Symptoms, Treatment and Self-Help for PTSD (from Helpguide.org)
After a traumatic experience, it’s normal to feel frightened, sad, anxious, and disconnected. But if the upset doesn’t fade and you feel stuck with a constant sense of danger and painful memories, you may be suffering from post-traumatic stress disorder (PTSD). It can seem like you’ll never get over what happened or feel normal again. But by seeking treatment, reaching out for support, and developing new coping skills, you can overcome PTSD and move on with your life.
What is post-traumatic stress disorder (PTSD)?
Wendy’s PTSD Story
Three months ago, Wendy was in a major car accident. She sustained only minor injuries, but two friends riding in her car were killed. At first, the accident seemed like just a bad dream. Then Wendy started having nightmares about it. Now, the sights and sounds of the accident haunt her all the time.
Wendy has trouble sleeping at night, and during the day she feels irritable and on edge. She jumps whenever she hears a siren or screeching tires, and she avoids TV programs that might show a car chase or accident scene. Wendy also avoids driving whenever possible, and refuses to go anywhere near the site of the crash.
Post-traumatic stress disorder (PTSD) can develop following a traumatic event that threatens your safety or makes you feel helpless.
Most people associate PTSD with battle-scarred soldiers—and military combat is the most common cause in men—but any overwhelming life experience can trigger PTSD, especially if the event feels unpredictable and uncontrollable.
Post-traumatic stress disorder (PTSD) can affect those who personally experience the catastrophe, those who witness it, and those who pick up the pieces afterwards, including emergency workers and law enforcement officers. It can even occur in the friends or family members of those who went through the actual trauma.
PTSD develops differently from person to person. While the symptoms of PTSD most commonly develop in the hours or days following the traumatic event, it can sometimes take weeks, months, or even years before they appear.
Traumatic events that can lead to PTSD include:
- Natural disasters
- Car or plane crashes
- Terrorist attacks
- Sudden death of a loved one
- Sexual or physical abuse
- Childhood neglect
- Or any shattering event that leaves you stuck and feeling helpless and hopeless
The difference between PTSD and a normal response to trauma
The traumatic events that lead to post-traumatic stress disorder are usually so overwhelming and frightening that they would upset anyone. Following a traumatic event, almost everyone experiences at least some of the symptoms of PTSD. When your sense of safety and trust are shattered, it’s normal to feel crazy, disconnected, or numb. It’s very common to have bad dreams, feel fearful, and find it difficult to stop thinking about what happened. These are normal reactions to abnormal events.
For most people, however, these symptoms are short-lived. They may last for several days or even weeks, but they gradually lift. But if you have post-traumatic stress disorder (PTSD), the symptoms don’t decrease. You don’t feel a little better each day. In fact, you may start to feel worse.
A normal response to trauma becomes PTSD when you become stuck
After a traumatic experience, the mind and the body are in shock. But as you make sense of what happened and process your emotions, you come out of it. With post-traumatic stress disorder (PTSD), however, you remain in psychological shock. Your memory of what happened and your feelings about it are disconnected. In order to move on, it’s important to face and feel your memories and emotions.
Signs and symptoms of post-traumatic stress disorder (PTSD)
The symptoms of post-traumatic stress disorder (PTSD) can arise suddenly, gradually, or come and go over time. Sometimes symptoms appear seemingly out of the blue. At other times, they are triggered by something that reminds you of the original traumatic event, such as a noise, an image, certain words, or a smell.
