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What is PTSD?

PTSD or Post-traumatic stress disorder is disorder that can emerge following exposure to a traumatic event.

 

Traumatic events of sufficient severity can give rise to PTSD being involved including a motor vehicle crash. It is estimated that approximately 1 in 4 individuals who have been in a motor vehicle crash develop PTSD one month after the crash. PTSD is not diagnosed within one month of the event, but it can be preceded by Acute Stress Disorder which is experienced as symptoms of post-traumatic stress within the first month following the event. Children can also experience PTSD even those as young as 2-3 years old. Children can perceive events differently to adults and so some events are experienced as more traumatic for children than adults.

Did you know?

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The Diagnosis of Post-Traumatic Stress Disorder

A diagnosis of PTSD is typically made on the basis of a clinical interview conducted by a trained health or mental health professional.

During the clinical interview, the health or mental health professional will enquire about details of the traumatic event to which the individual was exposed, as well as the types of symptoms the individual might be experiencing. Diagnosis of PTSD in children usually requires specialised training.

The Symptoms of Post-Traumatic Stress Disorder

The symptoms of PTSD fall into four main categories: re-experiencing symptoms, avoidance symptoms, negative cognition and mood and symptoms of hyper-arousal.

Re-Experiencing Symptoms

Following exposure to a traumatic event, individuals might experience recurrent nightmares of the event. Individuals might also have recurrent thoughts or images of the traumatic event, and have difficulty turning their attention away from these thoughts and images. At times, thoughts or images of the traumatic event will seem to ‘intrude’ into consciousness. Individuals with PTSD sometimes indicate that they feel as if they are reliving the traumatic event over and over.  In the case of a motor vehicle crash, an individual might have nightmares of the crash, might have recurrent thoughts about the crash, and might have difficulty turning attention away from memories of the crash. In a child this might take the form of the child retelling the story of the trauma over and over to friends and family. Images of the trauma might also be represented in the child’s drawings or play.

Avoidance Symptoms

Following exposure to a traumatic event, individuals might feel the need to avoid situations that remind them of the traumatic event. Because thoughts or images of the trauma are very distressing, the individual might try to avoid these thoughts or images as much as possible. Often, individuals with PTSD will try to avoid situations that might make them think or remember details of the trauma. In the case of a motor vehicle crash, individuals might feel the need to avoid the area where the crash occurred, they might avoid talking about the crash, they might also avoid driving altogether. Children might feel distressed in response to travelling near the site of the accident. The mere anticipation of travelling in a motor vehicle might sufficient to elicit intense emotional reactions in the child.

Hyper-arousal

Following exposure to a traumatic event, individuals might feel ‘on edge’ or easily startled. Some individuals report always being on alert for signs of danger or other impending disaster. This type of ‘hyper-arousal’ can interfere with a person’s ability to engage in activities of daily living. It can also interfere with sleep and contribute to problems of memory and concentration. In the case of a motor vehicle crash, individuals might feel overly anxious when driving; they might feel as if another crash is likely to happen. They might be easily startled by unexpected sights or sounds while travelling in a motor vehicle .For children hyper-arousal could be expressed as difficulties with sleep, maintaining attention or physical complaints such as stomach pain.

Negative mood and cognition

After a traumatic event an individual may experience negative thoughts about the world, the future and themselves, for example they may not believe the world is safe, or they may feel strongly that themselves (guilt) or others (anger) are to blame for what happened. They may also have difficulty recalling parts of the traumatic event. Children might experience emotional withdrawal or alternatively “acting out” behaviours which can be misinterpreted as naughtiness. In adolescents there may be increase risk taking behaviours and social withdrawal.  Younger children may also become afraid of being alone or separated from parents, and may start to develop new fears unrelated to the traumatic event.

Duration of Symptoms

It is difficult to predict how long the symptoms of PTSD will persist. Many individuals might recover within a few months of the onset of PTSD. For others, the symptoms of PTSD might persist for a longer period of time. Individuals who have severe pain symptoms and individuals who have previously experienced mental health problems may be more likely to develop chronic symptoms of PTSD. For children their parents’ distress and adjustment to trauma are associated with chronic symptoms of PTSD so that if parents cope well and recover from trauma their children are more likely to recover.

Disability associated with PTSD

When severe, the symptoms of PTSD can interfere with an individual’s ability to engage in many activities of daily living. In some cases, PTSD can contribute to work disability. Prolonged work absence can complicate the recovery process as a result of stresses brought about by loss of independence and the loss of financial security. For young children PTSD may be associated with changes in their developmental trajectory and can sometimes be associated with developmental regression, or displaying behaviours from an earlier age. For school aged children changes in academic performance might be seen as well as changes in social behaviours.

