Advances in PTSD Treatment
Although it has been around for a long time, Post Traumatic Stress Disorder (PTSD) gained national recognition in recent decades in the mainstream news media. Most people became familiar with the disorder from news stories of violent behavior or suicide being triggered by PTSD.
Like other aspects of war, PTSD has been portrayed in movies as one of the sad consequences. Media depictions of soldiers coming home from combat and facing night terrors, depression, suicide and unexplained violent behavior branded PTSD a military disease for many. But trauma is not just in war, and PTSD is not limited to people in uniform.
Expanding our understanding of PTSD, its definition and causes has increased treatment options. Once believed to resolve on its own, PTSD can now properly be diagnosed and overcome with treatment. As mental health research continues, new treatments are developed for disorders that were once considered incurable.
To understand PTSD and its treatment options, you have to begin by understanding trauma and its effects on the brain. Trauma is defined more by the emotional response than by the actual event. We can make a list of events we expect would be traumatic, like an accident, assault or natural disaster, but the individual’s response to witnessing these is what defines trauma.
Some people are able to process certain events without a severe emotional response. This is different, of course, from withholding emotions. Someone who doesn’t cry is not necessarily immune to trauma — he may be experiencing other symptoms and not realize their connection. Other people may have a lower tolerance for stress and could experience the symptoms of trauma with a less severe incident.
Every experience you have requires processing. That means you have to work through the thoughts and feelings brought on by a traumatic event. Most of the time, you do this processing automatically, unless there is an abundance of emotion attached to it. If you avoid emotions, they will find another way to get your attention, like maybe through physical symptoms. But everyone has to process their thoughts and emotions to move past them.
Trauma, addiction and other mental illnesses are not fully understood yet. For example, we do not know exactly why some people can drink alcohol and not develop an addiction while others are addicted after trying it just once. Individuals can display much different thresholds for pain, addiction and traumatic response, and we are not able to map or predict these.
Trauma and Mental Health
We have established, however, a direct connection between trauma and mental health. Childhood trauma, for example, is linked to learning and behavioral problems as well as obesity and addiction later in life. There doesn’t have to be a direct connection between the type of trauma and the long-term effects, either. A victim of sexual abuse may end up using drugs later in life to escape the emotional pain and become an addict without knowing exactly what the root cause is. But in order to overcome the addiction, that person will have to process the emotions surrounding the trauma.
These statistics about trauma in our society are staggering:
- 60% of Americans experienced some type of abuse while they were growing up
- Currently, one out of ten children has received an injury from an assault
- At least 13% of children have been the victim of physical bullying
- Each year, one out of every five children witnesses violence at home or in the streets
- By age 17, more than 60% of children have been exposed to crime, violence and abuse
- By the age of four, 26% of American children have witnessed or been part of a traumatic event
These statistics are even more concerning when you consider the connection between trauma and mental illness. Experiencing a trauma makes people more likely to:
- Inject drugs
- Attempt suicide
- Experience depression
- Contract a sexually transmitted disease
- Abuse alcohol
- Develop chronic diseases
- Be absent from work
- Take antidepressants
- Have serious financial problems
Experiencing trauma makes you 15 times more likely to attempt suicide and makes you three times more likely to develop depression. A trauma survivor is four times more likely to become an alcoholic than someone who’s never experienced a trauma. And trauma survivors are three times as likely to have serious problems holding a job.
The link between trauma and mental illness can be traced back to the complicated workings of the brain. The brain, like the body, is designed to protect itself. Events that are too terrible to recall are often forgotten. The extreme emotions associated with traumatic events can be too much to process all at once, so recall is often staggered. Your brain works to protect you from pain, but eventually all emotions have to be felt and understood.
PTSD Treatment for Veterans
Soldiers from the beginning of the civilized world have shown signs of mental illness as a result of their experiences in battle. The reaction to their afflictions was mostly fear and disgust. People who had never gone to war assumed soldiers were crazy in the first place, and their post-war behavior was just a manifestation of prior illness. With the end of each modern war came a whole new group of soldiers whose battle scars were invisible.
Throughout the 20th century, attempts were made to understand the psychological effects of warfare. At the end of World War I, the term was “shell shock,” which was believed to be a result of all the loud noises on the battle field. The recognition that soldiers who were not near the big guns in battle were also experiencing the same symptoms led to the broader term “war neuroses.”
