Cognitive-Behavioural Therapy

© 2009 by John D. Moore with www.mychicagotherapist.com

What is PTSD?

PTSD is the acronym for a clinical condition known as Post Traumatic Stress Disorder. PTSD is an anxiety disorder that can occur after you have been through a traumatic event. Typically, the traumatic event is one in which the fear for your life or the life of another person. Commonly, others who have been diagnosed with PTSD report that they felt as if they had no control over what was happening or the situation they were involved with. 

According the United States Department of Veterans Affairs, anyone can develop PTSD (National Center for PTSD, 2009). These events can include: 

How does PTSD Develop?

People who live with PTSD have survived a life threatening or traumatic event. Not everyone who experiences this however will develop PTSD. How likely it is that you will develop PTSD depends on a variety of factors, including the intensity of the trauma, if you lost someone close to you, how much support you received after the event and many other factors. 

What are the symptoms of PTSD?

According to the National Center for PTSD, there are four symptoms that are strongly related to Post Traumatic Stress Disorder. These four symptoms are: 

What treatments are available for PTSD?

According to the National Center for PTSD: “When you have PTSD, dealing with the past can be hard. Instead of telling others how you feel, you may keep your feelings bottled up. But treatment can help you get better. There are good treatments available for PTSD. Cognitive-behavioral therapy (CBT) is one type of counseling. It appears to be the most effective type of counseling for PTSD. There are different types of cognitive behavioral therapies such as cognitive therapy and exposure therapy. A similar kind of therapy called EMDR, or eye movement desensitization and reprocessing, is also used for PTSD. Medications can be effective too. A type of drug known as a selective serotonin reuptake inhibitor (SSRI), which is also used for depression, is effective for PTSD”.

 Source: (2009) National Center on PTSD. What is PTSD? Retrieved from the web at: http://www.ptsd.va.gov/

To learn more about PTSD and other forms of anxiety visit www.mychicagotherapist.com

All people experience stressful events which can affect them emotionally and physically. Our reactions to stress are usually brief, and most of us recover without any further problems. However, if you have experienced a catastrophic event, you may find that you have developed signs of ongoing problems, known as posttraumatic stress disorder (PTSD).
In PTSD, the stressful or traumatic event may have involved a situation where your life may have been threatened, severe injury had occurred or you may have been the victim of or a witness to physical abuse, sexual abuse or a particularly violent act. Or, you may have been involved in a life-threatening automobile accident or natural disaster or perhaps you were diagnosed with a life threatening illness.
Your risk of developing PTSD is related to the traumas seriousness, whether it has been repeated and your proximity to it. You may initially show agitated, anxious or confused behavior. You also may have experienced intense fear, feelings of helplessness, anger, sadness, or revulsion, horror or denial.
If you have experienced repeated trauma, you may have developed a sense of emotional numbing which serves to deaden or block the pain of the trauma. This is called dissociation and you may find yourself avoiding situations or places that remind you of it.
You may also have become less responsive emotionally, depressed, withdrawn or more detached from your feelings. It is also possible that you could emotionally re-experience the traumatic event by:
Having frequent memories of it or dreams in which some, or the entire trauma is repeated over and over,
Having upsetting and frightening thoughts that will not go away,
When reminded of the event, you may experience the same physical or emotional symptoms.
If afflicted with PTSD you may also show the following:
Anxiety about dying at an early age,
A loss of interest in activities,
Physical symptoms, such as headaches or backaches,
The displaying of emotional reactions that are more sudden and extreme,
Problems falling or staying asleep,
Irritability or angry outbursts,
Problems concentrating or focusing,
Signs of hyper vigilance meant to prevent the occurrence of other dangerous events,
Or, the repeating of behaviors that reminds you of the trauma.
Symptoms of PTSD may last from several months to many years. The best approach is prevention of the trauma. However, once it has occurred, early intervention is essential.
Support from family is important and emphasis needs to be placed upon establishing feelings of safety. Psychotherapy (individual, group, or family) which allows you to speak or write about the trauma is helpful.
Behavior modification techniques and cognitive therapy may help reduce your fears and anxieties. Medication may also be useful to deal with any agitation, anxiety, or depression you may experience.
Clinical psychologists can be very helpful in diagnosing and treating PTSD. With the sensitivity and support of families and professionals, you can learn to cope with the memories of the trauma and go on to lead a normal life.

