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Understanding Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder, commonly referred to as PTSD, is a condition that affects numerous individuals across different walks of life. Among the most fundamental aspects of nursing is understanding the underpinning factors of conditions like these and being equipped with the right skills to care for patients with such disorders.
Definition and Causes of Post-Traumatic Stress Disorder
Let's start with the basics. What is Post-Traumatic Stress Disorder?
PTSD is a psychiatric disorder that may occur in individuals who have witnessed or experienced traumatic events such as severe accidents, violent personal assaults, natural disasters or serious health problems.
These experiences can trigger a series of emotional and psychological reactions that can manifest in a variety of ways, depending on the individual and the severity of the traumatic event. Understanding the causes and risk factors can greatly help in the process of caring for a patient with PTSD.
For example, consider a patient who has witnessed a horrifying accident. This patient may begin to exhibit symptoms like flashbacks to the event, severe anxiety, and even physical reactions like sweating or shaking when reminded of the event. These are all possible indications of PTSD.
How Post-Traumatic Stress Disorder Develops
The development of PTSD can be complex and multifactorial. It is often influenced by a confluence of factors like the intensity of the trauma, a person's history of previous traumas, and their overall mental health condition.
It's worth noting that individuals do not necessarily develop PTSD immediately after a traumatic event. In some cases, symptoms can surface weeks, months or even years later.
Beyond trauma exposure, genetics also play a role in the development of PTSD. Studies suggest that certain genes may make people more susceptible to the condition, emphasizing that PTSD is often an interplay of genetic, environmental, and psychological factors.
Post-Traumatic Stress Disorder: Not Just a Military Issue
While PTSD is often associated with military veterans, it's important to understand that it is not exclusive to this group.
Anyone who has been through a traumatic event can develop PTSD. This includes survivors of physical and sexual assault, abuse, accidents, disasters, and many other serious events. Nurses need to be aware of this and ensure they can provide the necessary support and care for anyone struggling with the aftermath of traumatic events.
Take, for instance, a patient who has survived a major motor vehicle accident. Despite not having any military background, they can still develop PTSD due to the traumatic experience they have gone through. It is crucial for nurses to recognise this possibility and approach their care with sensitivity and understanding.
Recognising Post Traumatic Stress Disorder Symptoms
Identifying the symptoms of Post-Traumatic Stress Disorder (PTSD) is pivotal in providing early intervention and support. The manifestation of PTSD symptoms can be diverse, varying from individual to individual. Essentially, PTSD symptoms can be broadly categorised into psychological and physical symptoms.
Common Symptoms of Post Traumatic Stress Disorder
A critical step toward helping patients with PTSD is recognising the common symptoms of this disorder. While people react to trauma in different ways, there are certain symptoms that are widely observed among individuals with PTSD.
These symptoms can be divided into four main categories:
- Intrusive thoughts or memories of the traumatic event
- Avoidance behaviour or emotional numbing
- Changes in thoughts and mood
- Changes in physical and emotional reactions
Intrusive thoughts refer to unwanted recurrent memories or nightmares of the event. Avoidance behaviour, on the other hand, includes staying away from places or events related to the trauma, or blocking out the thoughts about the trauma. Mood changes can include feelings of guilt, irritability, lack of interest in previously enjoyed activities, and an overall pessimistic outlook on life. Alterations in physical and emotional reactions can include being constantly on guard or easily startled, or having trouble concentrating or sleeping.
Emotional and Psychological Symptoms of Post Traumatic Stress Disorder
PTSD has a profound impact on an individual's psychological and emotional wellbeing. It can disrupt a person's thought processes and emotional stability, leading to active distress and functional impairment in daily life. Understanding these symptoms is key to helping individuals with PTSD and providing them with appropriate treatment and support. Some of the emotional and psychological symptoms include:
| Increased irritability and aggressive behaviour |
| Persistent and exaggerated negative beliefs |
| Severe guilt or self-blame about the traumatic event |
| Persistent fear, anger, horror, guilt or shame |
| Feeling alienated from others |
It is important to note that the presence and severity of these symptoms can vary from person to person, and that they may fluctuate over time.
