PTSD is a mental health condition that, through the years, has been referred to as “shell shock” and “combat fatigue” because it affected soldiers who fought in World War I and World War II. Approximately 8 million people experience PTSD in any given year. Whereas PTSD was not always recognized for what it was, today more attention is drawn to this disorder so that the victims of PTSD can get the treatment they need and deserve. Today, it’s also recognized that all sorts of people in every walk of life suffer from this trauma. It need not be exclusive to the act of war, although soldiers tend to experience the most vivid and recognizable forms of the disorder. In fact, it happens to victims of abuse—women, men, and children—and to individuals who lead otherwise normal lives but have a singular trauma they are not equipped to process. It also happens to individuals who fall into or are exposed to prolonged and extreme poverty, systemic violence, or other forms of inequality.
What is PTSD?
PTSD (Post traumatic stress disorder) is a psychiatric disorder that happens to people who have witnessed or experienced a traumatic event. Although the people most commonly affected by PTSD were soldiers who were in combat, PTSD can result from various types of traumatic events, including terrorist acts, war, serious accidents, violent personal attacks like rape or assault, or natural disasters.
PTSD is not limited to a certain ethnicity or gender but can occur in all people and of any age. However, women are more likely to be affected by PTSD than men are. The American Psychiatric Association reports that about 3.5% of the adults in the United States suffer from PTSD, with the majority of that figure being women. This is, naturally, affected by those tested versus the whole population. A number of factors may skew the figure much higher, such as unequal access to healthcare.
Symptoms of PTSD
Although symptoms can vary not only in severity but from one person to another, they generally fall into four categories.
Intrusive thoughts – These may include flashbacks of a traumatic event, frightening dreams, or consistent, involuntary memories. The thoughts or memories can seem so real that the person often feels like the event is happening all over again right before their eyes, making them re-live the experience. This is most evident with individuals who have served in the military, primarily because they are ultimately reprogrammed for war and not reacclimated to normal, civilian life before they return. It becomes more problematic when the individual reverts to survival skills learned to endure war while reliving events or experiences from that time.
Avoiding things that remind them of the traumatic event – They may avoid certain people, activities, situations or even places that might bring on the memories. PTSD sufferers may also resist or refuse to talk about their feelings and what happened to them. While it may seem unusual to those surrounding them, this is an attempt to distance themselves from their own memories. While, again, the most dramatic and well-known instances occur in soldiers, this behavior can shape the lives of anyone who has suffered a traumatic experience.
Negative thoughts about themselves or others – Their feelings may often appear to be almost paranoid and filled with fear, shame, anger and even disinterest in things that previously interested them. Some may even have suicidal thoughts or take action on those thoughts if the issue is not diagnosed and treated.
Having sudden outbursts – They may have angry outbursts, be easily frightened or behave in a reckless manner. They may also have trouble sleeping or focusing. These symptoms can compound the problem, especially with insomnia.
The Amygdala and PTSD
The amygdala is integral in fear-based and anxiety disorders. In part, it also integrates with activity in the hypothalamus. However, because it is seen erroneously as a homogenous organelle, studies relating to the amygdala and PTSD have yielded mixed results. It is, in fact, made up of several parts or nuclei, which respond differentially to stressors of any large magnitude.
Additionally, the amygdala is responsible not only for fear, but its extinguishment or ablation. It also regulates reward signals and arousal of various types. This would explain why, when a trauma occurs but is not abated, it tends to grow or take on new tendencies. It spreads to other actions and events not associated with the original trauma, largely because it “recognizes” that fear of the original event is ongoing.
This is an integral part of human evolutionary neurobiology. If a behavior was dangerous until understood or managed, this led to both fear response creation and ablation. If the behavior remained dangerous, even once understood, it served to remind us that the behavior should not be undertaken.
The centrocorticomedial complex (CMA) is tied directly to the hypothalamus. The basolateral complex (BLA) is tied to the thalamus, sensory areas, and the prefrontal cortex. In a study published in Nature, authors pointed out that, in relation to PTSD, the two areas functioned differently. They used a new technology that allows these relatively small areas of the brain to be diagnostically tested in a non-invasive way called segmentation.
While the participants were young and the trauma occurred only once, it offers some insight into the formation of trauma memory and its relative importance in the survival schema of an individual. Over the course of the study, which lasted more than two years, most of the individuals who were observed to have PTSD also saw increased symptoms. This corresponds to a lessening of volume in the CMA.
What might be most interesting is for the study to be repeated with older and more diverse individuals who have a repeated history of trauma, such as soldiers or women in high-risk occupations such as sex work. Potentially, one might see an increase or a stabilization of the CMA’s volume. Similarly, there may be a reduction in the reward expectation of the brain that corresponds to a drop in serotonin. How might these two aspects of neurophysiology be interrelated?
In order for a diagnosis of PTSD to be made, the individual must exhibit the symptoms for at least a month. In many cases, the symptoms continue for months or even years. Some people with PTSD develop symptoms within a couple of months of the traumatic event, while others may not show symptoms until much later. The individual may have small symptoms or may have severe issues.
