11 Apr What is PTSD?
What is PTSD?
Post-Traumatic Stress Disorder (PTSD) is a trauma and stress-related disorder that can develop after exposure to an event or ordeal in which death, severe physical harm or violence has occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or unnatural disasters, accidents, or military combat. PTSD is frequently associated with depression, substance abuse, or anxiety disorders.
This debilitating stress disorder was known as “Shell Shock” before it was formerly identified as Post Traumatic Stress Disorder – PTSD. It was first contemplated a disorder when the Vietnam Veterans’ returned home from War. Sadly, it was considered to be a weakness in soldiers and carried great shame and humiliation. It soon became the foundation for diagnosis and the characteristic symptoms for an individual exposed to an extremely traumatic stressor.
The stressor usually involved being part of or witnessing an event of traumatic and horrific magnitude.
Many people with PTSD tend to re-experience aspects of the traumatic event especially when they are exposed to events or objects reminiscent of the trauma. Anniversaries of the event, similarities in person, place or circumstance can also trigger symptoms. People with PTSD also experience intrusive memories or flashbacks, emotional numbness, sleep disturbances, anxiety, intense guilt, sadness, irritability, or outbursts of anger, and dissociative experiences. Many people with PTSD may try to avoid situations that remind them of the ordeal.
A person with PTSD can experience:
• Nightmares of past traumatic events
• Flashbacks
• Triggers of physical and psychological stresses
• Avoidance of any reminders of similar stimuli
• Isolation from others
• Emotional numbness
• Outbursts of anger or irrational rage
• Problems with concentration and focus
• Paranoid thinking
Symptoms associated with reliving the traumatic event:
• Having bad dreams, or distressing memories of the event
• Behaving or feeling as if the event were actually happening all over again (known as flashbacks)
• Dissociative reactions or loss of awareness of present surroundings
• Having a lot of emotional feelings when reminded of the event
• Having a lot of physical sensations when reminded of the event (heart pounds or misses a beat, sweating, difficulty breathing, feeling faint, feeling a loss of control)
Symptoms related to avoidance of reminders of the traumatic event:
• Avoiding thoughts, conversations, or feelings about the event
• Avoiding people, activities, or places associated with the event
Symptoms related to negative changes in thought or mood:
• Having difficulty remembering an important part of the original trauma
• Feeling numb or detached from things
• Lack of interest in social activities
• Inability to experience positive moods
• Pessimism about the future
Arousal and reactivity symptoms:
• Sleeping Difficulties including trouble falling or staying asleep
• Irritability and outbursts of anger
• Difficulty concentrating
• Feeling easily startled
• Excess Awareness (hypervigilance)
The cause of PTSD is unknown, but psychological, genetic, physical, and social factors are involved. PTSD changes the body’s response to stress. It affects the stress hormones and chemicals that carry information between the nerves (neurotransmitters). Prior exposure to trauma in the past may increase the risk of PTSD due to re-experience of trauma. People who have suffered childhood abuse or other previous traumatic experiences are likely to develop the disorder, sometimes months or years after the trauma.
Temperamental variables such as externalizing behaviours or other anxiety issues may also increase risk. Other environmental risk factors include family dysfunction, childhood adversity, cultural variables, family history of psychiatric illness. The greater the magnitude of the trauma, the greater the risk for PTSD—witnessing atrocities, severe personal injury, perpetrating violence. Inappropriate coping mechanisms, lack of social support or family instability or financial instability may further worsen outcomes.
Other factors, called resilience factors, can help reduce the risk of the disorder. Some of these resilience factors are present before the trauma and others become important during and after a traumatic event. Resilience factors that may reduce the risk of PTSD include seeking out support from other people, such as mental health professionals, friends and family, finding a support group after a traumatic event, feeling good about one’s own actions in the face of danger, having a coping strategy, or a way of getting through the bad event and learning from it, and being able to act and respond effectively despite feeling fear.
PTSD is not just an issue among our soldiers and their families but is also an anxiety reaction to the trauma of any kind and can happen to anyone at any given time.
There is a one out of ten chance that you or someone you know will develop PTSD during your lifetime. It’s twice as likely if you have a significant traumatic experience and four times more likely if you are involved in some kind of disaster.
Over the past 40 years, Patients have been treated with medications (particularly antidepressants) and behavioural therapy, but these are often only partially effective and medications tend to create other problems. There is now scientific evidence that PTSD is a complex medical condition not just an emotional disorder. There are many kinds of PTSD and each case is unique. As a growing epidemic society cannot ignore the detriments of these traumatic disorders which spread into domestic violence, bullying, rapes and other forms of violence that many are innocently forced to endure.