Physical Symptoms Tied to Post Traumatic Stress Disorder
Beyond the emotional and psychological distress, PTSD can also manifest in physical symptoms. These physical symptoms are often a result of increased arousal in response to the traumatic event. Some commonly seen physical PTSD symptoms include:
| Trouble sleeping or nightmares |
| Feeling easily startled or frightened |
| Struggling with concentration |
| Self-destructive behavior like drug abuse or reckless driving |
These symptoms can have a profound impact on daily functioning and quality of life, further underlining the importance of recognising and addressing them in your role as a nurse.
Exploring Post Traumatic Stress Disorder Treatment
Effective treatment is fundamental to help individuals coping with Post Traumatic Stress Disorder (PTSD) regain control of their lives. From medication to therapy, different methods can be employed to alleviate symptoms, allowing individuals to handle stress and manage their responses to triggers.
Approaches to Post Traumatic Stress Disorder Treatment
Treating PTSD is not a one-size-fits-all process. Individualised treatment plans are often necessary as everyone is unique in their experiences and their response to therapy. Broadly speaking, PTSD treatment is usually a combination of medication and psychotherapy, also commonly known as counselling.
Psychotherapy, or counselling, is a type of therapy often used in PTSD treatment. It involves talking with a mental health professional to understand and change thought patterns that lead to distressing feelings, behaviours or mental health conditions.
Self-management strategies such as stress management techniques and mindfulness exercises can also be beneficial. Beyond this, societal support plays a crucial role in facilitating recovery and augmenting resilience.
Interestingly, virtual reality (VR) is one of the newer methods being explored for treating PTSD. This involves the use of immersive technology to recreate situations or circumstances related to a patient's traumatic experience in a controlled and therapeutic manner, enabling individuals to confront their fears and anxieties in a safe environment.
A patient with PTSD who experiences severe distress around loud noises, for example, may work with a therapist using controlled sound exposure therapy. This can help the patient slowly acclimate to these triggers in a safe, controlled environment, reducing their impact over time.
Medication and Post Traumatic Stress Disorder Treatment
Medication plays a crucial role in the treatment of PTSD, often used in conjunction with psychotherapy. The primary aim of medication is to reduce the intensity of PTSD symptoms, such as anxiety, depression and sleep disturbances. The most commonly prescribed medications for PTSD include antidepressants, anti-anxiety drugs, and occasionally, mood stabilisers.
Antidepressants often play a key role in managing the symptoms of PTSD. They work by boosting the levels of certain chemicals in the brain that help regulate mood and stress responses, making it easier for individuals to cope with the effects of the disorder.
Here are a few examples of commonly used medications in the treatment of PTSD:
| Sertraline (Zoloft) |
| Paroxetine (Paxil) |
| Fluoxetine (Prozac) |
| Venlafaxine (Effexor) |
The choice of medication will depend on the specific symptoms, any concurrent mental or physical health problems, the patient's personal response to medication, and their personal preferences.
Therapy Options for Post Traumatic Stress Disorder Treatment
Besides medication, therapy forms the cornerstone of PTSD treatment. Therapy can help individuals understand their thoughts and reactions, and equip them with skills to manage their symptoms effectively.
There is a wide range of therapy options available, few of which include:
- Cognitive Therapy
- Exposure Therapy
- Eye Movement Desensitization and Reprocessing (EMDR)
- Dialectical Behaviour Therapy (DBT)
Cognitive therapy helps individuals with PTSD understand and change thought patterns that lead to harmful feelings and behaviours. Exposure therapy, on the other hand, helps individuals safely face both situations and memories that they find frightening so they can learn to cope with them effectively. EMDR, incorporates elements of cognitive-behavioural therapy with eye movements or other forms of rhythmic, left-right stimulation that can work to change the way the brain processes information and memories. DBT is a type of cognitive-behavioural therapy that teaches individuals how to live in the moment, cope with stress, regulate emotions and improve relationships.
For example, in an exposure therapy session, a nurse might work with a patient who was in a severe car accident. They would revisit the accident site in a controlled manner or discuss the incident at length, ensuring that safety and comfort standards are always maintained. This can help the patient realise that their fears are irrational and promote emotional healing.
Diving Deep into DSM-5 Post Traumatic Stress Disorder
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is the gold standard for diagnosing mental health conditions such as Post Traumatic Stress Disorder (PTSD). The DSM-5 provides clear criteria for diagnosing PTSD, outlining the symptoms and behaviours that a patient must exhibit to meet this diagnosis.