Although childhood abuse and sexual abuse is a common cause of PTSD, other events which cause psychological trauma can also trigger the disorder. These include life threatening accidents, wars or natural disasters. Post traumatic stress disorder (PTSD) refers to the delayed reaction, sometimes for longer than 6 months, to a highly stressful or life threatening event. Often the causes for PTSD are myriad and distasteful, and more than 40 million women in America suffer from it.
PTSD usually occurs following a stressful or traumatic event that is highly severe, and often survivors and witnesses of such events will only start showing symptoms of PTSD after a few months. The reasons for this would be due to the event being perceived as dangerous and outside of the individual’s control, leading to feelings of helplessness and extreme anxiety.
Due to the severity of the event or disaster, the inability of the person to avoid or cope with the trauma is such that it results in PTSD. Due to the immense negative impact, the person will avoid any situation or trigger that might remind them of the event. Whilst it has been attributed to internal conflict, recent research has shown that these psychological conditions are actually due to past traumatic events. Further, it is likely that the extreme stress experienced during the event has resulted in physical damage to the hippocampus, the part of the brain that deals with the emotions of fear and stress.
Any spur of events occurring can trigger manifestations and he will suffer from the traumatic event both physiologically and psychologically. There will be repeated flashbacks of the event, and being subjected to this experience will cause a behavioral change eventually. Taken from the forms of amnesia, a need to isolate themselves and listlessness.
For children suffering from PTSD, they are likely to experience nightmares, memory fragmentation, hypertension, flashbacks, amnesia, panic attacks and some may turn to substance abuse to avoid memories of the event. Most victims will suffer from a range of effects, such as physiological, psychological, social and self destructive behaviors.
Physiological outcomes take the form of a change in the brain activity, structure and functioning, also known as neurobiological effects. There may also by psychophysiological effects, such as hyper arousal, increased propensity to be startles and increased neurohormonal changes which leads to greater stress and depression. It is often easy to overlook physiological outcomes as they take the form of physical issues such as headaches or lightheadedness and are treated accordingly.
Psychological outcomes include depression, anxiety disorders, eating disorders and dissociation, where the individual seeks to hide from the present by submerging into their selves. Other social indicators include low self esteem, substance abuse and an inability to form interpersonal relationships. At its extreme, the individual may turn to self destructive behavior and attempt suicide, or take part in self injury and risky behaviors that can lead to death.
There are options from medications and therapy when it comes to dealing with PTSD. These aim to correct the physical, physiological and psychological effects experienced and aim to integrate the person back into their current lives.

