Category Archives: Ptsd/cptsd Articles

Prolonged Exposure Therapy And Posttraumatic Stress Disorder (PTSD)

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Major symptom of posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (cPTSD)click here to read about the difference between these two conditions – are fear, anxiety and even terror induced by :

– situations related to the traumatic experience

– people related to the traumatic experience

– places related to the traumatic experience

– activities related to the traumatic experience

Prolonged Exposure Therapy Involves Two Specific Types Of Exposure To Trauma-Related Phenomena :

a) In Vivo Exposure

b) Imaginal Exposure

In Vivo Exposure :

Prolonged exposure therapy works by encouraging the individual with PTSD / cPTSD, in a supportive manner, very gradually, to confront these situations / people / places / activities whilst, at the same time, feeling safe, secure and calm. Because this part of the therapy involves exposure to ‘real life’ situations / people / places / activities it is called in vivo exposure.

This is so important because avoiding these situations / people / places / activities, whilst reducing the individual’s anxiety in the short-term, in the longer-term simply perpetuates, and, potentially, intensifies, his/her fear of these things.

Imaginal Exposure:

The therapy also involves the PTSD / cPTSD sufferer talking over details and memories of the traumatic experience in a safe environment and whilst in a relaxed frame of mind (the therapist can help to induce a relaxed frame of mind by teaching the patient/client breathing exercises and/or physical relaxation techniques; hypnosis can also be used to help induce a state of relaxation). Because this part of the therapy ‘only’ involves mental exposure to the trauma (i.e. thinking about it in one’s mind), it is called imaginal exposure and can help alleviate intense emotions connected to the original trauma (e.g. fear and anger).

Both in vivo and imaginal exposure to the trauma-related stimuli are forms of desensitizing and habituating the patient / client to them, thus reducing his/her symptoms of PTSD / cPTSD.

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How Effective Is Prolonged Exposure Therapy?

Prolonged exposure therapy is a type of cognitive behavioural therapy (CBT) and research into the treatment of PTSD suggests it is the most effective treatment currently available.

What Is The Duration Of The Treatment?

The length of time a patient / client spends in treatment varies in accordance with his/her needs and his/her therapist’s particular approach. However, the usual duration of the treatment is between two and four months, comprising weekly sessions of approximately ninety minutes each.

On top of this, the patient / client will need to undertake some therapeutic exercises/activities in his/her own time, set by the therapist as ‘ homework assignments’. These assignments will include listening to recordings of imaginal exposure therapy sessions.

RESOURCES :

The National Center For PTSD has developed a PROLONGED EXPOSURE APP, or PE APP. Click here for further information and download instructions.

eBook :

 

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David Hosier BSc Hons; MSc; PGDE(FAHE).

 

 

 

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Why Is Physical Illness More Common In PTSD Sufferers?

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If we have suffered from significant childhood trauma leading to the development of post traumatic stress disorder (PTSD) in our adult lives this also puts us at increased risk of developing various unpleasant physical symptoms. This is because the trauma has had chemical effects in our brain (leading to our PTSD) which can have knock-on adverse effects upon our body. I provide examples of the kind of symptoms that may result below :

SYMPTOMS :

  • increased rate of heartbeat
  • stomach / digestive problems
  • rapid and shallow breathing (often referred to as hyperventilation)
  • shaking / trembling / tremors / localized muscle spasms
  • feeling faint / light-headedness
  • sweating

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DISEASES AND DISORDERS :

A positive correlation exists between the incidence of post traumatic stress disorder (PTSD) in a population and the incidence of certain physical diseases and disorders (shown below) in that same population. However, further research needs to be conducted in order to ascertain whether having post traumatic stress disorder (PTSD) increases one’s risk of suffering these conditions or whether having such conditions makes one more vulnerable to developing post traumatic stress disorder (PTSD).

Some of the diseases and disorders associated with PTSD are as follows :

  • cardiovascular disease
  • increased probability of suffering from heart attacks
  • IBS (irritable bowel syndrome)
  • headaches
  • certain autoimmune disorders (eg those causing problems with the skin)
  • pregnancy complications
  • miscarriage
  • preterm contractions
  • obesity

 

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Above : PTSD physically, biologically and chemically alters the brain – these changes may lead to physical symptoms, diseases and disorders in some sufferers, on top of the immense psychological pain and suffering it causes all who are unfortunate enough to have the condition.

 

Why Do Such Links Between PTSD And These Disorders Exist?

Various theories have been put forward in an attempt to explain why such links between PTSD and physical disorders such as those listed above exist.

