Post Traumatic Stress Disorder (PTSD)
Lewis Psychology Services For Post Tramatic Stress Disorder (PTSD)
What is PTSD?
Post traumatic stress disorder (PTSD) is a collection of reactions - feelings, thoughts, behaviour that are experienced following a sudden distressing event which is outside the range of normal everyday human experience. It is the unexpectedness of the incident that seems to evoke the stress because it undermines one's trust in normalcy and our sense that life is fair, reasonably safe, and that we are secure. A traumatic experience makes it very clear that we can die at any time. The symptoms of PTSD are part of a normal reaction to narrowly avoided death.
How Does PTSD Start?
PTSD can start after any traumatic event. A traumatic event is one where we can see that we are in danger, our life is threatened, or where we see other people dying or being injured. Some typical traumatic events would be:
- Serious road accidents
- Violent personal assault (sexual assault, rape, physical attack, abuse, robbery, mugging)
- Being taken hostage
- Terrorist attack
- Natural or man-made disasters
- Being diagnosed with a life-threatening illness
- Serious physical injury
- Sexual attack
Even hearing about an unexpected injury or violent death of a family member or close friend can start PTSD.
When Does PTSD Start?
The symptoms of PTSD can start after a delay of weeks, or even months. They usually appear within six months of a traumatic event.
Why Does it Occur?
It is the way by which our mind and body 'processes' the event, to try to make sense of it, so that we can eventually react to it in a less distressing way. The processing is often made apparent through physical, emotional and psychological signs.
Many people feel grief-stricken, depressed, anxious, guilty and angry after a traumatic experience. As well as these understandable emotional reactions, there are three main types of symptoms produced by such an experience:
1. Flashbacks & Nightmares: You find yourself re-living the event, again and again. This can happen both as a "flashback" in the day, and as nightmares when you are asleep. These can be so realistic that it feels as though you are living through the experience all over again. You see it in your mind, but may also feel the emotions and physical sensations of what happened - fear, sweating, smells, sounds, pain. Ordinary things can trigger off flashbacks. For instance, if you had a car crash in the rain, a rainy day might start a flashback.
2. Avoidance & Numbing: It can be just too upsetting to re-live your experience over and over again. So you distract yourself. You keep your mind busy by losing yourself in a hobby, working very hard, or spending your time absorbed in crossword or jigsaw puzzles. You avoid places and people that remind you of the trauma, and try not to talk about it. You may deal with the pain of your feelings by trying to feel nothing at all - by becoming emotionally numb. You communicate less with other people, who then find it hard to live or work with you.
3. Being "On Guard": You find that you stay alert all the time, as if you are looking out for danger. You can't relax. This is called "hyper vigilance". You feel anxious and find it hard to sleep. Other people will notice that you are jumpy and irritable.
Emotional reactions to stress are often accompanied by:
- muscle aches and pains
- irregular heartbeats
- feelings of panic and fear
- drinking too much alcohol
- using drugs (including painkillers)
- changes in sleep (e.g. not being able to sleep, or wanting to sleep all the time)
- changes in behaviour (e.g. short temper)
- changes in feelings about yourself (e.g. feeling useless)
- numbed responses
- changes in work effectiveness (e.g. poor concentration)
- reduced interest in the external world (e.g. feelings of detachment and estrangement)
- a sense of always needing to be ultra-alert
- a sense of being vulnerable, leading to a fear of losing control
- avoidance of activities and / or places which arouse recollections of the event
- forgetting an important aspect of the event
- guilt at surviving, or for things not done
Why Does PTSD Happen?
We don't know for certain. There are a several possible explanations for why PTSD occurs.
When we are frightened, we remember things very clearly. Although it can be distressing to remember these things, it can help us to understand what happened and, in the long run, help us to survive.
- The flashbacks, or replays, force us to think about what has happened. We can decide what to do if it happens again. After a while, we learn to think about it without becoming upset.
- It is tiring and distressing to remember a trauma. Avoidance and numbing keep the number of replays down to a manageable level.
- Being "on guard" means that we can react quickly if another crisis happens. We sometimes see this happening with survivors of an earthquake, when there may be second or third shocks. It can also give us the energy for the work that's needed after an accident or crisis.
But we don't want to spend the rest of our life going over it. We only want to think about it when we have to - if we find ourselves in a similar situation.
- Adrenaline is a hormone our bodies produce when we are under stress. It "pumps up" the body to prepare it for action. When the stress disappears, the level of adrenaline should go back to normal. In PTSD, it may be that the vivid memories of the trauma keep the levels of adrenaline high. This will make a person tense, irritable, and unable to relax or sleep well.
- The hippocampus is a part of the brain that processes memories. High levels of stress hormones, like adrenaline, can stop it from working properly - like "blowing a fuse". This means that flashbacks and nightmares continue because the memories of the trauma can't be processed. If the stress goes away and the adrenaline levels get back to normal, the brain is able to repair the damage itself, like other natural healing processes in the body. The disturbing memories can then be processed and the flashbacks and nightmares will slowly disappear.