While everyone experiences PTSD differently, there are three main types of symptoms:
- Re-experiencing the traumatic event
- Avoiding reminders of the trauma
- Increased anxiety and emotional arousal
Symptoms of PTSD: Re-experiencing the traumatic event
- Intrusive, upsetting memories of the event
- Flashbacks (acting or feeling like the event is happening again)
- Nightmares (either of the event or of other frightening things)
- Feelings of intense distress when reminded of the trauma
- Intense physical reactions to reminders of the event (e.g. pounding heart, rapid breathing, nausea, muscle tension, sweating)
Symptoms of PTSD: Avoidance and numbing
- Avoiding activities, places, thoughts, or feelings that remind you of the trauma
- Inability to remember important aspects of the trauma
- Loss of interest in activities and life in general
- Feeling detached from others and emotionally numb
- Sense of a limited future (you don’t expect to live a normal life span, get married, have a career)
Symptoms of PTSD: Increased anxiety and emotional arousal
- Difficulty falling or staying asleep
- Irritability or outbursts of anger
- Difficulty concentrating
- Hypervigilance (on constant “red alert”)
- Feeling jumpy and easily startled
Other common symptoms of post-traumatic stress disorder (PTSD)
- Anger and irritability
- Guilt, shame, or self-blame
- Substance abuse
- Feelings of mistrust and betrayal
- Depression and hopelessness
- Suicidal thoughts and feelings
- Feeling alienated and alone
- Physical aches and pains
Symptoms of PTSD in children and adolescents
In children—especially those who are very young—the symptoms of PTSD can be different than the symptoms in adults. Symptoms in children include:
- Fear of being separated from parent
- Losing previously-acquired skills (such as toilet training)
- Sleep problems and nightmares without recognizable content
- Somber, compulsive play in which themes or aspects of the trauma are repeated
- New phobias and anxieties that seem unrelated to the trauma (such as a fear of monsters)
- Acting out the trauma through play, stories, or drawings
- Aches and pains with no apparent cause
- Irritability and aggression
Post-traumatic stress disorder (PTSD) causes and risk factors
While it’s impossible to predict who will develop PTSD in response to trauma, there are certain risk factors that increase your vulnerability.
Many risk factors revolve around the nature of the traumatic event itself. Traumatic events are more likely to cause PTSD when they involve a severe threat to your life or personal safety: the more extreme and prolonged the threat, the greater the risk of developing PTSD in response. Intentional, human-inflicted harm—such as rape, assault, and torture— also tends to be more traumatic than “acts of God” or more impersonal accidents and disasters. The extent to which the traumatic event was unexpected, uncontrollable, and inescapable also plays a role.
Other risk factors for PTSD include:
- Previous traumatic experiences, especially in early life
- Family history of PTSD or depression
- History of physical or sexual abuse
- History of substance abuse
- History of depression, anxiety, or another mental illness
- High level of stress in everyday life
- Lack of support after the trauma
- Lack of coping skills
Getting help for post-traumatic stress disorder (PTSD)
If you suspect that you or a loved one has post-traumatic stress disorder (PTSD), it’s important to seek help right away. The sooner PTSD is confronted, the easier it is to overcome. If you’re reluctant to seek help, keep in mind that PTSD is not a sign of weakness, and the only way to overcome it is to confront what happened to you and learn to accept it as a part of your past. This process is much easier with the guidance and support of an experienced therapist or doctor.
It’s only natural to want to avoid painful memories and feelings. But if you try to numb yourself and push your memories away, post-traumatic stress disorder (PTSD) will only get worse. You can’t escape your emotions completely—they emerge under stress or whenever you let down your guard—and trying to do so is exhausting. The avoidance will ultimately harm your relationships, your ability to function, and the quality of your life.
Why Should I Seek Help for PTSD?
- Early treatment is better. Symptoms of PTSD may get worse. Dealing with them now might help stop them from getting worse in the future. Finding out more about what treatments work, where to look for help, and what kind of questions to ask can make it easier to get help and lead to better outcomes.
- PTSD symptoms can change family life. PTSD symptoms can get in the way of your family life. You may find that you pull away from loved ones, are not able to get along with people, or that you are angry or even violent. Getting help for your PTSD can help improve your family life.
- PTSD can be related to other health problems. PTSD symptoms can make physical health problems worse. For example, studies have shown a relationship between PTSD and heart trouble. By getting help for your PTSD you could also improve your physical health.
