Post Traumatic Stress

Post-traumatic stress disorder (PTSD) can occur after someone goes through a traumatic event like combat, assault, or disaster. Most people have some stress reactions after a trauma. If the reactions don’t go away over time or disrupt your life, you may have PTSD. It can be the result of serious single traumatic event or the cumilitive effects of prolonged exposure to traumatic events.

What is PTSD?

CAMH

Center for Addiction and Mental Health

Posttraumatic stress disorder (PTSD) is a natural emotional response to frightening or dangerous experiences that involve actual or threatened serious harm to oneself or others. However, for some people, the thoughts or memories of these events seriously affect their lives, long after any real danger has passed. These types of experiences are called “traumatic.”

Trauma

Post Traumatic Stress (PTS)

  • a natural emotional reaction to terrible experiences involving actual or threatened serious harm to oneself or others
  • for some people, the thoughts or memories of these events seriously affect their lives, long after any real danger has passed resulting in post traumatic stress disorder

Post Traumatic Stress Disorder (PTSD)

  • If PTS symptoms last longer than four weeks, cause you great distress, or disrupt your work or home life, you may be suffering from acute stress that has developed into PTSD
  • a condition in the Diagnostic and Statistical Manual Of Mental Disorders Fifth Edition (DSM-5) category of Trauma- and Stressor-Related Disorders
  • characterized by the onset of psychiatric symptoms after exposure to one or more traumatic events. (see criteria below)
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What should I do if I have symptoms of PTSD?

PTSD symptoms usually start soon after the traumatic event

  • symptoms may not happen until months or years after the trauma
  • symptoms may come and go over many years
  • keep track of your symptoms and talk to someone you trust about them
  • seek professional help from a doctor or counsellor
  • Please check out the list of therapists and crisis resources listed by Province and Territory.

What are the symptoms of PTSD?

Symptoms of PTSD may disrupt your life and make it hard to continue with your daily activities. You may find it hard just to get through the day.

There are four types of PTSD symptoms:

1. Reliving the event (also called re-experiencing symptoms)

Memories of the traumatic event can come back at any time. You may feel the same fear and horror you did when the event took place.

For example:

  • You may have nightmares.
  • You may feel like you are going through the event again. This is called a flashback.
  • You may see, hear, or smell something that causes you to relive the event. This is called a trigger. News reports, seeing an accident, or hearing a car backfire are examples of triggers.

2. Avoiding situations that remind you of the event

You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event.

For example:

  • You may avoid crowds, because they feel dangerous.
  • You may avoid driving if you were in a car accident or if your military convoy was bombed.
  • If you were in an earthquake, you may avoid watching movies about earthquakes.
  • You may keep very busy or avoid seeking help because it keeps you from having to think or talk about the event.

3. Negative changes in beliefs and feelings

The way you think about yourself and others changes because of the trauma. This symptom has many aspects, including the following:

  • You may not have positive or loving feelings toward other people and may stay away from relationships.
  • You may forget about parts of the traumatic event or not be able to talk about them.
  • You may think the world is completely dangerous, and no one can be trusted.

4. Feeling keyed up (also called hyperarousal)

You may be jittery, or always alert and on the lookout for danger. You might suddenly become angry or irritable. This is known as hyperarousal.

For example:

  • You may have a hard time sleeping.
  • You may have trouble concentrating.
  • You may be startled by a loud noise or surprise.
  • You might want to have your back to a wall in a restaurant or waiting room.

PTSD Treatment

Treatment for Post-Traumatic Stress Disorder:

  • People can recover from PTSD
  • Some can recover within several months, while others take much longer
  • Everyone’s experience is different
  • The same event may be more traumatic for some people than for others
  • There is no “cookie-cutter” approach where members who suffer can find a “one cure – fits all” type of “fix” on the road to finding a new “normal”.