Other Problems Associated with PTSD

There are a number of additional health or mental health problems that can co-occur with PTSD. In individuals with PTSD, Major Depressive Disorder and Anxiety Disorder are common. In children separation anxiety disorder or oppositional disorder might also be seen.  Individuals who have been diagnosed with PTSD can report experiencing symptoms of pain. Pain symptoms might be experienced in parts of the body that were injured in the crash, or they might be unrelated to bodily injury. Individuals with PTSD might also have experienced a co-occurring mild traumatic brain injury or concussion. Individuals who have been diagnosed with PTSD often report symptoms of depression or anxiety. They might also experience problems with alcohol or drug abuse. The presence of these additional problems can slow the pace of recovery.

Research Participation

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The Treatment of Post-Traumatic Stress Disorder

Several psychological and pharmacological interventions have been shown to be effective in the treatment of the symptoms of PTSD.

Some of the more common treatments include:

  • Cognitive-Behaviour Therapy
  • Eye Movement Desensitisation and Reprocessing (EMDR)
  • Anti-depressant Medication
  • Rehabilitation

Psychological Interventions

There are many different forms of psychological interventions used to treat PTSD. These differ in terms of the focus of treatment, the duration of treatment, and the intended outcomes of treatment. Some treatments might be tailored to a particular client’s needs, and others might be provided in group format, and some are available online as e-therapy.

Cognitive-Behaviour Therapy

The most commonly used psychological approach to the treatment of PTSD is called Cognitive-Behaviour Therapy, or CBT. This type of treatment proceeds from the view that the symptoms of PTSD often persist as a result of the way in which the person ‘thinks’ or ‘acts’ in relation to a traumatic event. By guiding the client to think or act differently in relation to a traumatic event, the goal of treatment is to reduce the severity of symptoms of PTSD and assist the client in resuming involvement in important activities of his or her life. Cognitive Processing Therapy is a form of CBT that has been designed to address PTSD which has a focus on processing a narrative about memories of the trauma. Prolonged Exposure for PTSD is another form of CBT with a focus on reducing avoidance and fear about the trauma by gradual exposure.

A client with PTSD who is receiving CBT might meet with his or her therapist once per week for approximately 8 to 15 weeks.

A particular form of CBT referred to as Trauma-Focused Cognitive Behaviour Therapy has been used extensively with children suffering from PTSD.

Trauma-Focused CBT incorporates a number of different techniques designed to reduce the severity of symptoms of PTSD and to promote recovery.  Narrative techniques (story telling) are used to help the child derive a sense of meaning from the traumatic event. The development of trauma narrative also provides the therapist with the opportunity to correct inaccurate beliefs the child might hold about the trauma (I will die if I travel in a car again). Finally, a number of emotional regulation techniques are used to assist the child in controlling his or her emotional reactions to stressful or trauma-related situations.

Eye Movement Desensitisation and Reprocessing (EMDR)

Eye Movement Desensitisation and Reprocessing (EMDR) combines many techniques that might be used in CBT with the use of repeated voluntary eye movements to reduce the intensity or frequency of disturbing thoughts or images. A client receiving EMDR might be asked to recollect a disturbing image associated with a traumatic event, and while holding the traumatic image in mind, move his or her eyes side to side repeatedly. The repeated eye movement is thought to produce a type of ‘reprocessing’ of the trauma, ultimately reducing the frequency and intensity of the symptoms of PTSD. Although EMDR was considered a controversial treatment when it was first developed, it is now recognised as an effective treatment for PTSD. There is some emerging support for EMDR as an intervention for children with PTSD.

Rehabilitation

The treatment of PTSD is not just about reducing the severity of symptoms. Full participation in important life activities is as important as reducing the severity of symptoms.  Some symptoms of PTSD might persist for a long period of time. New research findings indicate that individuals with PTSD can resume important family, social and even occupational activities in spite of fact that symptoms of PTSD persist. Rehabilitation interventions can be useful to help individuals resume important activities of their lives even though they continue to experience symptoms of PTSD.

Pharmacological Interventions

There is no medication that is specifically designed to treat the symptoms of PTSD. However, antidepressant medication is prescribed for adults suffering from PTSD.

Anti-depressant Medication

The beneficial effects of antidepressants are not immediate; improvement might not be seen for one to two weeks after starting to take the medication. Some antidepressants will cause some side effects such as dry mouth, nausea or drowsiness. The side effects usually begin to subside within a week to 10 days of starting the medication. One thing all anti-depressants have in common is that they work best if taken the way they have been prescribed.

There are a number of types of anti-depressants. One class of anti-depressants known as ‘serotonin specific reuptake inhibitors’ or SSRIs, are the most frequently prescribed anti-depressants for symptoms of depression that might co-occur with PTSD. Medications such as Zoloft and Aropax are SSRIs that are often prescribed for individuals with PTSD.

While sometimes prescribed to children, antidepressant medication is not recommended for treatment of PTSD in children. In fact there is no class of drug recommended for treatment of PTSD in children.

Treatment Options

Recover researchers have developed a PTSD treatment options resource. The resource is designed to assist you in your discussions with your healthcare provider about the treatment of your PTSD

Would you like to participate in one of our research studies?

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