Dynamic treatment options make PTSD manageable

You trap your feelings into a time capsule. But it eventually becomes too full and explodes. The memories spill out and replay in front of your eyes over and over like a slideshow.

Your body is in the moment, while your brain is in the past. You become terrified to sleep because the nightmares bleed into your dreams.

ptsd-featured-imageAccording to the National Institute of Mental Health (NIMH), Post-Traumatic Stress Disorder (PTSD) develops in some people when they experience a shocking, scary, or dangerous event.

Dr. Alicia Barr, professor of psychology at South Plains College, said people who are placed into situations where their lives are in danger can develop PTSD, such as “people who serve in the military, women who are raped, people who are in car accidents, and people who are exposed to natural disasters.”

Marcie Miller, associate professor of psychology at SPC, said that people can develop PTSD if they’ve experienced a serious threat to their life, witnessed some things that happened to somebody else, or learned about something happening to someone who is interpersonally close to them.

“Some people think you have to had almost died,” Miller said. “But it could be learning about your mother almost dying that could even trigger PTSD.”

Miller explained that people who were exposed to war can experience PTSD, as well as first responders, victims of domestic violence, and people who were mugged or who were held hostage.

Symptoms usually begin within three months of an incident, according to NIMH. ptsd-treatment-2797659_FINAL-5c12be374cedfd00010f866aHowever, it can sometimes begin years after as well. In order for  adults to be diagnosed with PTSD, they must have: a re-experiencing symptom, an avoidance symptom, arousal and reactivity symptoms; and two cognition and mood symptoms, for at least one month.

Miller also said that PTSD will show up in an average person within three months, but sometimes symptoms will develop as early as within a month, though sometimes it can be years.

A common misconception, according to Miller, is that if symptoms don’t show up right away, then you’re fine.

Sometimes people will have some symptoms but not enough to be diagnosed, Miller said, and they might not be diagnosed for another six months or later until they have enough symptoms for meeting the criteria for PTSD.

“Symptoms generally include the person reliving the traumatic event,” said Dr. Barr.

Dr. Barr said someone who has experienced a traumatic event will have a very detailed memory of it.

“If their memory is triggered, the event unfolds in their head,” explained Dr. Barr. “It feels like they’re reliving that event.”

Dr. Barr said that sleep problems or recurring nightmares are common and can even develop into the person not wanting to go to sleep because of trying to avoid the nightmares, so they become sleep deprived.

“Folks who develop PTSD are hypervigilant,” said Dr. Barr.

Facts-About-Concussion-and-PTSD-722x406Miller explained that two people could have the same diagnosis but will experience different distressing symptoms.

“Intrusive thoughts that are distressing, such as memories or images that kind of intrude into their thinking, can take over and cause distress,” Miller said.

Avoidance is very common, and people with PTSD might avoid certain environments, people, places and objects, according to Miller. Some people may have trouble experiencing positive emotions and may lose interest in things they used to be interested in.

“Reckless and self destructive behaviors can be real common too,” Miller pointed out. “That could include substance use, or excessive speeding. Doing physically risky things. “

PTSD also manifests a little differently for children and adults, according to Miller.

“Adults will have these intensely detailed emotional dreams about their trauma,” Miller explained, “where as children might have dreams that they identify as distressing, but don’t remember what it was about.”

Miller also mentioned that children might reenact traumatic events in the way they play or story tell. They might describe how they are feeling as “they don’t feel good,” as if they were sick, while adults are better at explaining how they feel.

“For children, you’re often looking for changes,” Miller said. “They become socially withdrawn or avoid certain people in certain places.”

Dr. Barr said she thinks that PTSD is the kind of disorder that will always be with someone on some level after it develops.

About half of the people who suffer from PTSD will always have it during their life, but the other half could find relief within a matter of months, according to Miller.

Some resilience factors that may reduce the risk of PTSD are seeking out support from people, finding a support group, learning how to feel good about actions during danger, learning a positive coping strategy, and learning how to act or respond despite of fear, according to NIMH.

“I think sometimes the myth behind PTSD is that there’s some kind of weakness or inability to cope,” said Miller. “Having social support, from family, friends, or wherever can kind of validate that we’re behind you, and can increase positive emotions.”

Miller explained that when people feel isolated and alone, it could lead to more avoidance and more negative emotion.

pexels-photo-326559-1280x429Dr. Barr says that humans are social animals and need each other.

