Tag Archives: Post-traumatic Stress Disorder

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


12_steps_of_ptsd

 

 

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_of_PTSD_diagram

 

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.

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

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The Main Elements Of Posttraumatic Growth

childhood-trauma-fact-sheet

Many people, after suffering a terrible trauma, find that, once they have got through it and started to recover from its damaging psychological effects, they eventually reach a stage whereby they are able to use their adverse experiences to develop them as a person in highly positive ways that benefits both themselves and society at large. This has been termed by psychologists posttraumatic growth (click here to read an earlier article I have written about this).

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After experiencing trauma comes a slow process of recovery (assuming effective therapy is sought); the length of time recovery takes will depend both upon the type, intensity and duration of the trauma, as well as the age the individual was when s/he experienced the trauma, and also the affected individual’s personal characteristics, temperament and genetic make-up.

Once the person who experienced the trauma is able to manage his/her painful and distressing emotions more effectively, finds memories of the trauma less difficult to cope with, and is able to function reasonably well on a day to day basis, a transition can start to take place in which the person begins the process of moving on from recovery into posttraumatic growth. Ideally, this period of growth and development should be guided and facilitated by an appropriately qualified and experienced therapist.

The process of posttraumatic growth involves taking stock of what happened and analysing its significance. The American Psychological Association identify ten key elements that the process involves :

1) re-establishing meaningful relationships with other people

2) accepting that change is an inevitable part of life

3) setting goals and starting to move towards them

4) taking decisive action

5) working on developing a positive self-view

6) learning from the past

7) good self-care

8) developing an optimistic outlook

9) seeking out opportunities for self-discovery

10) seeing crises as challenges rather than as insurmountable obstacles

-76_AA278_PIkin4,BottomRight,-69,22_AA300_SH20_OU02_childhood traumachildhood trauma therapies and treatments

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Post Traumatic Stress Disorder (PTSD) Questionnaire

ptsd test

As we have seen in several of the previously published articles on this website (eg click here), severe childhood trauma can lead to the development of post traumatic stress disorder (PTSD). If you are concerned you might suffer from the condition, it is important to seek advice from a relevantly qualified mental health professional.

However, if you want to find out if you have symptoms which PTSD can cause, you may find it interesting and useful to look at the list of items below and count up how many apply to you. REMEMBER, THE TEST DOES NOT REPLACE A PROFESSIONAL MEDICAL ASSESSMENT AND DIAGNOSIS.

SELF-REPORT POST TRAUMATIC STRESS DISORDER (PTSD) TEST :

(score 1 point for each item you answer YES to)

1) Have you been exposed to a traumatic event or events?

2) Did the trauma cause you to experience feelings of intense fear/ horror and powerlessness/impotence/helplessness

3) Does it sometimes feel as if you are reliving or re-experiencing the trauma (ie flashbacks)

4) Do you experience nightmares which are associated with the trauma that you experienced

5) Did the traumatic experience involve you witnessing serious injury/death or did it involve you being seriously injured/threatened with death?

6) Do you have thoughts or mental images related to the trauma which are intrusive, difficult to control and hard to dispel from the mind?

7) When something reminds you of the trauma, or you find thoughts about it intruding on your mind, does it cause serious distress?

8) Do you avoid things that remind you of the trauma? Examples include activities, people and places

9) Do you find you have less interest in activities that you used to enjoy?

10) Are you unable to remember something significant that occurred during the trauma (this is sometimes referred to as repression)

11) Do you try to avoid speaking about what happened during the trauma?

12) Do you find yourself more irritable than you were before the trauma occurred and that you get angry much more often?

13) Do you suffer from insomnia (such as finding it hard to get off to sleep and/or waking too early)?

14) Has your concentration become impaired since the trauma?

15) Do you find you no longer wish to interact with others as much as you did prior to the trauma and that you now have difficulty trusting other people?