  1. Increases in stress hormones such as cortisol over time have an adverse physical effect upon the heart and cardiovascular system.
  2. PTSD can lead to unhealthy ways of trying to cope with mental pain and suffering such as excessive drinking, excessive smoking and the ingestion of dangerous narcotics and overeating (so-called ‘comfort eating’) all of which, in turn, can lead to declining physical health.
  3. PTSD sufferers tend also to be seriously depressed and therefore lethargic – this can mean that PTSD sufferers take very little physical exercise leading to a greater likelihood of developing physical health problems.
  4. PTSD causes a change in the balance of chemicals in the brain and these changes, in turn, may cause yet further changes adversely affecting the immune system and various bodily organs.
  5. Changes in certain chemicals that negatively affect the mind also adversely affect the stomach.

 

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David Hosier BSc Hons; MSC; PGDE(FAHE).

 

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C PTSD (Complex – PTSD) : Why Is It Becoming More Common?

 

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We have seen from numerous other articles that I have published on this site that severe and prolonged childhood trauma can lead to the development of c PTSD, or complex post traumatic stress disorder, in adulthood (to learn about the difference between post traumatic stress disorder [PTSD] and complex post traumatic stress disorder [c PTSD] read my previously published article here).

And the incidence of c PTSD is increasing. What are the possible reasons for this increase in the prevalence of this very serious psychiatric disorder?

First, it is possible that as the general population and clinicians become more aware of the existence of the disorder and its link to childhood trauma it is becoming increasingly reported and diagnosed. However, there are several other possible explanations and I examine these briefly below :

POSSIBLE REASONS FOR THE INCREASE IN PREVALENCE OF COMPLEX POST TRAUMATIC STRESS DISORDER (c PTSD) :

1) Growing up in unstable environments :

More and more young people are growing up in unstable environments. Increasing rates of divorce and separation means that a higher and higher number of children and adolescents are growing up in single parent households (to read my article about the possible effects of divorce upon the child, click here).

2) Reduction in social support systems :

Research shows that a lack of social support makes individuals much more vulnerable to the adverse effects of stress. And, today, children tend to have less access to others who could provide them with emotional support than has been the case in the past due to, for example :

  • communities that are not as close-knit as in the past
  • less contact with wider family (eg aunts, uncles, grandparents) than in the past as wider family members are becoming more geographically dispersed than in past

3) Increase in number of working mothers :

This can lead to infants having inconsistent early care as they me be shuttled around from day-care to nursery care to babysitters and so on possibly leading to a variation in quality of care and less opportunity for the infant to develop his/her bond with the mother

4) Parental preoccupation with their careers :

In a ‘go-getting’ society, in which status and wealth are of fundamental importance to many people, individuals are becoming very driven, even obsessively driven, in connection with their careers, sometimes leading to workaholism; this leaves such persons with less time to interact in any really meaningful way with their offspring or leads to such exhaustion that they simply do not have enough energy left over for such meaningful interactions.

5) Unhelpful effects of media :

Young people are becoming increasingly obsessed with media, such as computer games and so on, which leaves them with less time for psychologically nourishing face-to-face interaction with friends and family.

6) Unhelpful effects of living in  consumer society :

Society has become increasingly obsessed with acquiring consumer goods and the accumulation of these is often linked in people’s minds to their ‘status’ and ‘worth as a human being.‘ Such attitudes may lead young people to develop false values which in turn may aggravate psychological problems.

Related post :  c PTSD Treatment

 

David Hosier BSc Hons; MSc; PGDE(FAHE).

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Vital Environmental Factors That Can Prevent Recovery From PTSD And BPD

 

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If, as a result of childhood trauma, we have developed post traumatic stress disorder (PTSD) or borderline personality disorder (BPD) our post-traumatic environment can have an extremely strong impact upon our chances of recovery. I list some particularly important factors below :

  • LACK OF SUPPORT FROM FRIENDS, FAMILY AND THE WIDER COMMUNITY / SOCIETY

If we are not provided with such support, but, instead, are shunned and ignored, it is highly likely that our feelings of worthlessness, vulnerability and isolation will be intensified.

Support needs to be non-judgmental, empathic and validating both of our emotional pain and also of our interpretation of how our adverse experiences have affected us.

Also, those providing the support need to be ’emotionally literate’ (i.e. able and willing to discuss feelings and emotions in a compassionate and understanding manner)

  • NOT BEING BELIEVED

Obviously, if people we talk to about our traumatic experiences don’t believe what we are saying or believe we are exaggerating the seriousness of what happened to us (or the seriousness of the effect it has had upon us) our psychological condition is likely to be severely aggravated : our lack of self-esteem, sense of despair, sense of worthlessness, sense of unlovability, feelings of isolation and any feelings of anger, bitterness and resentment we may have are all likely to be severely intensified.

