Post-traumatic stress disorder

Gale Encyclopedia of Mental Disorders, (2003) by Rebecca J. Frey

witnessing someone being badly hurt or killed involvement in a fire, flood, earthquake, severe hurricane, or other natural disaster involvement in a life-threatening accident (workplace explosion or transportation accident) military combat Traumatic stressor: The patient has been exposed to a catastrophic event involving actual or threatened death or injury, or a threat to the physical integrity of the self or others. During exposure to the trauma, the person's emotional response was marked by intense fear, feelings of helplessness, or horror. In general, stressors caused intentionally by human beings (genocide, rape, torture, abuse, etc.) are experienced as more traumatic than accidents, natural disasters, or "acts of God." Intrusive symptoms: The patient experiences flashbacks, traumatic daydreams, or nightmares, in which he or she relives the trauma as if it were recurring in the present. Intrusive symptoms result from an abnormal process of memory formation. Traumatic memories have two distinctive characteristics: 1) they can be triggered by stimuli that remind the patient of the traumatic event; 2) they have a "frozen" or wordless quality, consisting of images and sensations rather than verbal descriptions. Avoidant symptoms: The patient attempts to reduce the possibility of exposure to anything that might trigger memories of the trauma, and to minimize his or her reactions to such memories. This cluster of symptoms includes feeling disconnected from other people, psychic numbing, and avoidance of places, persons, or things associated with the trauma. Patients with PTSD are at increased risk of substance abuse as a form of self-medication to numb painful memories. Hyperarousal: Hyperarousal is a condition in which the patient's nervous system is always on "red alert" for the return of danger. This symptom cluster includes hypervigilance, insomnia, difficulty concentrating, general irritability, and an extreme startle response. Some clinicians think that this abnormally intense startle response may be the most characteristic symptom of PTSD. Duration of symptoms: The symptoms must persist for at least one month. Significance: The patient suffers from significant social, interpersonal, or work-related problems as a result of the PTSD symptoms. A common social symptom of PTSD is a feeling of disconnection from other people (including loved ones), from the larger society, and from spiritual or other significant sources of meaning. description of the traumatic event sharing of survivors' emotional reactions to the event open discussion of symptoms caused by the event reassurance that the symptoms are normal responses to trauma, followed by discussion of coping strategies

Critical incident stress management is a system of interventions designed to help emergency/disaster response workers, public safety personnel, and therapists deal with stress reactions before they develop secondary PTSD.

Other mainstream treatment methods used with patients who have already developed PTSD include:

Cognitive-behavioral therapy . There are two treatment approaches to PTSD included under this heading: exposure therapy, which seeks to desensitize the patient to reminders of the trauma; and anxiety management training, which teaches the patient strategies for reducing anxiety. These strategies may include relaxation training, biofeedback , social skills training , distraction techniques, or cognitive restructuring. Psychodynamic psychotherapy . This method helps the patient recover a sense of self and learn new coping strategies and ways to deal with intense emotions related to the trauma. Typically, it consists of three phases:1) establishing a sense of safety for the patient; 2) exploring the trauma itself in depth; 3) helping the patient re-establish connections with family, friends, the wider society, and other sources of meaning. Discussion groups or peer-counseling groups. These groups are usually formed for survivors of specific traumas, such as combat, rape/incest, and natural disasters. They help patients to recognize that other survivors of the shared experience have had the same emotions and reacted to the trauma in similar ways. They appear to be especially beneficial for patients with guilt issues about their behavior during the trauma (such as submitting to rape to save one's life, or surviving the event when others did not). Family therapy . This form of treatment is recommended for PTSD patients whose family life has been affected by the PTSD symptoms. Spiritual/religious counseling. Because traumatic experiences often affect patients' spiritual views and beliefs, counseling with a trusted religious or spiritual advisor may be part of a treatment plan. A growing number of pastoral counselors in the major Christian and Jewish bodies have advanced credentials in trauma therapy. Yoga and various forms of bodywork are often recommended as ways of releasing physical tension or muscle soreness caused by anxiety or hypervigilance. Martial arts training can be helpful in restoring the patient's sense of personal effectiveness and safety. Some martial arts programs, such as Model Mugging, are designed especially for survivors of rape and other violent crimes. Art therapy, journaling, dance therapy, and creative writing groups offer safe outlets for the strong emotions that follow traumatic experiences. Eye Movement Desensitization and Reprocessing. This is a technique in which the patient reimagines the trauma while focusing visually on movements of the therapist's finger. It is claimed that the movements of the patient's eyes reprogram the brain and allow emotional healing. Tapas Acupressure Technique (TAT). TAT was derived from traditional Chinese medicine (TCM), and its practitioners maintain that a large number of acupuncture meridians enter the brain at certain points on the face, especially around the eyes. Pressure on these points is thought to release traumatic stress. Thought Field Therapy. This therapy combines the acupuncture meridians of TCM with analysis of the patient's voice over the telephone. The therapist then provides an individualized treatment for the patient. Traumatic Incident Reduction. This is a technique in which the patient treats the trauma like a videotape and "runs through" it repeatedly with the therapist until all negative emotions have been discharged. Emotional Freedom Techniques (EFT). EFT is similar to TAT in that it uses the body's acupuncture meridians, but it emphasizes the body's entire "energy field" rather than just the face. Counting Technique. Developed by a physician, this treatment consists of a preparation phase, a counting phase in which the therapist counts from 1 to 100 while the patient reimagines the trauma, and a review phase. Like Traumatic Incident Reduction, it is intended to reduce the patient's hyperarousal.