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STRESS HELP

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Post Traumatic Stress Disorder

THE EXTENT OF THE PROBLEM
Recent studies have estimated the prevalence of Post Traumatic Stress Disorder (PTSD) as approximately 5 - 10% of the general population. Incidence then varies following exposure to specific traumatic incidents, e.g. 11% of road traffic accident survivors; 33 - 50% in rape victims, 22 - 50% in combat veterans; 50% in bomb survivors; 22 - 40% in air-crash survivors. Studies have also indicated that approximately 20 - 40% of individuals exposed to traumatic events experience problems lasting for more than one year, and 15 - 20% for more than two years. Approximately half go on to develop a chronic form of the disorder.

WHAT IS PTSD?
An individual can be said to be suffering from PTSD if they develop, "characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate."

PTSD IS CHARACTERISED BY THREE MAIN GROUPS OF SYMPTOMS:

1. Re-experiencing the event in some way e.g. frequent intrusive thoughts, nightmares and flashbacks.

2. Persistently avoiding situations associated with the trauma, or experiencing a numbing of their emotions e.g. avoidance of people or places that serve as reminders of the event.

3. Persistent symptoms of increased arousal, e.g. sleeplessness, irritability and impaired concentration.

The symptoms described above must persist for at least a month following the incident and cause significant impairment to social and occupational functioning.

CAUSES
PTSD can be caused by exposure to traumatic events as outlined above. These will be as diverse as the following: a serious assault, road traffic accidents or accidental injury, fires, bomb explosions and natural disasters such as earthquakes. A variety of factors contribute to why one individual develops the disorder, while another does not.

MOOD
Changes in mood are common in PTSD, ranging from anger, shame, guilt, feeling isolated and alone, to a sense that life is pointless, with a diminished interest in the future. Anxiety symptoms, including feeling tense and on edge are often present, as is irritability. The individual may also experience difficulty expressing emotions. Moderate to severe depression is not uncommon.

COGNITIONS
These are characterized either by a pre-occupation with the traumatic event or a strong urge to avoid thinking about the event. Intrusive thoughts and images may keep re-occurring. Nightmares and flashbacks may also occur and cause the person to feel as if they were re-living the event. Reminders of the event, such as TV images or newspaper articles may also trigger these symptoms. In addition, there may be difficulty remembering certain parts of the event.

BIOLOGICAL
A person may also be in a state of heightened arousal and experience a range of anxiety symptoms, e.g. sweating, palpitations and startling easily. Biological feature of depression, such as sleep and appetite disturbance may also occur.

BEHAVIOUR AND MOTIVATION
A person may often avoid situations, places and activities associated with the trauma. They may cease previously enjoyed activities. In addition, there may also be an adverse effect on family relationships and occupational functioning. Drug and alcohol abuse is not uncommon as a way of trying to forget.

TREATMENT
Almost all treatment for PTSD is psychologically orientated and is aimed at dealing with the range of emotional and behavioural problems outlined above. Medication is occasionally used as an adjunct (see below). There is evidence that supportive counseling is only of general, not specific use, in PTSD sufferers and that many PTSD problems require specialized treatment.

Specific cognitive behavioural interventions include:

Exposure in real life - this involves the individual gradually confronting previously avoided anxiety provoking situations until their anxiety subsides.

Imaginal exposure - this is a technique that involves direct exposure to memories of the trauma and can involve the use of audio taped material. As with real life exposure, this can also be graded and with the repeated practice will eventually result in a reduction in anxiety and other related symptoms.

Cognitive therapy - many individuals often find that their beliefs and assumptions about themselves, others and their world have been "shattered" as a result of their trauma. They may also experience feelings of guilt or anger. Cognitive restructuring aims to address this and help them come to terms with their experience.

Eye Movement Desensitisation and Reprocessing (EMDR) - is a relatively new technique, which has been shown to be effective in the treatment for PTSD. In essence, the technique involves pairing memories / disturbing thoughts and the resultant emotions with repeated rapid and rhythmic eye movements, resulting in the desensitisation of the memories. A similar pairing of memory and a chosen positive cognition, with further eye movements, constitutes the reprocessing component.

Treatment is individually tailored after thorough assessment and only with the co-operation and collaboration of the survivor. An average treatment programme may take place over ten to twelve sessions, but this will vary in individual cases.

DEBRIEFING
Psychological debriefing is primarily a preventative measure and is not intended to be 'therapy'. The aim of debriefing, is to reduce the likelihood of the development of PTSD, by providing an opportunity for the expression of feelings and a framework for individuals to make sense of the traumatic experience.

MEDICATION
Anti-depressants can be very effective as an adjunct to psychological treatment, as many PTSD sufferers also have symptoms of clinical depression. Anti-depressants can also facilitate participation in therapy and thereby optimize the outcome of treatment. Medication alone may only achieve short-term improvement.

 

Source:  The British Association for Behavioural and Cognitive

Psychotherapies

www.babcp.com