PTSD Treatment

Post-traumatic stress disorder (PTSD) does not solely impact people who have served in the military.

Anyone can inherit this condition, especially if they have witnessed or experienced a traumatic event like a serious accident, natural disaster, terrorist act, rape, or other violent assault, and war or combat, states the American Psychiatric Association (APA).

Statistics help to substantiate the prevalence of this condition.

The Anxiety and Depression Association of America (ADAA) estimates that more than 8 million Americans, age 18 and older, have PTSD. It also states that about 67 percent of people exposed to mass violence develop this condition.

The 2013 Boston Marathon bombings, when two bombs were set off about 12 seconds apart near the finish line, killing three people and injuring 264, serve as a recent example. According to a 2014 report from NBC News, a local study found that 11 percent of the children present during the attack developed PTSD.

A Phoenix-area woman, who was there to see her husband run, sat in the bleachers across the street from the spot where the first bomb detonated.

“The way that the bomb concussion came towards us and the sound echoed off the buildings, and the way that the people in front of me were kind of like swirling in hysterics,” the woman told 12 News (KPNX). “It was terrible.”

According to the report, the harrowing scene she witnessed came back to haunt her three and a half years after the bombings.

“Panic attacks, nightmares, insomnia, anxiety, depression… it was very scary,” she said.

A Deeper Look at PTSD

PTSD is generally characterized by four primary symptoms, according to the ADAA. They are:

• A reexperiencing of the traumatic event through intrusive and distressing recollections, flashbacks, and nightmares.
• Experiencing emotional numbness and avoiding places, people, and activities that remind you of the trauma.
• Feeling cut off from others and having other negative impacts to your ways of thinking, understanding, remembering, and learning. The event also affects your mood.
• Displaying marked changes in arousal and reactivity. You may find it difficult to sleep and concentrate. You may feel jumpy, easily irritated, and angered.

Symptoms typically occur within a few weeks of the trauma, but they may also not appear for several months or years, the ADAA writes.

Traumatic Events That Cause PTSD

According to the Mayo Clinic, someone experiencing any of the following traumatic events can develop PTSD:

• Childhood physical abuse
• Combat exposure
• An accident
• Being threatened with a weapon
• Sexual violence
• Physical assault

How to Know If You Have PTSD

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), considered the principal authority for psychiatric diagnoses, lists criteria to help physicians make a PTSD diagnosis.

The criteria are all required for there to be a PTSD diagnosis.

The following is a summary of that criteria, according to the DSM-5, as published by the U.S. Department of Veterans Affairs:

Criterion A (one required): The person was exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):

• Direct exposure
• Witnessing the trauma
• Learning that a relative or close friend was exposed to a trauma
• Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)

Criterion B (one required): The traumatic event is persistently reexperienced in the following way(s):

• Unwanted upsetting memories
• Nightmares
• Flashbacks
• Emotional distress after exposure to traumatic reminders
• Physical reactivity after exposure to traumatic reminders

Criterion C (one required): Avoidance of trauma-related stimuli after the trauma, in the following way(s):

• Trauma-related thoughts or feelings
• Trauma-related reminders

Criterion D (two required): Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):

• Inability to recall key features of the trauma
• Overly negative thoughts and assumptions about oneself or the world
• Exaggerated blame of self or others for causing the trauma
• Negative affect
• Decreased interest in activities
• Feeling isolated
• Difficulty experiencing positive affect

Criterion E (two required): Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):

• Irritability or aggression
• Risky or destructive behavior
• Hypervigilance
• Heightened startle reaction
• Difficulty sleeping
• Difficulty sleeping

Criterion F (required): Symptoms last for more than one month.

Criterion G (required): Symptoms create distress or functional impairment (e.g., social, occupational).

Criterion H (required): Symptoms are not due to medication, substance use, or other illness.

Two specifications:

• Dissociative Specification. In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:
  • Depersonalization. Experience of being an outside observer of or detached from oneself (e.g., feeling as if “this is not happening to me” or one were in a dream).
  • Derealization. Experience of unreality, distance, or distortion (e.g., “things are not real”).
• Delayed Specification. Full diagnostic criteria are not met until at least six months after the trauma(s), although the onset of symptoms may occur immediately.

PTSD Dangers & Risk Factors

PTSD can upend your life, including your health, relationships, work, and well-being. About 80 percent of people with PTSD will have a co-occurring psychiatric disorder throughout their lives.

The mental disorders most associated with PTSD include major depressive disorder (MDD), anxiety disorders, borderline personality disorder (BPD), and substance use disorder (SUD).

According to Everyday Health, about 46 percent of people with PTSD meet the standards for an SUD.

Substance addiction and PTSD are not only commonly linked, but the relationship is also bidirectional: PTSD is a risk factor for SUD, and SUD is a risk factor for PTSD after the trauma has occurred, Everyday Health writes.

For instance, people with PTSD are more likely to have problems with drinking, according to the Department of Veterans Affairs.

Substance use can worsen PTSD in the following ways:

• It alters your mood.
• It affects your concentration.
• It perpetuates your cycle of avoidance.
• It interferes with your sleep.

PTSD Treatment

There are therapies available to you if you are experiencing PTSD. Most PTSD therapies fall under the umbrella of cognitive behavioral therapy (CBT), a psychotherapy treatment whose aim is to change the thought or behavior patterns that drive a person’s problem or disorder.

