PTSD- Milestone 3

7/28/2019 PTSD- Milestone 3

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PTSD - POST TRAUMATIC STRESS DESORDER

According to the DSM-IV (1994), Post Traumatic Stress Disorder is caused by

traumatic events that are outside the range of usual human experiences such as military

combat, violent personal assault, being kidnapped or taken hostage, terrorist attack, torture,

incarceration as a prisoner of war, natural or man-made disasters, automobile accidents, or

being diagnosed with a life-threatening illness.

The disorder also appears to be more severe and longer lasting when the event is

caused by human means and design (bombings, shootings, combat, etc.). Such incidents

would be distressing to almost anyone, and is usually experienced with intense fear, terror,

and helplessness. Typically, the initiating event involves actual or threatened death or serious

injury, or other threat to one's physical integrity; or witnessing an event that involves death,

injury, or a threat to the physical integrity of another person.

Anyone can get PTSD at any age. This includes war veterans and survivors of

physical and sexual assault, abuse, accidents, disasters, and many other serious events.

Not everyone with PTSD has been through a dangerous event. It is important to

remember this because not everyone who lives through a dangerous event gets PTSD. In fact,

most will not get the disorder. Some people get PTSD after a friend or family member

experiences danger or is harmed. The sudden, unexpected death of a loved one can also cause

PTSD.

Symptoms of PTSD are often intensified when the person is exposed to situations or

stimulus that resemble or symbolize the original trauma in a non-therapeutic setting. Such

uncontrolled exposure may lead the person to react with a survival mentality and mode of

response that could put the person and others at considerable risk. The essential feature of

PTSD is the development of characteristic symptoms that may include: intrusive thoughts and

flashbacks, anger, isolation, emotional numbing and constriction, anxiety, depression,

substance abuse(such as drugs or alcohol), survivor guilt, hyper-alertness, suicidal feelings


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and thoughts, alienation, negative self-image, memory impairment, problems with intimate

relationships, emotional distance from family and others, denial of social problems.

Thus it happened a long time in the person life, he can relive those situations in a

daily bases in many ways.

They may have upsetting memories of the traumatic event. These memories can come

back when they are least expecting them. At other times the memories may be triggered by a

traumatic reminder (such as when a combat veteran hears a car backfire, a motor vehicle

accident victim drives by a car accident or a rape victim sees a news report of a recent sexual

assault).

These memories can cause both emotional and physical reactions. Sometimes these

memories can feel so real it is as if the event is actually happening again. This is called a

"flashback." Reliving the event may cause intense feelings of fear, helplessness, and horror

similar to the feelings they had when the event took place.

A doctor who has experience helping people with mental illnesses, such as a

psychiatrist or psychologist, can diagnose PTSD. The diagnosis is made after the doctor talks

with the person who has symptoms of PTSD or someone related to an individual that suspects

him/her to have PTSD.

Despite increased recognition of prevalence of Posttraumatic Stress Disorder (PTSD)

in the general population, it is largely ignored among the severely mentally ill, so with this

work we intend to show how the PTSD manifests, their biological bases and how it works,

how some people of certain age and gender react to it and their possible treatments through

different methods. We will show some treatments works and some trials made by foreign

Psychologists (PhD).


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The clinical classification of physical and psychological stress symptoms that can

develop after experiencing a traumatic event (e.g., rape, war) can be classified into three

types: acute stress, late stress and post-traumatic stress (Waldanne, 2011). Acute stress starts

soon after the traumatic event has taken place and it is extremely visible because it exhibits

the most dramatic manifestations of emotion such as difficulty sustaining attention, anxiety,

panic and sweating (Mitchell & Bray, 1990). The time of occurrence lasts no more than four

weeks and one can more readily overcome the trauma and its stress symptoms without

needing professional help.

In contrast to acute stress, late stress can develop months or even years after the

traumatic event. The symptoms of late stress are similar to the acute stress symptoms, they

simply occur at a later stage in a persons life. Late stress is difficult to diagnose since the

manifestations are not easily associated to the traumatic event due to the long time gap

between the traumatic event and the resulting late stress. This type of stress is more resistant

and more difficult to recover from so professional help is often necessary (Waldanne, 2011).

