As you spend more time discussing goals and challenges with your Talkspace therapist, you may have questions or are interested in learning more about specific mental health topics and conditions. The Talkspace Bookshelf offers up-to-date mental health information directly from our behavioral health team to provide a better understanding of condition origins, diagnoses, various forms a condition may take, and different treatment options. Feel free to use this resource as a starting point to open up a dialogue and pose questions for your Talkspace therapist.
In the United States, according to the National Institute of Mental Health, approximately 3.5% of the population live with Posttraumatic Stress Disorder (PTSD) in a given year.
History of PTSD
Posttraumatic Stress Disorder has been through several iterations since the cluster of symptoms were first noted. In modern times, Austrian physician Josef Leopold is among those credited with studying and exploring trauma response in his studies back in the mid-1800s. Originally, PTSD was initially meant to represent an experience that many soldiers had experienced when they came back from war. Around the time, it was commonly thought that PTSD was a result of lingering emotional impact due to physical injury among soldiers. Around that time, terms like “soldier's heart” and “nostalgia” were widely used. PTSD became more common after the American Civil War and World War I. When soldiers returned home with several debilitating emotional, and often physical symptoms, treatment was brief and they were diagnosed with conditions like “shell shock.” This cluster of symptoms later became known as Posttraumatic Stress Disorder.
What is PTSD exactly and who can suffer from it?
According to the Diagnostic and Statistical Manual of Mental Health Disorders 5 (DSM 5), PTSD may be experienced by anyone, at any age. Both adults and children alike may develop the condition.
Posttraumatic stress disorder (PTSD) develops in some people after experiencing (either directly or indirectly, such as witnessing) a traumatic event or events. Often these events involve seriously bodily injury or threat of serious injury. Some types of events include, but are not limited to, automobile accidents, war, and sexual assault.
In order for an individual to be diagnosed with PTSD there must be what mental health providers call an activating event. This “event” may be singular, but it can also be a series of events that lead to the development of the condition.
A person has to be exposed to an event or events in which there was threatened or actual death, serious bodily harm, or sexual violence. In the early years of PTSD, it was commonly thought that the individual had to experience the exposure directly (as in be a direct victim), but as further studies have been conducted, experts have realized that others — such as witnesses — may also be at risk for developing PTSD. Indirect sufferers of PTSD can be a witness to the event as it happens, or can be exposed to the event while learning that the traumatic event has happened to a loved one, such as a family member or close friend. And those, such as first responders, who are exposed repeatedly to details of extreme traumatic events may also go on to develop PTSD (for example, family social workers who are repeatedly exposed to details of child abuse).
PTSD Symptoms
Following exposure to the event, either as a direct victim or witness, several symptoms may begin to appear. At times, these symptoms can be severe and may include:
- Involuntary and intrusive memories of the traumatic event. These intrusions can be quite powerful and debilitating
- Distressing recurrent dreams that mirror the event(s) itself or the emotional experience that occurred during initial exposure
- A temporary disconnection with reality in which the individual perceives the traumatic events to be reoccurring in real time. This can be experienced in a range of ways, such as bodily sensations reminiscent of the event or complete loss of awareness of current surroundings and environment.
- Physical reactions to cues (triggers) that remind the individual of the traumatic event(s)
- Significant and intense emotional or psychological distress when exposed to cues that the individual believes symbolizes or resembles some aspect or aspects of the traumatic events (smells, sounds, people, etc.)
As a result of these kind of adverse reactions, many who develop PTSD also begin to avoid all things reminiscent of the traumatic events. This is primarily in an effort to avoid memories, feelings, or thoughts that may be distressing.
PTSD is a particularly insidious condition and it can also lead to the development of a drastic change in thought patterns following the event. Some of the potential changes in thought patterns include:
- Disruption in memory about the event leading to loss of some details (not due to any physical injury or intoxication)
- Persistent, intensely negative thoughts about one’s self such as “It was all my fault” or “I can never trust anyone again”
- Self-blame and guilt or belief that the individual caused the event(s) to happen
- Loss of pleasure or interest in previously enjoyed activities
- Ongoing and persistent negative emotional state such as guilt, sadness, fear, etc.
- An ongoing inability to experience positive emotions such as happiness, joy, peace, etc.
Following the event, other symptoms may emerge as well, such as general increase in agitation or reactivity in the person who was exposed. For some this may manifest as being hyper vigilant (or acutely aware of his/her surroundings), exaggerated reactions to being startled, irritable or angry outbursts, difficulty sleeping, and problems focusing. Individuals may also engage in self-destructive behavior.