Source: National Center for PTSD
Treatment for post-traumatic stress disorder (PTSD)
Treatment for PTSD relieves symptoms by helping you deal with the trauma you’ve experienced. Rather than avoiding the trauma and any reminder of it, treatment will encourage you to recall and process the emotions and sensations you felt during the original event. In addition to offering an outlet for emotions you’ve been bottling up, treatment for PTSD will also help restore your sense of control and reduce the powerful hold the memory of the trauma has on your life.
In treatment for PTSD, you’ll:
- Explore your thoughts and feelings about the trauma
- Work through feelings of guilt, self-blame, and mistrust
- Learn how to cope with and control intrusive memories
- Address problems PTSD has caused in your life and relationships
- Trauma-focused cognitive-behavioral therapy.
Cognitive-behavioral therapy for PTSD and trauma involves carefully and gradually “exposing” yourself to thoughts, feelings, and situations that remind you of the trauma. Therapy also involves identifying upsetting thoughts about the traumatic event–particularly thoughts that are distorted and irrational—and replacing them with more balanced picture.
- Family therapy. Since PTSD affects both you and those close to you, family therapy can be especially productive. Family therapy can help your loved ones understand what you’re going through. It can also help everyone in the family communicate better and work through relationship problems caused by PTSD symptoms.
- Medication is sometimes prescribed to people with PTSD to relieve secondary symptoms of depression or anxiety. Antidepressants such as Prozac and Zoloft are the medications most commonly used for PTSD. While antidepressants may help you feel less sad, worried, or on edge, they do not treat the causes of PTSD.
- EMDR (Eye Movement Desensitization and Reprocessing) incorporates elements of cognitive-behavioral therapy with eye movements or other forms of rhythmic, left-right stimulation, such as hand taps or sounds. Eye movements and other bilateral forms of stimulation are thought to work by “unfreezing” the brain’s information processing system, which is interrupted in times of extreme stress.
- Neurofeedback has proven to be one of the most successful treatments for PTSD. EEG biofeedback (also known as neurofeedback), specifically alpha-theta protocol, is a training process that has been scientifically-proven to improve post traumatic stress disorder. It helps with issues that people develop as the result of trauma, grief, phobias or dysfunctional family systems.
Types of treatment for post-traumatic stress disorder (PTSD)
Alpha-theta protocol is named after the two main types of brainwaves that are involved during the neurofeedback training process. It brings on a deep calm witness state where people can often observe or think about their dislodged memories in a safe dream-like state. Issues such as distorted beliefs and trauma affect how the brain operates at a sub-conscious level. With alpha-theta, clients train their brain to let go of negative response patterns that are based on old or false beliefs so they can enjoy life with a new and healthier perspective. In addition, the brain becomes receptive to complementary psychological therapies that might otherwise have created avoidant or defensive reactions.
PTSD self-help tip 1: Reach out to others for support
Post-traumatic stress disorder (PTSD) can make you feel disconnected from others. You may be tempted to withdraw from social activities and your loved ones. But it’s important to stay connected to life and the people who care about you. Support from other people is vital to your recovery from PTSD, so ask your close friends and family members for their help during this tough time.
Also consider joining a support group for survivors of the same type of trauma you experienced. Support groups for post-traumatic stress disorder (PTSD) can help you feel less isolated and alone. They also provide invaluable information on how to cope with symptoms and work towards recovery. If you can’t find a support group in your area, look for an online group.
PTSD self-help tip 2: Avoid alcohol and drugs
When you’re struggling with difficult emotions and traumatic memories, you may be tempted to self-medicate with alcohol or drugs. But while alcohol or drugs may temporarily make you feel better, they make post-traumatic stress disorder (PTSD) worse in the long run. Substance use worsens many symptoms of PTSD, including emotional numbing, social isolation, anger, and depression. It also interferes with treatment and can add to problems at home and in your relationships.
PTSD self-help tip 3: Challenge your sense of helplessness
Overcoming your sense of helplessness is key to overcoming post-traumatic stress disorder (PTSD). Trauma leaves you feeling powerless and vulnerable. It’s important to remind yourself that you have strengths and coping skills that can get you through tough times.
