PTSD and TreatmentsResearch Paper

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PTSD: Summarize the Best Available Treatments for This

Post-traumatic stress disorder and healing:

The best treatment options available for PTSD

PTSD (post-traumatic stress disorder) can occur in any person, regardless of age or gender, who witnesses or experiences a crisis. This may include combat, sexual abuse, a terrorist attack, a car wreck, or a natural disaster. "During a traumatic event, you think that your life or others' lives are in danger. You may feel afraid or feel that you have no control over what is happening around you. Most people have some stress-related reactions after a traumatic event; but not everyone gets PTSD. If your reactions don't go away over time and they disrupt your life, you may have PTSD" ("What is PTSD," 2014). There are four major symptoms of PTSD: reliving the event with flashbacks or nightmares; avoiding situations that remind the sufferer of the event (such as getting in a car after a car crash or being unable to go to work after the workplace suffered a terrorist attack); negative feelings such as depression and anxiety; and hyper-arousal (continually living in 'flight or fight mode.') ("What is PTSD," 2014).

Cognitive behavioral therapies

PTSD was first widely identified after the Vietnam War in veterans and only poorly understood until recently. "Traumatic events such as the Sept. 11 attacks, Hurricane Katrina, and the wars in Iraq and Afghanistan have enabled researchers to learn a lot more about how best to treat post-traumatic stress disorder (PTSD)" (DeAngelis 2008:40). The Veteran's Administration has found two recent treatments for PTSD so promising -- that of "prolonged exposure therapy and cognitive-processing therapy -- that it is doing national rollouts of them within the VA" (DeAngelis 2008:30). Expecting soldiers and survivors of trauma to experience PTSD is now the norm, while before PTSD was classified as a medical illness and therefore often stigmatized.

As for most psychological disorders, the best treatment for PTSD is prevention or early treatment. After the individual experiences a crisis event such as sexual abuse, a national disaster or wartime trauma, participating in counseling before the symptoms manifest themselves can be extremely valuable. "Evidence suggests that brief (four to five sessions) cognitive behavioral therapy (CBT) that includes an exposure-based therapy component may help prevent PTSD" ("PTSD treatment options," 2010). Exposure-based therapy involves revisiting the trauma in a 'safe space.' These therapies include "in-vivo, imaginal, or narrative (oral and/or written) exposures to traumatic memories, situations, or stimuli. These therapies also generally include elements of cognitive restructuring (e.g., evaluating the accuracy of beliefs about danger) as well as relaxation techniques" ("PTSD treatment options," 2014). The new belief systems are encouraged as the therapist leads the patient through the negative experience that has been bothering him or her in a more positive fashion.

Exposing patients to the trauma that triggered the PTSD may seem "counterintuitive," but since so much of PTSD involves unwitting flashbacks and avoidance of the original stimuli, this type of rehearsal can actually prove to be very useful (DeAngelis 2008:40). The exposure must be performed by a trained therapist and "done in a gradual, controlled and repeated manner, until the person can evaluate their circumstances realistically and understand they can safely return to the activities in their current lives that they had been avoiding" (DeAngelis 2008: 40). A woman who experienced a rape, for example, can return to the activity or to the location where the rape took place without fear.

Another form of therapy for PTSD in the cognitive school of thought is that of cognitive-processing therapy. Rather than emphasizing imagined exposure, this form of therapy focuses on altering ingrained patterns of thinking and replacing them with more positive patterns. It "places greater emphasis on cognitive strategies to help people alter erroneous thinking that has emerged because of the event. Practitioners may work with clients on false beliefs that the world is no longer safe, for example, or that they are incompetent because they have 'let' a terrible event happen to them" (DeAngelis 2008: 30). Veterans often blame themselves for not doing more to save their comrades at war or may experience survivor guilt. Survivors of rape may blame themselves or mull over endlessly what ifs, such as 'what if I didn't go to that party that night, then I would never have been attacked.' Survivors of disasters and terrorists attacks may likewise be plagued by the unanswerable question of 'why me?'

Although not all persons who experience PTSD had issues before their condition took hold, a previous lack of positive coping mechanisms and a positive attitude can make PTSD far worse. That is why the cognitive-processing therapeutic approach can be so helpful, giving PTSD sufferers the inner resources they lacked until now. Other aspects which can heighten the response to trauma include the circumstances and the immediacy of the attack; the extent to which the individual experienced immediate trauma (such as the physical harm experienced by survivors of the Boston Marathon bombings); and the extent to which loved ones experienced trauma. Some people may experience PTSD as a result of someone they love suffering from an incident such a terrorist attack, even if they were not the direct victims of the actual conflagration.

