PTSD Symptoms, EMDR and CBT Therapy for Post Traumatic Stress Disorder

PTSD symptoms, EMDR Therapy and CBT for Post traumatic Stress

TRAUMA AND PTSD

PTSD, Post Traumatic Stress and Trauma

Almost 50% of people in the general population experience a traumatic event in the course of their lives. Some show no pathological reaction, some display acute and transient symptoms, but only a small proportion develop post-traumatic stress disorder (PTSD). The general prevalence is 8% (NAT'L Comorbidity survey USA). Of that group, women are more likely than men to suffer from PTSD 5% men vs. 10% women (Davidson et al., 1991; Kessler et al., 1994, 1995).

What is Post-Traumatic Stress Disorder?

Post traumatic stress is an anxiety disorder that occurs as a result of either being involved in or being witness to a major traumatic event. It is a common, but often misunderstood condition.

The essential element of PTSD is that a person either experienced or observed an event which involved actual or threatened death or serious injury to self or someone else. Any number of traumatic events can cause PTSD, including serious accidents, childhood sexual abuse, natural disasters, violent attacks (e.g., mugging, rape, physical abuse, terrorist attacks or being held captive). Post traumatic stress disorder can also arise if you witness any of these events or learn about someone you care for experiencing them.

What are the symptoms of PTSD?

In order to be diagnosed with PTSD, you need to present a number of symptoms in three domains:

1.RE-EXPERIENCING THE TRAUMATIC EVENT

The traumatic event is PERSISTENTLY re-experienced in ONE (or more) of the following ways:
- Frequently having upsetting thoughts, images or memories about a traumatic event
- Having recurrent distressing nightmares
- Acting or feeling as though the traumatic event were happening again (e.g. flashbacks). Sometimes these are about future events that never happened (e.g. baby after abortion). Flashbacks appear out of the failure to contextualise emotional memories temporally, affectively, and somatically.
- Intense psychological and emotional reactions to internal or external cues of the traumatic event
- Physiological reactivity on exposure to internal or external cues of the traumatic event (e.g. panic attacks, sweating, hot flushes).
It is possible to have strong feelings of distress and be physiologically responsive without recollection (e.g. people with PTSD amnesia).

2. AVOIDANCE

Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness as indicated by at least THREE (or more) of the following:
1 - Efforts to avoid thoughts, feelings, or/and conversations associated with the trauma
2 – Efforts to avoid activities, places, or/and people that arouse recollections of the trauma
3 - Inability to recall an important aspect of the trauma (e.g. How perpetrator ended up in her house)
4- Markedly diminished interest or participation in significant activities
5 – Feeling of detachment or estrangement from others
6 – Restricted range of affect (e.g. Numbing)
7 – Sense of a foreshortened future
3. HYPERAROUSAL
Persistent symptoms of increased arousal as indicated by at least TWO of the following:
1 - Difficulty falling or staying asleep
2 – Irritability or outbursts of anger
3 – Difficulty concentrating
4 - Hyper-vigilance
5 – Exaggerated startle response

PTSD is present when these symptoms last more than one month and are combined with loss of function in areas such as job or social relationships (APA 1994).

Adapted from: Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, 2000)

If you are experiencing a combination of the above-mentioned symptoms, you may be suffering from Post-Traumatic Stress Disorder.

If you have experienced symptoms for some time now, it is advisable to seek CBT therapy as soon as possible as the course of PTSD tends to become chronic in 40% to 60% of all cases if the symptoms persist for more than 6 months.

Sylvia Buet is specialised in treating post-traumatic stress disorder in all its forms and levels of severity. She works with victims of sexual and physical abuse, veterans and those who have suffered other kinds of trauma. She was the founder of the International Trauma Institute in 2006 and has been training mental health professionals in trauma and post-traumatic stress disorder all over the world and at international conferences. Sylvia is up to date with the most effective treatments for PTSD and has extensive experience in dealing with complex cases.

PTSD normally co-exists with other disorders such as depression, panic disorder, social anxiety, obsessive compulsive disorder (e.g. checking for safety, excessive washing resulting from mental pollution after sexual abuse, etc.), generalised anxiety disorder, and personality disorders (e.g. borderline, paranoid). It is important to choose a qualified and experienced CBT therapist, specialised in PTSD, in order to maximise the rate of success.