Most skilled therapists are trained in several types of treatment,

  • which they may use alone or in combination
  • treatment approaches should follow the stages of the trauma therapy model
  • good therapists adapt the different treatment approaches to best suit each client

For further information

  •  view the animated whiteboard videos found at the bottom of this page

Here is a brief description of the main therapeutic approaches:

Types of Therapy:

  • Cognitive Behavioural Therapy (CBT)
  • Trauma Focused Cognitive Behavioural Therapy (TFCBT)
  • Eye movement, Desensitization and Reprocessing Therapy (EMDR)
  • Narrative Therapy (NT)
  • Sensorimotor Therapy (ST)
  • Emotion-focused Therapy (EFT)
  • Stress Inoculation Therapy (SIT)
  • Cognitive Processing Therapy (CPT)
  • Prolonged Exposure Therapy (PET)
  • Dialectical Behaviour Therapy (DBT)
  • Group Therapy (GT)

(Adaptation Barbara L. Anschuetz, Clinical Director at The Trauma Centre – Registered Psychotherapist, EdD, RP, CTS)

Counseling and therapy

Trauma counseling or therapy can be done one-on-one or in a group, and can be very helpful for people with PTSD. Family counseling and individual treatment can help with relationship troubles.
What is psychotherapy?

Psychotherapy involves personal engagement in a process of exploration of various painful personal issues, emotional problems, physical symptoms and relationship dysfunction by means of verbal and non-verbal communication, rather than with the use of medications or physical interventions.

Psychotherapy may be performed by practitioners with a number of different qualifications, including psychologists, marriage and family therapists, licensed clinical social workers, counsellors, psychiatric nurses, and psychiatrists.

What is a Psychologist?

A psychologist is a professionally trained individual who has the skills and training necessary to assess, diagnose and treat mental health issues. Psychologists are registered, regulated, and licensed by the College of Psychologists of Ontario (CPO) and practice psychology under the framework of the Regulated Health Professions Act (RHPA).

To be registered as a psychologist in the Province of Ontario an individual must have a doctorate degree in psychology. In addition to this degree, he or she must pass professional examinations, complete a one-year supervised internship, and agree to follow ethical codes and standards of practice.

Psychologists have a doctoral degree in psychology that includes approximately 5000 hours of clinical training and specialization in assessment, diagnosis, and treatment of human emotion, thought, and behaviour. They have advanced training in counselling, psychotherapy, psychological testing, and the science of behaviour change. Psychologists are the only professionals qualified to use certain kinds of psychological tests to assess intelligence, emotional and behavioural problems, and neuropsychological dysfunction. Psychologist’s fees are covered by private payment, extended medical plans, employee assistance programs, and through government agencies or other special programs. In Ontario, the College of Psychologists of Ontario licenses Psychologists.

What is a Psychiatrist?

In Canada, psychiatrists must have a degree in medicine, a license to practise medicine in their province, and specialist certification in psychiatry by either the Royal College of Physicians and Surgeons of Canada or a provincial college.

The CPA defines psychiatrists as physicians who “enhance the person’s quality of life by providing psychiatric assessment, treatment and rehabilitation care to people with psychiatric disorders in order to prevent, reduce and eliminate the symptoms and subsequent disabilities resulting from mental illness or disorder”.

The psychiatrist is trained primarily as a clinician to diagnose, treat and provide ongoing care for mental disorders to patients of all ages. Psychiatrists are primary, secondary and tertiary care physicians. Psychiatrists not only provide direct care to patients but often act as consultants to other health professionals such as family doctors.

Psychiatrists work in a range of settings including psychiatric or general hospitals, private offices, research units, community health centres, social agencies or in government.

Psychiatrists use a mix of treatment options, including medications and psychotherapy, depending on the psychiatric conditions. Often part of the treatment or rehabilitation plan will include referral to or collaboration with a range of social and support services.

What is a psychotherapist?

