Tuesday, 25 September 2012

Post Traumatic Stress Disorder


Post Traumatic Stress Disorder
In this paper, the writer will discuss Post Traumatic Stress Disorder, a stress disorder borne of an ancillary trauma, in which the sufferer experiences repeated recurrent memories of trauma during periods of stress (www.emedicinehealth.com, 2012). The writer will talk about social reception of this disorder and how it is viewed. Both the cognitive and pharmacological treatments of Post Traumatic Stress Disorder as well as alternative approaches if any, will be examined. Finally, this paper will discuss the success rate and recidivism if any from recovery back into suffering of Post Traumatic Stress Disorder. What Post Traumatic Stress Disorder Is Post Traumatic Stress Disorder is a disorder in which a sufferer during periods of stress or heightened anxiety is doomed to relive moments of a painful memory in episodes for the duration of his or her stress (www.emedicinehealth.com, 2012). It was once termed “combat fatigue” or “shell shock” and associated with military soldiers who had been traumatized by war. It is now recognized that children who have endured domestic and social abuse, suffer from it. Automobile crash survivors suffer from it (www.ptsd.va.gov, 2012) While it is expected that a certain amount of anxiety and traumatic process is to be experienced after a tough event, the hallmark of PTSD is that the reliving of the trauma does not diminish after thirty days from the trauma. The understanding garnered through discovering the occurrence of PTSD in other facets of society outside the war context has come full circle back to the suffering veteran (www.ptsd.va.gov, 2012). The therapies and strategies developed in addressing all manner of sufferers has jettisoned the approaches healthcare providers take with suffering veterans (www.ptsd.va.gov, 2012).

Cognitive therapy For Post Traumatic Stress Disorder
Cognitive behavioral therapy (CBT) is the most effective treatment for PTSD. Although a combination of medication and CBT is the optimum treatment for PTSD, CBT can stand as effective treatment without pharmacological support (Falsetti, 2000).
There are different types of therapies for PTSD that are classified as CBT. All of the cognitive behavioral therapy can be simplified to strategy design. When the PTSD sufferer has a plan and is taught to be aware so as to be expectant, the sufferer is armed with tools that therefore reduce his or her fear and/or stress level, thus diminishing the painful episodic memories. A reduction in stress equals a reduction of symptoms, since PTSD is an anxiety disorder (Falsetti, 2000). One CBT approach is called Cognitive Processing Therapy (CPT) in which the sufferer comes to understand how the subject trauma has affected his or her thoughts and feelings. Taking the mystery out of the disorder allows the sufferer to keep it in pragmatic, clinical regard. This prevents PTSD from being so daunting and the sufferer feels less helpless (Falsetti, 2000). Prolonged Exposure (PE) therapy is another CBT strategy. This is the equivalent to desensitization therapy where the sufferer discusses the trauma to the point where the memories are no longer upsetting. This is controversial because sufferers of genuine PTSD usually have it for life and if reliving the episode created a lack of sensitivity, the repetition of episodic flashbacks would have a positive effect instead of a torturous one (Falsetti, 2000). CBT strategies are developed based on theories of how we learn and process. The primary focus is to create coping strategies which empower the sufferer to therefore diminish their stress (Falsetti, 2000).

Pharmacological Therapy
Pharmacological approaches to PTSD are not as long lasting or as successful as CBT approaches but in conjunction with CBT, they provide effective support (www.ptsd.va.gov, 2012). Further, since understanding of what occurs during the onset of PTSD is evolving, medication of it is not finely tuned. The primary and usual classification of medications is Serotonin Reuptake Inhibitors or SSRIs (Reeves, 2008). SSRIs work by blocking the re-absorption of the neurotransmitter Serotonin which elevates the mood. SSRIs are antidepressants and this is beneficial because PTSD sufferers have a great instance of depression co-morbidity (Reeves, 2008). Another approach has been the administration of hydrocortisone after a trauma to ward off the formation of PTSD. Hydrocortisone is thought to disrupt memory formation and retrieval in the hippocampus. It is thought to thwart flashbacks by targeting the memory center (Reeves, 2008). The pitfalls of pharmacological therapy are that it is not an exact one-size-fits-all therapy and in addition to issues of depression, PTSD sufferers have high occurrence of substance abuse problems. This is not compatible with a pharmacological therapy (www.ptsd.va.gov, 2012).