Over the past decade, as I have worked with cops, firfighters, abuse victims and children of addicts, I have learned that there are many causes for PTSD. It has also affirmed my belief that PTSD is real and harmful, not only to those who have it, but also to those around them. It impacts the way we act, react, our motivation and our capacity to feel–well, anything.
Terrifying experiences that shatter people’s sense of predictability and invulnerability can profoundly alter their coping skills, relationships and the way they perceive and interact with the world. The criteria for Post Traumatic Stress Disorder (PTSD) are 1) exposure to a traumatic event(s) in which the person witnessed or experienced or were 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, and 2) the person’s response involved intense fear, helplessness or horror DSM IV p. 427-28). Gradual Onset Traumatic Stress Disorder can be caused by repeated exposure to “sub-critical incidents” such as child abuse, traffic fatalities, rapes and personal assaults.
Nevertheless, not all people exposed to trauma are “traumatized.” Why? In 1998, Pynoos and Nader proposed a theory to assist in explaining why people have different reactions to the same event. They asserted that people are at greater risk of being negatively impacted by traumatic events if any of the following are present: 1) they have experienced other traumatic events within the preceding 6 months, 2) they were already stressed out or depressed at the time of the event, 3) the situation occurred close to their home or somewhere they considered safe, 4) the victims bear a similarity to a family member or friend and 5) they have little social support.
It has been argued that officers, emergency service personnel, children of addicts and abuse victims experience traumatic events or threats to their safety on an almost daily basis. Being abused, not knowing when or if your parents will come home, repeatedly seeing children murdered, people burned in car fires and devastated victims starts to take its toll. People like idealistic officers who joined the force to change the world and protect the innocent begin to feel like nothing they do makes a difference, they cannot even keep their zone safe (criteria 3). This is especially problematic for officers who live in or near their work zone and often leads to frustration and burnout (criteria 2). Children start to feel that the whole world is uncontrollable and unsafe.
It is still not totally accepted within the law enforcement community for officers to discuss the impact of situations on them. Anger, humor and sarcasm are but a brief outlet for what many officers dream about at night. As their condition worsens, many officers withdraw, because they are fearful of seeking help or support for fear it is a one way ticket to a fitness for duty evaluation or will get out and be an obstacle for future promotions. Several studies in recent years have shown that Post Traumatic Stress Disorder (PTSD) is among the most common of psychiatric disorders.
Another thing that distinguishes people who develop PTSD from those who are just temporarily overwhelmed is that people who develop PTSD become “stuck” on the trauma, keep re-living it in thoughts, feelings, or images. It is this intrusive reliving, rather than the trauma itself that many believe is responsible for what we call PTSD. For example, I have worked with officers who have responded to child abuse calls and had a child of their own who was a similar age (criteria 4). In the course of daily life children get hurt and have bad dreams. As parents they have seen looks of pain and fright on their kids faces. This makes it just that much easier to envision the looks of terror and agony on the face of the child as their parent beat them. Sometimes this visualization gets corrupted and officers suddenly they start to see their child in their mental re-enactment of the trauma, obviously a much more powerful memory. These officers are much more likely to be “traumatized” by the incident and potentially get “stuck.”
Traumatized individuals begin organizing their lives around avoiding the trauma. Avoidance may take many different forms: keeping away from reminders, calling in sick to work, or ingesting drugs or alcohol that numb awareness of distress. The sense of futility, hyperarousal, and other trauma-related changes may permanently change how people deal with stress, alter thier self-concept and interfere with their view of the world as a basically safe and predictable place. In the example above, these people often became even more overprotective of their children, suspicious of others, and had difficulty sleeping, because every time they close their eyes they see the child.
One of the core issues in trauma is the fact that memories of what has happened cannot be integrated into one’s general experience. The lack of people’s ability to make this “fit” into their expectations or the way they think about the world in a way that makes sense keeps the experience stored in the mind on a sensory level. When people encounter smells, sounds or other sensory stimuli that remind them of the event, it may trigger a similar response to what the person originally had: physical sensations (such as panic attacks), visual images (such as flashbacks and nightmares), obsessive ruminations, or behavioral reenactments of elements of the trauma. In the example above, sensory triggers that triggered some of the officers memories were certain cries, hearing or seeing a parent spank their child, returning to the same neighborhood for other calls and, of course, television shows or news reports that involved descriptions of abuse.
The goal of treatment is find a way in which people can acknowledge the reality of what has happened and somehow integrate it into their understanding of the world without having to re-experience the trauma all over again. To be able to tell their story, if you will.The Symptoms of PTSD