A psychotherapist is a professional who specifically offer talk therapy for the purpose of treating mental disorders. This title is protected in some jurisdictions. For example, in Ontario, Canada only members of College of Registered Psychotherapists of Ontario (CRPO) may call themselves psychotherapists or registered psychotherapists. Members of CRPO usually hold a Master’s degree in psychology or relevant fields. Psychotherapists are not allowed to prescribe medication. When it comes to the treatment of mental disorders, the roles of psychologists and psychotherapists overlap, but, in general, the type of services psychologists offer could go beyond therapy.

Medication:

Psychiatrists and family doctors can prescribe medication for depression, anxiety, nervousness and sleep problems, which are common in people with PTSD. Medication works best when a person is also in counselling.

psychiatric-medications

How is PTSD Measured?

  • most people who experience trauma have some symptoms for a short time
  • most people do not get PTSD

Four major symptom types are involved in PTSD

  • re-experiencing
  • avoidance
  • arousal
  • negative changes in beliefs and feelings.

Deciding if someone has PTSD can involve several steps

  • diagnosis made by a mental health provider
  • a mental health provider “measures,” “assesses”, or “evaluates” PTSD symptoms you may have had since the trauma

What is a PTSD screen?

A person who went through trauma might be given a screen to see if he or she could have PTSD.

A screen is

  • a very short list of questions just to see if a person needs to be assessed further
  • results do not show whether a person has PTSD only  whether this person should be assessed further

What is Post-Traumatic Growth?

Definition

Post traumatic growth is defined as the “experience of individuals whose development, at least in some areas has surpassed what was present before the struggle with crises occurred. The individual has not only survived, but has experienced changes that are viewed as important, and that go beyond the status quo” (Tedeschi and Calhoun, 2004).

Ted Talk Stacey Kramer offers a moving, personal, 3-minute parable that shows how an unwanted experience -- frightening, traumatic, costly -- can turn out to be a priceless gift.

Post-Traumatic Growth Theory into practice

Is it possible to prepare people for PTG, to pave the way should tragedy or trauma strike? Yes, says Tedeschi, noting that psychologists can "allow people to understand that this may be a possibility for themselves" and is a "fairly normal process" if and when trauma occurs.

More often, though, therapists will become involved not before adversity has occurred, but afterward. In this context, they can introduce PTG concepts but need to take care doing so.

H'Sien Hayward, PhD, cautions that therapists should not "jump right into the possibility of growth," which she says can "often be construed as minimizing someone's pain and suffering and minimizing the impact of the loss."

"PTG is sometimes considered synonymous with resilience because becoming more resilient as a result of struggle with trauma can be an example of PTG—but PTG is different from resilience, says Kanako Taku, PhD, associate professor of psychology at Oakland University, who has both researched PTG and experienced it as a survivor of the 1995 Kobe earthquake in Japan.

"Resiliency is the personal attribute or ability to bounce back," says Taku. PTG, on the other hand, refers to what can happen when someone who has difficulty bouncing back experiences a traumatic event that challenges his or her core beliefs, endures psychological struggle (even a mental illness such as post-traumatic stress disorder), and then ultimately finds a sense of personal growth. It's a process that "takes a lot of time, energy and struggle," Taku says.

Someone who is already resilient when trauma occurs won't experience PTG because a resilient person isn't rocked to the core by an event and doesn't have to seek a new belief system, explains Tedeschi. Less resilient people, on the other hand, may go through distress and confusion as they try to understand why this terrible thing happened to them and what it means for their world view.