16) Do you fear that, because of the trauma you suffered,  it will significantly, negatively impinge upon your future life in areas such as career, relationships and life span?

17) Has your ‘startle response’ become more sensitive since the trauma?

18) Have the symptoms that you’ve experienced since the trauma lasted for a minimum of one month so far?

19) Since the trauma, do you find it harder to feel emotions (eg feeling ‘numb’ for much of the time) and/or harder to display emotions to others?

20) Do you feel hypervigilant (ie feel as if you are constantly on ‘red alert’) for much of the time and constantly have a sense of impending disaster?

21) Have what used to be your everyday routines been disrupted by how you now feel (eg social life, work)?

A guide to interpreting your score :

0-3      It is not likely that you have PTSD

4-9      It is likely you have PTSD

10 +   It is very likely you have PTSD

DISCLAIMER – This does NOT provide you with a diagnosis, it is just a guide. If you suspect you have PTSD, or a related condition, you are strongly advised to seek the relevant professional advice.

 

 

 

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Childhood Trauma: Eye Movement Desensitisation and Reprocessing (EMDR).

EMDR

Individuals who have suffered severe childhood trauma may, as a result of it, later suffer from Post-Traumatic Stress Disorder (PTSD), or similar condition. Some professionals advocate a relatively new technique which aims to address this; it is known as Eye Movement Desensitisation and Reprocessing (EMDR).

WHAT IS EMDR?

The therapist administering EMDR will first examine the issues related to the individual’s psychological difficulties and, also, help him/her develop strategies to aid in relaxation and deal with stress. After this, the therapist encourages the individual to recall particular traumas, whilst, simultaneously, manipulating his/her eye movements by instructing him/her to follow the movements the therapist is making with a pen, or similar object, in front of the individual’s face). The theory is that this will facilitate the individual in effectively reprocessing his/her traumatic experiences, thus alleviating psychological distress.

THIS SOUNDS A LITTLE ODD; WHAT IS THE RATIONALE BEHIND EMDR AND, HOW, EXACTLY, IS IT THOUGHT TO WORK?

My first reaction to hearing about this particular therapy was that it sounded somewhat strange. However, the rationale behind EMDR is that disturbing memories from childhood need to be PROPERLY PROCESSED by the brain in order to alleviate symptoms associated with having experienced childhood trauma (eg PTSD, as already mentioned); this is because the view is taken that it is the UNRESOLVED TRAUMA that is the cause of the psychiatric difficulties the individual who presents him/herself for treatment is suffering. Those professionals who recommend the therapy believe that the EYE MOVEMENTS INDUCED BY THE THERAPIST IN THE INDIVIDUAL BEING TREATED LEAD TO NEUROLOGICAL AND PHYSIOLOGICAL CHANGES IN THE BRAIN WHICH AID IN THE EFFECTIVE REPROCESSING OF THE TRAUMATIC MEMORY, and, in this way, ameliorates psychological problems from which the individual had been suffering.

emdremdr

WHAT ARE THE STAGES INVOLVED IN EMDR THERAPY?

These are briefly outlined below:

1) The first stage is the identification of the specific memory/memories which underlie the trauma.

2) Next, the individual is asked to identify particular negative beliefs he/she links to the memory (eg ‘I am worthless’)

3) Then, the individual being treated is asked to replace the negative belief with a positive belief (eg ‘I am strong enough to recover’ or ‘I am a person of value with potential to have a bright future’ etc)

4) In the fourth stage, the therapist moves a pen (or similar object) in various, predetermined motions in front of the individual’s face and he/she is instructed to follow the movements with his/her eyes (eg repeatedly left and right). Whilst this is going on, the therapist instructs the individual to simply, nonjudgmentally observe his/her own thoughts, letting them come and go freely and without trying to influence them in any way – just to accept them, in other words, and let them happen.

5) This procedure is repeated several times.

