Post-traumatic Stress Disorder

"I try not to think about what happened to me, but nightmares and flashbacks keep bringing the memories back."

What is PTSD?

Posttraumatic stress disorder (PTSD) is a disorder that sometimes develops after a person has been exposed to or witnessed a trauma (an event that is life-threatening to the person or someone else, or an event (e.g., rape) that threatens the person’s physical integrity). Examples include events like rape, an automobile accident, or a natural disaster like an earthquake or fire. Sometimes experiences that do not meet the technical definition of a trauma can also result in some of all of the symptoms of PTSD.

PTSD involves four types of symptoms that can persist for an extended period of time, even years after the trauma.

Reexperiencing of the trauma in the form of:

  • Nightmares
  • Intrusive memories, images, and emotional reactions related to the trauma
  • Flashbacks or dissociative states in which memories of the trauma are so vivid and capture the person's attention so completely that the person experiences aspects of the trauma as if they were actually happening in the present;

Persistent increased arousal in the form of:

  • Difficulty falling or staying asleep
  • Irritability or angry outbursts
  • Hypervigilance, feeling on guard, or scanning one's environment
  • Being easily startled

Avoidance in the form of:

  • Avoidance of thoughts, feelings, or conversations associated with the trauma
  • Avoidance of activities, places, or people that trigger memories of the trauma
  • Difficulty remembering aspects of the trauma
  • Feeling detached or having less interest in other people or activities
  • Experiencing restricted emotional responding or emotional numbness
  • Feeling as if one has a limited future in terms of lifespan, career, marriage, or family life

Negative alterations in cognitions and mood, such as:

  • Beliefs that one is bad or the world is a dangerous place
  • Beliefs that one is responsible for the traumatic event
  • Persistent trauma-related negative emotions, such as guilt or shame
  • Difficulty remembering aspects of the trauma
  • Difficulty experiencing positive emotions

Cognitive-behavioral model of PTSD

The cognitive-behavioral model proposes that in individuals who have PTSD, a traumatic event is recorded as fragmented, raw, and sensory-based memories associated with strong emotions, including an acute sense of danger and alarm. These memory fragments may not be coded for time, and when they are activated, the person experiences emotions and memory fragments that give the person the sense that the event is happening in the present. As a result, the person becomes afraid of experiencing memories of the event; the memories seem dangerous and threatening. Protective responses that help the person cope with the event when it is happening and soon afterward, such as hypervigilance and avoiding trauma-related cues, persist after they are no longer adaptive. Those protective responses preserve the memories and emotions in their raw, fragmented state and prevent recovery. Trauma events that have not been fully processed can have a disillusioning and powerful impact on people's beliefs (cognitions) about themselves, their future, the world, and others. The person may come to believe that they are bad or damaged, or that the world is a dangerous place where the trauma is likely to happen again.

Cognitive-behavior therapy for PTSD

Cognitive-behavior therapy for PTSD includes several types of interventions designed to promote "emotional processing" of the fragmented trauma memories into a coherent memory that is integrated with the person's other memories, thoughts, and beliefs. The treatment helps the person reduce the effects of the trauma on his or her beliefs about the self, others, the world, and the future. Interventions include:

  • Education to learn and understand the triggers for trauma reactions, memories, and emotions;
  • Coping skills to better manage strong emotions (such as fear, shame, helplessness, and panic), to ground” yourself when trauma memories overtake you, to improve sleep, and to manage anger and improve interpersonal effectiveness;
  • Systematic and controlled exposure to trauma-related memories and cues; through systematic and gradual exposure, people become less reactive and reclaim these areas of life;
  • Cognitive strategies to understand and reconcile the effects of trauma-based beliefs (for example, the belief that the world is a dangerous place) on beliefs about oneself, others, and the world, and on personal goals and relationships.

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