Regardless of the origin of the terror, the brain reacts to overwhelming, threatening, and uncontrollable experiences with conditioned emotional responses. For example, rape victims may respond to conditioned stimuli, such as the approach by an unknown man, as if they were about to be raped again, and experience panic.
Remembrance and intrusion of the trauma is expressed on many different levels, ranging from flashbacks, feelings, physical sensations, nightmares, and interpersonal re-enactments. Interpersonal re-enactments can be especially problematic for the officer leading to over-reaction in situations that remind the officer of previous experiences in which she or he has felt helpless. For example, in the child abuse example above, officers may be much more physically and verbally aggressive toward alleged perpetrators and their reports tend to be much more negative and subjective.
Hyperarousal. While people with PTSD tend to deal with their environment by reducing their range of emotions or numbing, their bodies continue to react to certain physical and emotional stimuli as if there were a continuing threat. This arousal is supposed to alert the person to potential danger, but seems to loose that function in traumatized people. This is sort of like when rookie officers start and a hot call is toned out, they usually have an adrenaline rush. After two or three years, the tones hardly have any impact on them. Since traumatized people are always “keyed up” they often do not pay any attention to that feeling which is supposed to warn them of impending danger.
Numbing of responsiveness. Aware of their difficulties in controlling their emotions, traumatized people seem to spend their energies on avoiding distress. In addition, they lose pleasure in things that previously gave them a sense of satisfaction. They may feel “dead to the world”. This emotional numbing may be expressed as depression, and lack of motivation, or as physical reactions. After being traumatized, many people stop feeling pleasure from involvement in activities, and they feel that they just “go through the motions” of everyday living. Emotional numbness also gets in the way of resolving the trauma in therapy.
Intense emotional reactions and sleep problems. Traumatized people go immediately from incident to reaction without being able to first figure out what makes them so upset. They tend to experience intense fear, anxiety, anger and panic in response to even minor stimuli. This makes them either overreact and intimidate others, or to shut down and freeze. Both adults and children with such hyperarousal will experience sleep problems, because they are unable to settle down enough to go to sleep, and because they are afraid of having nightmares. Many traumatized people report dream-interruption insomnia: they wake themselves up as soon as they start having a dream, for fear that this dream will turn into a trauma-related nightmare. They also are liable to exhibit hypervigilance, exaggerated startle response and restlessness.
Learning difficulties. Being “keyed-up” interferes with the capacity to concentrate and to learn from experience. Traumatized people often have trouble remembering ordinary events. It is helpful to always write things down for them. Often “keyed-up” and having difficulty paying attention, they may display symptoms of attention deficit disorder.
After a trauma, people often regress to earlier modes of coping with stress. In adults, it is expressed in excessive dependence and in a loss of capacity to make thoughtful, independent decisions. In officers, this is often noticed because they suddenly begin making a lot of poor decisions, their reports lose quality and detail and they are unable to focus. In children they may begin wetting their bed, having fears of monsters or having temper tantrums.
Aggression against self and others: Both adults and children who have been traumatized are likely to turn their aggression against others or themselves. Due to their persistent anxiety, traumatized people are almost always “stressed out,” so it does not take much to them set off. This aggression may take many forms ranging from fighting to excessive exercise or obsession about something—anything to keep them from thinking about the trauma.
Psychosomatic reactions. Chronic anxiety and emotional numbing also get in the way of learning to identify and discuss internal states and wishes. May traumatized people report a high frequency of headaches, back and neck aches, gastro-intestinal problems etceteras. Since the stress is being held inside, the body begins to become distressed.Summary
After a trauma, people realize the limited scope of their safety, power and control in the world, and life can never be exactly the same. The traumatic experience becomes part of a person’s life. Sorting out exactly what happened and sharing one’s reactions with others can make a great deal of difference a person’s recovery. Putting the reactions and thoughts related to the trauma into words is essential in the resolution of post traumatic reactions. This should, however, be done with a professional specializing in PTSD due to the wide range of reactions people have when they start confronting and integrating the memories of the trauma.
Failure to approach trauma related material gradually is likely to make things worse. Often, talking about the trauma is not enough: trauma survivors need to take some action that symbolizes triumph over helplessness and despair. The Holocaust Memorial in Jerusalem and the Vietnam Memorial in Washington, DC, are good examples of symbols for survivors to mourn the dead and establish the historical and cultural meaning of the traumatic events. There are several events for survivors of traumas that officers can also take part in. These events remind survivors of the fact that there are others who have shared similar experiences. Other symbolic actions may take the form of writing a book, taking political action or helping other victims.
PTSD is real, and can be resolved with time, patience and compassion.

