Recognising and Treating PTSD

What is PTSD?

PTSD-Image-Gibson-feature-300x336According to BeyondBlue, Post-traumatic Stress Disorder (PTSD) is “a particular set of reactions that can develop in people who have been through a traumatic event which threatened their life or safety, or that of others around them. This could be a car or other serious accident, physical or sexual assault, war or torture, or disasters such as bushfires or floods. As a result, the person experiences feelings of intense fear, helplessness or horror.” PTSD affects about 12% of the Australian population in their lifetime, which is a significant number if you stop and think about it.

What are the signs?

Trauma can be experienced in a number of ways and can be the mental impact of a traumatic event at any stage of life. I’ve treated both children and adults with PTSD symptoms and diagnoses and it’s a challenging presentation. The key signs that someone may be experiencing PTSD, can include:

  • Re-living the traumatic event – This can happen through unwanted and recurring memories, often in the form of vivid images and nightmares. There may be intense emotional or physical reactions, such as sweating, heart palpitations or panic when reminded of the event.
  • Being overly alert or wound up – This can include sleeping difficulties, irritability and lack of concentration, becoming easily startled and constantly on the lookout for signs of danger.
  • Avoiding reminders of the event – This can include deliberately avoiding activities, places, people, thoughts or feelings associated with the event because they bring back painful memories.
  • Feeling emotionally numb – Often this results in the loss of interest in day-to-day activities, feeling cut off and detached from friends and family, or feeling emotionally flat and numb.

Often people with PTSD experience other mental health challenges either as a result of, or concurrent with their PTSD symptoms. These additional problems, most commonly depression, anxiety, and alcohol or drug use. It’s understandable that the fear response, being triggered as frequently as it is, can wear a person down and have them seek ways to numb the discomfort or self-medicate.

Studies show that people with PTSD often have atypical levels of key hormones involved in the stress response. For instance, research has shown that they have lower-than-normal cortisol levels and higher-than-normal epinephrine and norepinephrine levels — all of which play a big role in the body’s “fight-or-flight” reaction to sudden stress. (It’s known as “fight or flight” because that’s exactly what the body is preparing itself to do — to either fight off the danger or run from it.)

PTSD in Children: Signs and Symptoms

Both children and adults with PTSD have symptoms of stress, anxiety and depression that include any of the following:

Intrusive thoughts or memories of the event

  • unwanted memories of the event that keep coming back
  • upsetting dreams or nightmares
  • acting or feeling as though the event were happening again (flashbacks)
  • heartache and fear when reminded of the event
  • feeling jumpy, startled, or nervous when something triggers memories of the event
  • children may reenact what happened in their play or drawings

Avoidance of any reminders of the event

  • avoiding thinking about or talking about the trauma
  • avoiding activities, places, or people that are reminders of the event
  • inability to remember important parts of what happened

Negative thinking or mood since the event happened

  • persistent worries and beliefs about people and the world being unsafe
  • blaming oneself for the traumatic event
  • lack of interest in participating in regular activities
  • persistent feelings of anger, shame, fear or guilt about what happened
  • feeling detached or estranged from people
  • not able to have positive emotions (happiness, satisfaction, loving feelings)

Persistent feelings of anxiety or physical reactions

  • trouble falling or staying asleep
  • feeling cranky, grouchy, or angry
  • problems paying attention or focusing
  • always being on the lookout for danger or warning signs
  • easily startled

Treatments for PTSD

There are many treatment programs available for PTSD. When trauma first happens, in the first few weeks following most people recover on their own with the help and support of friends and family. As such, a diagnosis of PTSD and other treatments aren’t considered until about 2 weeks after a traumatic experience. The best thing is immediate help and support, however this isn’t always possible and some people don’t have the right support around them. About 25% of people who experience a traumatic event develop PTSD. If traumatic events occur often (e.g. childhood abuse, domestic abuse, living in a war zone) PTSD can become a pervasive, debilitating condition that makes the trauma feel real and present, even after the abuse or life threatening conditions are removed.

Effective treatments are available and these apply for both adults and children. Most involve psychological treatment (talking therapy), and medication can also be prescribed in some cases. Drug treatments are not recommended within four weeks of symptoms appearing unless the severity of the person’s distress cannot be managed by psychological means alone. Generally, it’s best to start with psychological treatment rather than use medication as the first and only solution to the problem.

Cognitive-Behavioural Therapy (CBT)

PTSD is categorised as a type of anxiety disorder, and CBT is one of the most evidence-based and common treatment programs used to treat both anxiety and PTSD. CBT is a structured psychological treatment which recognises that the way we think (cognition) and act (behaviour) affects the way we feel. As a psychologist, I seek to help clients to identify thought and behaviour patterns that are either making them more likely to become anxious, or stopping them from getting better when they’re experiencing anxiety. Being able to recognise unhelpful patterns that are contributing to anxiety, allows people to make changes to replace these with new ones that reduce anxiety and improve coping skills.

