Anxiety Disorders: Post-Traumatic Stress Disorder

PTSD from Video

Soldiers are returning from home and cannot adjust

They miss being in battle, they miss being with people that are going through the same things they did

They would go back any second; they are so used to living on edge and coming home is now foreign

77% of Veterans say that the sessions help

Cognitive Processing Therapy

Repeating and listening to the memory you are trying to avoid

Constantly reliving memories to take away its power

PTSD

A psychological syndrome that is triggered by a specific traumatic event (life threatening and overwhelming) or ongoing traumatic situation and is characterized by certain symptoms

Causes of PTSD

Natural disasters
Life threatening situations
Abuse (physical, sexual, emotional)
Second hand seeing a disaster (cleaning up 9/11, hospitals, working with abused children)
Burglary
Infidelity
Crime

PTSD Symptoms

Chronic anxious arousal and hypervigilance

Re-experiences the traumatic events (nightmares, memories, flashbacks)

Avoidance

Reduced responsiveness and emotional numbing, things of interest are no longer of interest

Survivors guilt

Symptoms may endure a long time and may have delayed onset (holocaust survivors)

Acute Stress Disorder

Same as PTSD but shorter, starts within month of trauma and last less than a month

Prevalence of PTSD or Acute Stress Disorder

7-12% of people

More likely in women than men

20% of traumatic women

8% of traumatic men

Wilbur PTSD

Wilbur and family were in the path of a dam, and it burst

He miraculously saw it coming and woke up wife and kids and they got away, house was gone and smashed

Why would someone develop anxiety and hypervigilance

On guard against a repeat, trying not to have anything else happen like that again

World becomes dangerous and unpredictable, safety is gone

ex: Wilbur will stay up whenever a storm comes, anxious around rain

Why Avoidance

Does not want to be reminded of think of traumatic event

Why reliving traumatic events

Person is going over it multiple times to add a different ending, to change the story in mind

It is attempted problem solving, processing, and coming to terms with the situation

Why reduced responsiveness

All the things person usually enjoyed is gone

They are emotionally preoccupied with their anxiety; how can you feel another emotion when you are constantly in danger

Preemptive motive

Motive that is so consuming that you cannot think of anything else, your life is consumed

Why Survivor Guilt

Simply because they survived, and others didn’t

Feel like they got something they did not deserve

Who is at greatest risk of PTSD

Those with greatest severity, proximity, and duration of trauma

Those with less social support, people who cannot talk about their problems, or feel shame

Those who suffer shattered assumptions

Biological factors (genetics) stronger than average physiological responders

Shattered Assumptions

Reassuring beliefs that are broken from trauma

“Something like that couldn’t happen to me”

“The world is meaningful and happens for a reason” but something happens, and they cannot find a reason

“Bad things don’t happen to good people”

Why delayed onset in some cases of PTSD

Person can repress something until stressor occurs later in life and person can no longer maintain repression and repressed contents emerge

However, cases exist where there is no repression and no memory at all for the accident like going into denial or not letting it sink in

Drug Therapies

SSRI’s like Zoloft and Paxil are most helpful

Drugs achieve partial symptom reliefs

Usually suppress but do not cure, problems return when drug use stops

Exposure Therapies

Disclosure Therapy

Desensitization

EMDR

Disclosure Therapy

Disclosing what happened to another empathic human being over and over again

Effective 2/3 of the time

Desensitization

Deep muscle relaxation to settle body and build a hierarchy of things they are not that afraid of to things that terrify them

Desensitizes them to traumatic situation by slowly building up tolerance

Eye Movement Desensitization and Reprocessing (EMDR)

Let patient relax and you wave hand in front of face the whole time. Tell patient to look at hand while recalling memories and feelings from traumatic event.

Makes memory less destressing, makes you focus on something else, no panic attack

Case of Anne

Anne is an elderly woman that had PTSD after a car accident Dr. Bergner treated her with EMDR and was able to achieve success