Cognitive behavioral therapy (CBT), because of its behaviorally-oriented nature can be very useful for treating physical symptoms of PTSD such as insomnia. Because variations of the therapy are extremely goal-oriented, setting goals for patients to deal with their physical symptoms can be very useful and sometimes by mitigating those physical symptoms such as insomnia, the emotional symptoms of PTSD themselves will lessen. "CBT is aimed at changing sleep habits and scheduling factors, as well as misconceptions about sleep and insomnia, that perpetuate sleep difficulties… Stimulus Control Instructions are created by looking at the patient's sleep habits and pinpointing different actions that may be prohibiting sleep" ("CBT for insomnia," 2014). Of course, insomnia is not the root cause of the sleep difficulties, but CBT suggests that by changing behaviors and replacing them with new behaviors (such as going to sleep at a reasonable hour, not drinking before sleeping, and reading or watching positive images before sleep), the person's mental state can experience an alteration with the change in behavior.

CBT's focus on behavior is also extremely useful because sessions are of short duration and have a targeted, goal-focused endpoint. In an era of cost-cutting regarding mental health coverage, this can be essential for patients to receive appropriate treatment. Psychoanalysis is open-ended and many patients cannot afford or do not desire the long-term commitment demanded by this approach.

Other therapies

Some PTSD sufferers have used imagery rehearsal therapy to alleviate the trauma of the nightmares they suffer ("PTSD treatment options," 2014). It too is a behaviorally-directed therapy. The patient is asked to write down the description of his or her nightmare and to think of a way to change the nightmare in a more positive fashion. The patient visualizes the change, replacing the positive image with the negative image ("When nightmares won't go away," 2014).

Other therapies are more physically-oriented. "Eye Movement Desensitization and Reprocessing (EMDR)…involves focusing on sounds or hand movements while you talk about the trauma" ("PTSD treatment options," 2014). It should be noted, however, that EMDR is seldom used alone and patients must achieve a certain degree of cognitive stability and have positive enough coping mechanisms for the treatment to work well. The client "is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client" ("What is EMDR," 2014). Afterward, the client is told to let the mind go blank and notice what sensations come to mind. When the client does not feel anxiety or trauma at the image, the reconditioning process is deemed successful.

Psychotropic drugs are often used in conjunction with therapy for PTSD. Selective serotonin reuptake inhibitors (SSRI) such as Prozac are often used to treat depression in subjects ("What is PTSD," 2014). Xanax is a popular anti-anxiety drug (DeAngelis 2008:40). Prazosin been used to decrease nightmares related to the trauma and sleep aids such as Ambien are sometimes given to victims ("CBT for insomnia," 2014). But "benzodiazepines and atypical antipsychotics should generally be avoided for PTSD treatment because they do not treat the core PTSD symptoms" as well have very severe side effects ("What is PTSD," 2014). Most agree that psychotropic medicine, however, should merely be a support for talk-based therapy for victims, not a replacement.

References

CBT for insomnia. (2014). Sleep Foundation. Retrieved from:

http://sleepfoundation.org/sleep-news/cognitive-behavioral-therapy-insomnia/page/0%2C2/

DeAngelis, T. (2008) PTSD treatments grow in evidence, effectiveness. APA, 29 (1): 40.

Retrieved from: http://www.apa.org/monitor/jan08/ptsd.aspx

PTSD Treatment Options. (2014). Defense symptoms of excellence. Retrieved from:

http://www.dcoe.mil/PsychologicalHealth/PTSD_Treatment_Options.aspx

What is EMDR? (2014). EMDR Institute. Retrieved from:

http://www.emdr.com/general-information/what-is-emdr.html

What is PTSD? (2014). U.S. Department of Veteran's Affairs. Retrieved from:

http://www.ptsd.va.gov/public/PTSD-overview/basics/what-is-ptsd.asp

When nightmares won't go away. (2011). WebMD. Retrieved from:

http://www.webmd.com/sleep-disorders/features/when-nightmares-wont-go-away?page=3 [END OF PREVIEW]

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