As we gather this Remembrance Day to honour the contributions of so many veterans it is important to gain a greater understanding of the unique issues facing these brave individuals. One of the biggest being Post-Traumatic Stress Disorder (PTSD.) Delrae Fawcett, a clinical health psychologist at the University of British Columbia helps us understand the science behind PTSD and new approaches to help manage this sometimes debilitating condition.
PTSD is characterised by persistent re-experiencing of the traumatic event, persistent avoidance of stimuli associated with the trauma, numbing of general responsiveness, and persistent symptoms of increased physiological arousal. In other words, these individuals are caught inside the events experienced during the trauma. In order to better understand how this works it helps to get some background about how our emotions and nervous system generally work.
The sympathetic and parasympathetic systems, together, make up our autonomic nervous system (ANS). Simply put, the ANS is responsible for all the functions in your body that you do on an involuntary basis; without really meaning to, like breathing, or hormone release. The parasympathetic nervous system (PSNS) is responsible for functions such as digestion and internal organ mobilisation ie.things that you generally do when you are relaxed. It’s in charge of what’s often referred to as rest and digest functions and it works to calm the body down. The sympathetic nervous system (SNS) is in charge of just the opposite. Its activation triggers what’s known as the fight or flight response. Its activation prompts the body to release adrenaline which in turn increased heart rate and prepares the body to deal with a threat. The brain is constantly processing information and tagging it with its appropriate emotion; the things we like prompt us to move forwards and the things we don’t like prompt us to move away.
This evolutionary response to threat is a survival mechanism. It prepares your body to take action against (fight) or away (flight) from a threat. This is the stress response and it’s very useful. However, that heightened level of the SNS activity is only good for a short period of time in order to respond to the threat before your PSNS returns your body to its resting state. A key part of being able to return to a calm state is the ACTION part; being able to respond to the threat to eliminate it.
Trauma occurs when you are somehow immobilised. This is often characterised by a feeling of helplessness where the person perceives a threat (whether that be emotional or physical) and for whatever reason cannot take action to either escape or fight. In other words, they do not have control over the situation. In a way these individuals then become stuck in that state of heightened stress -- frozen in time -- ready to respond to a threat, but unable to complete the cycle. At this point the brain seems unable correctly tag information with the associated emotions, thus they begin to constantly feel under threat.
PTSD is thought to develop in a third of individuals who experience an extremely stressful event. It is most well-known and understood in the context of military personnel, but it reaches much further than that. People with PTSD can have symptoms lasting anywhere from 6 months to a lifetime. Although treatment options are available, they are not always used due barriers such as low accessibility, cost, or stigma. Treatments for PTSD seem to target the dysregulation of the nervous and emotional system at various levels.
Here are some evidence based therapy options:
Exposure Therapy is based on confronting distressing stimuli in order to reduce their triggered effect of anxiety and avoidance. This can either be in the form of mental images or real life confrontation. The exposure is meant to re-condition the brain to show that bad things won’t happen. Over time this is meant to reduce anxiety and re-train the brain to feel safe in those situations. Evidence supports this treatment method in reducing symptoms as well as loss of PTSD diagnosis.
Eye movement desensitisation and reprocessing (EMDR):
EMDR is a form of psychotherapy where patients are asked to hold a distressing image or memory in their mind while the clinician guides them through quick bilateral eye movements. The eye movements are supposed to disrupt working memory and allow the patient to become desensitized to the stimulus.
Mixed Cognitive Behavioural Therapy (CBT):
CBT is based on the idea that individual's perception of a situation influences how they respond emotional to it. Meaning that the thoughts and beliefs we have strongly impact how we will feel in a situation and thus more likely our behaviour. Mixed CBT style interventions use this foundation, but also integrate components of mindfulness, relaxation training, education, or self-monitoring. There is evidence to show that a mixture of these is effective in improving symptoms of PTSD and depression.
Mindfulness style interventions are aimed at learning to become aware of the constantly changing internal environment that is the human experience. This helps them to become familiar with their internal sensations and emotion to which they have been disconnected from. Studies on yoga and other mindful based stress reduction programs show a lot of good results within this population, but they are not conclusive at this point.
It is the time of year when we cast our thoughts to those who dedicated or gave their lives so that we could live in the free world we do. Part of that is continuing to improve our understanding of how such an experience can impact a person’s life, and being compassionate towards those who are experiencing similar things to this day.
These strategies are only a few of the many that are lending hope to what can seem like a helpless situation. As research regarding management strategies comes to light, hope grows stronger for victims of trauma whose experiences may have left them feeling shattered, fearful, and alone. If you or someone you know is suffering, talk to someone and know you are not alone.