Post traumatic stress disorder
What is Post Traumatic Stress Disorder?
According to the Department of Veteran Affairs
PTSD is a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a natural disaster, a car accident, or sexual assault. It's normal to have upsetting memories, feel on edge, or have trouble sleeping after this type of event. If symptoms last more than a few months, it may be PTSD.
About 7 or 8 out of every 100 people (or 7-8% of the population) will have PTSD at some point in their lives.
About 8 million adults have PTSD during a given year. This is only a small portion of those who have gone through a trauma.
About 10 of every 100 women (or 10%) develop PTSD sometime in their lives compared with about 4 of every 100 men (or 4%). Learn more about women, trauma and PTSD.
What is PTSD? (Whiteboard Video)
Whiteboard video covering PTSD basics, such as types of trauma and symptoms.
ARTICLES ABOUT PTSD
Experiencing a traumatic event can cause life-long anxiety problems, called posttraumatic stress disorder. Researchers from Uppsala University and the medical university Karolinska Institutet in Stockholm now show that people with posttraumatic stress disorder have an imbalance between two neurochemical systems in the brain, serotonin and substance P. The greater the imbalance, the more serious the symptoms patients have.
Many people experience traumatic events in life, e.g. robbery, warfare, a serious accident or sexual assault. Approximately 10 percent of people subjected to trauma suffer long-lasting symptoms in the form of disturbing flashbacks, insomnia, hyperarousal and anxiety. If these problems lead to impairment, the person is said to suffer from posttraumatic stress disorder, PTSD.
It has previously been shown that people with PTSD have altered brain anatomy and function. A new study by researchers from the Department of Psychology at Uppsala University and Clinical Neuroscience at Karolinska Institutet shows that people with PTSD have an imbalance between two neurochemical signalling systems of the brain, serotonin and substance P. Professors Mats Fredrikson and Tomas Furmark led the study using a so-called PET scanner to measure the relationship between these systems.
The study, which has been published in the scientific journal Molecular Psychiatry, shows that it is the imbalance between the two signalling systems which determines the severity of the symptoms suffered by the individual rather than the degree of change in a single system. Others have previously speculated that the biological basis of psychiatric disorders such as PTSD includes a shift in the balance between different signalling systems in the brain but none has yet proved it. The results of the study are a great leap forward in our understanding of PTSD. It will contribute new knowledge which can be used to design improved treatments for traumatised individuals.
"At present, PTSD is often treated with selective serotonin re-uptake inhibitors (SSRIs) which have a direct effect on the serotonin system. SSRI drugs provide relief for many but do not help everybody. Restoring the balance between the serotonin and substance P systems could become a new treatment strategy for individuals suffering from traumatic incidents," says lead author Andreas Frick, researcher at the Department of Psychology, Uppsala University.
HOW DOES TREATMENT HELP?
"The main treatments for people with PTSD are specific short-term psychotherapies. These treatments are described below. Everyone is different, so a treatment that works for one person may not work for another. Some people may need to try different treatments to find what works best for their symptoms. Regardless of which option you chose, it is important to seek treatment from a mental health professional who is experienced with PTSD.
Cognitive Behavior Therapy (CBT):
CBT is a type of psychotherapy that has consistently been found to be the most effective treatment of PTSD both in the short term and the long term. CBT for PTSD is trauma-focused, meaning the trauma event(s) are the center of the treatment. It focuses on identifying, understanding, and changing thinking and behavior patterns. CBT is an active treatment involved the patient to engage in and outside of weekly appointments and learn skills to be applied to their symptoms. The skills learned during therapy sessions are practiced repeatedly and help support symptom improvement. CBT treatments traditionally occur over 12 to 16 weeks.
Main Components of CBT:
While different CBTs have different amounts of both exposure and cognitive interventions, they are the main components of the larger category of CBTs that have been repeatedly found to result in symptom reduction.