 

Santa Rosa, CA: Researchers have published findings indicating that PTSD may be successfully treated in veterans in just six therapy sessions, without drugs, opening the possibility of help for the estimated 300,000 troops returning from Iraq or Afghanistan with traumatic stress disorders.

 

According to a pilot study published in the latest issue of the peer-reviewed International Journal of Healing and Caring, veterans with high levels of PTSD saw their PTSD levels drop to within normal limits after treatment. They reported that combat memories that had previously haunted them, including graphic details of deaths, mutilations, and firefights, dropped in intensity to the point where they no longer resulted in flashbacks, nightmares, and other symptoms of PTSD. The study involved veterans from Vietnam, as well as more recent conflicts.

 

One Vietnam veteran in the study had been obsessed by the details of his best friend’s killing for 40 years. When the two of them went on patrol, his friend always walked to his left. On the day of his death, his friend was on his right, and the veteran believed for decades that “my buddy took the sniper’s bullet that was meant for me.” After treatment, his guilt evaporated, and he realized that “my buddy would willingly have died for me.”

 

Practitioners in the study had veterans report the emotional intensity of such memories on a scale from zero to 10, with 10 being very intense, and zero being no intensity. They reported that, over the course of the six sessions, the intensity of most combat memories dropped to zero, and remained there subsequently. Measured on standardized psychological questionnaires, the PTSD levels of veterans in the study dropped by 50 percent. Their scores also dropped by 49 percent for depression and 46 percent for anxiety, indicating that other psychological problems that often accompany PTSD improved too.

 

The method used in the study is called EFT or Emotional Freedom Techniques. It involves the veterans recounting their memories of combat trauma, while rubbing or tapping 14 specific acupuncture points on their bodies. Scientists theorize that linking the mental recall of emotionally disturbing incidents to the physical stimulation used by EFT makes the person’s body feel secure. This associates an unsafe memory with a safe physical stimulus, which breaks the link between the emotional trauma and physical stress. After EFT treatments, veterans are still able to remember the incidents, but without an emotional charge.

 

The pilot study is the first step in a large nationwide study of EFT and veterans currently taking place. The pilot study produced statistically highly significant results with just 7 veterans, while the national study is collecting data from over 100 veterans with PTSD. Both are being conducted by the Iraq Vets Stress Project (www.StressProject.org), a nonprofit which connects veterans to free and low-cost treatments using rapid therapies like EFT.

 

With up to one in four returning veterans reporting PTSD, as well as other psychological problems, the military has been increasingly open to new approaches. Such studies are a first step to implementing effective new therapies in the Veterans Administration system, according to Dr. Stephen Ezeji-Okoye, head of the VA Field Advisory Committee on Complementary and Alternative Medicine. His office examines potential alternative therapies that can help veterans. If the clinical trials show good results, he says, they’re “exactly the sort of thing we want to take a look at.”

 

Veterans with PTSD are able to enroll in the nationwide study through www.StressProject.org and receive six free sessions of EFT. Dr. Dawson Church, the Stress Project’s director, says, “I’m hoping our society does not repeat the mistakes of Vietnam, where we brought a quarter million troops back home without adequate PTSD treatment. That’s why I’m so interested in therapies like EFT, that are fast, safe and effective.”

