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Post Traumatic Stress Disorder (PTSD) - A Guide

Post Traumatic Stress Disorder can cause serious psychological and physical symptoms
caused by the stress of involvment in or witnessing a traumatic incident

What is Post Traumatic Stress Disorder

Someone is said to be suffering from PTSD if they develop:-
Characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity;
or witnessing an event that involves death, injury, or threat to the physical integrity of another person;
or learned about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate.

Recent studies have estimated the prevalence of Post Traumatic Stress disorder (PTSD) as approximately 5 - 10% of the general population. Incidence then varies following exposure to specific traumatic incidents, e.g. 11% of road traffic accident survivors; 33 -50% of rape victims, 22 - 40% in combat veterans; 50% in bomb survivors. Studies have also indicated that approximately 20 - 40% of individuals exposed to traumatic events experience problems lasting for more than one year, and 15 -20% for more than two years. Approximately half go on to develop a chronic form of the disorder.



Symptoms

There are three main groups of symptoms:

1. Re-experiencing the event in some way e.g. frequent intrusive thoughts, nightmares and flashbacks.

2. Persistently avoiding situations associated with the trauma, or experiencing a numbing of their emotions e.g. avoidance of people or places that serve as reminders of the event.

3. Persistent symptoms of increased arousal, e.g. sleeplessness, irritability and impaired concentration.

The symptoms described above must persist for at least a month following the incident and cause significant impairment to social and occupational functioning.

The causes of PTSD

It can be caused by exposure to traumatic events as outlined above. These will be as diverse as the following: serious assault, road traffic accidents or accidental injury, fires,bomb explosions and natural disasters such as earthquakes. A variety of factors contribute to why one individual develops the disorder, while another does not.

Mood

Changes in mood are common in PTSD, ranging from anger, shame, guilt, feeling isolated and alone, to a sense that life is pointless, with a diminished interest in the future. Anxiety symptoms, including feeling tense and on edge are often present, as is irritability. The individual may also experience difficulty expressing emotions. Moderate to severe depression is not uncommon.

Cognitions

Pre-occupation with the traumatic event may be seen or a strong urge to avoid thinking about the event. Intrusive thoughts and images may also occur and cause the person to feel as if they were living the event. reminders of the event may trigger these symptoms. In addition there may be difficulty remembering certain parts of the event.

Biological Symptoms

Anxiety symptoms may occur such as sweating and palpitations. Biological features of depression such as sleep and appetite disturbance may also occur.

Behaviour and Motivation

A person may avoid situations, places and activities associated with the trauma. They may cease previously enjoyed activities. In addition, there may also be an adverse effect on family relationships and occupational functioning. Drug and alcohol abuse is not uncommon as a way of trying to forget.



Treatment

Almost all treatment for PTSD is psychologically orientated and is aimed at dealing with the range of emotional and behavioural problems outlined above. Medication is occasionally used as an adjunct ( see below). there is evidence that supportive counselling is only of general, not specific use, in PTSD sufferers and that many PTSD problems require specialised treatment

Specific cognitive behavioural interventions include:

1. Exposure in real life - this involves the individual gradually confronting previously avoided anxiety provoking situations until their anxiety subsides.

2. Imaginal exposure - this is a technique that involves direct exposure to memories of the trauma and can involve the use of audio taped material. As with real life exposure, this can also be graded and with the repeated practice will eventually result in a reduction in anxiety and other related symptoms.

3. Cognitive therapy - many individuals find that their beliefs and assumptions about themselves, others and their world have been "shattered" as a result of their trauma. They may also experience feelings of guilt or anger. Cognitive restructuring aims to address this and help them come to terms with their experience.

4. Eye Movement Desensitisation and Reprocessing (EMDR) - is a relatively new technique, which has been shown to be effective in the treatment of PTSD. In essence, the technique involves pairing memories/disturbing thoughts and the resultant emotions with the repeated rapid and rhythmic eye movements, resulting in the desensitisation of the memories. A similar pairing of memory and a chosen positive cognition, with further eye movements, constitutes the reprocessing component.
Treatment is individually tailored after thorough assessment and only with the co-operation of the survivor. An average treatment program may take place over ten to twelve sessions, but this will vary in individual cases.

Debriefing

Psychological debriefing is primarily a preventive measure and is not intended to be "therapy". the aim of debriefing, is to reduce the likelihood of the development of PTSD, by providing an opportunity for the expression of feelings and a framework for individuals to make sense of the traumatic experience.

Medication

Anti-depressants can be very effective as an adjunct to psychological treatment, as many PTSD sufferers also have symptoms of clinical depression. Anti-depressants can also facilitate participation in therapy and thereby optimise the outcome of treatment. Medication alone may only achieve short-term improvement



Resources

The British Association of Behavioural and Cognitive Psychotherapies (BABCP) is a multidisciplinary interest group for people involved in the practice and theory of these therapies.

Contact BABCP
Website - http://www.babcp.com/
BABCP
Imperial House, Hornby Street, BURY, BL9 5BN
Telephone: 0161 705 4304
Fax: 0161 705 4306

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