Alternative Therapy
Alternative approaches to treating PTSD are psychotherapy, which is analysis of feelings about the trauma and group support. Group support is crucial because we tend to learn most from our peers. The tendency of feeling alone and stranded with the disorder is mitigated by bonding with others who are similarly situated (Vasterling, 2005). Other alternative approaches are eye movement desensitization and reprocessing (EDMR). This therapy involves focusing on sounds or hand movements while the sufferer talks about the trauma. This assists in desensitizing the sufferer from the trauma by disassociation. While it reduces the agony of episodic memory for the time being, it does not arm the sufferer with skills like CBT that also reduces the agony of episodic memories without shutting off feeling (Vasterling, 2005).

Measures of Effectiveness, Such as Validity, Efficacy, Symptom and Behavior Management, and Recidivism
Observation is one mode of measuring whether or not therapy works but the primary mode of measure of effectiveness of PTSD treatments is self-reporting. The sufferer him or herself is the greatest diviner of treatment success (www.ptsd.va.gov, 2012).
Another instrument is the sufferer’s social stability. A person with an unstable neurological disorder like PTSD will likely experience function set-back, the inability to work or to easily maintain a home. But the greatest measure of whether or not therapy works and the disorder is managed is the obvious stability of a sufferer’s life, how well he or she engages and what he or she will report as to how he or she is feeling (www.ptsd.va.gov, 2012).While women suffer PTSD more frequently than men, men have a greater occurrence of recidivism. PTSD is a disorder that requires lifelong maintenance. Without treatment, recidivism is imminent (www.ptsd.va.gov, 2012).

Differential Symptoms Associated with PTSD and Success of Symptom Reduction or Management as Reported with the Three Treatments
The hallmark symptom of PTSD is the episodic, repetitious memories of an ancillary traumatic event. There is a cyclic status after the onset of these episodic memories or flashbacks of struggling to put them out of mind. Re-experiencing memories occur not only when the sufferer is awake but during sleep. Recurrent nightmares are symptomatic of PTSD (www.emedicinehealth.com, 2012). Other symptomatic behavior is avoiding situations and other reminders that might trigger such flashbacks. This would include avoiding any remote element of the trauma or exciting situations where even the elevated mood may trigger flashbacks. Numbing is also characteristic of a PTSD victim. Disassociating from the event and any accompanying feelings, or avoiding situations where feelings may arise. If left unchecked, sufferers stop engaging in social activities and lead occluded lives. Sufferers of PTSD are often hyper vigilant, perceive danger and trauma where there is none, something like paranoia but more like a lack of faith or belief that everything is okay. Hyper vigilance is both a reaction to trauma and an attempt to ward off any future trauma (www.emedicinehealth.com, 2012). Panic attacks, depression and substance abuse, while not necessarily the defining symptoms of PTSD, do often present in PTSD sufferers(www.emedicinehealth.com, 2012).

The Treatment of Choice for PTSD
The most effective treatment for PTSD is Cognitive Behavioral Therapy (www.ptsd.va.gov, 2012). This is supported by material reviewed and by the positive effect produced in sufferers. Cognitive Behavioral Therapy demystifies the disorder of PTSD for sufferers and arms them with strategies to manage it. The great fear of PTSD sufferers is that they are doomed to suffer the traumatic memory for the rest of their lives. They are; but with the assistance of empowering strategy, combined in some instance with pharmacological support and the support of fellow sufferers, PTSD patients have a strong change of leading functional, happy lives (www.ptsd.va.gov, 2012).

The Neurophysiological Underpinnings of PTSD
The concept of what occurs neurologically at the instance of PTSD is constantly changing. PTSD has been regarded, and still widely held to be an aberrant fight or flight reaction. It has been held as an understandable reaction to often incomprehensibly horrific situations. Under the old belief, it was held that we as humans have a reaction to a threatening or traumatic event. We can take fight, flight or freeze. The neurotransmitters that drive us during these challenges are associated with components of the limbic system within the brain. Within that system, the hypothalamic-pituitary-adrenal complex regulates emotion, mood, sexuality, energy level and in the context of PTSD, stress (Kaufman, 2004)

New information about PTSD has allowed these ideas to evolve to accept that certain genetic predisposition plays a major role in the likelihood of the occurrence of PTSD in a stressful situation (Kaufman, 2004). This may explain why in the same event two persons can experience the same traumatic event and one suffers more significantly than others. While it was once held that PTSD was an abuse reaction, with a surge of neurotransmitters formulating aberrant messages, some of us may simply be hard-wired to react to harsh situations in more acute ways than others do. The idea of physiology and being ready-wired for PTSD may also explain why even though men experience more trauma than women do, women suffer PTSD more than men do (Kaufman, 2004).