The World War II names for the condition many soldiers came home with were Combat Stress Reaction and “battle fatigue.” By the 1950s, the American Psychiatric Association was attempting to document what they referred to as “gross stress disorder” and suggested possible treatment. The early definitions of the disorder considered it to be a short-term condition, and the possible causes were limited to suicidal thoughts with unwanted pregnancy, fear of combat in military personnel and mental confusion of prisoners awaiting death. The main treatment for military personnel involved removing the soldier from combat, allowing him to rest and convincing him the problem would resolve itself so he could return to combat.
In the 1980s, PTSD was officially added to the Diagnostic and Statistical Manual of Mental Disorders and recognized by a broader set of criteria. While the traumas of war led the charge to understand this disorder, research involving survivors of the Holocaust, sexual assaults and other traumatic events helped widen the diagnosis and search for an effective treatment.
Recognizing the commonality between war and other traumas and the prevalence of trauma in our society, PTSD is far more common than originally believed. Approximately 60% of men and 50% of women will experience at least one trauma in a lifetime. Sexual assault and child sexual abuse are more common in the female experience, while men are more likely to be involved in physical assaults, disasters or accidents, or witness a death.
At some point in their lives, approximately 7-8% of Americans will suffer from PTSD. Approximately 8 million adults are diagnosed with PTSD each year. A larger percentage of women develop PTSD than men — 10% compared to 4% respectively. The rates of PTSD are relatively low considering the rates of trauma in our society.
Who Gets PTSD?
It is clear people in military service are frequently exposed to trauma and therefore more likely to get PTSD than the average population. Rates of PTSD diagnosis vary based on the era of service. Veterans of the Vietnam War were diagnosed with PTSD at a rate of about 15 out of every 100. During the Gulf War, 12 of every 100 veterans developed PTSD. In the more recent conflicts in Iraq and Afghanistan, the range of PTSD diagnosis was from 11% to 20%.
Not everyone who suffers a trauma or witnesses a traumatic event develops PTSD. Trauma sufferers are more likely to get PTSD if they:
• Thought they were in danger
• Were seriously injured in the incident
• Reacted severely during the event with shaking, vomiting or crying
• Were a victim or witness to the trauma
• Experienced a feeling of helplessness during the event
• Thought a family member was in danger
Certain demographics also put you at greater risk for developing PTSD as a result of trauma. Some of these conditions are within your control, and some are not. Women are more susceptible to PTSD than men, and younger people are more at risk than older adults. Also at increased risk are people who have:
• Mental health issues
• A loss of a loved one
• Drinking problems
• Recent and stressful life changes
• Little support from friends and family
• Childhood traumas
There is also evidence that African Americans, Hispanics and Native Americans develop PTSD at a greater rate than other ethic groups. This statistic could be explained by the fact that these groups of people are more likely to experience trauma, the number one trigger for PTSD.
Symptoms of PTSD can appear immediately following the trauma or not show up until months or years later. It is possible to experience a trauma with no PTSD and then experience a similar situation and develop PTSD right away. The difference is in the variables that make up your vulnerability, like your state of mind when it happens, and those variables can shift over time.
People who have PTSD experience a range of symptoms including:
• An emotional numbness that makes them pull away from people and relationships
• A heightened sense of danger all around
• An avoidance of people or places reminiscent of the trauma
• Vivid memories of the event that evoke the same or a worse feelings of fear
• Inability to talk about the trauma
• Unexplained physical symptoms
• Uncontrollable emotionality
Cognitive Behavioral Therapy for PTSD Treatment
Treatment for PTSD usually involves psychotherapy or counseling. The formal name for this type of treatment is Cognitive Behavioral Therapy (CBT), but it is often referred to as talk therapy. CBT involves talking with a therapist in his or her office once a week for at least four months. CBT does not involve any physically invasive procedures or medication. On the surface, it just looks like a conversation.
Cognitive Processing Therapy (CPT) is a form of CBT that is frequently used for PTSD. One of the most prevalent experiences of people with PTSD is being stuck. They continually relive the events of the trauma and try to make sense of what happened. Since they cannot figure anything out, they repeat the exercise over and over again.
Each time a person with PTSD relives the events, they experience the emotions all over again. Because the person is not able to process the emotions, they continue and even intensify, doing further damage to mental well-being.
CPT helps you understand what happened and how the trauma effected you, not only physically, but mentally and emotionally. People who have been through trauma gain a different perspective on life, and sometimes that change is difficult to accept. CPT attempts to change the way you think about the trauma, so your feelings about it change as well.
