Post Traumatic Stress Disorder

WHAT IS PTSD?

Symptoms of Posttraumatic Stress Disorder (PTSD) are most commonly presented in individuals who witnessed or were exposed to an event that caused them emotional or physical distress, causing them to respond with intense fear, helplessness or horror. Individuals who qualify for a PTSD diagnosis have been known to previously experience events such as personal violence (ex. sexual assault), military combat, kidnapping, terrorist attacks, torture, incarceration as a POW, natural or manmade disasters, severe auto accidents, or diagnosis with a life-threatening illness (DSM IV-TR, p. 463–464). Additionally, onset time varies; some people suffer from acute onset in which the symptoms last for only approximately three months. PTSD is defined as chronic when the symptoms are present for more than three months, and Delayed Onset is when the symptoms of PTSD are manifested only after six or more months have passed since the traumatic event occurred (DSM IV-TR, p. 465).

HOW PTSD IS MANIFESTED?

According to the Diagnostic and Statistical Manual of Mental Disorders IV-TR or DSM (2000), symptoms of this disorder are manifested in three forms. All three symptom categories must be present for at least one month in order to warrant this diagnosis, and may present themselves instantly, or 6 months or more after the traumatic event has occurred:

• The traumatic event is persistently re-experienced in the form of thoughts, dreams, the re-living of the experience, psychological distress, or physiological reactivity upon exposure to things that symbolize or resemble an aspect of the event itself.

• Avoidance of stimuli associated with the traumatic event, as seen in efforts to avoid thoughts, feelings, or conversation associated with the event, avoid activities, people or places that remind them of the event, the inability to recall pertinent portions of the event, a decreased interest in previously enjoyed activities, detachment or estrangement from other people, restricted affect, and the expectation of restricted future (cannot view emselves as marrying, having a career, etc).

• Persistent increased arousal manifested by difficulty in sleeping, irritability or outbursts of anger, difficulty in concentration, hypervigilance, or an increased startle response.

Symptoms of PTSD can also be manifested in what are known as Maladaptive Patterns of behavior. As mentioned in Crisis Intervention Strategies, there are five common patterns seen in the behaviors of those with PTSD (James, 2008, p. 138–139). They are:

• Death Imprint: where “the normal boundary between living and dying is suspended… the only way they have of testing the boundary between life and death is to seek sensation, even if it means danger and physical pain.”

• Survivor’s guilt: thoughts such as “I should have been the one to die, instead of _____”, or “If I had just done this or that, it (the trauma) wouldn’t have happened.”

• Desensitization: they can become desensitized to traumatic events and can feel badly or have fear regarding the feeling of “pleasurable responses to physical violence” they may have against others.

• Estrangement: most frequently this can be seen to affect relationships in negative ways such that they can have little or no meaning, they can have feelings that other people just do not understand what they have gone through, feelings of victimization, and negative intimacy experiences.

• Emotional enmeshment: those suffering with PTSD have a difficult time moving past their traumatic experiences and struggle “to find any significance in life.” Many struggle with depression, anger and substance abuse, which can negatively affect their relationships.


WHAT CAN CLERGY DO?

Those struggling with PTSD need clinical help, but there are some things clergy can do until help is available. Consider these, from the National Institute of Mental Health (2009), when assisting those with PTSD:

• Educate yourself about the symptoms of PTSD (listed above in How PTSD is Manifested), so you can be aware when someone is struggling.

• Recognize that it is a real problem which can be very difficult to deal with.

• Offer emotional support, understanding, patience and encouragement.

• Talk to them about what they are experiencing and listen carefully.

• Invite the person to engage in positive distractions such as outings, getting fresh air and other activities.

• Remind them with time that they can receive treatment and get better.

As stated in the previous section, realize when you need to refer out. PTSD is a difficult issue for individuals to deal with, and by showing empathy and active listening, you can greatly help the individual to better cope and recover from PTSD.

TREATMENT

There are various forms of treatment for those suffering with PTSD. Some of these are mentioned below, however the most effective types are that of Cognitive therapy and Drug Therapy (Treatment of PTSD, n.d).

• Cognitive Behavioral Therapy: this focuses on the idea that if a behavior is learned, it an be unlearned. A therapist will work with a client to help them learn new responses to old situations.

• Exposure Therapy: this therapy puts the client in direct contact with the situation they are trying to avert. This exposure comes on slowing and progressively, or can be done with immediate intensity. The idea is to disprove believes about the situation.

• Drug Therapy: this is used to deal with certain receptors in the brain that can cause anxiety. This is usually not a cure, but a helpful method of beginning to stabilize a person.

• Group Therapy or Family Therapy: Therapy in a group can help to normalize their feelings. It can offer the person support, help them deal with their issues openly in a safe environment.

• Brief Psychodynamic Psychotherapy: Short-term therapy used to deal with specific issues. It acts as a kind of one issue therapy, where the focus is on small gains made in one area of functioning.


RESOURCES

The Utah State VA Blog and Suicide Hotline
http://utahstatevablog.blogspot.com/2007/11/va-suicide-hotline.html

Neurofeedback Training for PTSD
http://utahcountyneurofeedback.blogspot.com/2008/05/neurofeedback-training-for-ptsd.html

National Institute of Mental Health. (2009). Post-Traumatic Stress Disoder (PTSD).
Retrieved March 30, 2009, from http://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-ptsd/index.shtml