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As the name implies, Posttraumatic Stress Disorder can develop post, or following, exposure to a traumatic event. The traumatic event can include war-related experiences, motor vehicle accidents, physical or sexual assault, physical or sexual abuse, armed holdups, threatened violence, traumatic childbirths, through psychotic episodes, or through witnessing others experience violence or trauma. This list is far from exhaustive and PTSD can develop through myriad other pathways. Often during violent or traumatic events people can fully expect that they are going to die, that their life is over, or that someone close to them will die. This is a hallmark of PTSD. Unreservedly expecting that you are going to die, naturally elicits intense anxiety, fear and distress.
Most people will be exposed to some form or trauma throughout their life. Most people will also not go on to develop PTSD. Around 5-10% of people will develop PTSD within their lifetime. The days and weeks following exposure to trauma can be challenging, upsetting, and distressing, but this is not necessarily indicative of PTSD, but rather a natural and normal response to highly challenging and scary life events. Other people, however, will go on to develop further PTSD symptoms, and perhaps full Posttraumatic Stress Disorder. These PTSD symptoms can become intrusive, chronic and can come to affect one's abilty to live on a day-to-day basis.
Scroll down to skip to psychological treatment approaches for PTSD.
There are several core types of symptoms that develop in PTSD, as follows:
Reexperiencing - Following a traumatic event, sufferers of PTSD may experience intrusive and recurrent thoughts, images, or memories of the event. This may include flashbacks, whereby an environmental trigger (e.g. someone who looks like the perpetrator of the violence, or a sight, sound or smell that is associated with the traumatic event) can leave someone feeling as though the traumatic event is happening all over again, resulting in severe anxiety. Sufferers can also often experience nightmares where the traumatic event is replayed during sleeping hours. Thus, in effect, the PTSD sufferer experiences the trauma again and again.
Avoidance - A typical, and understandable, reaction to trauma is to avoid all reminders of the traumatic event. This may include people or places associated with the traumatic incident, but also includes avoidance of talking or thinking about the traumatic incident. People tend to avoid these reminders because of the intense anxiety that they evoke, and so it makes sense that sufferers would want to avoid these triggers. However, chronic avoidance can lead to further problems whereby life can become more and more restricted.
Arousal or Anxiety - Sufferers of PTSD tend to experience heightened general anxiety or arousal. Their baseline levels of arousal increase, and daily stressors, that they may have previously managed quite well, can become overwhelming and can lead to severe anxiety. Sufferers can become easily flustered and may become easily irritated with close others. Managing the regular demands of daily life can become difficult.
Hypervigilance and Exaggerated Startle Response - Sufferers of posttraumatic stress often become hyper-aware of the threat of further trauma or acts of violence. If a person was involved in a motor vehicle accident that led to the development of PTSD, they may become aware of all erratic drivers on the road, all cars that are driving too fast, and may be aware of any car that seems to come too close to their own car. This is called hypervigilance and its our way of fending off the threat of any further trauma (we may believe, "If I'm very watchful, I'll be able to avoid trauma in the future"). PTSD sufferers can also experience an exaggerated startle response, whereby previously benign incidents (e.g. someone shouting or a loud unexpected noise) can lead to high anxiety and the activation of the fight or flight response.
Other Aspects of Posttraumatic Stress Disorder - Those experiencing PTSD can also struggle with close relationships, anger, feeling numb and disconnected from others, changes in beliefs about the self (e.g. I'm helpless and vulnerable), others (e.g. others are dangerous and no one can be trusted) and the world (e.g. the world is completely unsafe and dangerous).
The symptoms of PTSD are complex, multifaceted, and unique to each individual. The good news is that effective and well researched psychological treatments are available.
A range of psychological treatments for PTSD have been researched, evaluated, and have been shown to be highly effective in the treatment of PTSD. Below are some of the most widely used and researched treatment approaches.
Trauma-focussed Cognitive Behavioural Therapy - Perhaps the most widely researched and utilised treatment for PTSD, is trauma-focussed CBT. There are many components to trauma-focussed CBT, but the most central two components are exposure therapy and cognitive restructuring.