Nightmares
Nightmares are lengthy, elaborate dreams with imagery that evokes fear, anxiety, or sadness. The dreamer may wake up to avoid the perceived danger. Nightmares can be remembered upon awakening and may lead to difficulties returning to sleep or even cause daytime distress. Isolated nightmares are normal, but when dreams that bring extreme terror or anxiety recur often they can become a debilitating sleep disorder.
Occurring during rapid eye movement (REM) sleep, a nightmare is a dream that results in feelings of extreme fear, horror, distress, or anxiety. This phenomenon tends to occur in the latter part of the night and often awakens the sleeper, who is likely to recall the content of the dream.
Most nightmares are a normal reaction to stress, and some clinicians believe they help people work through traumatic events. The frequent occurrence of nightmares, however, becomes a disorder when it impairs social, occupational, and other important areas of functioning.
Dreaming and REM Sleep
We typically spend more than two hours each night dreaming, yet scientists do not know much about how or why we dream. Dreams almost occur during the REM part of sleep. While most mammals and birds show signs of REM sleep, reptiles and other cold-blooded animals do not.
REM sleep begins with signals from the pons, an area at the base of the brain. These signals travel to a region called the thalamus, which relays them to the cerebral cortex—the outer layer of the brain responsible for learning, thinking, and organizing information. The pons sends signals that shut off neurons in the spinal cord, causing temporary paralysis of limb muscles. If something interferes with this paralysis, people will begin to physically act out their dreams—a rare, dangerous problem called REM sleep behaviour disorder. For example, a person dreaming about a cricket game may run into furniture or inadvertently strike a person sleeping nearby while trying to catch a ball in the dream.
REM sleep stimulates the brain regions used in learning, which may be important for normal brain development during infancy. This would explain why infants spend much more time in REM sleep than adults. Like deep sleep, REM sleep is associated with increased production of proteins. One study determined that REM sleep affects learning certain mental skills. People taught a skill and then deprived of non-REM sleep were able to recall, upon awakening, what they had learned, while people deprived of REM sleep were not.
Some scientists believe dreams are the cortex’s attempt to find meaning in the random signals received during REM sleep. In trying to organise and interpret these signals, the cortex creates a “story” out of fragmented brain activity.
Treatments
Treatment for PTSD typically begins with a detailed evaluation and development of a treatment plan that meets the unique needs of the survivor. The main treatments for people with PTSD are psychotherapy, medications, or both. Due to differences in experience and consequence of the trauma, treatment varies and is tailored to the symptoms and needs of the individual. Treatment by a mental health care provider who is experienced with PTSD allows for people to lead more balanced and functional lives. Some people with PTSD may need to try different treatments to see what works for their symptoms.
If someone with PTSD is going through an ongoing trauma, such as being in an abusive relationship, treatment may include helping find safety. PTSD-specific-treatment can begin only when the survivor is safely removed from the crisis situation. Individuals who experience other symptoms of a panic disorder, depression, substance abuse, and feeling suicidal may need treatment to focus on those issues as well.
Other strategies for treatment include:
• Educating trauma survivors and their families about risks related to PTSD, how PTSD affects survivors and their loved ones, and other problems commonly associated with PTSD symptoms. Understanding that PTSD is a medically recognized disorder is essential for effective treatment.
• Examining and resolving strong feelings such as shame, anger, or guilt, which are common among survivors of trauma.
• Teaching the survivor to cope with post-traumatic memories, reminders, reactions, and feelings without avoiding them or becoming overwhelmed or emotionally numb. Trauma memories usually do not go away entirely as a result of therapy, but new coping skills can make them more manageable.
Medications
Using medications co-jointly with therapy or prior to starting therapy may make it easier to use treatment effectively. If an antidepressant is prescribed, it may need to be taken for several days or weeks before noticing significant improvement. It is important to not get discouraged and prematurely stop taking medications before they’ve had a chance to work. It is important to work collaboratively with your doctor.
Sometimes people taking these medications have side effects. Medications affect everyone differently. Any side effects or unusual reactions should be reported to a doctor immediately.
Psychotherapy
Therapy is well-regarded in the treatment of PTSD. It involves talking with a mental health professional to work through the experience and its impact on the individual. Psychotherapy can occur one-on-one or in a group format. Therapy for PTSD usually lasts until the individual has learned to manage and cope with their experience and is able to be more functional.
Many types of psychotherapy can help people with PTSD. Some types target the symptoms of PTSD directly. Other therapies focus on social, family, or job-related problems. The doctor or therapist may combine different therapies depending on each person’s needs.
Cognitive behavioural therapy or CBT can be effective in treating PTSD.
• Cognitive restructuring: This therapy helps people make sense of their memories and experiences. Sometimes people remember the event differently than how it actually happened. They may feel guilt or shame about what is not their fault. The therapist helps people with PTSD look at what happened in a realistic way.