How can PTSD be treated?

Cognitive-behavioural therapy online or face-to-face is one of the most effective treatments for post-traumatic stress disorder. However, there is not just one type of CBT intervention available for PTSD. Some of the trauma-based CBT treatments that Sylvia uses in her practice are as follows:

- Prolonged Exposure
- Cognitive Therapy for PTSD (Ehlers and Clark's model)
- Eye Movement Desensitisation and Reprocessing Therapy (EMDR)
- Imagery Rescripting and Reprocessing Therapy (IRRT)

2.Sylvia is an experienced CBT psychotherapist who has developed advanced therapeutic skills in each of these methods and uses each one depending on the trauma characteristics and needs of the person. Only after a thorough assessment, are treatment options explored.

1.PROLONGED EXPOSURE

Treatment for PTSD typically begins with a detailed evaluation, and development of a treatment plan that meets the unique needs of the person. Generally, PTSD-specific-treatment is begun only when the individual currently exposed to trauma (such as by ongoing domestic or community violence, abuse or homelessness), severely depressed or suicidal, experiencing extreme panic or disorganised thinking, or in need of drug or alcohol detoxification, is stabilised enough. Addressing these crisis problems becomes part of the first treatment phase.

Prolonged exposure (PE) therapy for post-traumatic stress disorder is a cognitive-behavioural treatment program for adult men and women (ages 18-65+) who have experienced single or multiple/continuous traumas and have post-traumatic stress disorder (PTSD). The program consists of a course of online individual therapy designed to help clients process traumatic events and reduce their PTSD symptoms as well as depression, anger, and general anxiety. PE has three components: (1) psychoeducation about common reactions to trauma and the cause of chronic post- trauma difficulties, (2) imaginal exposure (also called revisiting the trauma memory in imagination), repeated recounting of the traumatic memory, and (3) in vivo exposure, gradually approaching trauma reminders (e.g., situations, objects) that are feared and avoided despite being safe.

The objective of this online therapeutic method is to allow the person suffering from PTSD to re-experience the event in a safe, controlled environment, while also carefully examining their reactions and beliefs in relation to that event. It is also part of the treatment to learn to cope with post-traumatic memories or flashbacks, reminders, managing anger, guilt, disgust and shame feelings without becoming overwhelmed or emotionally numb as well as addressing urges to use alcohol or drugs when they occur and communicating effectively with people (socials skills and assertiveness training).

Cognitive therapy for PTSD (Ehler's and Clark's model)

Ehlers and Clark propose that PTSD develops if and when the traumatised person makes maladaptive interpretations of the event(s) and of the consequences those event(s) have for them. Examples of appraisals about the event or the consequences are "It was my fault, I should have run faster to get help, I need to avoid talking about it or I will get upset, my life has been ruined, I will never recover, I must be defective if I am not able to cope with this situation, I cannot trust anybody".

Therefore, an essential component of the treatment focuses on identifying all possible appraisals maintaining the dysfunctional meaning of the traumatic event. A narrative of the incident is produced in order to reconstruct the event with as many details as possible. From the worst moments (hotspots), you will be helped to identify the emotions, meanings and appraisals associated with each hotspot.

A second factor, which may explain why the person perceives a current threat is due to the nature of the trauma memory by itself. When traumatic information has to be processed, sometimes it does not fit with pre-existing templates or autobiographical memories resulting in poor elaboration and integration of the memory, which may be triggered unintentionally and make the person feel like it is happening all over again.

When memories are not properly integrated, they are experienced as if they were out of context, time or place.
The second component of this online treatment focuses on updating and contextualising the traumatic event and this is necessary in order to achieve a less fragmented elaboration of the memory. This is done by restructuring the meaning and appraisals found from the hotspots of the reconstruction of the event captured in the narrative. Therefore, beliefs such as "I didn't do enough to protect myself" are modified and updated in order to be able to create a different meaning for the different aspects of the traumatic event.

Once the cognitive restructuring process is completed, a new narrative is created introducing the new insights about the traumatic event. This new updated information can be either relevant details from the course, circumstances and outcome of the trauma or the result of cognitive restructuring of the highly idiosyncratic meanings of the trauma.