Exposure therapy. This type of intervention helps people face and control their fears by exposing them to the trauma memory they experiences in the context of a safe environment. Exposure can use mental imagery, writing, or visits to places or people that remind them of their trauma. Virtual reality (creating a virtual environment to resemble the traumatic event) can also be used to expose the person to the environment that contains the feared situation. Virtual reality, like other exposure techniques can assist in exposures for treatment for PTSD when the technology is available. Regardless of the method of exposure, a person is often gradually exposed to the trauma to help them become less sensitive over time.
Cognitive Restructuring. This type of intervention helps people make sense of bad memories. Oftentimes people remember their trauma differently than how it happened (e.g., not remembering certain parts of the trauma, remembering it is a disjointed way). It is common for people to feel guilt of shame about aspects of their trauma that were not actually their fault. Cognitive restructuring helps people look at what happened with fact to get a realistic perspective on the trauma.
What is CBT? Listen to this podcast.
It is important for anyone with PTSD to be treated by a mental health care professional who is experienced with PTSD. Some people will need to try different treatments to find what works for their symptoms.
Description of Specific CBTs for PTSD:
Cognitive Processing Therapy (CPT) is an adaptation of cognitive therapy that aims toward the recognition and reevaluation of trauma-related thinking. The treatment focuses on the way people view themselves, others, and the world after experiencing a traumatic event. Often times inaccurate thinking after a traumatic event "keep you stuck" and thus prevent recovery from trauma. In CPT you look at why the trauma occurred and the impact it has had on your thinking. It can be especially helpful for people who, to some extent, blame themselves for a traumatic event. CPT focuses on learning skills to evaluate whether you thoughts are supported by facts and whether there are more helpful ways to think about your trauma. There is strong research support showing the effectiveness for people recovering from many types of traumas.
Prolonged Exposure (PE) is another form of CBT that relies more heavily on behavioral therapy techniques to help individuals gradually approach trauma related memories, situations, and emotions. PE focuses on exposures to help people with PTSD stop avoiding trauma reminders. Avoiding these reminders may help in the short term, but in the long term it prevents recovery from PTSD. PE uses imaginal exposures, which involve recounting the details of the trauma experience, as well as in vivo exposures, which involve repeatedly confronting trauma-related situations or people in their life that they have been avoiding. There is strong research support showing PEs effectiveness across a wide range of traumas.
Stress Inoculation Training (SIT) is another type of CBT that aims to reduce anxiety by teaching coping skills to deal with stress that may accompany PTSD. SIT can be used as a standalone treatment or may be used with another types of CBTs. The main goal is to teach people to react differently to react differently to their symptoms. This is done through teaching different types of coping skills including, but is not limited to, breathing retraining, muscle relaxation, cognitive restructuring, and assertiveness skills.
Other PTSD Treatments:
There are other types of PTSD interventions that are not considered CBTs.
Eye Movement Desensitization and Reprocessing (EMDR) is a form of psychotherapy that involves processing upsetting trauma-related memories, thoughts and feelings. EMDR asks people to pay attention to either a sound or a back and forth movement while thinking about the trauma memory. This treatment has been found to be effective for treating PTSD, but some research has shown that the back and forth movement is not the active treatment component but rather the exposure alone is.
Present Centered Therapy (PCT) is a type of non-trauma focused treatment that centers around current issues rather than directly processing the trauma. PCT provides psychoeducation about the impact of trauma on one’s life as well as teaching problem solving strategies to deal with current life stressors.
Medications are sometimes used as an adjunct to one of the therapies described above. One of the more common types of medications used are selective serotonin reuptake inhibitors (SSRIs). SSRIs are antidepressants, and depressed mood can be part of PTSD. Also sometimes used as a short term and adjunctive treatment are benzodiazepines. Benzodiazepines are quick-acting medications that are effective but can be habit forming.
If PTSD is a problem for you or for someone you care about, seek out a consultation with an experienced mental health professional. PTSD is a treatable condition -- find out what help there might be for you or your loved one."
