Post Traumatic Stress / Trauma

Overview of Post Traumatic Stress / Trauma: Trauma is an event that severely threatens our physical survival or safety or our emotional and psychological integrity and safety. A trauma is an event that frightens or shocks us, endangers our long-term well-being, causes us to fear for our life, safety, or sanity, or causes deep emotional pain, confusion, or fear. Even if our life is not in danger, if we believe it is, or if we experience very intense negative emotions for some reason, we may have the experience of trauma.

Trauma probably affects most people at some point in our lives – we may have a car accident, suddenly lose a loved-one to death, experience a criminal act (armed robbery, sexual assault, etc) be subject to serious emotional or physical abuse, live or serve in a place where war or terrorism occur, or in some other way be subject to intense fear, either for a moment or for a long period. Some people experience repeated trauma (such as victims of repeated abuse as a child, people who live in war zones, etc). Some psychologists consider birth to be an almost universally traumatizing experience for the newborn baby, who must suddenly leave the warm, dark safety of the womb for the bright, cold, relative chaos of life on Earth.

We can recover from trauma, and many people bounce back from traumas quickly and with great resiliency. Many, however, do not.

The Medical Model and Post Traumatic Stress / Trauma: The best chance of recovering quickly from trauma is to address it in the immediate aftermath. Crisis debriefing, or Critical Incident Stress Debriefing, is a form of very short-term therapy or counseling that helps people make sense of their experience and feelings, plan to cope and stay safe, and connect with resources that can help them. If you experience trauma, talking about it with a professional as soon as possible can help diminish the chances of lasting ill-affects.

However, sometimes trauma does lead to long-term difficulties. The painful or frightening event may be replayed in memories, daydreams, and nightmares. We may avoid situations or people that remind us of the trauma. We may be emotionally numb, depressed, or anxious. Sometimes, people turn to drugs to numb feelings of terror that last for weeks, months, and in some cases, years after a trauma. If you experience such feelings, thoughts, or behaviors after a trauma, know that such experiences are very human and nothing to be ashamed of.  Trauma is more and more common in the United States military due to the current military engagements, and many soldiers seek help to deal with thoughts and feelings that result in being injured, watching fellow soldiers be injured or killed, killing opposing soldiers, or simply from experiencing the intense danger of war. Trauma can be treated, even long after the traumatic event. One very promising treatment is Eye Movement Desensitization and Reprocessing. Other forms of therapy can be helpful as well.

Diagnostic and Statistical Manual of Mental Disorders (DSM): Post Traumatic Stress Disorder is diagnosed in certain cases. The following is the 309.81 DSM-IV Criteria for Posttraumatic Stress Disorder:

A. The person has been exposed to a traumatic event in which both of the following have been present:

(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.

B. The traumatic event is persistently reexperienced in one (or more) of the following ways:

(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.

(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.

(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.

(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma

(2) efforts to avoid activities, places, or people that arouse recollections of the trauma

(3) inability to recall an important aspect of the trauma

(4) markedly diminished interest or participation in significant activities

(5) feeling of detachment or estrangement from others

(6) restricted range of affect (e.g., unable to have loving feelings)

(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

• difficulty falling or staying asleep

• irritability or outbursts of anger

• difficulty concentrating

• hypervigilance

• exaggerated startle response

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than one month.

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:

Acute: if duration of symptoms is less than 3 months 
Chronic: if duration of symptoms is 3 months or more
With Delayed Onset: if onset of symptoms is at least 6 months after the stressor

Case Examples of Post Traumatic Stress:

Ricky, 24, has recently returned from Iraq where he saw combat. He says he was doing fine until last week, when a robbery occurred in a local store while he was there. Suddenly, memories of combat flooded his senses, and he was paralyzed by them. Now he has nightmares about Iraq, but images of home get “mixed up in there.” Not only does Ricky feel overwhelmed and anxious about these flashbacks, he feels guilty for surviving while two of his friends did not, and guilty for not stopping the robbery at home. Talking about his feelings helps somewhat; focusing on ways to stay safe helps as well. Ricky’s guilt is addressed by exploring the choices Ricky has made and their motivations. Ricky’s beliefs about what it means to be a man, and his high expectations of himself are also explored. The therapist helps Ricky make peace with his own mortality, and teaches Ricky relaxation skills. Ricky asks for a psychiatric referral, and takes anti-anxiety medications to sleep a few times a week. He is also referred to a support group. A year after his first visit, he is no longer taking medications, and is feeling more hopeful, though he still struggles at times with intense grief about the war.

Patricia, 39, is a highly anxious person. A full history reveals severe abuse as a child, which Patricia is reluctant to revisit. The therapist allows several sessions to go by before bringing it up again, and when she does, Patricia becomes very upset and angry. Patricia finally agrees that her reaction indicates the abuse is still “dogging” her, and she agrees to a referral for EMDR. The EMDR process helps her being a real recovery from the abuse, and her anxiety diminishes considerably.

Therapy for Post Traumatic Stress / Trauma: There is a wide range of Psychotherapy Treatment Models or types of therapy used in the treatment of post traumatic stress and trauma. Most of these approaches fall into three historic camps of psychology: Psychoanalytic / Psychodynamic approaches; Behaviorism and; Humanism. Regardless of the type of therapy, there are some generally agreed upon elements of healthy therapy which are universal to all forms of psychotherapy. Before beginning therapy for trauma or any other issue, it is helpful to familiarize oneself with these elements.

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