All of these symptoms typically occur within one month of the exposure to the traumatic event(s). In some instances, symptoms may not be fully expressed until 6 months after the event(s). For individuals who may be involved with the legal system as a result of the event(s), the psychological impact of surviving trauma can make it difficult to form coherent and cogent recollections of the event.
Treatment
Medication or Pharmacotherapy
There are different medication options for managing the effects of PTSD. Psychiatrists may prescribe medications such as antidepressants like selective serotonin reuptake inhibitors to help lift mood. Some examples of commonly used medications in the treatment of PTSD include: fluoxetine (generic for Prozac), citalopram (generic for Celexa), and sertraline (generic for Zoloft) among others. Additionally, medications that treat insomnia and anxiety may be indicated depending on individual circumstances.
Cognitive Therapy
Experiencing trauma is incredibly difficult, and for those who go on to develop PTSD, thoughts of guilt, shame, and self-blame can be all consuming. Many people who experience trauma find themselves ruminating over these ideas and feelings, often in isolation.
In individual cognitive therapy, a therapist will help you more accurately assess the event and place responsibility appropriately. Additionally, he or she will work with you to help adjust the recurring thoughts of guilt, shame, self-criticism, and self-blame and start to practice healthier — and more accurate — thought patterns.
Additionally, it should be noted that following a traumatic event, safety is a big concern. Therapy can offer a safe space, free of judgment and blame, that will allow you to heal in your own time, on your own terms.
Exposure Therapy
One of the most effective, and arguably the most difficult, forms of therapy in the treatment of PTSD is exposure therapy. In a highly controlled environment, an experienced therapist will gradually, and safely, help you confront the distressing triggers and cues that may remind you of the traumatic event(s). This will be done in conjunction with the development of healthy coping and relaxation strategies as typically occurs in Cognitive Behavior Therapy. By gradually allowing you to re-experience parts of the event with the support and aid of a professional, you will be able to resolve,move forward, and heal from the traumatic experiences.
While facing the event triggers may be daunting and overwhelming to think about, your therapist will help you feel safe and secure by pacing treatment appropriately and ensuring you have the skills and capacity to move forward in recovery.
Eye Movement Desensitization Therapy
Eye Movement Desensitization Therapy, or EMDR as it is more commonly called, is a form of therapy found to be very powerful and healing for survivors of trauma. A specially trained therapist will help you re-process thoughts and feelings about the traumatic events by pairing “bilateral stimulation,” — which includes being exposed to a traumatic memory (retelling) — with the movement of a therapist’s finger (or lights) and following it with only your eyes. The tracking of the stimulation helps reduce distress when recalling the traumatic event(s) and may be paired with alternative thoughts and beliefs about the traumatic incident(s).
Support Groups & Group Therapy
In conjunction with individual therapy, support groups and group therapy can be powerful spaces to engage with others and promote healing. Meetings led by a facilitator or therapist may include a specific agenda at times, or be more free flowing at others. It depends on the structure and specific purpose of the group and so it’s important to find one that meets with your needs and expectations.
Additionally, groups are often conducted with a “closed” format, meaning those who sign up to attend commit to the group from its onset, which limits new people from joining later in the group’s run. This can help create a greater sense of safety among group members. Examples may include groups for survivors of hate violence, sexual assault survivors, and survivors of child abuse.
The Benefits of Immediate Intervention
In recent years, greater research has demonstrated the benefits of early intervention after someone experiences a crisis or traumatic event. By engaging in early supportive care, it may be possible to stave off the development of PTSD. While further research needs to be conducted, there have been indicators that psychological first aid in the wake of traumatic events can help ease emotional distress following traumatic events and tragedies.
Therapeutic Note
Remember your therapist is here to help you figure out the best way to address your concerns. Therapy works best when it is a collaboration between you and your therapist. It is important to be open, honest, and an active participant in this process. Talk to your therapist about your goals for therapy so that together you can come up with the best plan to achieve your goals.
Questions You Might Have For Your Talkspace Therapist
- How do I talk about what I am experiencing with my family and friends? There’s no way they can understand.
- Will talking about my experiences cause someone else to become traumatized too?
- How can I find a support group? Is there one for me at Talkspace?
- How long will it take for me to get over what happened to me?
Sources
American Psychiatric Association. "Trauma- and Stressor-Related Disorders." Desk Reference to the Diagnostic Criteria From DSM-5®. Washington: American Psychiatric Publishing, 2014. 141-153.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Friedman, M. J., MD, PhD. (2007, July 05). PTSD: National Center for PTSD. Retrieved May 24, 2017
Gradus, J. L., DSc, MPH. (2007, January 31). Epidemiology of PTSD. Retrieved May 24, 2017
PTSD: National Center for PTSD. (2007, January 01). Treatment of PTSD. Retrieved May 24, 2017