Each time the process is undertaken, the therapist asks the individual being treated to rate how much distress he/she feels – this continues until his/her self-reported level of distress becomes very low. Similarly, each time the process is undertaken, the individual is asked to report how strongly he/she now feels he/she believes in the positive idea given in stage 3 (see examples provided above); therapy is only concluded once the level of reported belief becomes very high.

NB. The therapy is actually more involved than this, so the above should only be taken as a brief outline. There are, too, different variations of procedure outlined above which can be employed within the EMDR range of therapies available.

WHAT DO EVALUATION STUDIES OF EMDR THERAPY SUGGEST ABOUT ITS EFFECTIVENESS?

A recent meta-analysis of evidence (ie an overview of a large number of particular, individual studies of EMDR) supported the claim that it is effective, as have other meta-analyses. However, some researchers have suggested that it is not the EYE MOVEMENT PART of the therapy which is of benefit, but only the act of repeatedly recalling traumatic memories which is the effective component (based on the idea that these repeated mental exposures, under close supervision and in a supportive and safe environment, of the traumatic memories alone facilitates their therapeutic reprocessing).

In response to this criticism, its exponents (and there are many professionals who are), regard the EYE MOVEMENT COMPONENT of the therapy as ESSENTIAL in giving rise to the NECESSARY NEUROLOGICAL CHANGES which allow the EFFECTIVE REPROCESSING OF THE TRAUMA; these proponents also emphasize that the therapy only requires short exposures to the traumatic memory/memories, thus giving it an advantage over therapies which utilize far more protracted exposures.

Research into EMDR is ongoing.

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Childhood Trauma: Complex Post Traumatic Stress Disorder (with Questionnaire).

 

complex post traumatic stress disorder questionnaire

Survivors of extreme trauma often suffer persistent anxiety, phobias, panic, depression, identity and relationship problems. Many times, the set of symptoms the individual presents with are not connected to the original trauma by those providing treatment (as certainly was the case for me in the early years of my treatment, necessitating me to undertake my own extensive research, of which this blog is partly a result) and, of course, treatment will not be forthcoming if the survivor suffers in silence.

Any treatment not linked to the original trauma will tend to be ineffective as THE UNDERLYING TRAUMA IS NOT BEING ADDRESSED. Also, there is a danger that a wrong diagnosis may be given; possibly the diagnosis will be one that may be interpreted, by the individual given it, as perjorative (such as a personality disorder).

ptsd

Individuals who have survived protracted and severe childhood trauma often present with a very complex set of symptoms and have developed, as a result of their unpleasant experiences, deep rooted problems affecting their personality and how they relate to others. The psychologist, Kolb, has noted that the post-traumatic stress disorder symptoms survivors of severe maltreatment in childhood might develop ‘may appear to mimic every personality disorder’ and that ‘severe personality disorganization’ can emerge.

Another psychologist, Lenore Terr, has differentiated between two specific types of trauma: TYPE 1 and TYPE2. TYPE 1 refers to symptoms resulting from a single trauma; TYPE 2 refers to symptoms resulting from protracted and recurring trauma, the hallmarks of which are:

– emotional numbing
– dissociation
– cycling between passivity and explosions of rage

This second type of trauma response has been referred to as COMPLEX POSTTRAUMATIC STRESS DISORDER (CPTSD) and more research needs to be conducted on it; however, an initial questionnaire to help in its diagnosis has been developed and I reproduce it below:

CPTSD QUESTIONNAIRE

1) A history of, for example, severe childhood trauma

2) Alterations in affect regulation, including
– persistent dysphoria
– chronic suicidal preoccupation
– self-injury
– explosive or extremely inhibited anger (may alternate)
– compulsive or extremely inhibited sexuality (may alternate)

3) Alterations in consciousness, including
– amnesia or hypernesia for traumatic events
– transient dissociative episodes
– depersonalization/derealization
– reliving experiences, either in the form of intrusive post-traumatic stress disorder symptoms or in the form of ruminative preoccupation

