What is Posttraumatic Stress Disorder?
BY: Dr Mike Drayton, Consultant Clinical Psychologist, Isham House
Mary was driving home from London to Oxford on the M40. It was about 10pm and she was tired. Mary was in the outside lane of the motorway overtaking two lorries when she saw a pair of headlights in the distance. They looked to be heading directly at her. Mary thought that the car was on the opposite carriageway, but it wasn't. To her absolute horror she realised that the other car was driving directly towards her, in her lane and on the wrong side of the motorway. At that moment she realised that she was going to die and that she was absolutely helpless to prevent it. Mary swerved into the crash barrier and the cars collided in a glancing impact. She survived with only minor injuries but unfortunately the other driver, who was an elderly man, died.
Mary was discharged from hospital a few days after the accident. She could not bring herself to drive, even the thought of getting into a car terrified her. At night she could not sleep. Every time she closed her eyes she could see the headlights of the on-coming car coming at her and then she would hear the tremendous bang of the collision. When she did get to sleep she would, more often than not, awake screaming and covered in perspiration. During the day she would experience frequent flashback of the accident which caused her to panic. Her family and friends commented on how 'on edge' and irritable she was and Mary would snap back at them. Mary had developed posttraumatic stress disorder (PTSD). This continued for six months before Mary decided to seek help. Mary was referred to a Consultant Psychologist at Cygnet Health Care where she was offered a treatment called EMDR. After ten sessions of therapy Mary was able to drive again, she was no longer troubled by nightmares or flashbacks and she returned to being her old relaxed self.
Mary's story is a fictional one, but her experiences are very similar to those of many patients referred for treatment of PTSD.
PTSD is a disorder that people may develop in response to serious traumatic events like the one described above. Common causes include: deliberate acts of interpersonal violence, severe accidents, disaster, or military action.
The symptoms of PTSD:
The most characteristic symptoms of PTSD are: re-experiencing symptoms, where the person involuntarily has intrusive vivid and disturbing flashbacks and nightmares related to the traumatic incident. Avoidance of reminders of the trauma is also a core symptom of PTSD. The person will avoid circumstances that remind them of the event and will try and push thoughts of the trauma out of their head, and will avoid thinking or talking about the event in any detail, particularly the worst parts of the trauma. The final characteristic symptom of PTSD is emotional hyperarousal. The person will feel on edge and irritable and will often have an exaggerated 'startle' response. Alternatively, some people experience emotional numbing. Excessive use of alcohol or other drugs is not uncommon in sufferers of PTSD.
What treatment is available?
In March 2005, the National Institute of Clinical Excellence (part of the department of Health) issued their treatment guidelines for PTSD. They recommend only two treatments for people with PTSD. These are: Trauma-focused cognitive behavioral therapy (TF-CBT) and Eye Movement Desensitisation and Reprocessing (EMDR).
Trauma-focused cognitive behavioral therapy (TF-CBT): This is a psychological treatment for PTSD based on cognitive behavioural therapy (CBT). CBT focuses on a person's distressing feelings, thoughts (or 'cognitions') and behaviour and helps to bring about a positive change. In trauma-focused CBT,t he treatment concentrates specifically on the memories, thoughts and feelings that a person has about the traumatic event. If you are offered this treatment, your therapist will encourage and help you to gradually recall and think about the trauma. This can be done in various ways including listening to recordings of your own account of the trauma. You will be given help to cope with any emotional distress and behavioural problems that may arise during treatment. As the painful and traumatic memories begin to decrease, you may be encouraged and helped to start activities that you have been avoiding since the trauma, such as driving a car if you have avoided driving since an accident. Treatment will take, on average twelve sessions lasting an hour each.
Eye Movement Desensitisation and Reprocessing (EMDR):EMDR is the other evidence-based therapy recommended by NICE. EMDR is in some ways similar to TF-CBT; however, one unusual element in EMDR is that the patient is asked to move their eyes rapidly from side to side (following the therapists hand or moving lights). There is a great deal of evidence that this speeds up the reprocessing of disturbing emotional or traumatic material and at the same time helps the sufferer confront the traumatic memories in a safer way than without the eye movements. It is believed that the eye movements induced in EMDR mirror the natural eye movement process that occurs in the REM (Rapid Eye Movement) phase of sleep during which information is processed naturally.
In EMDR, the therapist will always firstly carry out a careful psychological assessment of whether EMDR would be suitable for the problem(s) presented, and will elicit a memory representing the problem. The client will be asked for a picture that represents the memory, a negative belief that they have about themselves in relation to the memory, and to notice associated physical sensations. Thereafter, a number of sets of eye movements or other bilateral stimulation are commenced, and after each set of eye movements the therapist will ask the client what they noticed. Typically, the images, emotions, and sensations experienced change through this process. At some point these changes become more positive and adaptive as the client reprocesses old dysfunctional information and connects with presently held adaptive and functional information. The aim is always to enable the client to recollect the original traumatic material without disturbance and to have new and more adaptive beliefs about themselves in relation to the experience.
With "simple" or "one off" traumas or experiences in adult life, EMDR can be remarkably rapid in its effects, and average treatment times for these kinds of problems are from 3 to 5 sessions. With more "complex" or multiple traumas treatment can take much longer but the evidence that we have to date suggests that EMDR is the most efficient and rapid psychotherapeutic procedure available for the treatment of traumatic memories and Post Traumatic Stress Disorder.
TF-CBT and EMDR are available at many of Cygnet's hospitals. Both are very effective and can help most sufferers to overcome PTSD.