According to WebMD, PTSD treatment has three primary goals:

• Improve symptoms
• Teach ways to cope with it
• Restore self-esteem

PTSD Therapies

The standard therapeutic approaches to treat PTSD are:

Cognitive processing therapy (CPT)

This form of treatment arrives as a 12-week course with weekly sessions between 60 to 90 minutes. You will talk about how the traumatic event and associated thoughts have impacted your life. Then you may also compose a detailed account of what happened.

Eye movement desensitization and reprocessing (EMDR)

EMDR aims to help patients think about something positive while recounting the actual trauma. With this therapy, you may be asked to concentrate on your experience while you watch or listen to something your therapist is doing, like moving a hand, flashing a light, or making a sound, says WebMD.

Prolonged exposure therapy (PE)

The goal of this therapy is to help you confront the things that remind you of the traumatic event. PE teaches breathing techniques that help to ease anxiety. You may also be asked to compose a list of things you have been avoiding and learning how to face them, one by one, according to WebMD. In another session, a therapist can have you recount the traumatic experience and, later on, have you listen to a recording of your account.

Stress inoculation training (SIT)

This type of CBT approach can be done by yourself or within a group. The goal of SIT is to transform how you deal with stress related to a traumatic event. Through SIT, you may learn breathing techniques, massage, and other techniques that serve to address negative thoughts.

Treatment Medications

According to the Mayo Clinic, several kinds of medications can improve PTSD symptoms. They are:

• Antidepressants: Selective serotonin reuptake inhibitor (SSRI) drugs like Zoloft (sertraline) and Paxil (paroxetine) are prescribed to treat symptoms of depression.
• Anti-anxiety medications: These are used to relieve severe anxiety and related issues. These medications are typically prescribed for a short time due to their abuse potential.
• Minipress (prazosin): Minipress, which belongs to a group of drugs called alpha-adrenergic blockers, treats high blood pressure. However, according to the Mayo Clinic, some studies have indicated that it is capable of reducing or suppressing nightmares in some people with PTSD. But those studies have not been corroborated.

Holistic Treatments

Yoga, massage, and meditation can help people with PTSD reduce stress and anxiety and allow them to realize mental and physical well-being, as it does with anyone who undertakes them.

According to a study published by the American Journal of Occupational Therapy (AJOT), yoga has been shown to reduce stress and enhance the mental well-being of veterans who have combat-induced anxiety.

Other holistic approaches can serve as complementary or alternative treatments that address PTSD.

According to the Acupuncture Massage College, those holistic treatments include:

• Relaxation therapy
• Reiki
• Tai chi
• Hypnosis
• Acupuncture
• Biofeedback
• Guided imagery

Sources

Guided imageryAcupuncture & Massage College. (n.d.). How to Treat PTSD Naturally. Retrieved from https://www.amcollege.edu/blog/how-to-treat-ptsd-naturally

American Psychiatric Association. (n.d.). What Is Posttraumatic Stress Disorder? Retrieved from https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

Anxiety and Depression Association of America. (n.d.). Posttraumatic Stress Disorder (PTSD). Retrieved from Anxiety and Depression Association of America. (n.d.). Posttraumatic Stress Disorder (PTSD). Retrieved https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd

CNN.com. (2019, April 10). Boston Marathon Terror Attack Fast Facts. Retrieved from https://www.cnn.com/2013/06/03/us/boston-marathon-terror-attack-fast-facts/index.html

Hendricks, T. (2018, June 27). Chandler mom opens up about battle with PTSD after witnessing Boston Marathon bombing. Retrieved from https://www.12news.com/article/news/local/valley/chandler-mom-opens-up-about-battle-with-ptsd-after-witnessing-boston-marathon-bombing/75-568129568

Mastroianni, B. (2018, April 27). 5 PTSD Comorbidities: Depression, Anxiety, Chronic Pain, More | Everyday Health. Retrieved from https://www.everydayhealth.com/ptsd/comorbidities-depression-anxiety-chronic-pain-more/

https://www.everydayhealth.com/ptsd/comorbidities-depression-anxiety-chronic-pain-more/Mayo Clinic. (2018, July 06). Post-traumatic stress disorder (PTSD). Retrieved from https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/diagnosis-treatment/drc-20355973

Mayo Clinic. (2018, July 06). Post-traumatic stress disorder (PTSD). Retrieved from https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967

National Center for PTSD. (2013, June 06). National Center for PTSD. Retrieved from https://www.ptsd.va.gov/professional/treat/essentials/dsm5_ptsd.asp

National Center for PTSD. (2018, August 05). National Center for PTSD. Retrieved from https://www.ptsd.va.gov/understand/related/substance_misuse.asp

NBC News. (n.d.). Boston Bomb Attack Triggered PTSD in Local Kids, Study Finds. Retrieved from https://www.nbcnews.com/health/health-news/boston-bomb-attack-triggered-ptsd-local-kids-study-finds-n118856

Posttraumatic Stress Disorder: PTSD [PDF File]. (n.d.). Silver Spring, MD: Anxiety and Depression Association of America. Date Retrieved from https://adaa.org/sites/default/files/ADAA_PTSD.pdf

Stoller, C. C., Greuel, J. H., Cimini, L. S., Fowler, M. S., & Koomar, J. A. (2012, January 01). Effects of Sensory-Enhanced Yoga on Symptoms of Combat Stress in Deployed Military Personnel. Retrieved from https://ajot.aota.org/article.aspx?articleid=1851541

WebMD. (n.d.). 6 Common Treatments for PTSD (Post-Traumatic Stress Disorder). Retrieved from https://www.webmd.com/mental-health/what-are-treatments-for-posttraumatic-stress-disorder#1