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Trauma & PTSD
In the aftermath of a
traumatic event, it is normal to have feelings of detachment or emotional
numbness, a feeling of distorted or altered reality, amnesia or even
repeated reliving of the event. For most, these feelings will fade within
the next few weeks. For others, they become a part of life. This
information sheet explains why this happens and what can be done about it.
We hope it leads to a greater understanding of the disorder, for patients
and their families.
As the name implies, posttraumatic stress
disorder (PTSD) occurs only after (post) an extremely stressful event
(trauma). The more severe the trauma and the longer the person is exposed
to it, the greater the likelihood of developing PTSD. PTSD is only
diagnosed after a) a person has been exposed to an extreme trauma, b)
symptoms develop that last at least one month and c) the symptoms create
extreme distress and dysfunction. Three or more of the following
characteristics are usually present:
- numbing, detachment or absence of
emotional response
- reduced awareness of surroundings (being dazed)
- sensation that surroundings are distorted or unreal
- the feeling that you are different, strange or unreal
- an inability to remember parts of the trauma.
In addition to three or more of these five
characteristics, the traumatic event is relived repeatedly. This can take
the form of recurrent images, thoughts, and dreams or
"flashbacks" of the event. Even reminders of the event can cause
extreme distress, so many people go out of their way to avoid places or
events that resemble the traumatic event in some ways. Many experience
increased anxiety, restlessness, sleeplessness, irritability, poor
concentration, hypervigilance or an exaggerated startle response. Some are
even plagued by feelings of "survivor's guilt," because they
survived when others did not or because of certain things they may have
had to do to survive. This complete set of symptoms is obviously very
disruptive and stressful to the victim as well as their family and loved
ones. It can even impair job performance and social functioning.
Cognitive Behavioural Treatment
Three kinds of psychotherapy have been shown to be effective in the
treatment of PTSD: cognitive therapy, exposure therapy, and stress
innoculation & coping. All of these appraoches have been researched
and are all effective for some people.
Cognitive therapy
Cognitive therapy is very much like the positive or
constructive thinking described above. Cognitive therapy helps you
understand how your thoughts affect your feelings. In PTSD people have a
tendency to overestimate the likelihood of trauma occurring again and feel
fear. For example if the trauma followed a car accident the person may
think "I will crash" or "Other drivers are careless and
will hit me." Likewise, if the trauma following being assaulted then
they may think, "Other people want to hurt me" "All men are
dangerous." This is why people become anxious in situations that
remind them of the traumatic situation. Other people feel shame through
having shame related thoughts e.g. "I am weak because I should be
able to cope with the accident." Whilst other people feel guilty,
e.g. "I should have died not ……." "It was my
fault" even when there is no or little evidence that the person was
to blame. There are four steps to reducing this negative thinking and
feeling better:
Exposure Therapy
Exposure therapy is based on the principle
that we get used to things that are just annoying and not truly dangerous.
This is called habituation, and it occurs naturally in over 95% of
people.
Exposure therapy is the opposite of how
people typically respond to anxiety which is avoidance. Because while
avoidance may provide temporary relief, it just doesn't last. Facing
triggers for anxiety is the key to reducing the frequency and severity of
PTSD symptoms.
Exposure may be done in real life or in
imagination. It is believed by some that real life exposure is more
effective than imaginal exposure. While anxiety or other discomfort may
get worse in the first few minutes of real life exposure, it is important
to continue exposure until the discomfort and anxiety has diminished.
Escaping discomfort only reinforces avoidance as a coping tactic, and
produces all the limitations associated with avoidance—like avoiding
safe places or situations that might be fun, beneficial or essential for a
career and a full family life. It also increases the likelihood that the
anxiety might spread, first to similar triggers and eventually to triggers
that have little or nothing to do with the original anxiety. Examples of
exposure are resuming driving after being in an accident or returning to a
now-safe site where an assault once occurred.
Exposure in imagination involves the person
recounting traumatic memories until they lose they no longer cause
excessive distress. This can be done by saying them aloud repeatedly,
writing, reading and rewriting a biography of the events or recording them
on a tape and playing them over and over until they are no longer
distressing.
Stress Inoculation and Coping
Stress Inoculation involves learning
several skills that will help you cope better with PTSD symptoms. People
usually try all a range of coping techniques to determine what helps most.
When PTSD symptoms strike, coping techniques are used to reduce the
intensity of symptoms and the distress they create. But it is not enough
to understand the principles behind these techniques; they must be
practiced repeatedly until they can be employed easily and automatically—almost
without thinking about them. Some people use anxiety coping techniques to
help control anxiety while they do exposure therapy. For example some
techniques of stress inoculation are:
Your therapist will help you to choose
which of the above or which combination of approaches is most likely to
help you. Most people also do improve with psychological treatment.
11 November 2002 10:43:15
© Michael Townend
Cognitive Behavioural Psychotherapist
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