To evaluate whether and to what extent someone has achieved growth after a trauma, psychologists use a variety of self-report scales. One that was developed by Tedeschi and Calhoun is the Post-Traumatic Growth Inventory (PTGI) (Journal of Traumatic Stress, 1996). It looks for positive responses in five areas:

  • Appreciation of life.
  • Relationships with others.
  • New possibilities in life.
  • Personal strength.
  • Spiritual change. For full article see apa.org/monitor

Most of the literature concerning PTG conceptualizes growth following trauma or stress as an outcome of experiencing that stressor (Tedeschi & Calhoun, 2004). However, one issue that has arisen in the literature is whether PTG is an outcome of the stressor or a process that the victim goes through in the aftermath of a trauma that eventually leads to positive outcomes (e.g. less depression or a re-organisation of life priorities). There is very little literature that examines the difference between PTG as a process and PTG as an outcome, indeed longitudinal research that tracks a trauma victim over an extended period of time is likely to be examining PTG as both a process and an outcome, without differentiating between the two. Existing measurement tools such as the Posttraumatic Growth Inventory (Tedeschi & Calhoun, 1996) do not distinguish between these two types of growth either so it is very difficult to examine the different ways that PTG may occur.

DSM-5 Criteria for PTSD

Full copyrighted criteria are available from the American Psychiatric Association (1). All of the criteria are required for the diagnosis of PTSD. The following text summarizes the diagnostic criteria:

Criterion A (one required): The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):

  • Direct exposure
  • Witnessing the trauma
  • Learning that a relative or close friend was exposed to a trauma
  • Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)

Criterion B (one required): The traumatic event is persistently re-experienced, in the following way(s):

  • Unwanted upsetting memories
  • Nightmares
  • Flashbacks
  • Emotional distress after exposure to traumatic reminders
  • Physical reactivity after exposure to traumatic reminders

Criterion C (one required): Avoidance of trauma-related stimuli after the trauma, in the following way(s):

  • Trauma-related thoughts or feelings
  • Trauma-related reminders

Criterion D (two required): Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):

  • Inability to recall key features of the trauma
  • Overly negative thoughts and assumptions about oneself or the world
  • Exaggerated blame of self or others for causing the trauma
  • Negative affect
  • Decreased interest in activities
  • Feeling isolated
  • Difficulty experiencing positive affect

Criterion E (two required): Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):

  • Irritability or aggression
  • Risky or destructive behavior
  • Hypervigilance
  • Heightened startle reaction
  • Difficulty concentrating
  • Difficulty sleeping

Criterion F (required): Symptoms last for more than 1 month.

Criterion G (required): Symptoms create distress or functional impairment (e.g., social, occupational).

Criterion H (required): Symptoms are not due to medication, substance use, or other illness.

Two specifications:

  • Dissociative Specification.In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:
    • Depersonalization. Experience of being an outside observer of or detached from oneself (e.g., feeling as if “this is not happening to me” or one were in a dream).
    • Derealization. Experience of unreality, distance, or distortion (e.g., “things are not real”).
  • Delayed Specification.Full diagnostic criteria are not met until at least six months after the trauma(s), although onset of symptoms may occur immediately.

Note: DSM-5 introduced a preschool subtype of PTSD for children ages six years and younger.

PTSD Video References

National Center for PTSD

References

  1. American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders, (5th ed.). Washington, DC: Author.
  2. Friedman, M. J., Resick, P. A., Bryant, R. A., & Brewin, C. R. (2011). Considering PTSD for DSM-5. Depression & Anxiety, 28,750-769. doi:10.1002/da.20767
  3. Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J. (2013). National estimates of exposure to traumatic events and PTSD prevalence using DSM-IVand DSM-5criteria. Journal of Traumatic Stress, 26,537-547. doi:10.1002/jts.21848

Disclaimer: The above listed criteria is not meant to be “all encompassing” nor used as a “check-list” for a member or family member to make a “self-diagnosis” regarding their mental wellness. If  feel that you are suffering please see a medical professional for a proper diagnosis to begin the process of submitting a claim to the workplace insurance board within your Province or Territory. Early diagnosis and  can lead to effective results for many members so that they do not have to suffer in silence.

 

Adapted from:

  • Post-Traumatic Stress Disorder: An Information Guide © 2009 Centre for Addiction and Mental Health
  • Mental Health Commission of Canada
  • Moods Disorder Society of Canada
  • The U.S. Department of Veterans Affairs