CPT helps people begin by recognizing the thoughts and feelings that are associated with the trauma. Then it teaches cognitive restructuring, a way of changing those thoughts. Understanding that everyone who experiences trauma also undergoes certain changes in their thought process helps to release some of the emotions. Using logic to adjust the thought patterns surrounding the incident allows a person with PTSD to get unstuck and move past the trauma.
Prolonged Exposure Therapy
Another type of CBT that is often used to treat people suffering from PTSD is Prolonged Exposure Therapy (PE). PE deals with the avoidance factor involved for some with PTSD. By helping you realize you do not have to avoid remembering the traumatic event, PE allows you to work through the emotions and move on with your life.
In some cases of PTSD, the thoughts and emotions related to the trauma are not being processed because of avoidance. The fear and anxiety of remembering the event and feeling the associated emotions is so great that it is blocking the brain from any recollection. People experiencing this type of PTSD avoid any places or people who might remind them of what happened.
The problem is emotions need to be felt in order for them to fade away. When they are not felt, they remain just as sharp as when the event happened. PE teaches people about the symptoms they are feeling and shows them how to relax to manage anxiety. Then it exposes them to situations they have been avoiding and shows them how to reduce their stress. Finally, PE allows people with PTSD to work through the trauma and address the thoughts and feelings that arise.
EMDR for PTSD Treatment
In 1987, Francine Shapiro developed Eye Movement Desensitization and Processing (EMDR) as an effective therapy for PTSD. She discovered a connection between lateral eye movement and emotional desensitization. The actual physiological explanation for this phenomenon is not yet understood, but the changes in thought patterns elicited have been documented.
According to Shapiro, it is the extreme emotions associated with trauma that keep people from processing their feelings about the event. EMDR reduces the emotional impact of nightmares, flashbacks and other forms of anxiety, so the traumatic event can be dealt with and the client can move past it.
One of the benefits of EMDR is that it does not take as long as traditional CBT therapies. With EMDR, the extreme emotional stress of trauma can be reduced quickly and without discussing the event itself. Once the client learns to manage emotional stress, the trauma can be processed more quickly and with less pain.
Although EMDR is a relatively new therapy that strays from the conventional wisdom of talk therapy, it shows promising results. There are already over 20,000 therapists trained in EMDR helping thousands of clients overcome PTSD.
There are studies that show EMDR was 77-90% effective in eliminating PTSD after three to seven sessions. EMDR creates significant symptom decrease in most PTSD cases in the first two sessions. An 84% remission of PTSD was documented by one study at the 15-month follow-up mark.
Future PTSD Treatment Methods
Research continues into the causes of PTSD and new treatment options. As we learn more about the intricate workings of the brain, new treatment methods continue to be developed.
Technology is one thing being used to develop new PTSD treatment options. Virtual reality holds some promise for enhancing treatment options. A lot of PTSD treatment relies on visualization, and not everyone is good at that. Virtual reality could increase the effectiveness of the visualization process by making it more tangible. Using computer-generated images, for example, might speed up the connection between event memories and emotions.
The internet could also become an effective tool for fighting PTSD. Through enhanced communication technologies, different types of therapies could be administered via the internet when a qualified therapist is not nearby. This method would extend the reach of therapy programs and service clients in remote locations without requiring travel. For many who suffer from PTSD, certain forms of travel are part of their trauma and therefore evoke unbearable memories.
How to Seek Treatment for PTSD
If you suspect you are suffering from PTSD, it is important to get treatment right away to reduce your pain and eliminate the risk of any dangerous behavior. PTSD is one of the mental illnesses we treat at 12 Keys. Treatment for PTSD can resolve your problem and make you more resilient to future traumas.
Contact 12 Keys today to learn more about our individualized approach to PTSD treatment. We offer an array of treatment modalities to fit your needs because not everyone comes from the same place. PTSD is not just a military disorder anymore. We recognize there are a lot of trauma situations in daily life that could cause your PTSD. Each case is separate and unique, which is why we provide our clients with individual counseling.
At 12 Keys, we work with you to develop a treatment plan that includes all the treatment modalities that are right for you. With all of our practitioners available on site, we can remain flexible in our treatment options. Frequent assessments allow us to change your program to meet your changing needs as you progress.
For people suffering from addiction and PTSD, dual diagnosis treatment is available. We recognize the importance of treating addiction and the underlying mental illness at the same time to achieve the best overall outcome. Call 12 Keys today to learn about the many treatment options we have available and how we can help you overcome addiction, resolve PTSD and build a happy, healthy life.