoms result from the physiological changes that happen to someone while they undergo a life-threatening or horrific experience.  There are many excellent treatments available, but also some unproven, experimental techniques.

References

Allen, J. (2005). Coping with Trauma: Hope Through Understanding, 2nd ed. Washington, DC: American Psychiatric Press.

Courtois, C. A., & Ford, J. D., (eds.) (2009).  Treating Complex Traumatic Stress Disorders:  An Evidence-Based Manual.  New York:  Guilford Press.

Herman, J.L. (1992). Complex Ptsd: A syndrome in survivors of prolonged and repeated trauma.  Journal of Traumatic Stress, 5 (3).

Pearlman, L.A., and Saakvitne, K.W. (1995). Trauma and the Therapist: Countertransference and Vicarious Traumatization in Psychotherapy with Incest Survivors. New York: W.W. Norton.

Saakvitne, K., Gamble, S., Pearlman, L., & Lev, B. (2000). Risking Connection®: A Training Curriculum for Working with Survivors of Child Abuse, Baltimore, MD: Sidran Institute Press.  

Copyright Anne Pratt 2010

About the Author

Dr. Anne Pratt is a clinical Psychologist who has specialized in treatment of trauma since 1992, and has worked with countless survivors of trauma.  She practices at the Family Care Medical Center, 1515 Allen Street, Springfield, Massachusetts.  The phone number is 413-783-9114.  Read more about Dr. Pratt at http://www.drannepratt.com

PTSD II: Researching and treating post-Traumatic Stress Disorder

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