In PTSD, it’s common to find someone stuck in catastrophising thinking patterns. This means thinking the worst, believing something is far worse than it actually is, or anticipating things will go wrong. Using CBT, I help people to think that more realistically and focus on problem-solving, plus to systematically reduce the distress certain situations or things that cause anxiety or trigger flashbacks, so that fears can be faced and these situations be approached more rationally. This is called ‘exposure therapy’.

CBT techniques can include:

  • encouraging you to recognise the difference between productive and unproductive worries
  • teaching you how to let go of worries and solve problems.
  • teaching relaxation and breathing techniques, particularly muscle relaxation, to control anxiety and the physical symptoms of tension.

Time Line Therapy™ (TLT)

I utilise a set of techniques called Time Line Therapy™ that has helped a number of my clients with both PTSD and anxiety to reduce their emotional reactivity and find meaning from their experiences. Clients who are undergoing TLT treatment learn how to externalise and disassociate from traumatic experiences, find positive resources and coping strategies from within themselves, and let go of the emotional charge attached to specific events. I’ve found that letting go of the emotions of Fear, Horror/Terror, Overwhelm and Helplessness using TLT particularly effective in reducing or even completely overcoming the symptoms of PTSD.

Eye Movement Desensitisation and Reprocessing (EMDR)

There is a kind of therapy called Eye Movement Desensitization and Reprocessing (EMDR) that is used for PTSD. Eye movement desensitization and reprocessing (EMDR) is another type of therapy for PTSD. Like other kinds of counseling, it can help change how people react to memories of their trauma. With an EMDR-trainer counsellor, the client talks about their memories, while focusing on other stimuli like eye movements, hand taps, and sounds. For example, the therapist moves his or her hand, and the client follows this movement with their eyes.

EMDR has grown in popularity of the years and the evidence supporting it’s effectiveness does exist. At this time I am not EMDR trained, so if you’re looking to try EMDR, there are many good psychologists and other therapists who provide this service. Experts are still learning how EMDR works, and there is disagreement about whether eye movements are a necessary part of the treatment.

Group Therapy

Many people want to talk about their trauma with others who have had similar experiences; group therapy allows this to happen with a group of people who also have been through a trauma and who have PTSD. Sharing their story with others may help the person with PTSD feel more comfortable talking about their trauma. This can help them cope with their symptoms, memories, and other parts of their life. Given how important social support is for recovery, this can be one of the best actions to take, along with individual counselling/psychotherapy.

Group therapy helps build relationships with others who understand what a person has been through. It often includes learning how to deal with emotions such as shame, guilt, anger, rage, and fear. Sharing with the group also can help build self-confidence and trust. Ultimately it encourages people to focus on their present life, rather than feeling overwhelmed by the past.

Extra Support for Children with PTSD

Along with the above treatments, there are some extra forms of help and support that can be given to children with PTSD. Here is some help tips*:

  • Most kids will need a period of adjustment after a stressful event, so during this time, it’s important for parents, caregivers, teachers and loved ones to offer support, love, and understanding.
  • It can help to try to keep kids’ schedules and lives as similar as possible to before the event. This means not allowing the child to take off too much time from school or activities, even if it’s hard at the beginning.
  • Let them talk about the traumatic event when and if they feel ready. It’s important not to force the issue if they don’t feel like sharing their thoughts. Praise them for being strong when they do talk about it. Some kids may prefer to draw or write about their experiences. Either way, encouragement and praise can help them get their feelings out.
  • Reassure them that their feelings are typical and that they’re not “going crazy.” Support and understanding from those around them can help with processing difficult feelings.
  • Some kids and teens find it helpful to get involved in a support group for trauma survivors. Look online or check with your pediatrician or the school counsellor to find groups nearby.
  • Get professional help immediately if you have any concern that a child has thoughts of self-harm. Thoughts of suicide are serious at any age and should be treated right away.
  • Help build self-confidence by encouraging kids to make everyday decisions where appropriate. PTSD can make kids feel powerless, so parents can help by showing their kids that they have control over certain aspects of their lives. Depending on the child’s age, parents might consider letting him or her choose a weekend activity or decide things like what’s for dinner or what to wear.
  • Tell them that the traumatic event is not their fault. Encourage kids to talk about their feelings of guilt, but don’t let them blame themselves for what happened.
  • Stay in touch with caregivers. It’s important to talk to teachers, babysitters, and other people who are involved in your child’s life.
  • Do not criticise regressive behavior (returning to a previous level of development). If children want to sleep with the lights on or take a favorite stuffed animal to bed, it might help them get through this difficult period. Speak to a counsellor or the child’s therapist/psychologist if you need extra information or ideas.

Is PTSD a Life Sentence?

PTSD is certainly a challenging condition to treat, but that doesn’t mean it’s not recoverable. Sometimes it takes finding the right therapist, treatment protocol, support group or school to make it work. Sometimes it takes a number of years of consistent work with a therapist, deeper spiritual searching, undertaking self-help programs or a myriad of conditions to recover from PTSD, so the key is to not give up on the possibility of better mental health and keep looking until the right fit is found.

*Reference: http://kidshealth.org/en/parents/ptsd.html#