4) Alterations in self-perception, including
– a sense of helplessness or paralysis of initiative
– shame, guilt and self-blame
– sense of defilement or stigma
– sense of complete difference from others (may include sense of specialness, utter aloneness, belief no other person can understand, or nonhuman identity)

5) Alterations in perceptions of perpetrator, including

– preoccupation with relationship with perpetrator (includes preoccupation with revenge)
– unrealistic attribution of total power to perpetrator (although the perpetrator may have more power than the clinician treating the individual is aware of)
– idealization or paradoxical gratitude
– sense of special or supernatural relationship
– acceptance of belief system or rationalizations of perpetrator

6) Alterations in relations with others, including

– isolation and withdrawal
– disruption in intimate relationships
– repeated search for rescuer (may alternate with isolation and withdrawal)
– persistent distrust
– repeated failures of self-protection

7) Alterations in systems of meaning
– loss of sustaining faith
– sense of hopelessness and despair

Anyone who feels their condition may be reflected by the above is urged to seek professional intervention at the earliest opportunity.

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Childhood Trauma: Aiding Recovery through Diet and Lifestyle.

Several of my posts have discussed research that shows childhood trauma can profoundly influence the biochemistry of the brain and that these biochemical changes can, and do, lead to problems with the individual’s psychological state and behaviour.

Fortunately, however, research has also demonstrated that these adverse biochemical changes and their negative effects may be, at least in part, reversed by the individual adopting an appropriate diet and lifestyle.

The brain is able to naturally produce its own mood-benefitting neurochemicals (technically known as ENDOGENOUS neurochemicals).

One way to do this (which many of us are already familiar with) is through EXERCISE – research suggests that regular and mild exercise causes the brain to produce ENDORPHINS which work in a similar manner to prescribed anti-depressants (eg Prozac, Setraline etc).

BODY MASSAGE, too, has been shown to be helpful; indeed, a study by Field (2001) revealed that it can REDUCE STRESS HORMONES in the body.

Furthermore, a study by Jevning et al (1978) demonstrated that MEDITATION can be of great benefit. Indeed, more and more therapies are integrating meditative techniques (eg the therapy known as MINDFULNESS) to help alleviate patients alleviate their anxiety. It has been shown that meditation works by reducing the levels of the stress hormone CORTISOL in the body (which is of particular importance as high levels of cortisol can physically harm the body).

The brain is a physical organ so it should come as no surprise to us that what we eat affects its NEUROCHEMICAL BALANCE. Research shows that FATTY ACIDS are VITAL TO EMOTIONAL WELLBEING. In particular, LOW LEVELS OF OMEGA-3 FATTY ACID have been shown to be linked to DEPRESSION, ANXIETY and ANTISOCIAL BEHAVIOUR.

OMEGA-3 FATTY ACID can be purchased as a supplement in most pharmacists. It has been used to treat ADHD in children; also, a study by Gesch et al (2002) showed that giving young offenders OMEGA-3 supplements reduced their offending rate by 37%.

Another neurochemical which ENHANCES MOOD and helps to COMBAT ANXIETY and DEPRESSION is SEROTONIN. Many prescribed medications work by increasing the availability of serotonin in the brain, but SEROTONIN LEVELS CAN ALSO BE RAISED THROUGH DIET; research suggests that a diet RICH IN PROTEIN can help to achieve this and that research remains ongoing.

NOTE: One GP, who became so ill with bipolar depression that she had to be sectioned in a psychiatric ward and featured in an award winning documentary on mental illness, recovered sufficiently to return to her profession as a doctor. She has remained symptom free for 15 years (most people with bipolar disorder frequently relapse) and ATTRIBUTED THIS TO TREATING HERSELF BY CHANGING HER DIET. THE MAIN FEATURE OF THE DIET WAS THAT SHE TOOK 3 GRAMMES of COD LIVER OIL (a source of fatty acids) per day. Because this evidence, if it can be deemed as such, comes from just one individual it is obviously very far removed from providing a proper scientific sample or study. Nevertheless, I felt it to be of sufficient interest to make reference to it here. For those who are interested, the documentary is entitled ‘The Secret Life of a Manic Depressive’ and, in my view, makes compelling viewing.