  •  SECONDARY VICTIMIZATION

We need to avoid those who would cause us secondary victimization. Secondary victimization occurs when those who ought to be helping us instead harm us further. Indeed, the example of not being believed (see above) is one such form of secondary victimization.

Other examples of secondary victimization include :

having a doctor who minimizes / trivializes the seriousness of what has occurred to us and its effects

– being stigmatized by society for having developed a psychiatric condition

– being shunned and ostracized by friends / family due to our condition

– being made to feel ashamed in connection with what has happened to us and its effects

– having the vulnerable nature we have developed as a result of our mental condition exploited by an intimate partner (the risk of this is especially high as those who have suffered significant abuse in their early lives are frequently (on an unconscious level) driven to seek out intimate partners who are likely to abuse them further (this is sometimes referred to as a repetition compulsion).

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David Hosier BSc Hons; MSc; PGDE(FAHE).

 

 

 

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PTSD Symptom Categories

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Those of us who experienced high levels of stress as children are at increased risk of developing PTSD, sometimes referred to as complex post traumatic stress disorder (CPTSD), as adults.

Whilst it is imperative that a diagnosis for PTSD does NOT derive from self-diagnosis but, instead, comes from a relevantly qualified professional (such as a psychiatrist), the symptoms I list below can give an idea of whether or not one may be suffering from it :

These can be split up into three main PTSD symptom categories as follows below:

1) Symptoms related to avoidance behavior

2) Symptoms related to re-living/ re-experiencing the traumatic events

3) Symptoms related to a person’s biology/physiology/level of physical arousal.

Let’s look at each of these three specific categories of possible PTSD symptoms in turn:

1) Symptoms related to avoidance behavior :

– avoidance of anything that triggers memories of the traumatic experiences, including people, events, and places

– avoiding people connected to the trauma, or avoiding people in general

– avoidance of talking about one’s traumatic experiences

– avoidance of intimacy (both physical and emotional)

2) Symptoms related re-living/ re-experiencing the traumatic events :

– nightmares

– distressing, intrusive, unwanted thoughts

– flashbacks

– obsessive and uncontrollable thinking about the trauma one has experienced, perhaps to the point that it is hard to think about, or concentrate on, anything else

– constant sense of fear, vulnerability, being under threat and of being in extreme imminent danger

– transient and spontaneous psychotic symptoms (eg visual hallucinations -such as ‘seeing’ past traumatic events happen again, or auditory hallucinations – such as ‘hearing’ sounds or voices connected to the original trauma

3) Symptoms relating to a person’s biology/physiology/level of physical arousal.

– hypervigilance (feeling ‘keyed up’, tense and constantly on guard)

– hyperventilation (rapid, shallow breathing)

– sweating

– shaking/trembling

– extreme irritability

– proneness to outbursts of rage that feel out of control and surface unpredictably

– getting into physical fights, especially if using alcohol to numb feelings of distress/fear

– an over-sensitive startle response

– feeling constantly ‘jittery’ and ‘on-edge’

– inability to relax

– insomnia/frequent waking/unrefreshing sleep

Miscellaneous Other Possible Symptoms:

– despair; feeling life is empty and meaningless; feeling numb and ‘dead inside’; anhedonia (inability to feel pleasure); inability to trust others; loss of motivation; loss of interest in previous hobbies/pursuits; loss of interest in sex; cynical and deeply pessimistic outlook; self-neglect; self-harm; thoughts of suicide/suicide attempts; extreme and chronic fatigue; agoraphobia and phobias related to the original trauma.

(NB : Whilst the above list of symptoms is extensive, it is not exhaustive).

Recommended link:

For more detailed help and advice regarding this serious condition, click here : Advice from MIND on PTSD.

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David Hosier BSc Hons; MSc; PGDE(FAHE)

 

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Horowitz’s Information Processing Theory, Flashbacks And Nightmares

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According to the psychological researcher Horowitz, some symptoms of post traumatic stress disorder (PTSD) can be understood more clearly with reference to what he termed Information Processing Theory.

What Is Information Processing Theory And How Does It Relate To Post Traumatic Stress Disorder?

Horowitz suggests that if we undergo a very traumatic experience, such as significant and chronic childhood trauma, we develop a powerful unconscious drive to ‘make sense of it’, ‘work through it’ and mentally process it.