How Do I Know When I've Got Over A Traumatic Experience?
When you can:
- think about it without becoming distressed
- not feel constantly under threat
- not think about it at inappropriate times.
How Can You Help Yourself?
- Keep in touch with information about the event and any developments. This keeps the trauma 'real' and helps you come to terms with what has happened and how it has affected you.
- It can be a relief to receive other people's physical and emotional support, even though part of you might want to reject it as part of wanting to deny what has happened. Sharing with others who have had similar experiences can feel good, barriers can break down and close relationships develop.
- As well as being with other people, you will sometimes want to be alone in order to deal with your feelings: privacy (as opposed to isolation) is important.
Some 'Does' and 'Do Nots'
- Do keep life as normal as possible
- Do get back to your usual routine
- Do talk about what happened to someone you trust
- Do try relaxation exercises
- Do go back to work
- Do eat and exercise regularly
- Do go back to where the traumatic event happened
- Do take time to be with family and friends
- Do drive with care - your concentration may be poor
- Do be more careful generally - accidents are more likely at this time
- Do speak to a doctor
- Do expect to get better.
- Do not beat yourself up about it - PTSD symptoms are not a sign of weakness. They are a normal reaction, of normal people, to terrifying experiences
- Do not bottle up your feelings. If you have developed PTSD symptoms, don't keep it to yourself because treatment is usually very successful.
- Do not avoid talking about it.
- Do not expect the memories to go away immediately; they may be with you for quite some time.
- Do not expect too much of yourself. Cut yourself a bit of slack while you adjust to what has happened.
- Do not stay away from other people.
- Do not drink lots of alcohol or coffee or smoke more.
- Do not get overtired.
Counselling and Cognitive Behavioural Therapy (CBT) For PTSD
Counselling can help you to feel safe again and in control of your feelings so that you won't need to avoid the memories as much. You can gain more control over your memories so that you only think about them when you want to.
Cognitive behavioural therapy (CBT) is a school of counselling that helps you to think differently about your memories, so that they become less distressing and more manageable. It will usually also involve some relaxation work to help you tolerate the discomfort of thinking about the traumatic events.
EMDR for PTSD
Eye Movement Desensitization and Reprocessing (EMDR) is an approach to therapy that is particularly effective for PTSD. That can be something we would normally think of as traumatizing (a sexual assault, an earthquake, a bank robbery) or an experience that was disturbing and personally traumatizing (an incident of bullying, humiliation, betrayal, complicated bereavement).
If you are involved in a distressing event that leads to PTSD, you may feel overwhelmed and your brain may be unable to process what has happened. The distressing memory seems to become frozen on a neurological level. When you recall that memory, you can re-experience what you saw, heard, smelt, tasted or felt, and this can be quite intense. Sometimes the memories are so distressing, that the person affected tries to avoid thinking about the event to avoid experiencing the disturbing feelings.
The alternating left-right stimulation of the brain with eye movements, sounds or taps during EMDR, seems to stimulate the brain's frozen or blocked information processing system. This may be by helping to connect the cognitive/thinking areas of the brain with the more primitive emotional/feeling areas. As this processing takes place, the distressing memories of being bullied seem to lose their intensity, so that they are less disturbing and seem more like 'ordinary' memories. The effect is believed to be similar to that which occurs naturally during REM sleep (Rapid Eye Movement) when your eyes rapidly move from side to side. EMDR helps reduce the distress of all the different kinds of memories, whether it was what you saw, heard, smelt, tasted, felt or thought.
EMDR:The Treatment Of Choice For PTSD
The evidence base for the effectiveness and efficiency of EMDR, in particular for treating Post Traumatic Stress Disorder and trauma related problems, is extremely strong. As such EMDR is acknowledged as effective in the treatment of PTSD by The UK DOH National Institute of Clinical Excellence (NICE) March 2005 in the Guidelines for the Management of PTSD. Also, independent reviewers for the American Psychological Association (APA), who placed EMDR on a list of "Empirically Validated Treatments" for civilian PTSD (Chambless et al 1998).
It has been designated an effective psychotherapy for PTSD in the practice guidelines of the International Society for Traumatic Stress Studies (Chemtob et al 2000, Shalev et al 2000).
In research terms, the most powerful method of ascertaining the effectiveness of procedures is through what are called "Randomised Controlled Trials" (RCTs). Currently there are over 20 RCTs on EMDR and PTSD, which is a considerable outcome research base in a relatively short period of years since the seminal papers on EMDR in 1989, and represents a considerably greater research interest in this area than in any other single approach whether psychological or pharmacological to PTSD. Overwhelmingly, these RCTs demonstrate superiority for EMDR against its comparisons.
Given its wide application and evidence base, EMDR is rapidly becoming the psychotherapy treatment of choice.
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Medical disclaimer: The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice by a qualified doctor.