Jury PTSD
solider with PTSD

PTSD Therapy - Edmonton Psychologist

Post-Traumatic Stress Disorder or PTSD has been receiving more and more mentions in the media.  In Edmonton PTSD counseling with a psychologist is becoming more sought after, as the disorder has become understood and accepted.  PTSD is most associated with Canadian Forces (CF) active members, and with military veterans.  Recent times has seen an increased recognition of PTSD in First Responders (police, firefighters, paramedics, child welfare workers, 911 dispatch workers, Search and Rescue (SAR) staff, etc...) and for those who have served as jurors on murder, assault, and abuse trials.  PTSD has been blamed for marital breakdown, job loss, violence, poverty, development of chronic physical illness, addictions, other mental health issues (e.g. depression / anxiety), and in the most serious cases, homicide and suicide.  So what is happening?  Is PTSD a new thing?  Has it suddenly gotten worse?  Is it real or just an excuse to avoid facing up to reality?

HISTORY OF PTSD - THE GREEKS

              Ajax suffering PTSD trauma following battle

              Ajax suffering PTSD trauma following battle

There are various documented reports in Greek history of famed warriors being "struck blind" after seeing many of their comrades fall in battle and experiencing near death themselves.  Sometime after 489BC, Sophocles, a decorated general and Greek philosopher, wrote the play Ajax. Ajax is a celebrated warrior who comes home from battle to a loving wife and child.  He suddenly find himself experiencing dissociation, depression, anxiety, and hyper-vigilance.  Nothing his wife or friends can do can calm him.  Abruptly Ajax snaps, falls into a killing rage, committing murder and ultimately suicide.  Sadly, this story is not just a work of fiction.  There are many instances, even today, of people having similar experiences following exposure to major traumas.

History of PTSD -  FROM SHAKESPEARE TO THE VICTORIAN ERA

Historical authors have written on the theme of mental distress following war.  In one play Shakespeare's described a vaunted fighter who subsequently suffered terrible nightmares about "iron wars", and experienced dissociative periods and depression.  In another Shakespearean play, Macbeth, a Scottish general, kills the king to gain his throne and then suffers what appears to be a mental breakdown.  Macbeth reports experiencing hallucinations, delusions, periods of intense sorrow, and at one point asking the universe, "Canst though not minister to a mind diseased/Pluck from the memory a rooted sorrow?"

trauma face and hand

Charles Dickens wrote in letters about having an "inexpressibly distressing" feeling when thinking of having to travel by rail after a train he was on derailed off a bridge.  Ten people died in the accident with another 49 injured.  Dickens was never the same afterwords.  He spoke of being "curiously weak... as if I were recovering from a long illness."  "I begin to feel it more in my head.  I sleep well and eat well; but I write a half dozen notes, and turn faint and sick.. I am getting right, thought still low in pulse and very nervous".  He was never as prolific an author after the accident, and often complained bout difficulties with focus and attention.

In 1895 Stephen Crane's Red Badge of Courage became a popular novel and later a hit movie.  The focus of the story-line describes the psychological response of a new recruit to the barrage of fighting during the American Civil war.  Many of the symptoms of anxiety, panic, sleep disruption, sadness, and avoidance experienced by the central character fit within the PTSD diagnosis criteria.  Unfortunately, this solider did not receive treatment.  Instead his peers and leaders treated him with shame, disgust, and negative judgements for being morally weak.

HISTORY OF PTSD - WAR IN THE 20TH CENTURY

The term 'shell shock' was coined to describe psychological distress World War I vets experienced after periods of bombardment.  The defining features of shell shock include insomnia, nightmares, racing heartbeat, headaches, tremors, amnesia, and regressive behaviors particularly after loud and unexpected noises.  Soldiers diagnosed with shell shock often had great difficulty returning to civilian life, and were at higher risk for suicide.  By World War II shell shock was referred to as battle fatigue or Combat Stress Reaction.

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PTSD OUTSIDE OF WAR

In 1952 the American Psychiatric Association included a diagnosis of 'gross stress reaction', in the Diagnostic and Statistical Manual (the 'Bible' of mental health disorders).  But this diagnosis was only applicable to those showing symptoms for six months after the trauma.  Ongoing symptoms were considered to suggest a different mental health issue.  By 1980 the American Psychiatric Association had formally called collection of symptoms PTSD and suggested such a diagnosis could apply to war veterans, Holocaust survivors, sexual trauma victims and others directly involved in traumatic events. 

Research in 2013 showed that PTSD is a relatively common occurrence with 4 out of 100 men (4%), and 10 out of 100 women (10%) exhibiting PTSD symptoms at some point in their lifetime.   As these numbers clearly exceed the rates of direct, significant trauma exposure in first world countries, it is now accepted that PTSD can also result from intense or repeated exposure to the aftermath of trauma.  That is, hearing about, or being involved with traumatized people, can result in the listener / helper developing PTSD.  Thus, the latest Diagnostic and Statistical Manual (DSM-5) adds a section specifically acknowledging that First Responders are equally susceptible to PTSD as those traumatized by direct combat, assault or accident victims.