 

Post-Traumatic Stress Disorder (PTSD). It’s one of the signature conditions of the conflicts in Iraq and Afghanistan, and by many accounts, a great deal of returning service members will be coping with the effects of PTSD as they transition to civilian life. For employers, that brings up some important questions – among them, what should they expect from employees with PTSD, and how can they support them in the workplace.
It’s true that veterans – and anyone experiencing the effects of PTSD – may face day-to-day difficulties in their work environment. However, employers can play a vital role in these individuals’ recovery by recognizing the challenges associated with PTSD and making adjustments and reasonable accommodations to help ensure workplace success. And disabled veterans aren’t the only ones that stand to benefit from the implementation of workplace supports. Veterans are known to make excellent employees, so helping them succeed on the job can not only contribute to the veteran’s recovery – it can positively impact a business’s bottom line.
People with PTSD may experience some of the limitations discussed in this article, however they seldom will develop all of them. The severity of the combat stress and degree of limitation will vary among individuals. Employers should be aware that not all people with PTSD will need accommodations to perform their jobs, and many others may only need a few accommodations. However, in many cases, simple, inexpensive workplace supports can make all the difference toward a successful employment experience.
Employers should also know that unless the employee reveals, or makes available information, that they have been diagnosed with post-traumatic stress, the employer will not necessarily know whether the condition is present. In fact, job applicants do not have to disclose a disability on a job application, or in a job interview, unless they need an accommodation to assist them in the application or interview process.
KEY QUESTIONS
Prior to implementing workplace accommodations for employees with post-traumatic stress, employers should ask themselves the following questions:
- What limitations is the employee with PTSD experiencing, and how do these limitations affect the employee’s job performance?
- What specific job tasks are problematic as a result of these limitations?
- What accommodations are available to reduce or eliminate these problems?
- Has the employee with PTSD been consulted regarding possible accommodations?
- Do supervisory personnel and employees need training regarding PTSD and workplace accommodations?
ACCOMMODATION IDEAS
Once they have considered these questions, employers and human resource professionals will be poised to identify appropriate workplace supports that can help those with PTSD succeed on the job. The following represents only a sample of the types of accommodations and/or adjustments an employer might consider for an employee experiencing combat stress.
Memory:
- Provide written instructions
- Post written instructions for use of equipment
- Use a wall calendar
- Use a daily or weekly task list
- Provide verbal prompts and reminders
- Use electronic organizers or hand held devices
- Allow the employee to tape record meetings
- Provide written minutes of each meeting – Allow additional training time
Lack of Concentration:
- Reduce distractions in the work environment
- Provide space enclosures or a private space
- Allow for the use of white noise or environmental sound machines
- Allow the employee to play soothing music using a music player and a headset
- Increase natural lighting or increase full spectrum lighting
- Divide large assignments into smaller goal-oriented tasks or steps
- Plan for uninterrupted work time
Time Management/Performing or Completing Tasks:
- Make daily “TO-DO” lists and check items off as they are completed
- Divide large assignments into smaller tasks and steps
- Schedule weekly meetings with supervisor, manager or mentor to determine if goals are being met
- Remind employee of important deadlines via memos or e-mail
Disorganization:
- Use calendars to mark meetings and deadlines
- Use electronic organizers
- Hire a professional organizer or organizational coach
- Assign a mentor to assist the employee
Coping with Stress:
- Allow longer or more frequent work breaks
- Provide back-up coverage for when the employee needs to take breaks
- Provide additional time to learn new responsibilities
- Restructure job to include only essential functions
- Allow time off for counseling
- Assign a supervisor, manager or mentor to answer employee’s questions
Working Effectively with a Supervisor:
- Give assignments, instructions or training in writing or via e-mail
- Provide detailed day-to-day guidance and feedback
- Provide positive reinforcement
- Provide clear expectations and the consequences of not meeting expectations
- Develop strategies to deal with problems
Interacting with Co-workers:
- Encourage the employee to walk away from frustrating situations and confrontations
- Allow employee to work from home part-time
- Provide partitions or closed doors to allow for privacy
- Provide disability awareness training to coworkers and supervisors
Dealing with Emotions:
- Refer to employee assistance programs (EAP)
- Use stress management techniques to deal with frustration
- Allow the use of a support animal
- Allow telephone calls during work hours to doctors and others for needed support
- Allow frequent breaks
Sleep Disturbance:
- Allow the employee to work one consistent schedule
- Allow for a flexible start time
- Combine regularly scheduled short breaks into one longer break
- Provide a place for the employee to sleep during break
Muscle Tension or Fatigue:
- Build in “stretch breaks” during the workday
- Allow private space to meditate or do yoga
- Allow time off for physical therapy or massage therapy
- Encourage use of the company’s wellness program
Absenteeism:
- Allow for a flexible start time or end time, or work from home
- Provide straight shift or permanent schedule
- Modify attendance policy (e.g., count one occurrence for all PTSD-related absences, or allow the employee to make up the time missed)
- Consider allowing telework on occasion
Panic Attacks:
- Allow the employee to take a break and go to a place where s/he feels comfortable to use relaxation techniques or contact a support person
- Identify and remove environmental triggers such as particular smells or noises
- Allow the presence of a support animal
Headaches:
- Provide alternative lighting
- Take breaks from computer work or from reading print material
- Practice stress-relieving techniques

