Problems that Usually Need Psychotherapy or Psychiatry Treatment

Post-Traumatic Stress Disorder or PTSD

Post-traumatic stress disorder or PTSD occurs when someone has experienced a trauma and thoughts and feelings produced by the trauma disrupt their life afterwards. The PTSD sufferer will often re-experience the trauma involuntarily, while awake or asleep, through flashbacks, nightmares, and intrusive thoughts and images. Re-experiencing the trauma is itself terrifying, and knowing that this could happen at any time causes constant anxiety. Sometimes sufferers develop insomnia because the nightmares make them afraid to go to sleep. Sufferers also usually develop intense fears of things associated with the trauma, such as fear of driving after a car accident or anxiety about sex after a sexual assault. These effects can persist for years if untreated (although this is not always the case), and can constrict and damage the lives people lead in many ways.

Many people forego treatment for PTSD because they feel that their reactions are inevitable responses to an experience that can never be erased. Many others stay away from treatment because of feelings of shame and weakness, especially following physical and sexual assaults. While it will always be true that the trauma has happened, the symptoms of PTSD (including shame) are not inevitable and can be treated successfully.

One way of conceptualizing PTSD is that it is a phobia of something inside oneself, namely recollections and memories of a negative life event or adverse experience. An individual may have more than one trauma. These may range from childhood humiliations, failures, rejections, arguments to major events suc as accidents, physical, sexual or emotional abuse, combat, attacks or natural disasters. The sufferer fears the memories and tries to shut them out by avoiding anything that might trigger the memories, and often by trying to distract oneself with constant activity. Yet these memories intrude, and when they do the person feels not only the terror of the trauma, but also helplessness at not being able to control what he or she is thinking and feeling. This may lead to more fear and phobic avoidance of the memories and people, places or things that trigger them and might include intrusive thoughts, sleep disturbances, hyperarousal or numbing. In addition, an individual’s quality of life may be negatively impacted - overall health, shorter life expectancy, increased risk of developing an addiction and/or reckless behaviors.

If you have already read the sections on phobias and OCD, you should be able to understand the treatment for PTSD. There are several ways an individual may be treated for PTSD, including graduated Exposure Therapy to the traumatic memories. Typically the patient will be taught relaxation exercises at first, and after these are mastered then controlled activation of the memories can begin in therapy. The therapist and patient create a hierarchy of anxiety-producing thoughts related to the trauma, from thoughts of similar but non-traumatic events, up through events just before and after the trauma, up to direct recollection of the actual trauma and what it felt like.

After the hierarchy is constructed the patient will do the relaxation exercises and then recollect the lowest item on the hierarchy. This will cause some anxiety, and then the patient will do the relaxation exercises and the therapist will talk the patient through the experience. When the patient has mastered this and can talk about it and remember it comfortably, then the same is done with the next item on the hierarchy. Each item is gradually mastered, and eventually the patient can recall the traumatic event voluntarily without undue anxiety. At this point, since the patient now has voluntary control over the memories, the flashbacks and nightmares generally subside.

Another treatment for PTSD that has recently become prominent is EMDR Therapy which stands for Eye Movement Desensitization and Reprocessing. This treatment is actually a blend of psychotherapy and neuroscience, and combines psychotherapeutic conversation with structured tactile or touch, sound, or eye movements known as Bilateral Stimulation. Many practitioners and child, adolescent and adult clients have reported great success positive therapeutic outcomes with EMDR all over the world. EMDR is recognized by a range of organizations worldwide as an effective treatment for PTSD including the US Department of Defense and the American Psychiatric Association.

A few things should be mentioned here. Patients who have PTSD resulting from repeated childhood trauma will probably experience heightened anxiety during the early stages of treatment. Generally, the more severe and deeply ingrained the fear, the greater the anxiety when the memories are triggered. This can be uncomfortable for a while. However, a general rule with anxiety is that tolerating it will diminish it, as long as the level of anxiety is not too high. Part of the job of the therapist is to know how much is too much, and to protect the patient from it. Many people also have a lot of negative feelings about themselves and the circumstances that led to the PTSD, and therapy can help clients feel better about themselves and their experiences.

Thomas B. Hollenbach, Ph.D.

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