Trauma and PTSD
Trauma is a distressing event in which a person feels severely threatened emotionally, psychologically, or physically. Most people will experience a traumatic event at some point in their lives, such as a car accident, abuse or neglect, the sudden death of a loved one, a violent criminal act, exposure to the violence of war, or a natural disaster. Many people recover from trauma with time and through the support of family and friends, bouncing back with great resiliency, but for others, the effects of trauma are lasting, causing a person to live with deep emotional pain, fear, confusion, or posttraumatic stress far after the event has passed. Often, the support, guidance, and assistance of mental health professionals is fundamental to healing from trauma.
What Is Posttraumatic Stress (PTSD)?
Posttraumatic stress is the psychological reaction to a severely stressful and physically threatening event that often results in anxiety, flashbacks, hypervigilance, depression, suicidal ideation, and other mental health concerns for an extended period of time. People who experience PTSD may continue to feel afraid or anxious even when no danger is present.
Studies indicate that 3.5% of the U.S. population will experience PTSD in any given 12-month period, and almost 37% of these cases can be classified as “severe.” Although men are statistically more likely to experience traumatic events than women, women are more than twice as likely to develop PTSD than men, perhaps due to the fact that sexual assault leads to PTSD more frequently than do other forms of trauma, and women experience sexual assault at higher rates than men do.
Diagnosis and Symptoms
PTSD can develop from a variety of traumatic incidents, from natural disasters to sexual assault. According to the Diagnostic and Statistical Manual, 5th edition (DSM-5), to be diagnosed with PTSD, a person must have experienced or witnessed a traumatic, physically threatening event or have learned that a traumatic event happened to a close friend or family member, and display specific symptoms for at least one month. Four types of symptoms are listed in the DSM-5:
- Avoidance Symptoms:
- Avoiding specific locations, sights, situations, and sounds that serve as reminders of the event
- Anxiety, depression, numbness, or guilt
- Re-experiencing Symptoms:
- Intrusive thoughts, nightmares, or flashbacks
- Hyperarousal Symptoms:
- Anger, irritability, and hypervigilance
- Aggressive, reckless behavior, including self-harm
- Sleep disturbances
- Negative Mood and Cognition Symptoms:
- Loss of interest in activities that were once considered enjoyable
- Difficulty remembering details of the distressing event
- Change in habits or behavior since the trauma
Therapy for Trauma and PTSD (Including treatment offered by Prive-Swiss professionals)
Psychotherapy is the most effective form of treatment for healing from the effects of trauma. Therapy or counseling can help people who have experienced trauma and those diagnosed with PTSD make sense of their experiences and feelings, develop plans to stay safe, learn healthy coping skills, and connect with other resources and support.
The types of therapy that are most commonly used and recognized for their effectiveness in trauma treatment are cognitive behavioral therapy and eye movement desensitization and reprocessing (EMDR). Other forms of therapy that have been clinically tested include mindfulness-based cognitive therapy, psychodynamic therapy, hypnotherapy, and exposure therapy. Adjunctive therapies may be used, such as group therapy or art/expressive therapy, the goal of which is to heal through addressing the existential questions that arise in the aftermath of trauma and to discover meaning in life.
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR is a psychotherapy that enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences. Repeated studies show that by using EMDR therapy people can experience the benefits of psychotherapy that once took years to make a difference. It is widely assumed that severe emotional pain requires a long time to heal. EMDR therapy shows that the mind can in fact heal from psychological trauma much as the body recovers from physical trauma. When you cut your hand, your body works to close the wound. If a foreign object or repeated injury irritates the wound, it festers and causes pain. Once the block is removed, healing resumes. EMDR therapy demonstrates that a similar sequence of events occurs with mental processes. The brain’s information processing system naturally moves toward mental health. If the system is blocked or imbalanced by the impact of a disturbing event, the emotional wound festers and can cause intense suffering. Once the block is removed, healing resumes. Using the detailed protocols and procedures learned in EMDR therapy training sessions, clinicians help clients activate their natural healing processes.