“Deep down, we know that we’re better off when we have people close to us,” said Dr. Barr. “It gives us a sense of safety. For someone who has developed PTSD and does not feel safe, to suddenly be abandoned by family and friends or who aren’t trying to understand, would absolutely make it worse.”

Researchers thought that if they had people who just experienced a trauma to sit down and tell them in detail what they experienced, that it would help them debrief and get over it, according to Dr. Barr. However, what they found is that it increased the likelihood of developing PTSD, and essentially people need room to decompress on their own, because some people can work through it by themselves.

Researchers are studying risk and resilience factors, along with genetic and neurobiology, taking more of a biological approach.

“With any disorder, there are different theoretical explanations,” said Miller, “and that’s kind of taking more of a biomedical explanation that people who have genotye A are more likely to develop PTSD than people with genotype B.

“Structurally speaking,” she added, “there are some findings that suggest that folks with PTSD show structural differences in memory, in emotional centers of their brain… the limbic system specifically.”

Miller explained that the Limbic system is the part of the brain that is involved in human behavioral and emotional responses, especially negative and fear.

The Limbic system is just above the brainstem and underneath the cerebral cortex.brain-limbic-system

“If you were to find your temples,” Miller said, “picture your fingers all the way into the center. That’s where those structures exist, one in each hemisphere.”

Within the Limbic system, there are two major structures, the Hippocampus and the amygdala.  According to Queensland Brain Institute, the amygdala has a big role in emotional responses. The amygdala also plays a key role in forming memories, specifically memories related to fear.

“If it’s altered and does things differently, than I’m going to do things differently,” Miller explained. “Those differences were always there, and that’s why this person’s more likely to develop PTSD, or that trauma created these changes, and that’s why they responded to the world differently now Post-Trauma.”

The most studied medicines for treating PTSD are antidepressants, according to NIMH, because it can help control PTSD symptoms such as worry, anger, and feeling numb.

Beta blockers can be used if the doctor feels it is right for the patient, Dr. Barr said.

“Beta blockers basically decrease blood pressure,” Dr. Barr said, “in theory decreasing epinephrine or adrenaline.”

Dr. Barr explained that some people who have PTSD will remember the trauma. So when the memory is triggered they remember the event, and adrenaline or epinephrine is released in their system. This gives them a physical reaction, and the chemicals will help to sear this memory deeper, and in more detail, causing the memory to become more potent. So the next time that memory gets triggered, they release more epinephrine. It is the cycle that makes the memory stronger and stronger.

“Beta blockers will decrease levels of these chemicals, and essentially make that person less likely to be creating this super potent memory that’s harassing them,” said Dr. Barr.

Antidepressants can help control sadness, worry, and anger, which are commonly seen with PTSD symptoms.

“Antidepressants are a pretty common approach,” said Miller, adding that while some may be classified an antidepressant, they can work well for alleviating symptoms of anxiety in PTSD.

Miller also said that antidepressants can help with sleep disturbances, mood swings, hypervigilance, and emotional reaction.

julie-berman-therapy-and-counseling-in-portland-or-trauma-therapy-picture-1“A lot of antipsychotics are also approved for antidepressant treatments as well,” Miller mentioned.

Miller said Psychotherapy (talk therapy), Cognitive Behavioral Therapies (CBT), and Cognitive Processing Therapy (CPT) are often used to help treat PTSD.

Psychotherapy may help people identify and change their troubling thoughts, according to the NIMH.

According to the American Psychological Association (APA), CBT helps individuals learn how to be their own therapist with exercises in sessions and outside of sessions. This helps the person to develop coping skills to learn how to change thinking of problematic emotions or behavior.

CPT is a specific type of CBT which can help people with PTSD learn how to challenge or modify unhelpful beliefs, according to the APA. CPT is usually delivered during 12 sessions. By practicing this therapy, patients create new conceptualization of the traumatic event.

CPT is strongly recommended to help treat PTSD, according to the APA.

Some self-help tips include working on slowing your breath, relaxing your muscles, working on grounding techniques such as describing objects as you touch them, saying the alphabet backwards, and facing your fears and building upon bravery.

Miller said she thinks that acceptance of the idea that humans change in response to trauma is a step toward helping oneself overcome PTSD.

“More often than not, it was nothing they did wrong,…” Miller said. “Coming around to that idea of this isn’t a flawed state of me, that this was trauma induced, could be very beneficial.”