POST-TRAUMATIC STRESS DISORDER
Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical
or psychological harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat.
Among those who may experience PTSD are military troops who served in the Vietnam and Gulf Wars; rescue workers involved in the aftermath of disasters like the terrorist attacks on New York City and Washington, D.C.; survivors of the Oklahoma City bombing; survivors of accidents, rape, physical and sexual abuse, and other crimes; immigrants fleeing violence in their countries; survivors of earthquakes, floods, and hurricanes; and people who witness traumatic events. Family members of victims also can develop the disorder. PTSD can occur in people of any age, including children and
adolescents. Right now, I am seeing in
therapy Iraqi soldiers who are experiencing intense PTSD.
An estimated 5.2 million American adults ages 18 to 54, or approximately 3.6 percent of people in this age group in a given year, have PTSD (Narrow et al., 1998). About 30 percent of Vietnam veterans developed PTSD at some point after the war (Robins & Regiew, 1991). The disorder also has been detected among veterans of the Persian Gulf War, with some estimates running as high as 8 percent (The NIMH Genetics Workgroup, 1998). More than twice as many women as men experience PTSD following exposure to trauma (Regier et al., 1998).
Participants in the Iraqi war have reported grave PTSD symptoms, from
traumas directed personally toward them or from having witnessed
tragedies cast upon their fellow colleagues..
Depression, alcohol or other substance abuse, or other anxiety disorders frequently co-occur with PTSD.
The likelihood of treatment success is increased when these other
conditions are appropriately diagnosed and treated as well.
Complex PTSD (sometimes called "Disorder of Extreme Stress") is found among individuals who have been exposed to prolonged traumatic circumstances, especially during childhood, such as childhood sexual abuse. Developmental research is revealing that many brain and hormonal changes may occur as a result of early, prolonged trauma, and contribute to difficulties with memory, learning, and regulating impulses and emotions. Combined with a disruptive, abusive home environment that does not foster healthy interaction, these brain and hormonal changes may contribute to severe behavioral difficulties (such as impulsivity, aggression, sexual acting out, eating disorders, alcohol/drug abuse, and self-destructive actions), emotional regulation difficulties (such as intense rage, depression, or panic) and mental difficulties (such as extremely scattered thoughts, dissociation, and amnesia). As adults, these individuals often are diagnosed with depressive disorders, personality disorders or dissociative disorders. Treatment often takes much longer, may progress at a much slower rate, and requires a sensitive and structured treatment program delivered by a trauma specialist.
Many people with PTSD repeatedly re-experience the ordeal especially when they are exposed to events or objects reminiscent of the trauma. Anniversaries of the event can also trigger symptoms. People with PTSD also experience emotional numbness and sleep disturbances, depression, anxiety, and irritability or outbursts of anger. Feelings of intense guilt are also common. Most people with PTSD try to avoid any reminders or thoughts of the ordeal. PTSD is diagnosed when symptoms last more than one month.
Symptoms associated with reliving the traumatic event:
- Having bad dreams or nightmares about the event or something similar
- Behaving or feeling as if the event were actually happening all over again (these
are known as "flashbacks")
- Having a lot of emotional feelings when reminded of the event
- Having a lot of physical sensations when reminded of the event (e.g. heart races, pounds, or "misses a beat"; sweating, difficulty breathing, feeling faint, feeling a loss of control)
Symptoms related to avoidance of reminders of the traumatic event:
- Avoiding thoughts, conversations, or feelings about the event
- Avoiding people, places, or activities that associated with the event
- Having difficulty remembering some important part of the event
Changes frequently made after the
- Loss of interest in things that once were considered important
- Feeling "detached" from people and finds it difficult to trust people
- Feeling emotionally "numb" and finds it hard to have loving feelings even toward those who are emotionally close
- Difficulty falling or staying asleep
- Irritable and angry
- Difficulty concentrating
- Feeling that one is not going to live very long and there is no reason to plan for the future
- Feeling easily startled
- Always "on guard"
Medical or emotional problems:
- Stomach problems
- Intestinal problems
- Gynecological problems
- Weight gain or loss
- Chronic pain (e.g. back, neck, in women-pelvic area)
- Problems getting to sleep
- Problems staying asleep
- Skin rashes and other problems
- Irritability, "short fuse", "quick temper", other anger problems
- Lack of energy, chronic fatigue
- Alcoholism and other substance use problems
- General anxiety
- Anxiety (panic) attacks
Research is continuing to reveal factors that may lead to PTSD. People who have been abused as children or who have had other previous traumatic experiences are more likely to develop the disorder. In addition, it used to be believed that people who tend to be emotionally numb after a trauma were showing a healthy response; but now some researchers suspect that people who experience this emotional distancing may be more prone to PTSD.
Studies in animals and humans have focused on pinpointing the specific brain areas and circuits involved in anxiety and fear, which are important for understanding anxiety disorders such as PTSD. Fear, an emotion that evolved to deal with danger, causes an automatic, rapid protective response in many systems of the body. It has been found that the fear response is coordinated by a small structure deep inside the brain, called the amygdala. The amygdala, although relatively small, is a very complicated structure, and recent research suggests that posttraumatic stress disorder may be associated with abnormal activation of the amygdala.