Diagnosing Post Traumatic Stress Disorder using DSM-5
For a robust and accurate PTSD diagnosis, the DSM-5 criteria are utilised. The diagnostic criteria cover a range of symptoms that an individual should be experiencing for a certain length of time, along with the impact they have on their ability to function in daily life.
According to the DSM-5, PTSD is categorised as a Trauma-and-Stressor-Related Disorder, which occurs following a traumatic or stressful event. Diagnosis involves the presence of specific symptoms in several categories following exposure to a traumatic event.
The DSM-5 lays down specific criteria for diagnosing PTSD which can be divided into six main components:
- Criteria A (stressor)
- Criteria B (intrusion symptoms)
- Criteria C (avoidance)
- Criteria D (negative alterations in cognitions and mood)
- Criteria E (alterations in arousal and reactivity)
- Criteria F (duration)
An individual who meets the DSM-5 PTSD diagnosis may have experienced a traumatic event, such as a severe car accident (Criterion A). This individual could experience recurring nightmares about the accident (Criterion B), and may avoid driving or even travelling in cars (Criterion C). They may also feel detached from their friends and family and lose interest in activities they previously enjoyed (Criterion D). They may be easily startled and feel on edge, constantly expecting another accident to happen (Criterion E). If these symptoms persist for more than a month, causing significant distress and impacting their ability to function (Criterion F), a diagnosis of PTSD may be appropriate.
Overview of the DSM-5 Criteria for Post Traumatic Stress Disorder
The DSM-5 clearly indicates specific criteria that help diagnose PTSD. Let's briefly summarise these criteria and what they entail:
| Criterion A (stressor): The person was exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence. |
| Criterion B (intrusion symptoms): The traumatic event is persistently re-experienced. |
| Criterion C (avoidance): Persistent effortful avoidance of distressing trauma-related stimuli after the event. |
| Criterion D (negative alterations in cognitions and mood): Negative alterations in cognitions and mood that began or worsened after the traumatic event. |
| Criterion E (alternations in arousal and reactivity): The traumatic event is associated with increased arousal and reactivity that began or worsened after the traumatic event. |
| Criterion F (duration): Symptoms last more than 1 month. |
By providing specific, uniform criteria, the DSM-5 ensures that PTSD is diagnosed consistently and accurately across different clinicians and settings.
Changes to DSM-5 Criteria for Post Traumatic Stress Disorder
The release of the DSM-5 brought about some important changes in the criteria for diagnosing PTSD compared to its predecessor (DSM-IV). Understanding these changes is crucial as they reflect updated knowledge and research on PTSD.
The most significant change is the relocation of PTSD from the category of anxiety disorders to a new category, known as Trauma-and-Stressor-Related Disorders.
Further changes include the addition of a preschool subtype of PTSD for children six years and younger. The DSM-5 also introduced a separate diagnostic criteria for those who experience ongoing, repeated traumatic events like child abuse or war, a subtype known as Complex PTSD (CPTSD).
Other important changes to the PTSD criteria in the DSM-5 include:
- Introducing harder thresholds and splitting the avoidance and numbing cluster, which has led to an increase in the number of symptoms from 17 to 20.
- Two of the three new symptoms relate to reckless or self-destructive behavior and distorted blame of self or others for creating the trauma.
- Removal of the requirement that an individual must experience fear, helplessness, or horror immediately following the trauma.
Whether you're diagnosing PTSD or providing support for someone with this disorder, understanding the DSM-5's diagnosis criteria and updates is crucial to effective care and treatment.
EMDR and Cognitive Behavioural Therapy for Post Traumatic Stress Disorder
Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive Behavioral Therapy (CBT) are two key therapeutic approaches commonly used in Post Traumatic Stress Disorder (PTSD) treatment. These therapies are tailored to address traumatic memories and distorted thought patterns, intending to transform how individuals perceive and respond to stressful experiences.
Post Traumatic Stress Disorder Eye Movement Desensitization and Reprocessing
EMDR is a type of psychotherapy uniquely designed to alleviate the distress associated with traumatic memories. This therapy utilises bilateral sensory input, such as side-to-side eye movements, to facilitate processing of traumatic memories. EMDR is primarily used for individuals who have experienced severe traumatic events, making it a frequently chosen method for treating PTSD.
