Therapy for PTSD & Trauma-Related Disorders
Post-Traumatic Stress Disorder (PTSD) is a complex disorder that can present quite differently in different people. It is often seen to co-occur with other psychological issues including depression, anxiety & substance abuse.
Post-Traumatic Stress Disorder (PTSD) is a complex disorder that can present quite differently in different people. In all cases the below symptoms are most commonly seen:
- Re-experiencing the incident / Flashbacks – which can include experiencing distressing memories or dreams related to the traumatic event; distress physiological reactions to reminders of the trauma; flashbacks of certain parts of the trauma; or dissociation (zoning out, missing time or blanking out).
- Persistent avoidance of anything that may trigger the trauma – such as trying to avoid thoughts, feelings and physical sensations related to the trauma; or avoiding external reminders that may trigger the trauma, such as: people, places, images and activities linked with the trauma.
- Thoughts and feelings becoming more negative – this could include unfairly blaming yourself or others; unrealistic expectations about how you should be coping or what others should be doing; recued interest in regular activities and difficulty experiencing positive emotions; feeling detachment from others; or feeling negative or sad all the time.
- Changes in arousal and reactivity or ‘hyperarousal’ – which often looks like an exaggerated startle response, hypervigilance, feeling on edge and irritable, easily upset and angered, or problems with sleep or concentration.
PTSD is so distressing that it is often seen to co-occur with a number of other psychological issues, such as: depression; anxiety, and substance misuse.
Most Common Types of Trauma
Post-Traumatic Stress Disorder (PTSD)
PTSD can develop following exposure to one or more traumatic events. The main symptoms for PTSD have been highlighted above. The clinical presentation however of PTSD varies. In some individuals, fear-based reactive re-experiencing, emotional, and behavioural symptoms may be most present. Others may respond by shutting down and avoiding and being overwhelmed by depression, in others symptoms of dissociation may be the most obvious. Some individuals will experience of combination of these symptoms.
Acute Stress Disorder
Acute stress disorder occurs in reaction to a traumatic event, just as PTSD does, and the symptoms are similar. However, the symptoms occur between three days and one month immediately after the event. People with acute stress disorder may relive the trauma, have flashbacks or nightmares and may feel numb or detached from themselves. These symptoms cause major distress and problems in their daily lives. About half of people with acute stress disorder, if there symptoms persist, will go on to develop PTSD. Acute stress disorder has been diagnosed in 19%-50% of individuals that experience interpersonal violence (e.g., rape, assault, intimate partner violence).
Adjustment disorder usually occurs in response to stressful life event(s) such as: divorce or relationship breakup; termination of employment, changing jobs, transitioning to high school; having experienced a permanent injury; or life changing disability. As a result you may experience a range of symptoms which could present in emotionally, physiological or behavioural. The symptoms caused by the stressor are generally more severe or more intense than what would be reasonably expected for the type of event that you were experiencing.
Symptoms can include: feeling tense; sad or hopeless; withdrawing from other people; acting defiantly; or an inability to control impulsive behaviours; or physical symptoms like: tremors; palpitations; or headaches. The symptoms cause significant distress or problems functioning in key areas of your life, for example, at work, school or in social interactions.
Disinhibited Social Engagement Disorder
Disinhibited social engagement disorder occurs in children who have experienced severe social neglect or deprivation before the age of two. Similar to reactive attachment disorder, it can occur when children lack the basic emotional needs for comfort, stimulation and affection, or when repeated changes in caregivers (such as frequent foster care changes) prevent them from forming stable attachments.
Disinhibited social engagement disorder involves a child engaging in overly familiar or culturally inappropriate behaviour with strangers or adults they barely know. For example, the child may often approach and talk to strangers and may be willing to go off with a stranger with no hesitation. Developmental delays including cognitive and language delays often co-occur with this disorder. Caregiving quality has been shown to dramatically improve the course of this illness. Yet even with improvements in the caregiving environment some children may have symptoms that persist through to adolescence.
Reactive Attachment Disorder
Reactive attachment disorder occurs in children who have experienced severe social neglect or deprivation during their first years of life. It can occur when children lack the basic emotional needs for comfort, stimulation and affection, or when repeated changes in caregivers (such as frequent foster care changes) prevent them from forming stable attachments. Children with reactive attachment disorder are emotionally withdrawn from their adult caregivers. They rarely turn to caregivers for comfort, support or protection or do not respond to comforting when they are distressed. During routine interactions with caregivers, they show little positive emotion and may show unexplained fear or sadness. The problems appear before age 5. Developmental delays, especially cognitive and language delays, often occur along with the disorder.
Therapy for PTSD
When you have PTSD, it might feel like you’ll never be the way you were. Treatments for PTSD can help. The most common treatments are listed below.
Eye Movement Desensitisation & Reprocessing (EMDR)
EMDR combines exposure therapy with a series of guided eye movements that help you process traumatic memories and change how you react to them. For more information on EMDR, go to EMDR Therapy.
Trauma Focussed Cognitive Behaviour Therapy (TF-CBT)
TF-CBT incorporates a range of cognitive behavioural interventions including:
- Imaginal exposure – this teaches you to confront traumatic memories in a safe environment. Imaginal exposure continues until the memories no longer create high levels of distress. This approach varies between Prolonged Exposure and TF-CBT.
- In vivo exposure – this assists you to gradually confront the situations, people or places that they have been avoiding due to the associated distress.
This behavioural therapy helps you safely face both situations and memories that you find frightening so that you can learn to cope with them effectively. Exposure therapy can be particularly helpful for flashbacks and nightmares. One approach uses virtual reality programs that allow you to re-enter the setting in which you experienced trauma.
Prolonged Exposure (PE)
Prolonged exposure is a specific type of cognitive behavioural therapy that teaches individuals to gradually approach trauma-related memories, feelings and situations. By facing what has been avoided, a person learns that the trauma-related memories and cues are not dangerous and do not need to be avoided. Prolonged exposure incorporates:
- psychoeducation about common trauma reactions
- breathing retraining
- in vivo and imagery exposure
- processing of thoughts and feelings related to the exposure sessions
PE is founded on the notion that: the most important thing for recovery is to face, and deal with, the memory of the traumatic event. Rather than push it into the back of the mind. PE assists to gradually face the traumatic memories, and confront situations in a safe way.