Psych 101: PTSD (part 2)

Treatment for posttraumatic stress disorder will vary depending on the severity of the symptoms, the treatment approach of the therapist, and, of course, the motivation of the client. Sometimes medication is necessary to control incapacitating depression (anti-depressants), anxiety (anti-anxiety medicine), or thought disturbances (anti-psychotics) like paranoia, or hallucinations (for example, hearing voices or seeing things). The use of medication can be temporary, but will offer some immediate relief from the symptoms, and help the client respond better to treatment.

I use a Cognitive - Behavioral approach. It addresses the thinking (cognitive) problems that support the illness, and teaches new behaviors to use in response to the situations which trigger the symptoms. It helps if the client is able to recall and discuss the traumatic event, in order to better understand and help change the irrational thinking patterns that have developed. For example, the sense of child-like vulnerability experienced when an adult with PTSD feels threatened by things said by an angry spouse. If that person can change their mindset to include the fact that they are now an adult capable of protecting themselves, then their response to the verbal "assault" will not be as dramatic. I often use relaxation breathing as an alternate behavioral response to practice in the presence of the "trigger." In the example above, relaxation can be used to facilitate a healthier response, instead of extreme anger and perhaps violence (to protect the vulnerable "inner child"). I focus a lot on what the client presents with respect to their perception of their experience. I try to understand their experience as much as possible the way that they do, in order to develop a treatment plan that is relevant to their needs. Some therapists make the mistake of imposing their views and values on the client and prematurely move them in a direction that the person may be unable or unwilling to go. For example, it may not be necessary to explore too deeply the original trauma, causing the client to "relive" the horror and pain they've suffered. In such cases I focus more on a behavioral approach.

The client suffering from PTSD must be highly motivated in order to do the work necessary to heal. It is helpful if they have a support system, which can include friends, family, their church. Not that these people need to know the details of the individual's situation, but they can provide encouragement, reassurance, or even distraction when needed. There is a range of stress reactions. There could be "milder" reactions that would not be considered PTSD (like the anxiety reaction some people have when going to a doctor's office), which may not relate to a trauma but to a negative past experience (or experiences). These can interfere with a person's life (for example avoiding doctor's visits) , but not incapacitate them. I use a similar approach to working with these clients.

If you suffer from PTSD, or have extreme stress reactions that interfere with your life (or if your child does), get help. You do not have to live with this forever.

Psych 101: PTSD

The DSM-IV-TR describes Posttraumatic Stress Disorder (PTSD) as the "the development of characteristic symptoms following ... direct personal experience of an event that involves actual or threatened death or serious injury; ... or witnessing an event that involves death, injury or threat of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate. The person's response to the event must involve intense fear, helplessness or horror." The "characteristic symptoms" are 1. a reliving of the event (called a flashback); 2. avoidance of things associated with the incident, and difficulty responding to such things when having to deal with them; and 3. increased sensitivity and emotional arousal when in the presence of such reminders. These "reminders" are considered triggers, ie. they trigger the PTSD reaction.

So, just to review. PTSD is a reaction to some really bad thing that has happened to a person (or someone close to that person) earlier in their life. The stress reaction usually occurs several months after the event, but could also happen several years later. The initial event could be remembered or not. Not remembering may be because it happened when the person was too young to remember (including prenatally, as when a pregnant woman has been abused and the unborn child is affected), or because amnesia (or blocking the memory) is a symptom of the stress reaction. PTSD can include severe mood swings; self-destructive and impulsive behavior; somatic complaints (eg. stomach or headaches), feelings of helplessness, shame, guilt and hopelessness; hostility; isolation; paranoia; damaged relationships with others; personality changes. People with PTSD often suffer from depression, substance abuse, panic, agoraphobia (fear of public places) and other phobias, OCD and other anxiety disorders, and bipolar disorder. PTSD significantly interferes with the person's functioning in various areas of their life, including relationships, career, and general social functioning.

PTSD came to more popular awareness during the Vietnam War, when soldiers were coming home after experiencing the trauma of war. This is happening today as soldiers return from the war in Iraq. This illness also affects people who have suffered violent personal attack (including child abuse), torture, natural or man made disasters, automobile accidents, or have been diagnosed with a life-threatening illness.

I have found that many people are affected by significant events in their lives, that effect them with a stress reaction later, but not to the degree of someone with PTSD. People who have learned to function fairly well in spite of earlier bad experiences, but still have anxiety, or depression triggered by a current event or situation (likely in which they feel threatened). I'll talk more about that later, as well as discussing my approach to treating someone with PTSD.

TO BE CONTINUED...