Posttraumatic stress disorder(PTSD) is an anxiety disorder that can develop after exposure to one or more terrifying events in which grave physical harm occurred or was threatened.

It is a severe and ongoing emotional reaction to an extreme psychological trauma. This stressor may involve someone’s actual death or a threat to the patient’s or someone else’s life, serious physical injury, or threat to physical and/or psychological integrity, to a degree that usual psychological defenses are incapable of coping. In some cases it can also be from profound psychological and emotional trauma, apart from any actual physical harm. Often times, however, the two are combined.

PTSD is a condition distinct from Traumatic stress, which is of less intensity and duration, and combat stress reaction, which is transitory. PTSD has also been recognized in the past as shell shock, traumatic war neurosis, or post-traumatic stress syndrome (PTSS).

PTSD is believed to be caused by psychological trauma. Possible sources of trauma includes experiencing or witnessing childhood or adult physical, emotional or sexual abuse. In addition, experiencing or witnessing an event perceived as life-threatening such as physical assault, adult experiences of sexual assault, accidents, drug addiction, illnesses, medical complications, or the experience of, or employment in occupations exposed to war (such as soldiers) or disaster (such as emergency service workers).

Traumatic events that may cause PTSD symptoms to develop include violent assault, kidnapping, torture, being a hostage, prisoner of war or concentration camp victim, experiencing a disaster, bad car accidents or getting a diagnosis of a life-threatening illness.

Children may develop PTSD symptoms by experiencing sexually traumatic events like age inappropriate sexual experiences. Witnessing traumatic experiences or learning about these experiences may also cause the development of PTSD symptoms.

The amount of dissociation that follows directly after a trauma predicts PTSD.

Individuals that are more likely to dissociate during a traumatic event are considerably more likely to develop chronic PTSD.

Which brings us to Nurses and PTSD.

I am a member of the “Bereavement Team” at my hospital. We are mostly concerned with families who lose babies before they are born, who birth dead babies or who deliver premature live babies who subsequently die.

Yet the nurses who care for these families undergo trauma and the more cases we have on a weekly or monthly basis, the more severe the trauma, or dare I say, PTSD.

Our team writes personal notes to the nurses involved in the more difficult cases, and we have a Care For The Care Giver at our yearly Bereavement Skills Day.

Yet this may not be enough.

Even though we are recognizing the condition, a note or a sympathetic nod will not erase the grief that a nurse often feels in these situations.

She may have lost a pregnancy in her past; she may have been sexually abused or raped when she was young; she may be an Adult Child Of An Acoholic; she may have addiction challenges herself.

She may have been raised in a war-torn country; she may have been or is a victim of Domestic Violence; she may have a debilitating chronic illness or perhaps someone close to her has this.

In any event, our bereavement team can help our nurses.

