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Problems that Usually Need
Psychotherapy or Psychiatry Treatment
Post-Traumatic Stress Disorder or PTSD
Post-traumatic stress disorder or PTSD is also classified as an anxiety disorder. PTSD occurs when someone has experienced a trauma and thoughts and feelings produced by the trauma disrupt their life afterwards. The PTSD sufferer will often re-experience the trauma involuntarily, while awake or asleep, through flashbacks, nightmares, and intrusive thoughts and images. Re-experiencing the trauma is itself terrifying, and knowing that this could happen at any time causes constant anxiety. Sometimes sufferers develop insomnia because the nightmares make them afraid to go to sleep. Sufferers also usually develop intense fears of things associated with the trauma, such as fear of driving after a car accident or anxiety about sex after a sexual assault. These effects can persist for years if untreated (although this is not always the case), and can constrict and damage the lives people lead in many ways.
Many people forego treatment for PTSD because they feel that their reactions are inevitable responses to an experience that can never be erased. Many others stay away from treatment because of feelings of shame and weakness, especially following physical and sexual assaults. While it will always be true that the trauma has happened, the symptoms of PTSD (including shame) are not inevitable and can be treated successfully.
One way of conceptualizing PTSD is that it is a phobia of something inside oneself, namely recollections and memories of the trauma. The sufferer fears the memories and tries to shut them out by avoiding anything that might trigger the memories, and often by trying to distract oneself with constant activity. Yet they intrude, and when they do the person feels not only the terror of the trauma, but also helplessness at not being able to control what he or she is thinking and feeling. This leads to more fear and phobic avoidance of the memories, but added fear also reactivates the memories and causes continued flashbacks, nightmares, and intrusions.
If you have already read the sections on phobias and OCD, you should be able to understand the treatment for PTSD. It can be thought of as a graduated exposure treatment to the traumatic memories. Typically the patient will be taught relaxation exercises at first, and after these are mastered then controlled activation of the memories can begin in therapy. The therapist and patient create a hierarchy of anxiety-producing thoughts related to the trauma, from thoughts of similar but non-traumatic events, up through events just before and after the trauma, up to direct recollection of the actual trauma and what it felt like.
After the hierarchy is constructed the patient will do the relaxation exercises and then recollect the lowest item on the hierarchy. This will cause some anxiety, and then the patient will do the relaxation exercises and the therapist will talk the patient through the experience. When the patient has mastered this and can talk about it and remember it comfortably, then the same is done with the next item on the hierarchy. Each item is gradually mastered, and eventually the patient can recall the traumatic event voluntarily without undue anxiety. At this point, since the patient now has voluntary control over the memories, the flashbacks and nightmares generally subside.
A few things should be mentioned here. Patients who have PTSD resulting from repeated childhood trauma will probably experience heightened anxiety during the early stages of treatment. Generally, the more severe and deeply ingrained the fear, the greater the anxiety when the memories are triggered. This can be uncomfortable for a while. However, a general rule with anxiety is that tolerating it will diminish it, as long as the level of anxiety is not too high. Part of the job of the therapist is to know how much is too much, and to protect the patient from it. Many people also have a lot of negative feelings about themselves and the circumstances that led to the PTSD, and therapy can help clients feel better about themselves and their experiences.
Thomas B. Hollenbach, Ph.D.
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