One of the best ways to reclaim your sense of power is by helping others: volunteer your time, give blood, reach out to a friend in need, or donate to your favorite charity. Taking positive action directly challenges the sense of helplessness that is a common symptom of PTSD.
Positive ways of coping with PTSD:
- Learn about trauma and PTSD
- Join a PTSD support group
- Practice relaxation techniques
- Pursue outdoor activities
- Confide in a person you trust
- Spend time with positive people
- Avoid alcohol and drugs
- Enjoy the peace of nature
PTSD self-help tip 4: Spend time in nature
The Sierra Club in the United States offers wilderness expeditions for veterans who have served in recent wars such as Iraq and Afghanistan. Anecdotal evidence suggests that pursuing outdoor activities like hiking, camping, mountain biking, rock climbing, whitewater rafting, and skiing may help veterans cope with PTSD symptoms and transition back into civilian life.
It’s not just veterans who can benefit from spending time outdoors. Anyone with post-traumatic stress disorder can benefit from the relaxation, seclusion, and peace that come with being in the natural world. Focusing on strenuous outdoor activities can also help challenge your sense of helplessness and help your nervous system become “unstuck” and move on from the traumatic event. Seek out local organizations that offer outdoor recreation or teambuilding opportunities.
Post-traumatic stress disorder (PTSD) and the family
If a loved one has post-traumatic stress disorder (PTSD), it’s essential that you take care of yourself and get extra support. PTSD can take a heavy toll on the family if you let it. It can be hard to understand why your loved one won’t open up to you—why he or she is less affectionate and more volatile. The symptoms of PTSD can also result in job loss, substance abuse, and other stressful problems.
Letting your family member’s PTSD dominate your life while ignoring your own needs is a surefire recipe for burnout. In order to take care of your loved one, you first need to take care of yourself. It’s also helpful to learn all you can about post-traumatic stress disorder (PTSD). The more you know about the symptoms and treatment options, the better equipped you’ll be to help your loved one and keep things in perspective.
Helping a loved one with PTSD
- Be patient and understanding. Getting better takes time, even when a person is committed to treatment for PTSD. Be patient with the pace of recovery and offer a sympathetic ear. A person with PTSD may need to talk about the traumatic event over and over again. This is part of the healing process, so avoid the temptation to tell your loved one to stop rehashing the past and move on.
- Try to anticipate and prepare for PTSD triggers. Common triggers include anniversary dates; people or places associated with the trauma; and certain sights, sounds, or smells. If you are aware of what triggers may cause an upsetting reaction, you’ll be in a better position to offer your support and help your loved one calm down.
- Don’t take the symptoms of PTSD personally. Common symptoms of post-traumatic stress disorder (PTSD) include emotional numbness, anger, and withdrawal. If your loved one seems distant, irritable, or closed off, remember that this may not have anything to do with you or your relationship.
- Don’t pressure your loved one into talking. It is very difficult for people with PTSD to talk about their traumatic experiences. For some, it can even make things worse. Never try to force your loved one to open up. Let the person know, however, that you’re there when and if he or she wants to talk.
What Happens to People After a Traumatic Event?
Disasters have darkened our landscapes – what are the human consequences?
The Oklahoma tornadoes, the Boston Marathon bombing, IEDs, refugees who flee their towns and country to stay alive, 9/11, sexually and physically abused children (and adults), Katrina, Newtown, Aurora, Columbine, Cleveland’s three young women, Hurricane Sandy… the list goes on. These are traumas where survivors experienced or witnessed a life threatening event to either themselves or others.
What happens to these people in the wake of such catastrophic events? When does a searing experience become more than a lasting memory? When does it become a disorder – like post-traumatic stress disorder (PTSD), or depression or a substance use disorder?