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In relation to this, Horowitz proposes that we all have an internal mental model of how the world works (mental models are sometimes referred to by psychologists as schemas).

However, when we undergo severe trauma, the experience does not ‘fit’ this internal mental model/schema. This causes us stress and we are unconsciously driven to reconstruct our mental model/schema so that the traumatic experience CAN be fitted into it (ie. mentally integrated).

This process is complex and takes time – especially if the traumatic experience was severe and long – lasting.

Horowitz states that this processing of the traumatic event involves repeatedly, mentally replaying it; this can lead to :

intrusive memories

nightmares

flashbacks

But :

The intensity and frequency of these intrusive memories, nightmares and flashbacks can attain a critical point at which they are so distressing, mentally overwhelming and emotionally exhausting that, to avoid them, we become psychologically numb.

Horowitz suggests that the processing of the traumatic experience can involve vascillating between these two states until a final state of mental equilibrium is reached at which point the trauma has been successfully processed.

Problems arise, of course, if we become ‘stuck’ in the ‘vascillation phase’ and, in such a situation, professional therapy may be considered. Research suggests that two effective therapies are dialectical behavioral therapy and mindfulness meditation.

eBook:

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David Hosier BSc Hons; MSc; PGDE(FAHE).

 

 

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Developmental Trauma Disorder

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Researchers van der Kolk et al. have proposed that children who are significantly psychologically and emotionally disturbed as a result of their traumatic upbringings be diagnosed with Developmental Trauma Disorder  (although the proposed diagnosis is not yet included in the DSM or, to give it its full title, The Diagnostic and Statistical Manual of Mental Illness).

The researchers who propose the diagnosis argue that the various diagnoses disturbed children currently receive, such as Oppositional Defiant Disorder, Reactive Attachment Disorder and anxiety, are too narrow, restricted and limiting and, furthermore, do not recognize or acknowledge the ‘big picture’ (i.e. the full extent and range of the damage that has been done to child’s functioning).

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They also argue that limited and narrow diagnoses like Oppositional Defiant Disorder lead to clinicians focusing too much on correcting the behaviour at the expense of identifying and understanding the underlying cause of it (i.e. the trauma that the child has suffered).

Van der Kolk, in his book The Body Keeps Score (see below) describes Developmental Trauma Disorder as having three prime features; these are as follows:

1) A pervasive pattern of dysregulation:

According to van der Kolk, this may entail dramatic mood swings, outbursts of extreme temper, panic, detachment, flatness, dissociation and the inability to self-sooth

2) Impaired ability to pay attention and concentrate (due to agitation and hyperarousal)

3) Impaired ability to get along with others and, as van der Kolk puts it, ‘a failure to get along with [ oneself ].’

 

Associated Physical Symptoms:

Van der Kolk also draws our attention to the fact that, because the child suffering from Developmental Trauma Disorder is constantly in a state of high stress (and, subsequently, is likely to have an abnormally high level of stress hormones – such as cortisol – coursing through his/her veins) s/he will also be susceptible to various physical symptoms; these include:

– headaches

– sleep disruption

– stomach upsets

– oversensitivity to sounds and tactile experiences

– problems with fine motion movements

Extreme Need To Relieve Stress:

The young person with Developmental Trauma Disorder, in an attempt to alleviate the severe stress s/he perpetually feels, may, also, according to van der Kolk:

– self-harm (e.g. cutting self with razor)

– masturbate excessively

– rock to and fro whilst sitting down

Neediness And Self-Hatred:

If the child has been rejected and/or largely ignored by his/her parents/caregivers this may lead him/her to become extremely ‘needy’ and ‘clingy.’

Also, s/he is likely to have internalized his/her parents’/caregivers’ negative view of him/her and therefore develop feelings of self-hatred, of being intrinsically unlovable, and of being worthless and of no value to others.

Resources:

To purchase van der Kolk’s book/eBook, click on image below:

 

To purchase Childhood Trauma And Its Link To Borderline Personality Disorder click image below:

 

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David Hosier BSc Hons; MSc; PGDE(FAHE).

 

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What Is ‘Trauma Informed’ Therapy?

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Many individuals who seek treatment and therapy for problems such as alcoholism, drug addiction, clinical depression, severe anxiety, anger management issues and eating disorders (or a combination of such problems) often have an underlying problem: they have experienced severe and protracted childhood trauma.

In other words, it is their experience of trauma that has significantly contributed to the existence of such problem as those mentioned above.

Such people are increasingly being said by psychiatric professionals to be suffering from complex posttraumatic stress disorder (CPTSD). However, this diagnosis has yet to be included in the DSM (Diagnostic And Statistical Manual Of Mental Disorders).