To accurately diagnose PTSD, the person must have exposure to a distressing traumatic event. For instance, a person may go through a traumatic event like an assault but may not show PTSD symptoms until he or she has exposure to another upsetting event, such as a family death. Victims of PTSD may also suffer from substance abuse, memory problems, depression, and other mental health or physical problems.
While each of these issues should be treated distinctly, they can often mask PTSD, rendering it difficult to treat. PTSD has been shown to have a high comorbidity or co-occurrence with other issues, such as schizophrenia, borderline personality disorders, depression, and anxiety disorders of varying types. The use of alcohol or drugs is heightened in these cases, which can make diagnosing PTSD difficult.
Treatment for PTSD
The treatments for PTSD can depend on the individual, the severity of the symptoms or the specialist treating the person. In some cases, the person may get better on their own over time, but many others must seek professional treatment. Treatment might be one or more of the following.
Group Therapy – This involves other PTDS sufferers meeting together and sharing their traumatic events.
Cognitive Processing Therapy – This helps the person come to grips with frightening memories and modifying negative emotions.
Prolonged exposure therapy – This uses repeated and specific images of the traumatic event to trigger the PTSD symptoms but in a controlled and safe environment.
Medication – This is used to help control the PTSD symptoms, relax the individual, and help with sleep. While it absolutely does treat symptoms of the disorder, one should not rely on it. The underlying problem will persist.
Alternative therapies – These might include animal-assisted therapy, acupuncture or even outpatient therapy.
It should be noted that several therapies and medications may have success when a singular approach does not. Animal assisted therapy often involves horses or dogs, two noted animals with high empathy. Service animals, such as dogs can also give an individual something to focus on besides themselves, which is helpful when triggers occur. Their role goes deeper than that, though.
These service dogs are specially trained to note the physical symptoms of an anxiety attack or other behavioral change that is spurred in the amygdala. They then may interrupt the cascading sequence of events, to which the person is accustomed. It also calls attention to the behavior of a person’s higher brain functions, which know that the cascade is not a desired effect. Concomitantly, they perform all the associated roles of a dog—boosting serotonin, lowering blood pressure and stress, and reducing anxiety—making them one of the most successful auxiliary therapy tools available.
Similarly, the process engaged in with acupuncture is more than the insertion of needles. It creates a state of mind that is, in a sense, concrete. The practitioner leads the patient through meditation exercises they can and are encourage to repeat as needed before beginning the treatment.
ABA and PTSD
Applied Behavior Analysis (ABA) represents the application of principals of learning to manifest discernible results. Individuals who enact this type of treatment are also encouraged to assess through direct observation and assessment whether the therapy is having the desired effect. With PTSD, it’s important to understand that it’s ultimately a behavioral issue, as discussed above. Therefore, therapists use a specific model, known as ABC—antecedent, behavior, and consequence to better diagnose it. This ABC model is at the root of Applied Behavioral Analysis.
Antecedent refers to what triggers PTSD behaviors. These may be fast or slow, with slow triggers manifesting as unanticipated comments about the trauma, sights, sounds, touches, tastes, smells, or loud noises that take an individual back into the moment of the trauma. Slow triggers are anniversaries of a trauma or pending court dates related to anything about the trauma.
Behaviors are specific and differential, meaning that they correspond to both the trauma setting and to the individual’s underlying problem-solving techniques. A person could devolve into a panic attack relatively quickly, with sweating, shaking, trouble breathing and focusing on other stimuli. They might run away or shut down in an attempt to escape the perceived trauma. Alternatively, they may become violent, which is the person attempting to fight off the trauma.
Consequences are exactly that, the reactions of others or additional stimuli. Most of the time, the individual seeks to isolate themselves from the consequences. While it does remove some of the triggering events, what it also does is to remove the person from their support network. They make themselves truly alone, outside the circle of support and love of their close connections. It is not a viable, long-term solution for PTSD.
What many therapists are now doing is, perhaps, counterintuitive. They are exposing patients to stimuli that mirror or evoke their trauma in order to begin desensitizing them. While it is not expected to render their experience in a positive light, successful desensitization does portray memories of the event in a neutral way. Behavioral Activation is a formal therapy. It involves first exposing a patient to a trigger. Then, their behaviors are assessed and a treatment plan is formed.
With ABA and PTSD, it’s important to involve individuals in their own treatment goals. This gives them a sense of control when everything about their trauma robs them of it. By continuing to confront the trauma and its effects, they are essentially taking control of their lives, which before were characterized by anxiety and panic.
People suffering from PTSD often have a difficult time functioning in society. This may be largely because trauma is often hidden and also misunderstood by those who do not experience it. However, as many cultures come to grips with what PTSD is and how it may be challenged through ABA and other therapies, this will change. With treatment as well as understanding and compassion from society, PTSD sufferers have a good chance of getting better and retaining the life they had before the traumatic event.
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