The risk of developing a post-traumatic mental or substance use disorder is principally a function of: three things: the degree of exposure to the trauma (sometimes called the ‘dose’ of exposure); a preexisting vulnerability to traumatic illness; and the extent to which a person will face adversity (or alternatively have support available) in the aftermath of the event.
Watching television, with its endless replays of horrific scenes, is not a good idea. It is apt to cause you (and your children) distress. But it is not the type of exposure known to produce a disorder. For sure, you should limit what you and your family watch – but this is not what spawns a persistent and debilitating emotional condition. The closer a person is to an event, to the danger and its consequences, amplified by enduring danger (hurricanes come and go but civil war or ten years of being hostage do not) the greater the risk of becoming ill. The closer someone is to losing his or her life – or witnessing that danger to others – the more our brains and bodies, not just our minds, are altered. While an extreme – though appropriate at the moment – stress response is mobilized during a life threatening or horrific event the graver the danger the more likely that the immediate flight/fight response will not recede. It continues to burn and change a person’s neurology and physiology, becoming very difficult to quiet. In time a disorder develops.
Those individuals who enter a traumatic moment or ongoing disaster scenario with a pre-existing vulnerability also are at greater risk of disorder because they do not bring much margin to the table. These are people who may already have a mental illness or substance use disorder. Trauma is not new to their lives, whether it is natural or human-made. Poverty, with its grinding and corrosive effects, adds risk of developing a disorder, as does isolation and limited family and community supports.
Adversity is the third element that predicts who will fall ill after a trauma. Financial and job losses, displacement from home and neighborhood (and the privation that derives from being uprooted), and disconnection from loved ones, family and friends all portend trouble ahead.
Yet, most people are resilient. Early identification of problems, mental and physical, and the concrete delivery of safety as well as stable and enduring housing are fundamental to the human hierarchy of needs. Many survivors will need crisis counseling and some need treatment; the latter being a needed prescription for those at greatest risk. Psychological interventions are not just humane they are essential investments in people and communities. When not done the cost is more than human misery: it is a deep erosion of hope and community; it breeds the extraordinary economic costs that derive from incapacitated lives and disrupted economies.
The accumulated disasters of the past twenty or more years have taught us that much can be done in the wake of a trauma. Effective interventions include crisis counseling, medications, and therapy to control symptoms and enable return to every day live. The detection and treatment of very common co-occurring illnesses, like substance use disorders or depression in people with PTSD, permit recovery from the primary traumatic condition. Gentle but insistent expectations for returning to daily routines and resuming functioning as soon as possible are essential. Preventing relapse by identifying traumatic triggers as well as learning the skills to manage them is now a highly refined practice. And finally, and perhaps the most difficult to master, is searching for meaning in the most awful of events – and with that the prospect of finding hope.
There is a core of faith, non-sectarian in nature, to be mined in all of us that can make bearable and lend perspective to a seemingly senseless and horrific experience. When that happens we find hope. We find and nourish the capacity to keep a catastrophic and tragic situation from becoming an enduring tragedy.
Dr. Sederer is Adjunct Professor at the Columbia/Mailman School of Public Health, Mental Health Editor for The Huffington Post, and author of The Family Guide to Mental Health Care.
Recovering From Military Trauma
New approaches to psychotherapy for PTSD
Each year on Veterans’ Day, we honor the men and women who protect our country by serving in the military. Their courage and integrity are an inspiration every day, but on November 11 we pay special homage to those who have served and are now serving, many of whom risk their lives by going into harm’s way.
Military personnel are highly trained, skilled, and resilient.
Yet there is no preparation for the extreme danger and deadly encounters of war. Even the strongest person can be completely impervious to the traumatic shock and stressful aftermath. Symptoms of post-traumatic stress are almost universal in the wake of life-threatening military incidents. Lasting problems with posttraumatic stress disorder (PTSD), anger, depression, or addictions occur for years to at least one in three soldiers.