HISTORY OF PTSD TREATMENT

Throughout history some believed that PTSD, shell shock, war malaise, or whatever the term of the day, is more a moral failing (not strong enough, not brave enough, not determined enough) than a mental health issues.  For this population treatment involves 'ignoring it', 'burying it', shaming, chastising, and insisting one 'get back on the horse right away'.  Civil war physicians termed the disorder 'irritable heart" (rapid pulse, anxiety, trouble breathing), and treated it with medications aimed at controlling the symptoms, and then ordered their patients back to battle. 

World War I shell shock was attributed to traumatic brain injury from being too close to big gun explosions.  Some soldiers were given a few days rest before returning to war, others deemed more serious were pulled from the front and provided support to manage daily living tasks, while being offered hydrotherapy, electrotherapy, and hypnosis as treatment.  While hydrotherapy or 'taking the waters' (often in hot, sulphur based pools) has long been a treatment for civilians suffering from anxiety, electrotherapy and hypnosis were relatively new interventions.  As a result, even for those who received treatment, the long term prognosis for shell shock was highly unpredictable.

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Soldiers affected by Combat Stress Reaction (CSR) in World War II were treated using a Proximity, Immediacy, Expectancy approach. This meant that those diagnosed with CSR received some kind of immediate medical response, were assured they would make a complete recovery, and were notified they would be returning to the front lines at the earliest opportunity.  The effectiveness of such a treatment approach was not tracked.  For the first time though, the combat stress responses were being treated in a standardized manner that incorporated the concept of relationships and psychological support as being a means of preventing, moderating, and healing the effects of CSR. 

WHO IS AT RISK FOR PTSD?

To be diagnosed with PTSD you must have been directly involved with a trauma, or be intensely exposed to the aftermath of a trauma, or repeatedly exposed to the aftermath of traumas.

  • war refugee
  • chronic bullying
  • neglected as a child
  • in the field medical personnel
  • exposed to domestic violence as a child
  • military combat
  • serving as a First Responder
  • being a juror on a graphic trauma case
  • front-line reporter
  • involved in a road accident
  • engaged in domestic violence
  • medical trauma (chronic illness / injury with multiple surgeries)
  • repeated exposure to trauma stories
  • victim of assault (physical, sexual, emotional)
  • held hostage
  • victim of a natural disaster (flood, earthquake...)

SIGNS YOU MAY HAVE PTSD

  • intrusive symptoms: nightmares, repetitive play/thoughts about the event, flashbacks, psychological or physical distress in response to a trauma reminder
  • avoidance behavior: attempts to not think about the event, attempts to avoid feelings associated with the event, attempts to avoid where the event took place or places that are similar to where the event took place
  • negative changes in mood or thought in relationship to the trauma: inability to recall some or all of trauma, lost time, negative beliefs about self/others "I am bad" "the world is bad", chronic negative mood (fear, horror, shame, guilt, anger), loss of interested in previously enjoyed activities, sense of detachment from others, difficulty feeling or sustaining positive emotions (happiness, satisfaction, love)
  • dark moods and overreactions are easily triggered: irritable/angry over minor things (may include unwarranted physical aggression), reckless/self-destructive behavior, hyper-vigilance, easily and overly startled, difficulty with concentration/memory/learning, difficulty falling or staying asleep
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RISKS ASSOCIATED WTIH PTSD

  • anger / regression issues
  • substance abuse issues
  • social isolation
  • high risk of suicide
  • memory / focus / learning difficulties
  • overreactive
  • risk taking behavior / impulsivity

 

  • inability to settle (chronic restlessness)
  • loss of friends and family
  • inability to maintain employment
  • depression / anxiety / panic attacks / social phobia
  • physical illness

 

CURRENT PTSD THERAPY

Currently there are over 200 kinds of programs for treating PTSD.  While the now traditional trauma therapy approaches of Cognitive Processing Therapy and Prolonged Exposure continue to be utilized, recent progress with Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization Reprocessing (EMDR) are the recognized gold standard approaches. 

Certain medications such as Selective Serotonin Re-uptake Inhibitors (SSRI's), sertraline, and paroxetine have been helpful in reducing symptoms, while research continues on the efficacy of MDMA for otherwise treatment resistant individuals.  What all of this means is that PTSD for many is no longer a life sentence.  With the right treatment and support many PTSD suffers may have their symptoms become 'livable' or even resolve altogether.

Finding a psychologist or counsellor trained in EMDR therapy or other trauma informed practice is an important step in recovery from PTSD.  Other steps of PTSD counselling involves addressing co-morbid issues such as insomnia, irritability, depression, hypervigalence, anxiety and panic.  While psychological therapy may be enough, in some cases medication is needed so that a person is able to settle enough to engage in the therapeutic process. 

Ultimately, the application of trauma informed treatment provides therapy to reduce the symptoms of PTSD, while also addressing associated physical and mental health challenges.

 

Karin and Edmonton psychologist who works extensively with civilians, First Responders, and military to treat PTSD