Once fear is conditioned in the amygdala, it is virtually indelible. However, the neural mechanisms from the amygdala to the hippocampus and to cortical regions, such as, the frontal lobes allow its suppression until triggered. Fear rapidly returns when the individual is re-exposed to the trauma related material. An increase in stressors seems to differentially affect the fear inducing and the fear inhibiting pathways. High stress levels decrease the capacity of the inhibitory pathway to suppress fear, and increase the ability of conditioned fear pathways to induce it. Thus, the fear induced by re-exposure of traumatic material indicates a failure of inhibition on the part of the hippocampus, and is evidence that the traumatic episode is not integrated as a narrative, spatio-temporal event in autobiographical memory. Furthermore, the heightened sensitivity of exposure of PTSD patients to trauma-related material, or traumatic imagery, results in an increase in fearfulness in response to stimuli which were not truly life threatening.
Studies using MRI in PTSD have measured volume of the hippocampus, a brain structure involved in learning and memory. This line of research was prompted by studies in animals showing that high levels of cortisol seen in stress are associated with damage to the hippocampus. Patients with combat-related PTSD had an 8 percent decrease in right hippocampal volume when compared with controls. Deficits in free verbal recall tasks were associated with this decrease. A decrease of 12 percent in left hippocampal volume was found in patients with a history of PTSD related to severe childhood physical and sexual abuse. Reduced hippocampal volume was associated with dissociative symptoms in women who had a history of childhood sexual abuse.
People with PTSD tend to have abnormal levels of key hormones involved in response to stress. When people are in danger, they produce high levels of natural opiates, which can temporarily mask pain. Scientists have found that people with PTSD continue to produce those higher levels even after the danger has passed; this may lead to the blunted emotions associated with the condition.
Some studies have shown that cortisol levels are lower than normal and epinephrine and norepinephrine are higher than normal. Norepinephrine is a neurotransmitter released during stress, and one of its functions is to activate the hippocampus, the brain structure involved with organizing and storing information for long-term memory.
This action of norepinephrine is thought to be one reason why people generally can remember emotionally arousing events better than other situations. Under the extreme stress of trauma, norepinephrine may act longer or more intensely on the hippocampus, leading to the formation of abnormally strong memories that are then experienced as flashbacks or intrusions. Since cortisol normally limits norepinephrine activation, low cortisol levels may represent a significant risk factor for developing PTSD.
Treatment for PTSD typically begins with a detailed evaluation, and development of a treatment plan that meets the unique needs of the survivor. Generally, PTSD-specific-treatment is begun only when the survivor is safely removed from a crisis situation. For instance, if currently exposed to trauma (such as by ongoing domestic or community violence, abuse, or homelessness), severely depressed or suicidal, experiencing extreme panic or disorganized thinking, or in need of drug or alcohol detoxification, addressing these crisis problems becomes part of the first treatment phase. Other strategies for treatment include:
- Educating trauma survivors and their families about how persons get PTSD, how PTSD affects survivors and their loved ones, and other problems that commonly come along with PTSD symptoms. Understanding that PTSD is a medically recognized anxiety disorder that occurs in normal individuals under extremely stressful conditions is essential for effective treatment.
- Exposure to the event via imagery allows the survivor to re-experience the event in a safe, controlled environment, while also carefully examining their reactions and beliefs in relation to that event.
Regression therapy via Hypnotherapy can be the treatment
- Examining and resolving strong feelings such as anger, shame, or guilt, which are common among survivors of trauma.
- Teaching the survivor to cope with post-traumatic memories, reminders, reactions, and feelings without becoming overwhelmed or emotionally numb. Trauma memories usually do not go away entirely as a result of therapy, but become manageable with new coping skills.
- Although medications can be helpful at first, they deal
with the symptoms only as long as the person stays on the
medication. They do not offer permanent relief.
HYPNOTHERAPY TO HEAL PTSD
As stated herein, with PTSD "norepinephrine may act
longer or more intensely on the hippocampus, the brain's memory
storage area. This leads to the
formation of abnormally strong memories". These cause
flashbacks or intrusions of memory. Thus, persons experiencing PTSD
are excellent candidates for Regression Therapy, where the memories
can easily be brought to the surface.
The idea of Regression Therapy is to have the individual re-experience or relive the traumatic events within a safe or controlled
environment. In regression hypnotherapy, a patient who is returning
to the scene of the trauma will release in his brain the
norepinephrine and other chemical hormones related to the original
traumatic events. This will bring to the surface the vivid memories
and their related feelings not only at a mental level but also at a
physiological level. Bringing this material to the surface is
necessary for a final release of the stored information in order for
the person to become whole again. Thus the individual has not only the opportunity to re-examine his or her reactions and beliefs about the event, he/she has a chance to again experience
the related feelings from both a mind and body perspective. The individual then can "release" these old feelings, letting go of shame, guilt and anger with tears of sadness and rage reactions. Sometimes the patient needs to relive the experience more than once. As Freud said back in the nineteenth century, and as hypnotherapy has demonstrated to be correct, "Release of feelings is the essence of cure."
When my patients emote and release feelings, their reactions to the archaic events lose their power over the individual, the drama is over and is put into another perspective. One is then better able to cope with the left over memories. The symptomatology of PTSD diminishes and eventually the patient "forgets to remember" or "remembers to forget" the traumatic events. He/she has placed all this in a different perspective and is able to move on with their life.
Doctor Elly also has a special methodology for a final release of feelings. This is a neuro-dissociation process whereby "a part of the person" relives the event "for the person" as he/she lets go of the feelings for the very last time.
Hypnosis of this nature can be thought of as the treatment of choice for PTSD.
|My panic attacks were horrible. Before coming to Dr. Elly I was
placed on more and more Xanax medication. A few sessions with Dr. Elly and
I was able to throw the medication away. I now function like a different
person and I no longer have panic attacks. I also deal with stress in a
more positive manner.
-- Michael DeJanes