Examples of PTSD Triggers

* For an auto accident survivor: The smell of gasoline

* For a combat veteran: The sound of a helicopter or firecrackers

* For a rape victim: The sight of a person suddenly appearing around the corner

* For a carjacking victim: The song that was playing on the radio at the time of the assault

Symptoms of avoidance

Symptoms of avoidance are prominent in PTSD. You may persistently avoid situations that remind you of the traumatic event you experienced, minimize the event’s significance, or push all thoughts of it out of your mind. Avoidance can also take the form of detachment and apathy.

Symptoms of avoidance include:

* Avoiding thoughts, feelings, or conversations associated with the trauma

* Avoiding activities, places, or people that remind you of the trauma

* Inability to remember important aspects of the trauma

* Loss of interest in activities and life in general

* Feeling detached or estranged from other people

* Feeling emotionally numb, especially toward loved ones

* Sense of a limited future (you don’t expect to live a normal life span, get married, have a career)

Symptoms of increased arousal

PTSD can cause you to feel and react as if you’re constantly in danger. In this state of chronic hyperarousal, your mind and body is on constant red alert, making it impossible to fully relax, be productive, or enjoy life.

The PTSD symptoms of increased arousal and anxiety include:

* Difficulty falling or staying asleep

* Irritability or outbursts of anger

* Difficulty concentrating

* Hypervigilance, or being constantly “on guard”

* An exaggerated startle response, or jumpiness

Treatments for post-traumatic stress disorder (PTSD)

Treatments for PTSD relieve symptoms by helping you deal with the trauma you’ve experienced. Rather than avoiding the trauma and any reminder of it, you’ll be encouraged in treatment to recall and process the event that caused your PTSD. In treatment for PTSD, you’ll also:

* Explore your thoughts and feelings about the trauma

* Work through feelings of guilt, self-blame, and mistrust

* Learn how to cope with and control intrusive memories

* Address problems PTSD has caused in your life and relationships

In addition to offering an outlet for emotions you may have been bottling up, treatment for PTSD will also help restore your sense of control and reduce the powerful hold the memory of the trauma has on your life.

Cognitive-behavioral therapy is believed to be the most beneficial treatment for PTSD. There are several types of cognitive-behavioral therapies.

* Exposure therapy – According to a October 2007 report issued by the Institute of Medicine, there is strong evidence for the effectiveness of exposure therapy in PTSD treatment. Exposure therapy for PTSD involves carefully and gradually “exposing” yourself to thoughts, feelings, and situations that remind you of the trauma.

Often, you’ll start by focusing on a memory that is upsetting but still manageable, then slowly work your way up to more upsetting memories in a process known as systematic desensitization.

As you think about and re-experience these memories in a safe, controlled environment, they will start to feel less intense and overwhelming.

* Cognitive restructuring – In cognitive restructuring, the focus of treatment is to identity upsetting thoughts about the traumatic event’particularly thoughts that are distorted and irrational?and replace them with more accurate, balanced views. For example, you may blame yourself for failing to save a fallen comrade, even if you did everything you could. Cognitive restructuring would help you challenge this troubling thought and learn to look at what happened in a healthier way.

* EMDR (Eye Movement Desensitization and Reprocessing) – EMDR incorporates elements of cognitive-behavioral therapy with eye movements or other forms of rhythmic, left-right stimulation, such as hand taps or sounds. For example, in EMDR therapy you might talk about the traumatic event while following your therapist’s finger back and forth with your eyes.

Eye movements and other bilateral forms of stimulation are thought to work by “unfreezing” the brain’s information processing system, which is interrupted in times of extreme stress, leaving only frozen emotional fragments which retain their original intensity. Once EMDR frees these fragments of the trauma, they can be integrated into a cohesive memory and processed.

* EFT: Tapping on strategic pressure points while at the same time, saying phrases that release the anxiety associated with the trauma.

Positive ways of coping with PTSD include:

* Learning about trauma and PTSD.

* Joining a PTSD support group

* Practicing relaxation techniques

* Confiding in a person you trust

* Spending time with positive, supportive people

* Avoiding alcohol and drugs

Our Bereavement Team can guide our nurses in the direction of full recovery.