BOOKS THAT EFFECTIVELY PORTRAY PTSD
waiting for first light: my ongoing battle with PTSD
By Roméo Dallaire
"At the heart of Waiting for First Light is a no-holds-barred self-portrait of a top political and military figure whose nights are invaded by despair, but who at first light faces the day with the renewed desire to make a difference in the world.
Roméo Dallaire, traumatized by witnessing genocide on an imponderable scale in Rwanda, reflects in these pages on the nature of PTSD and the impact of that deep wound on his life since 1994, and on how he motivates himself and others to humanitarian work despite his constant struggle. Though he had been a leader in peace and in war at all levels up to deputy commander of the
Canadian Army, his PTSD led to his medical dismissal from the Canadian Forces in April 2000, a blow that almost killed him. But he crawled out of the hole he fell into after he had to take off the uniform, and he has been inspiring people to give their all to multiple missions ever since, from ending genocide to eradicating the use of child soldiers to revolutionizing officer training so that our soldiers can better deal with the muddy reality of modern conflict zones and to revolutionizing our thinking about the changing nature of conflict itself.
His new book is as compelling and original an account of suffering and endurance as Joan Didion's The Year of Magical Thinking and William Styron's Darkness Visible."
i'm fine and neither are you
by Camille Pagán
"Wife. Mother. Breadwinner. Penelope Ruiz-Kar is doing it all—and barely keeping it together. Meanwhile, her best friend, Jenny Sweet, appears to be sailing through life. As close as the two women are, Jenny’s passionate marriage, pristine house, and ultra-polite child stand in stark contrast to Penelope’s underemployed husband, Sanjay, their unruly brood, and the daily grind she calls a career.
Then a shocking tragedy reveals that Jenny’s life is far from perfect. Reeling, Penelope vows to stop keeping the peace and finally deal with the issues in her relationship. So she and Sanjay agree to a radical proposal: both will write a list of changes they want each other to make—then commit to complete and total honesty.
What seems like a smart idea quickly spirals out of control, revealing new rifts and even deeper secrets. As Penelope stares down the possible implosion of her marriage, she must ask herself: When it comes to love, is honesty really the best policy?"
all the light we cannot see
by Anthony Doerr
"From the highly acclaimed, multiple award-winning Anthony Doerr, the stunningly beautiful instant New York Times bestseller about a blind French girl and a German boy whose paths collide in occupied France as both try to survive the devastation of World War II.
Marie-Laure lives in Paris near the Museum of Natural History, where her father works. When she is twelve, the Nazis occupy Paris and father and daughter flee to the walled citadel of Saint-Malo, where Marie-Laure’s reclusive great uncle lives in a tall house by the sea. With them they carry what might be the museum’s most valuable and dangerous jewel.
In a mining town in Germany, Werner Pfennig, an orphan, grows up with his younger sister, enchanted by a crude radio they find that brings them news and stories from places they have never seen or imagined. Werner becomes an expert at building and fixing these crucial new instruments and is enlisted to use his talent to track down the resistance. Deftly interweaving the lives of Marie-Laure and Werner, Doerr illuminates the ways, against all odds, people try to be good to one another."
CELEBRITIES WHO ADVOCATE
“I [...] developed PTSD as a result of being raped and also not processing that trauma,” she told Oprah."
“Mental health is a medical condition. It should be treated as a medical condition, it should not be ignored,” she said. “I take an oath as a commitment today, with you, it's 2020 and for the next decade and maybe longer, I'm going to get the smartest scientists, doctors, psychiatrists, mathematicians, brain surgeons, and professors in the same room together and we're going to go through each problem one by one and we're going to solve this mental health crisis.”
"I know those families and my fans, and everyone there experienced a tremendous amount of it as well," Grande said of suffering the symptoms of PTSD. "I feel like I shouldn't even be talking about my own experience -- like I shouldn't even say anything."