PTSD symptoms continuation can be explained by how the person deals with traumatic memories once the event has occurred. Once the traumatic materials are triggered and the current threat is perceived, it is normal (although dysfunctional) to develop thought control mechanisms, rumination, safety behaviours, avoidance of reminders, etc., in order to gain a sense of control over the memories and their consequences. However, this does not allow elaboration and integration of traumatic material, perpetuating the PTSD. These coping strategies prevent change in meaning or memory structure.

Therefore, another component of the online treatment addresses and attempts to eliminate safety behaviours, avoidance of triggers and thought suppression. We use "Behavioural Experiments" in order to test predictions about the need to use avoidance, safety behaviours or any other maladaptive strategies maintaining PTSD symptoms.
Other components of this online intervention include reclaiming your life, dealing with triggers of intrusions, including discrimination of "Then" vs. "Now" in intrusions and site visits where the trauma occurred when appropriate.

Eye movement desensitisation and reprocessing therapy

EMDR is a relatively new treatment of traumatic memories which involves elements of exposure therapy and cognitive behavioural therapy, combined with techniques (eye movements, hand taps, sounds) which create an alteration of attention back and forth across the person's midline. This technique is very effective and results can be obtained in a short period of time without the need for homework. It can, however, be uncomfortable at times. If you want to know how this therapeutic intervention is applied please click here.

Sylvia Buet and John Dunlop are both Level II qualified EMDR practitioners although Sylvia treats more complex cases. However, EMDR can only be delivered face-to-face and we cannot offer this therapeutic approach for online clients.

Imagery rescripting and reprocessing therapy

Imagery rescripting and reprocessing therapy (IRRT) was originally developed in the mid-1990s for treating adult survivors of childhood sexual abuse (Smucker & Dancu, 1999). The treatment has now been expanded to other traumatic events such as industrial and motor vehicle accidents and violent assaults (Smucker & Boos, 2005).

IRRT includes four main components of treatment: (1) imaginal exposure, which is utilised to activate the trauma memory along with distressing emotions and related maladaptive cognitions; (2) imagery rescripting, during which the trauma memory is modified to replace victimisation/traumatic imagery with mastery and coping imagery; (3) self-calming/nurturing imagery, during which clients visualise themselves as an ADULT (today), calming, comforting and reassuring the traumatised CHILD (back then); and (4) linguistic processing, which involves transforming the traumatic imagery and emotions into a verbal narrative while simultaneously challenging related maladaptive beliefs (Grunert et al., 2003; Smucker, 1997; Smucker & Boos, 2005; Smucker & Dancu, 1999).

The goal of IRRT is to decrease PTSD and related symptoms through emotional processing of the trauma memory and to modify maladaptive schemas while increasing the survivor's ability to self-soothe (Grunert et al., 2003). Maladaptive secondary beliefs, such as powerlessness, mistrust, guilt/shame, and incompetence are challenged during the mastery and self-nurturing imagery rescripting phases (Smucker, Dancu, Foa, & Niederee, 1995). Socratic imagery during the imagery rescripting reportedly helps the survivor identify, challenge and modify maladaptive beliefs while empowering them to take mastery of the imagery (Grunert et al.; Smucker & Boos, 2005; Smucker & Dancu, 1999).

Through active cognitive restructuring, imaginal rescripting allows for transformation of the traumatic memory to an adaptive one and an emphasis on positive, corrective cognitive changes to negative secondary beliefs and pathogenic schemas (Grunert et al.; Smucker & Niederee, 1995).

According to cognitive-behavioural theorists, imagery rescripting techniques may reduce symptoms of PTSD through activation of the fear network and exposure to traumatic content resulting in habituation to trauma images and related effects. It has also been hypothesised that imagery techniques may be therapeutic because they identify and modify maladaptive beliefs, empower the client through increased mastery over the images, and improve self-soothing abilities and imagery control.

As you can see, there are effective CBT treatments to deal with the aftermath of trauma. Whether you never received treatment for your possible PTSD or your previous attempts to resolve the problem failed, you have the opportunity to undergo therapy with someone who understands the field, who works regularly with this type of problem and who is well known in Northern Ireland for her expertise and CBT therapeutic skills.

Please contact us on 02890586361 or send an email to enquire about anything you are unsure of before making an appointment.

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