In CPTSD sufferers, the problems that go with it such as those listed above (alcoholism, drug addiction etc) are often referred to secondary problems/conditions/diagnoses whilst the the core CPTSD is referred to as the primary problem/condition/diagnosis).

Sadly, all too frequently, the diagnosis of CPTSD is missed due to practitioners focusing exclusively on the secondary problems without taking the time to discover the underlying and primary problem, namely the effects of childhood trauma manifesting as CPTSD.

Unfortunately, it is much harder to treat the secondary problems if their link to the primary problem (the experience of childhood trauma / CPTSD) is not identified. Indeed, in my own case, for years my secondary symptoms were treated without success due in large part due to the fact none of my doctors or psychiatrists I saw (and, believe me, these were numerous) thought to ask me about my childhood.

TRAUMA INFORMED THERAPY:

Trauma informed therapy is treatment which identifies the link between the primary problem (the effects if childhood trauma) and the secondary problems (alcoholism, drug addiction etc…).

Indeed, according to the principles of trauma informed therapy, if the psychiatric professional fails to make this connection and tailor the treatment accordingly, it is much less likely the patient will be able to permanently conquer his/her secondary problems, let alone the primary problem (as it remains unidentified as a causal factor and as a major problem in its own right).

Resource:

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David Hosier BSc Hons; MSc; PGDE(FAHE).

 

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PTSD Sufferers More Likely To Be Obese.

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PTSD And Obesity

Currently, in the UK, about 65% of men and 58% of women are clinically classified as being either overweight or obese. In the USA, the figures are similar : approximately 58% of women are clinically defined as overweight or obese, whilst the corresponding statistic for male Americans is 70%.

A study conducted by Bartoli et al. found that those suffering from post-traumatic stress disorder (PTSD) were about one and a half times more likely to suffer from obesity than were the controls (participants who did not have PTSD) who took part in the research.

So, if, as adults, we suffer from PTSD as a result of our highly disturbed childhoods we are at increased risk of also becoming obese compared with the average individual (all else being equal).

Why should this be the case? Well, one explanation is that the depressive symptoms that accompany PTSD can lead to the so-called ‘comfort eating’ phenomenon as well as much decreased levels of physical activity due to lack of motivation (in my own case, I was frequently utterly incapable of getting out of bed); therefore, we are likely to consume more calories each day than we burn up.

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Above : The Cookie Monster : Me love cookie…

Also, the severe anxiety that accompanies PTSD can lead to various different compulsions, one of which being compulsive eating.

Furthermore, many PTSD sufferers experience severe insomnia and intense, terrifying nightmares (as I know from my own bitter experiences). This can lead (as it did in my own case) to getting out of bed frequently in the night for the purpose of consuming self-medicating (i.e. mentally soothing), nocturnal feasts (especially carbohydrates, which help many to feel slightly calmer, temporarily).

A Psychodynamic Theory Of Why Some Individuals May Become Obese:

Psychodynamic theory suggests that if we suffered severe childhood trauma and frequently felt threatened, intimidated and fearful due to the treatment we received by those who were supposed to be caring for us and protecting us then we might be unconsciously driven to become very large (i.e. obese) as it gives us the feeling that we are less vulnerable and more able to defend ourselves. This theory is, however, difficult to prove (although it does not logically follow, of course, that it is necessarily incorrect; indeed, it seems to make intuitive sense).

David Hosier BSc Hons; MSc; PGDE(FAHE).

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Hartman’s 12 Stages Of Post-Traumatic Stress Disorder (PTSD)


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I have written extensively on this site about how severe and chronic childhood trauma can lead to the development of post-traumatic stress disorder (PTSD) in adulthood (see the PTSD section on the main menu). This is also sometimes referred to as complex post-traumatic stress syndrome (CPTSD). In order to understand the theoretical difference between PTSD and CPTSD, click here.

In connection with PTSD, the writer and researcher, Hartman, has proposed a model of how the terrible mental illness can progress over time, involving the afflicted individual going through 12 painful steps.

This theoretical model is shown in diagrammatic form below:

 

The 12 Steps Of Post-Traumatic Stress Disorder (PTSD):

12 steps ptsd chart - Hartman's 12 Stages Of Post-Traumatic Stress Disorder (PTSD)

 

PTSD Treatment:

The NHS provides excellent information about treatment options for PTSD and this can be found by clicking here.

Information For Therapists:

A downloadable course that trains practitioners to treat PTSD  (using the Rewind Technique) can be found by clicking here.

EBook:

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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