For those who wish to try such fish oils like those described above as a nutrient supplement, I include a link directly below where you may purchase Hypercet Omega 3-6-9 :

Please click on this link for Hypercet Omega 3-6-9 : http://mhlnk.com/DF066C19

I hope you have found this post of interest. If you have any experience of making a change to diet which had beneficial psychological effects I would be most interested to hear about it in the ‘COMMENT’ section. Thank you.

This post may be shared through TWITTER and FACEBOOK. New posts are added to this blog at least twice per week.

Best wishes, David Hosier BSc Hons; MSc; PGDE(FAHE).

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Exciting Early Research Findings on the Medication Propranolol’s (a Beta-Blocker) Effectiveness for Treating Symptoms of Trauma.

Recent studies on the beneficial effects of the beta-blocker medication PROPRANOLOL on REDUCING THE ADVERSE SYMPTOMS OF TRAUMA are very encouraging and exciting.

One study, by Dr Roger Pitman, involving 22 patients, found that anxiety associated with trauma was greatly reduced in those patients given the drug compared with those who were not given it.

In another study, conducted in France, it was found that anxiety in patients suffering the effects of trauma was halved compared to those patients to whom the drug was not administered.

HOW IS THE BETA-BLOCKER PROPRANOLOL THOUGHT TO WORK?

What is particularly exciting about this drug is that it is thought to actually WEAKEN THE NEURAL MEMORY TRACE OF THE MEMORY ITSELF.

The drug blocks beta receptors in the brain, reducing the effects of adrenaline on neurons (neurons are brain cells).

The drug works on the SYMPATHETIC NERVOUS SYSTEM which has the effect of reducing physiological symptoms associated with anxiety such as a pounding, racing heart and rapid, shallow breathing (also known as hyperventilation).

Individuals suffering from the effects of trauma often report having vivid and intense memories of the traumatic event/s. It is thought that the drug addresses this problem by acting on the memory trace, causing it to fade away and decay normally, thus greatly weakening its grip on the individual and ameliorating symptoms of anxiety.

One study has even demonstrated that just a single dose of propranolol, in certain, specific cases, can be of benefit (although it is usually prescribed over the long-term).

FURTHER RESEARCH:

As stated above, research into the uses of this drug to treat the effects of trauma is at an early stage; more studies are being conducted. It should be pointed out, though, that the drug is not effective in every case.

Anyone considering taking the medication should discuss it with their doctor.

Best wishes, David Hosier BSc Hons; MSc; PGDE(FAHE).

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Anger Resulting from Childhood Trauma. Part 2.

anger management

It is better to express anger in a healthy and helpful way rather than to REPRESS or DENY it (in the case of the latter, it can profoundly, negatively affect our peace of mind or lead us to TURN THE ANGER IN ON OURSELVES or DISPLACE it (i.e. take it out in an inappropriate way on those who do not deserve it).

AMBIVALENCE.

It is natural to feel anger towards the person/s who caused our childhood trauma but the anger we feel is often COMPLICATED BY FEELINGS OF AMBIVALENCE if the person/s who caused our trauma also did good things for us. Such ambivalence can feel very painful and confusing, leaving us feeling CONFLICTED. In simple terms, we develop mixed, and very often contradictory, feelings towards the person/s.

Alternatively, we may excuse the person/s who caused the trauma by telling ourselves they behaved as they did due, for example, to the extreme stress they themselves were under.

This may make it more difficult to feel the anger, and, as a result, we may feel EMOTIONALLY NUMB ( a kind of dissociative state).