Nor is there any way to prepare for the traumatic shock of betrayal and violation of one’s body that happens when a sexual or physical assault is perpetrated by one’s own military comrades. At least one in every three to five women serving in the United States military is sexual assaulted, and most (an estimated 80%) suffer silently without reporting the trauma for fear of the stigma or retaliation. Military men also are sexually assaulted, albeit more rarely and almost never officially reported. These women and men are highly likely—50% or more—to develop severe and chronic PTSD and related problems.
Effective psychotherapeutic treatments are increasingly available to traumatized military personnel and veterans through Department of Defense and Department of Veterans Affairs healthcare programs. Hundreds of DoD and DVA mental health professionals have been trained to provide two therapies at bases and VA centers nationally: Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT). These therapies guide the recipient in safely re-experiencing specific traumatic events that are particularly troubling memories. The goal is to break the vicious cycle of attempts to avoid these memories, which only increases their strength and the distress they cause. PE and CPT have been found to be effective in promoting recovery from PTSD for many military personnel and veterans.
However, at least half of the men and women with military PTSD do not recover, or only partially recover, with these therapies. And many others never seek treatment because they do not want to re-live traumatic events even with the best therapeutic guidance. These soldiers and veterans often get no treatment, or receive only medications, which can be helpful but rarely are sufficient to overcome PTSD.
Fortunately, new approaches to psychotherapy for PTSD without re-experiencing trauma memories have been developed to meet this need.
One therapy, called Trauma Affect Regulation: Guide for Education and Therapy (or TARGET), shows recipients how their brains have shifted into a perpetual alarm state in order to survive traumatic danger—and how to use the mind’s capacity to focus in order to reset that alarm system in the brain.
Military personnel and veterans are not surprised to learn that they have an alarm in their brains. They know what it’s like when that alarm kicks off an adrenaline rush in the body and the fight-flight response essential to surviving extreme threats.
But they’ve never been provided with a user’s guide to turning down or resetting the alarm. That’s what is needed in order to stop a healthy survival reaction from becoming a toxic perpetual alarm state of hyper vigilance, anxiety, and anger.
The TARGET intervention explains how to reset the brain’s alarm, so that it no longer hijacks the brain and creates a chronic state of PTSD. The area of the brain that coordinates all conscious thinking—the pre-frontal cortex, or for short, the brain’s “thinking center”—can be activated to reset the brain’s alarm center. TARGET shows how we all intuitively activate this thinking center and reset the alarm by following a set of steps that focus the mind simultaneously on two essential things:
- What we need to be alert to in order to recognize actual or potential problems
- What we most deeply value and care about in life that is a solution, not a problem
These focusing steps seem deceptively simple once you know them, but they are almost impossible to follow unless they are carefully understood, and diligently and purposefully practiced many times each day.
Fortunately, there is a way to focus that takes only a few moments of concentrated thought, and can be repeated almost any time and anywhere. Target explains the focusing steps as an exercise easily remembered as “SOS”:
- Sweep your mind clear of all thoughts
- Orient yourself to one thought that you choose because it is the most important thing (or person, relationship, activity, or resource) in your life at this moment
- Self-check your stress level (from 1=no stress to 10=worst stress ever) and your level of personal control (from 1=confused and out of control to 10=completely mentally focused and in control)
In a research study ongoing at the University of Connecticut, military men who have been deployed to Afghanistan or Iraq in the past 10 years are receiving TARGET or Prolonged Exposure, in order to compare the effectiveness of the two therapies.
Although the study is not complete, results to date indicate that recipients view both therapies as meeting their needs. TARGET recipients are finding the focusing perspective and skills to be the “user’s guide” that they have needed in order to reset their alarm states.
An added benefit for TARGET recipients has been taking what they’ve learned about their posttraumatic stress alarm reactions and sharing this information with their families. Family members experience troubling stress reactions as a result of the fear and anxiety of not knowing if their military member will come home safely, and as a side-effect of living with a military member who is in an alarm state because of PTSD.
The focusing perspective helps the family to understand their military members’ stress reactions and their own stress reactions, and enables them to join together in healing from the trauma.