Exposure therapy. As mentioned early, a core component of PTSD is avoidance, both external reminders of the trauma (e.g. people, places, objects, etc.) and internal (thoughts, sensory experiences such as smells, memories, images, feelings, etc.). Exposure therapy, as the name suggests, encourages PTSD sufferers to gradually confront the avoided stimuli. This needs to be done at the right pace, and is done in a manner that the client is comfortable with. The most important component of exposure therapy is often exposure to the memory of the trauma. We have little opportunity to revisit our traumatic memories without explicit instruction to do so, and therefore often push away or block out any trauma memories as soon as they appear. This is proposed to disallow the processing of the trauma memories, and perpetuates PTSD symptoms. Avoidance makes it seem as though the memory of the trauma is the same as the trauamatic event itself. Imaginal exposure involves having the person recount the trauma, in increasingly more detail, in order to allow them to eventually overcome the distressing memories of the event.
Exposure therapy (one component of trauma-focussed CBT) can seem daunting to some clients. However, near countless studies have demonstrated the strong effectiveness of this approach to trauma. Clients need not be fearful when entering therapy. Exposure therapy is conducted when the client is ready and willing to engage in the treatment, and can be modulated to help with the management of distress. To be effective, exposure therapy takes time. That is, a PTSD sufferer needs to 'sit with' the challenging image or memory for long enough, that it begins to lose its anxiety-inducing power. If someone spoke about a traumatic incident for 2 minutes, there would likely be little impact or reduction in anxiety. But, hypothetically, let's say you spoke about a trauamtic incident for 8 hours a day, everyday, for one month. By the end of that time we'd hope that you almost be 'bored' with the memory, because you've recounted it so many times. That's the aim of exposure therapy.
Cognitive Restructuring. When psychologists talk about a cognition, it's generally another way of saying thought or belief. As such, cognitive restructuring implies that this component of PTSD treatment aims to restructure, or change, trauma-related thoughts that may be perpetuating trauma-related symptoms. Cognitive restructuring, and cognitive therapy, are used to identify, challenge, and modify, any biased or distorted views that may have developed through the traumatic event. For example, if following a traumatic event I believe that "the world is not safe" then my emotions and behaviours will follow. I'll likely feel more anxious and distressed, and I may withdraw from engaging and rewarding activities. Cognitive restructuring looks to evaluate anxiety-inducing beliefs rationally by, for example, looking for evidence for or against the beliefs, assessing the helpfulness of the belief, by testing out beliefs, and by generally taking a closer look at the ideas we are telling ourselves about life following a traumatic life event.
Trauma-focussed CBT often also includes psychoeducation, whereby PTSD sufferers learn about PTSD and its many manifestations. Trauma-focussed CBT can include relaxation and symptom management techniques. Symptom management techniques can include training in mediation, relaxation, grounding techniques, and mindfulness.
Cognitive Processing Therapy - Cognitive Processing Therapy, or CPT, is a particular form of cognitive therapy which has been further refined for use with people struggling with PTSD symptoms. CPT focusses on key themes associated with PTSD, which includes themes of safety, trust, power and control, self-esteem, and intimacy. Similar to Cognitive Therapy, but with it's own techniques, CPT helps clients to identify PTSD-related unhelpful thoughts and beliefs, or 'stuck points', and to challenge and evaluate these beliefs with a view to replacing them with more helpful and adaptive beliefs. Although there are some exposure components included in CPT, its primary focus in on cognitions (thoughts and beliefs) associated with the traumatic event.
Eye Movement Desensitisation and Reprocessing (EMDR) - The theoretical underpinnings of EMDR propose that during a traumatic event, the high degree of distress involved, and potential dissociative experiences, may interfere with information processing (i.e. processing and understanding the traumatic event). Thus, the trauma is stored in the mind in an unprocessed way. In EMDR therapy the PTSD sufferer is encouraged to focus on trauma-related images and memories, negative thinking patterns associated with the trauma, difficult emotions and bodily sensations, while simultaneously moving their eyes back and forth, following the movement of the psychologist's fingers or hand. EMDR proposes that the dual processes, of focussing on the trauma and the psychologist moving their fingers back and forth, facilitates the processing of the traumatic event and leads to symptom reduction. The presice mechanisms of change in EMDR are unknown.
The psychological treatment approaches covered above are all well supported by research and are considered 'Grade A' treatments by PTSD institutes within Australia.
Psychotherapy is an effective way to manage PTSD, anxiety symptoms, and depression symptoms.
If you would like more information about PTSD treatments, PTSD therapy, or trauma therapy, you can contact our Gold Coast Psychologist at MHM Psychology on 1300 848 072.
Dr Mark Bartholomew is a Clinical Psychologist located in Coomera on the Gold Coast. Dr Bartholomew works with a variety of trauma survivors including current and past serving military personnel, people involved in motor vehicle accidents, assault and sexual assault survivors, survivors of childhood abuse and those who have suffered workplace injuries.