Whilst anger should not be forced, if we find it difficult to connect to our anger the following exercise may be useful:

1) to imagine ourselves at the age we suffered the trauma, remembering how young and vulnerable we were (if you have a photograph of yourself at the relevant age to look at this could be helpful).

2) think about what occurred and how it made us feel

3) think of the ways in which our lives have been damaged as a result, and how many years have been lost (it is important to do this in a safe way and reading my post on COPING MECHANISMS could be helpful in order to help ensure this).

When we can start to feel the anger without it overwhelming us, we can try to focus on our anger for longer periods of time.

Now we turn to how to deal with these angry feelings:

HOW TO DEAL WITH FEELINGS OF ANGER.

We often respond to anger in ways that only damage us. This may include turning the anger in on ourselves (eg self-harm, self-hatred), turning it on others who do not deserve it (DISPLACEMENT) or perhaps turning to drink and/or drugs to temporarily dissipate the pain and anguish our feelings entail.

However, clearly it is important to deal with our anger in a CONSTRUCTIVE way.

One way to do this is to express it ASSERTIVELY (i.e. in a CONTROLLED, APPROPRIATE and RESPECTFUL manner).

To express anger towards a particular person, in a SAFE and appropriate way, can be achieved in the two ways outlined below:

1) INDIRECTLY:

here, the person is not confronted face-to- face. Examples would be to write a letter (it is not even necessary to send it; merely writing down our feelings towards the person with whom we are angry can be a step forward, alleviating the painful feelings associated with repressing anger) or to role play (perhaps getting a friend to play the part of the person we are angry with).

2) DIRECTLY:

In order to make sure this is done appropriately and safely, planning and preparation are definitely helpful.

If you have found this post of interest you may wish to read my article on ‘Intermittent Explosive Disorder’ which can be accessed by clicking here.

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Coping Mechanisms for Survivors of Childhood Trauma

survivors of child abuse

How Do Survivors Of Child Abuse Cope?

In my last post I mentioned it might be useful to look at some coping mechanisms one may wish to make use of in the recovery stage from childhood trauma and it is to some of these that I now turn.

There are two main types of coping mechanisms:

1) Those which are helpful in the short-term, but unhealthy in the long-term.

2) Those which are useful in the long-term (but can take more effort and discipline).

Examples of the first include: drinking too much, use of illicit drugs, gambling, over-eating and taking anger out on others (and, almost always, later regretting it).

Examples of the second are: going for a walk, talking things over with a friend, having a relaxing bath or listening to music.

It should be pointed out that the strategies in the first category tend to leave the person with a lower sense of self-worth over time whereas the opposite tends to be the case with the kinds of strategies mentioned in the second category.

The key is to gradually reduce the use of the coping strategies in category one and gradually increase the use of the coping strategies in category two. This can take time.

BREATHING EXERCISES:

Another coping strategy is very simple but very effective (when I first learned this one I was dubious that something so simple could help and was surprised when it did) is to learn ‘controlled breathing’.

Under stress, we tend to HYPERVENTILATE (this refers to the type of breathing which is rapid and shallow) which has the physiological (and indeed psychological) effect of making us feel much more anxious. CONTROLLED BREATHING, on the other hand (breathing DEEPLY, GENTLY and EVENLY THROUGH THE NOSE) has the physiological (and, again, psychological) effect of calming us down. It is recommended by experts that with controlled breathing we should take 8-10 breaths per minute (breathing in AND out equates to ONE breath). With pratise, this skill can become automatic.

FORMING SUPPORTIVE RELATIONSHIPS:

Survivors of childhood trauma often find it difficult to form lasting relationships in adulthood (sometimes related to anger-management issues, volatility, inability to trust others and other problems). However, those who can form such relationships tend to have a much better outcome.

My next post will look at ways to help overcome difficulties in building and sustaining relationships.

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

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