Trauma, PTSD, and Evidence Based Treatment

by Annabelle Parr

When someone experiences a life threatening event, the nervous system kicks into gear to help them survive. It automatically initiates a fight, flight, or freeze reaction. Once the event is over, it’s natural to be emotionally, cognitively, and physically distressed by what occurred. However, for some individuals, the brain and the body can get stuck continuing to respond as if the threat is still present. When this occurs for an extended period of time, the person may be experiencing post-traumatic stress disorder (PTSD).

From Victim Blaming to Recognition of Suffering

PTSD is often associated with combat veterans, as the diagnosis was developed in an effort to characterize and explain the cluster of symptoms that some soldiers experienced after returning from combat (Herman, 1997). Prior to the development of an official diagnosis, PTSD in soldiers was known as “shell shock,” and those suffering from shell shock were often blamed, told they were weak, and punished for their symptoms. In the late nineteenth and early to mid twentieth centuries, a significant number of women also exhibited symptoms of PTSD from sexual trauma and domestic violence. However, rather than psychiatric professionals acknowledging or investigating the trauma these women had experienced, they too were blamed for their symptoms, and were diagnosed with “hysteria,” which was explained as a manifestation of inherent female weakness and emotionality. In the 1970s, survivors of both combat and domestic abuse began advocating for themselves. It was not until 1980 that the American Psychological Association finally recognized PTSD as an official diagnosis (Herman, 1997).

What is Trauma?

Trauma can and does include both experiences in combat and sexual abuse, but it is not limited to these events. Trauma is defined by the Diagnostic and Statistical Manual for Mental Disorders, 5th edition (DSM-V) as “exposure to actual or threatened death, serious injury, or sexual violence” (American Psychiatric Association, 2013, p. 271). Exposure can include personally experiencing the event, witnessing the event occurring to another, learning that such an event occurred to a loved one, or being exposed to extreme details of a traumatic event (such as a first responder or police officer). While it is common for survivors to compare the intensity of their experience to that of another survivor and to minimize what they have been through, according to Dr. Peter Levine and Maggie Kline (2006) “trauma is defined by its effect on a particular individual’s nervous system, not on the intensity of the circumstance itself” (p. 37). Furthermore, as Dr. Judith Herman (1997) noted, “the severity of traumatic events cannot be measured on any single dimension; simplistic efforts to quantify trauma ultimately lead to meaningless comparisons of horror” (pp. 33-34). Trauma encompasses a wide range of experiences, including but not limited to childhood abuse, sexual assault or rape, emotional abuse, combat, medical procedures, natural disasters, car accidents, and physical assault.

What is PTSD?

PTSD is characterized by intrusion in the form of repetitive and distressing thoughts, memories, or nightmares; avoidance of trauma-related triggers such as people, places, or situations; reactivity in the form of hypervigilance, exagerrated startle, irritability, or similar; and changes in beliefs and mood, such as self blame or detachment (for a more comprehensive list of symptoms, you can refer to the diagnostic criteria in the DSM-V)

While PTSD symptoms often begin soon after experiencing the trauma, they can surface months or even years following the event. It is very common to experience some symptoms of PTSD immediately following a trauma due to the natural reactions of the nervous system when faced with threat. However, for the majority of individuals, recovery tends to occur naturally and the symptoms resolve without treatment. For some, the brain and the body can get stuck, and continue to experience the effects of trauma long after the threat has passed.

Why Does PTSD Occur?

The effects of trauma are incredibly complex, and there is not one clear answer for why PTSD occurs in some but not others. When faced with threat, there are a number of changes that occur in both our brains and our bodies to maximize efficiency and to help us access the resources and responses that allow us the best chance at survival. One factor that seems to distinguish the experiences of those who develop PTSD is “a feeling of ‘intense fear, helplessness, loss of control, and threat of annihilation’….When neither resistance nor escape is possible, the human system of self-defense becomes overwhelmed and disorganized. Each component of the ordinary response to danger, having lost its utility, tends to persist in an altered and exaggerated state long after the actual danger is over” (Herman, 1997, pp. 33-34). Having felt extreme powerlessness at the time of the trauma (and continuing to experience powerlessness after the fact), the individual’s body and brain attempt to reclaim power by continuing to respond to the threat as if it were perpetually present. Feeling and behaving as if the trauma is still occurring in the present rather than lodged safely in the past is a characteristic experience of those with PTSD.

Treatment for PTSD:

PTSD can be incredibly debilitating, tends to place a strain on relationships, and can impair the survivor’s ability to function in other important areas of life, such as work or school. However, the good news is that while we cannot undo the traumatic event, PTSD does not have to be permanent. Evidence based treatments are available to help survivors recover from the aftermath of their trauma.  Evidence based treatments available at CSAM include:

• Prolonged Exposure (PE) involves gradually facing the memories, thoughts, feelings, and situations that the client has been avoiding since the traumatic experience. Avoidance may offer temporary relief, but can severely limit the person’s life and ultimately serves to maintain symptoms of PTSD in the long run.

• Cognitive Processing Therapy (CPT) involves exploring the ways that the trauma has altered the way the client sees him/herself, others, and the world. CPT helps the person to learn new ways to cope with upsetting thoughts, how to challenge unhelpful thoughts, and how to reframe the thoughts in more helpful ways.

• Eye Movement Desensitization Reprocessing (EMDR) involves bringing the traumatic experience to mind while the client moves his/her eyes from side to side or experiences tactile or auditory bilateral stimulation. EMDR can help the client to process the trauma in a new way.

• Acceptance and Commitment Therapy (ACT) focuses on the use of experiential exercises to help foster greater acceptance of emotional experiences, decrease the power of negative thoughts, identify values, and help the client commit to taking action in service of his/her values in order to create a more meaningful and fulfilling life even in the face of pain. ACT also often involves exposure exercises to help decrease avoidance.

Coping with PTSD and deciding to seek treatment takes immense strength and courage. The beautiful thing about treatment for PTSD is that although it is challenging, it gives survivors their power and their voices back. When PTSD limits confidence and life engagement, evidence based therapy conducted in the presence of a warm, supportive, empathic clinician can help restore a sense of safety and willingness to engage in a full and meaningful life.

CSAM’s Lead Trauma Specialist, Dr. Janina Scarlet, is a trauma survivor who is extremely passionate about helping other trauma survivors to cope with and recover from PTSD. Her approach includes finding strength in the trauma survivors. She says, “Every hero has a traumatic origin story. Your trauma does not define you. Your trauma is just the beginning of your quest. The rest is up to you.” She collaboratively works with trauma survivors to turn their pain into a superpower, allowing survivors to move past their pain, and find meaning, hope, and recovery.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, depression, stress, PTSD, insomnia, or chronic illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. 

Herman, J. (1997). Trauma and recovery: The aftermath of violence – from domestic abuse to political terror. New York, NY: Basic Books.

Levine, P. A., & Kline, M. (2006). Trauma through a child’s eyes: Awakening the ordinary miracle of healing. Berkeley, CA: North Atlantic Books.