More than 30 positive controlled outcome studies have been done on EMDR therapy. Some of the studies show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions. Another study, funded by the HMO Kaiser Permanente, found that 100% of the single-trauma victims and 77% of multiple trauma victims no longer were diagnosed with PTSD after only six 50-minute sessions. In another study, 77% of combat veterans were free of PTSD in 12 sessions. There has been so much research on EMDR therapy that it is now recognized as an effective form of treatment for trauma and other disturbing experiences by organizations such as the American Psychiatric Association, the World Health Organization and the Department of Defense. Given the worldwide recognition as an effective treatment of trauma, you can easily see how EMDR therapy would be effective in treating the “everyday” memories that are the reason people have low self-esteem, feelings of powerlessness, and all the myriad problems that bring them in for therapy. Over 100,000 clinicians throughout the world use the therapy. Millions of people have been treated successfully over the past 25 years.
Dialectical Behavior Therapy (DBT)
Dialectical Behavior Therapy (DBT) is a structured form of Cognitive Behavioral Therapy (CBT) that helps people build practical coping skills for managing traumas and regulating emotional highs and lows. It focuses on changing negative thoughts, behaviors, and beliefs to help people manage their emotions.
Extreme emotions often come as a result of experiencing trauma, which can manifest in relationships with spouses, friends, family, and others. When trauma goes unresolved, emotions can run higher and faster than they typically would.
DBT can include mindfulness meditation skills, help with managing interpersonal relationships, learning different ways to handle and tolerate stress, and learning how to regulate emotions.
Yoga and Tai Chi
Yoga and Tai Chi can help individuals soothe an over-stimulated nervous system and reconnect to their body. Research shows it can support healing conditions like sleep disorders and depression.
Acupuncture – with this therapy thin needles are inserted into the body to regulate the flow of energy. Acupuncture corrects imbalances in the flow of qi by stimulating pressure points.
There are preliminary positive findings for acupuncture in the treatment of chronic anxiety associated with PTSD. A systematic review of acupuncture for PTSD found that the evidence of effectiveness is encouraging (Kim 2013): all four reviewed randomised controlled trials (RCTs) indicated that acupuncture was equal to or better than orthodox treatments, or that it added extra effect to them when used in combination. Three of the four are Chinese studies that used earthquake survivors and one similar RCT (Wang 2012) was too recent to be included in the review. It found that both electroacupuncture and paroxetine resulted in significantly improved scores for PTSD, but that the improvement was greater with electroacupuncture. There is also some evidence that the acupuncture effects may continue for at least a few months after the treatment course is finished (Hollifield 2007).
A review that looked at the effects of combining brief psychological exposure with the manual stimulation of acupuncture points in the treatment of PTSD and other emotional conditions found evidence suggesting that tapping on selected points during imaginal exposure quickly and permanently reduces maladaptive fear responses to traumatic memories and related cues (Feinstein 2010).
Kim’s review (Kim 2013) also included two uncontrolled trials (they too had positive outcomes). A more recent uncontrolled pilot study found that acupuncture appeared to be a therapeutic option in the treatment of sleep disturbance and other psycho-vegetative symptoms in traumatised soldiers (Eisenlohr 2012).
Although more high quality trials are needed to substantiate these results, the overall evidence does lie promisingly in a positive direction, and, given the very low level of side effects and lack of demonstrably superior outcomes from other interventions, acupuncture could be considered as one possible therapeutic option alongside the existing repertoire. (See table overleaf)
In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body’s homeostatic mechanisms, thus promoting physical and emotional well-being.
Research has shown that acupuncture treatment may specifically benefit anxiety disorders and symptoms of anxiety and stress by:
- Acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for anxiety and worry (Hui 2010);
- Regulating levels of neurotransmitters (or their modulators) and hormones such as serotonin, noradrenaline, dopamine, GABA, neuropeptide Y and ACTH; hence altering the brain’s mood chemistry to help to combat negative affective states (Lee 2009; Zhou 2008);
- Stimulating production of endogenous opioids that affect the autonomic nervous system (Arranz 2007). Stress activates the sympathetic nervous system, while acupuncture can activate the opposing parasympathetic nervous system, which initiates the relaxation response;
- Reversing pathological changes in levels of inflammatory cytokines that are associated with stress reactions (Arranz 2007);
In some cases, medications, such as anti-depressants, anti-anxiety medications, and mood stabilizers, are employed to help manage the more challenging symptoms of post traumatic stress.