• Stress inoculation training: This therapy tries to reduce PTSD symptoms by teaching a person how to reduce anxiety when confronting anxiety-provoking situations. Like cognitive restructuring, this treatment helps people look at their experiences in a healthy way.
There are also other types of treatment that can help people with PTSD and a client may want to discuss with their therapist about therapy options and treatment focus that may include:
• Learning about trauma and its effects
• Using relaxation and anger management skills
• Improving sleep, diet, and exercise habits
• Identifying and dealing with guilt, shame, and other feelings about the event
• Focusing on our reactions to PTSD symptoms—for example, therapy helps people visit places and people that are reminders of the trauma
Brief psychodynamic psychotherapy focuses on the emotional conflicts caused by the traumatic event. This therapy helps a person understand how the past affects the way you feel now. Through the retelling of the traumatic event to a calm and empathic counsellor, the survivor achieves a greater sense of self-esteem, develops effective ways of thinking and coping, and more successfully deals with the intense emotions that emerge during therapy.
Family therapy is a type of counselling that involves your whole family, as PTSD can affect the entire family. The family can learn about PTSD and how it is treated. Each person can express their fears and concerns. It’s important to be honest about one’s feelings and to listen to others. One can talk about their PTSD symptoms and what triggers them. Discuss the important parts of one’s treatment and recovery. By doing this, the family will be better prepared to help. One can have individual therapy for their PTSD symptoms and family therapy to help manage their relationships.
Tips for a Good Night’s Sleep
Set a schedule.
Go to bed at a set time each night and get up at the same time each morning. Disrupting this schedule may lead to insomnia. Sleeping in on weekends makes it harder to wake up early on Monday morning as it resets your sleep cycles for a later awakening.
Exercise.
Aim to exercise 20 to 30 minutes a day. Daily exercise often helps people sleep, although a workout before bedtime may have an adverse effect. For maximum benefit, work out about five to six hours before going to bed.
Avoid caffeine, nicotine, and alcohol.
Avoid drinks that contain caffeine, a stimulant. Sources of caffeine include coffee, chocolate, diet drugs, soft drinks, non-herbal teas, and some pain relievers. Smokers tend to sleep very lightly and often wake up in the early morning due to nicotine withdrawal. Alcohol robs people of deep sleep and REM sleep, so drinkers also sleep only lightly.
Relax before bed.
A warm bath, reading, or another soothing routine can make it easier to fall asleep. You can train yourself to associate certain restful activities with sleep and make them part of your bedtime ritual.
Sleep until sunlight.
If possible, wake up with the sun, or use very bright lights in the morning. Sunlight helps the body’s internal clock reset itself daily. Sleep experts recommend exposure to an hour of morning sunlight for people having sleep issues.
Don’t lie in bed awake.
If you can’t fall asleep, don’t just lie in bed. Do something else, like reading or listening to music, until you feel tired. The anxiety of being unable to fall asleep can actually contribute to insomnia.
Control the room temperature.
Maintain a comfortable temperature in the bedroom. Extreme heat or cold may disrupt sleep or prevent you from falling asleep.
See a doctor if your sleeping problem continues.
If you have trouble falling asleep every night, or if you always feel tired the next day, then you may have a sleep disorder and should see a physician. Your primary care physician may be able to help you, or you can consult a sleep specialist at a major hospital near you. Most sleep disorders can be treated effectively.
Researchers now know that sleep is an active and dynamic state that strongly influences our waking hours. Innovative techniques, such as brain imaging, help researchers understand how different brain regions function during sleep and how activities and disorders affect sleep.
I believe PTSD needs a more holistic approach to human healing. The integration of the biology (healing the brain) psychology (redeveloping the emotional brain) and spirituality (redefining and redeveloping the individual’s core value system and having faith in life again.) The entire inner compass of an individual can be reset and re-calibrated so they can find their true North, their true self. Being able to create a sense of higher purpose, reconnect to a set of core values that create a personal connection.
To accept and receive love. To feel safe within the domain of reality. Being open to being part of something greater than oneself. To regain one’s Soul.
As an outside of the box thinker, I am always researching for new methods and innovative ways to deal with some of our challenging mental disorders. An impressive piece of work I came across a few years ago was a book by Dr Frank Lawlis “PTSD Breakthrough”. Dr Lawlis has created the RESET program a six-step healing process. It offers new hope for PTSD sufferers and their families with strategies that can be used at home where the real challenges occur and persist. There is a great deal of insight and strategies, and inspiration for anyone who is dealing with these horrific challenges. I strongly recommend this life changing and insightful read.
PTSD is not a weakness. Know that help is at hand. Have the courage to step up and ask for the help that can assist you to truly live your best life!
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