Eye Movement Desensitization and Reprocessing (EMDR) is a phased, focused psychotherapy that stimulates information processing by evoking accelerated access to traumatic memories and promotes adaptive resolution.
How EMDR Works for Post Traumatic Stress Disorder
In EMDR, the therapist guides the patient to recall distressing images while conducting bilateral eye movements, ensuring that the patient’s eyes are moving from side to side. The goal of the process is to reduce the long-lasting effects of distressing memories by engaging the brain's natural adaptive information processing mechanisms, promoting a healthier perspective of the memory.
A woman with PTSD stemming from a traumatic childhood event may have a typical EMDR session that involves her recalling the disturbing event in detail, including the emotions and body sensations associated with it. During this recollection, her therapist would ask her to follow a moving object with her eyes. As she recalls the traumatic scene and follows the moving object, the distress associated with the memory tends to reduce.
Results and Effectiveness of EMDR Treatment for Post Traumatic Stress Disorder
There is a wealth of clinical evidence supporting the use of EMDR in treating PTSD. Many research studies have documented the effectiveness of EMDR, concluding it can significantly reduce the symptoms of PTSD. It is also noted that the benefits of EMDR may be long-term and not just a short-term alleviation of symptoms.
Post Traumatic Stress Disorder Cognitive Behavioural Therapy
Another widely accepted and effective form of therapy for treating PTSD is Cognitive Behavioural Therapy (CBT). CBT works by identifying and changing distressing thought patterns that have a detrimental influence on behaviour and emotions. This approach can enable individuals to react differently to their triggers and manage their symptoms more effectively.
Cognitive Behavioural Therapy (CBT) is a form of psychological treatment that seeks to identify and alter negative thought patterns and behaviours. It's widely used to treat a variety of disorders, including PTSD, as it helps individuals learn coping skills to deal with stressful situations.
Understanding CBT as a Tool for Post Traumatic Stress Disorder Treatment
CBT for PTSD generally involves two key components - exposure therapy and cognitive restructuring. Exposure therapy encourages individuals to confront and re-experience their traumatic event in a controlled and safe environment, fostering emotional processing of the traumatic memory. Cognitive restructuring, on the other hand, assists individuals to make sense of the bad memories and reframe negative thought patterns associated with the traumatic event.
An individual who was traumatised by a near-drowning incident might be gradually exposed to water-related activities in exposure therapy, starting from looking at pictures of swimming pools all the way to slowly entering a shallow pool. At the same time, the therapist would use cognitive restructuring to debunk the individual's belief that all water is dangerous, helping them develop a balanced perspective towards water-based activities.
Success Stories and Improvement Rates with CBT for Post Traumatic Stress Disorder
CBT has helped many people with PTSD regain control over their lives. Empirical studies have demonstrated that CBT significantly reduces the symptoms of PTSD, prevents relapses and improves daily functioning. The treatment gains made through CBT have been shown to be maintained even after the conclusion of therapy. It is worth noting that practical application of coping skills learned in CBT matters; the more an individual practices their new skills, the more beneficial the outcomes will be.
Post-Traumatic Stress Disorder - Key takeaways
- Post-Traumatic Stress Disorder (PTSD) symptoms can be categorized into four main components: intrusive thoughts or memories of the traumatic event, avoidance behaviour or emotional numbing, changes in thoughts and mood, and changes in physical and emotional reactions.
- Emotional and psychological symptoms of PTSD can include increased irritability, persistent and exaggerated negative beliefs, severe guilt and feelings of alienation. Physical symptoms can include trouble sleeping, feeling easily startled and struggling with concentration.
- Post Traumatic Stress Disorder Treatment often involves a combination of medication and psychotherapy. Medication aims to reduce the intensity of PTSD symptoms, with common medications including antidepressants and anti-anxiety drugs.
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) provides specific criteria for diagnosing PTSD, which include specific symptoms and duration. Changes to DSM-5 include the relocation of PTSD to the category of Trauma-and-Stressor-Related Disorders.
- Key therapeutic approaches for PTSD include Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive Behavioral Therapy (CBT). Both are designed to address traumatic memories and distorted thought patterns.
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