Post-Traumatic Stress Disorder: Treatments
This article details post-traumatic stress disorder. It explains how it develops and what current treatments are available.
Post-traumatic stress disorder (PTSD) occurs in some people who’ve suffered very stressful or catastrophic events. Such events could be the death of a loved one in traumatic circumstances, serious injury, sexual violence, etc. The circumstances can be real or simply threatened.
With PTSD, the sufferer usually experiences intrusive thoughts. These might be recurrent and involuntary memories of the traumatic event itself. Furthermore, the sufferers have distressing dreams or nightmares and experience dissociative reactions, such as amnesia, regarding the event. They may also feel disproportionately uncomfortable when faced with something that reminds them of the trauma.
Indeed, it’s quite normal for a person to develop any of these symptoms if they’ve suffered a traumatic experience.
Additional symptoms of post-traumatic stress disorder
Patients with PTSD develop a marked avoidance of any stimuli that could be associated with the trauma. In fact, they’ll try to avoid, at any cost, remembering the event or telling anyone else about it. Furthermore, they won’t approach any people, places, or objects that might cause them to relive the event.
They suffer cognitive and mood disturbances, such as being unable to remember details of the event. Also, they believe negative things about themselves, others, or the world in general. In addition, they might feel detached and unable to experience any positive emotions. And it isn’t unusual for them to feel irritable, angry, ashamed, or intensely guilty. They also might suffer from hypervigilance, sleep problems, and find it difficult to concentrate.
The DSM-5 states that, for PTSD to be diagnosed, the patient must suffer these symptoms for more than one month. Otherwise, the symptoms might be indicating acute stress disorder (ASD) instead.
How does post-traumatic stress disorder develop?
Experiencing trauma isn’t simply a matter of being exposed to a tough situation and dealing with it. Trauma overwhelms your psychological resources. Your brain, soul, and whole being simply can’t process or assume intense and sudden pain. Thus, you develop PTSD, which acts as a mechanism to protect you against future threats.
Not everyone who suffers trauma will experience the symptoms of PTSD. However, the prevalence of PTSD can reach up to 58% in the at-risk population.
In the case of rape, prevalence is usually 50% or more, and even higher if the victim knows the aggressor. This is because, if the victim knows their attacker, they tend to experience more insecurity. Indeed, they feel that they aren’t safe with anyone anywhere.
How the victim felt during the trauma, allows us to predict, via conditioning, how their future problems might develop. That’s why recounting the event to a friend or therapist later acts as a conditioned stimulus. In other words, it becomes associated with the traumatic event itself, and once again causes the sufferer very unpleasant symptoms.
These patients re-experience symptoms in the form of flashbacks. Foa and Kozak speak of a network of fears after trauma. These fears become reactivated again and again in the face of multiple stimuli. Therefore, the victim develops avoidance strategies that are perpetuated by negative reinforcement processes. In other words, the victim feels great relief when they escape from something that reminds them of the trauma.
Effective treatments for post-traumatic stress disorder
The models used to describe the development of PTSD make it clear that patients experience momentary relief when they avoid talking about the trauma or don’t have any contact with any stimuli that remind them of the event. However, this relief is short-lived. This is because the patient hasn’t undergone any emotional reprocessing. And emotional reprocessing is essential if the patient is to recover from this disorder.
For this reason, exposure therapy is the treatment of choice. Furthermore, it’s the treatment supported by the most empirical evidence, according to the latest studies (Cahill, Rothbaum, Resick, and Folette, 2009). The kind of exposure therapy used in PTSD involves repeated and prolonged exposure to all aspects related to the trauma.
The methods used vary, according to the triggers that are being avoided. For example, a patient may be repeatedly exposed to the clothes they wore on the day of the event. They might look at them, touch them, and smell them, until their levels of activation decline.
This therapy is also carried out using the patient’s imagination. In this process, the patient deliberately evokes the painful memory by writing it down, talking about it, or listening to it on a recording. This type of exposure therapy has proven to be very effective, particularly in treating adult patients with simple trauma.
Cognitive therapy has also been proved useful in treating PTSD patients. Its goal is to modify, using tools like Socratic dialogue, irrational beliefs and the patient’s thoughts about the trauma. For example, they may feel that it’s their fault that they were raped.
Cognitive therapy addresses the meanings that the trauma and the consequences have for the patient. The patient’s concepts of safety and danger are also worked on. Furthermore, whether they have faith in life and other people. This is due to the fact that trauma tends to damage these concepts in patients.
In cognitive therapy, it’s normal to work with patients who feel shame and guilt. Indeed, these feelings are very common overall in the clinical population. These emotions obstruct the patient in overcoming their trauma. Furthermore, they tend to encourage the patient to keep the traumatic event at the forefront of their mind.
Cognitive processing theory: Resick and Schnicke
A type of cognitive therapy is achieving very good results. This is Resick and Schnicke’s cognitive processing theory. This therapy combines aspects of cognitive therapy with information processing theory. It focuses on redirecting the patient’s attention to the present, on their secondary emotions and distorted thoughts. It targets their secondary symptoms like health, guilt, or low quality of life.
This therapy challenges the meaning of trauma in the five particular areas that patients struggle with the most. These are security, confidence, power or control, self-esteem and intimacy, and their implications.
In this therapy, the patient writes a detailed statement about their experience and reads it out loud. They choose their level of exposure to the trauma. This is because it’s been proven that the level of exposure doesn’t significantly affect a patient’s improvement.
There are many other treatments used in PTSD that are also effective, but this article centers on those that are scientifically valid. One treatment that shouldn’t be left out is EMDR. Shapiro developed EMDR as a specific technique for dealing with trauma. Other treatments include dialectical behavior therapy and stress inoculation therapy. This therapy is considered to be more effective when patients are experiencing exceptionally high levels of anger.