Contemporary Attitudes Toward the Three Treatments of PTSD
As stated, men experience more traumatic events than women do and when PTSD was first recognized, it was associated with war. The context of the social values of the time, this probably was an impediment and influence of the approach taken to treat PTSD. When it was viewed as a man’s disorder, “Combat Fatigue,” the initial reaction after prescribed rest, which was ironically appropriate treatment, was for the sufferer to “man up.” Once it was recognized that men, women and children suffered this disorder as a result of all manner of trauma, the attitudes and approaches to treating PTSD evolved (Mendelsohn, 2012). Of all the material reviewed, CBT is held as the most effective treatment to PTSD (www.ptsd.va.gov, 2012). It is a collection of strategies and insights that empower the sufferer. The fact that it can almost stand-alone without the support of drug intervention, also ameliorates its social reception. It de-stigmatizes the disorder (Mendelsohn, 2012). Pharmacological intervention on PTSD is not refined. It cannot stand alone for long periods of time and the presence of drug use in connection with a psychological disorder attaches social stigma to it. If the medication is a temporary bridge to the CBT, then judgment of it is not quite so stringent (www.ptsd.va.gov, 2012).

Fringe or alternative therapies are viewed with skepticism and less respect as CBT. The idea that objects or movement is used to detract the sufferer while he or she is discussing the traumatic event seems less practical than arming a sufferer with self-assuring strategies (Mendelsohn, 2012). In sum, Post Traumatic Stress Disorder was once often confused for a disorder that can be resolved by psychoanalyzing the ancillary traumatic event (Kaufman, 2004). It was once believed that if the sufferer resolved the feelings around the ancillary trauma, the plaguing episodic memories would diminish. This approach evinced a complete misunderstanding of PTSD as the anxiety disorder that it is. PTSD is a stress disorder in much the same way a panic attack is. The ancillary trauma is secondary and in some cases, analysis of it exacerbates the symptoms of PTSD as feelings become agitated rather than quieted. More is becoming known about PTSD and how it occurs. The old idea that it is an understandable response to an extraordinary event is giving way to the idea that some people are genetically preset to experience PTSD. It may be a fact that some of us are wired to experience trauma in a more traumatic way than others do (Kaufman, 2004). Finally, of all the treatments there are available, the most effective and enduring is Cognitive Behavioral Therapy (www.ptsd.va.gov, 2012. Because understanding is still evolving of what occurs neurologically and why in the event of PTSD, medications for it are just temporary treatments sometimes with no effect and some with just better effect than total suffering. Because PTSD sufferers are also often prone to substance abuse, support, therapy and CBT is best when pharmacological therapy is applied (www.ptsd.va.gov, 2012.

Falsetti, S. (2000). Treatment of PTSD Using Cognitive and Cognitive BehavioralTherapies. Journal of Cognitive Psychotherapy,14(3)

Kaufman, K. (March 2004) Clinical Correlates of Neurological Change in Posttraumatic Stress Disorder: an Overview of Critical Systems Boston University School of Medicine/Veterans Administration Boston Healthcare System

Mendelsohn, M. (June 25, 2012). Social Attitudes Toward Men and Women with PosttraumaticStress Disorder. Retrieved from http://www.digital.library.unt.edu

Post Traumatic Stress Disorder. (2012). Retrieved from http://www.emedicinehealth.com

Reeves, R. (2008, November). Latest Strategies in Diagnosis and Treatment ofPTSD. Medications for PTSD, Medical Economics

Vasterling, J. (2005). Neuropsychology of PTSD: Biological, Cognitive, and ClinicalPerspectives.. New York, New York: Guilford Press

What is Post Traumatic Stress Disorder? (2012) Retrieved from www.ptsd.va.gov