PTSD – Post Traumatic Stress Disorder
Most people encounter Trauma at some time in their lives. PTSD occurs when people have difficulty processing this event which results in lasting incongruent feelings or behaviours that have a long term impact on a person’s life.
About twice as many women as men experience PTSD. This is partly a reflection of women being more exposed to traumatic events. The popular image of PTSD is of a soldier’s experience of war, however PTSD occurs frequently as a result of domestic and relationship violence (including towards children) and more civilians are affected by PTSD in wartime than soldiers.
PTSD is not caused by the severity of an event, although this may be a contributing factor. It is the result of a person’s inability to process the event in terms of their pre-existing terms of reference. The event undermines a person’s sense that life is fair and that they are safe. High anxiety levels (arousal) are a consequence of a person trying to resolve contradictory ideas and feelings. Normally these symptoms reduce quickly as a person assimilates new information and adopts a new worldview. With PTSD this assimilation is more difficult as the person tends to try to apply a negative and threatening worldview to episodes in ordinary life.
Nothing feels safe, physiologically as well as psychologically. The person tends to re-experience the event in his or her imagination, may avoid activities or emotions (or experience a numbness of some feelings) and is likely to be hyper-vigilant, on the lookout and perceiving threat when it is not there.
Treatment
Over the last 20 years there has been a great deal of study in the US and UK on what interventions work (since the Marchioness disaster in London and the Oklahoma bombing).
Contrary to popular belief counselling and most psychotherapies are not effective. Looking for underlying causes in a person’s psyche has no effect on the condition. Similarly, debriefing models after an event can actually make matters worse as it reinforces a traumatic memory of the event, but orientation exercises do have a positive effect.
Medical opinion in the UK and US is consistent in considering that cognitive behaviour therapy (CBT) is effective in many cases and there is some evidence that Eye Movement Desensitisation and Reprocessing (EMDR) techniques can have a positive effect.
Both these models work on the principle that a person’s Thoughts, Feelings and Behaviours are interrelated and feed into each other. A person is encouraged to recognise their thoughts and feelings as they happen and to try to influence them positively, and to use behaviour to change beliefs or feelings when this is possible. At the very least behaviour can be changed to stop reinforcing negative ideas or feelings. It is worth noting that Feelings are not conceptual (eg upset or depressed), but physical sensations (eg butterflies, trembling, heart racing).
EMDR is a similar therapy that invokes controlling eye movement to induce different emotional states to recollections.
There is no evidence that complimentary therapies are any more effective that psychotherapies, with the exception that relaxing therapies such as massage, meditation or yoga can assist in reminding people what it is like to be in a relaxed state.
Medication is often also considered as a means of addressing specific symptoms (re-experiencing events, avoidance, hyper-arousal, depression). Sometimes these medications raise anxiety levels in a patient at the same time that they relieve symptoms and people need reassurance that this is a consequence of the treatment.
People recovering from PTSD require specialist treatment, support and monitoring while they are going through this process.
Useful websites
Geoff Hogan
30th March 2011
No comments:
Post a Comment