When an individual cannot overcome the traumatic event and fails to handle the acute

stress symptoms can develop Post-Traumatic Stress Disorder (PTSD). Similar to late stress,

PTSD is a late short or long-term response which can cause serious psychological

disturbance. Its symptoms include intrusive memories of reliving the memories of the trauma

(flashbacks), dreams and nightmares; physiological arousal manifesting in alertness and

insomnia; and isolation and insensitivity leading to social distancing and difficulty in

expressing ones feelings (Astin & Resick, 2003).In other words, since the individual wants

to escape of the distressing memories but fails in doing so, the psychological suffering

continues incessantly. Furthermore, PTSD can change a persons personality, social behavior,

and in the long run can cause extreme fear of leaving home, alcoholism and drugs. While


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self-healing is possible, it is highly recommended to seek medical or psychological help

which might consist of therapy and/or medication.

The brain areas involved in PTSD are the prefrontal cortex and hypothalamus.

Researchers of University of California, Los Angeles (Goenjian, Bailey, Walling, Steinberg,

Schmidt, Dandekar, Noble) investigated the role of PTSD on hormonal changes and found

that PTSD is related with two genes (TPH1 e TPH2) which are responsible for the production

of serotonin which is a neurotransmitter that regulates mood, sleep, and capability of

attention. In other words, due to the PTSD created genetic variation the body produces less

serotonin. Furthermore, researchers at the Veterans Affairs Medical Center (VAMC) in

Bronx, New York (Hellhammer, Wust, Kudielka) conducted a study where discovered that

adult children with at least one parent who is a Holocaust survivor have low cortisol levels.

The discovery means that low cortisol levels may be predictive of PTSD. Also, the results

showed that these cortisol level problems led to a reduction of 8-10% of activity in the

prefrontal cortex and hippocampus. Consequently, due to the reduced activity the prefrontal

cortex cannot control paranoid behavior, anxiety and depression as effectively which

enhances these symptoms in individuals suffering from PTSD.

PTSD can be caused by either a positive or negative event. So, while the event may

start out as a traumatic occurrence, this is not an absolute requirement. Trauma is defined

as physical, mental and emotional pain that goes beyond our control caused by an event

which is initiated by our environment, other people or even ourselves. Physical pain occurs

from an impact to our physical self and results in bruising, bleeding, cuts, fracture sand tears

to our body parts. Emotional pain stems from our emotions after being told negative

information, being threatened, or after being describing in demeaning and derogatory words.

Consequently, our memory implants this pain-related information and our skelton-

muscular system becomes imprinted with memory. Because of this imprinting in our visual,


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auditory and ol-factory sensory systems our fight or flight responses are triggered. More

specifically, someone suffering from PTSD can exhibit strong negative reactions when

confronted with just a smell, certain sounds, or even the sight of something.

Literature Review

The study the Vietnamese refugees traumatized about the effectiveness of treatment

CBT (Cognitive-Behavioral Therapy) has shown, unfortunately, be inconclusive. Moreover is

not assured, taking into account the observed symptoms (panic attacks and PTSD) if

treatment would be the best alternative therapy such as cognitive therapy, which possibly

have the same similar degree of benefit.

All study patients were taking medication, which means that future studies should

consider medication dosage, both as an outcome measure and as a possible confounding

variable.

Researchers B. Christopher Frueh & Anouk L. Grubaugh & Karen J. Cusack &

Matthew O. Kimble & Jon D. Elhai (2009) in their study, an open trial, tried to, through

exposure-based cognitive behavioral treatment of PTSD improve adults with schizophrenia.

Sequelae of PTSD typically include increased arousal and distress, social isolation and

interpersonal conflict, and generally poor occupational and social functioning. for that they

used treatment of prominent psychotic symptoms, such as hallucinations, delusions, and

bizarre behavior, often take precedence in treating individuals with persistent psychotic

disorders, leaving PTSD symptoms unaddressed.

The premise and evidence indicating that psychosocial stressors play a critical role in

the onset and relapse of psychotic episodes in individuals with schizophrenia suggests that

ongoing anxiety and trauma related symptoms is likely to precipitate increases in symptoms

or relapses in vulnerable individuals (Rosenberg, Lu, Mueser, Jankowski, & Cournos, 2007).


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The results of this study of manualized exposure-based cognitive-behavioral therapy showed,

according to the researchers preliminary optimism. They found out that significant

improvements were not noted in depressive symptoms, general anxiety symptoms, frequency

of self-reported social activities, or physical health status however they considered clinical

outcome efficacy for PTSD at post-treatment and 3-month follow-up is extremely promising

because in the clinical interviews data for completers showed significant symptom reductions

on most of them.

The study of the effectiveness of both methods of treatment compared with the

control group, they are: The method of treatment CBT (Cognitive-Behavioral Therapy) in

reducing symptoms and healing PTSD (according to studies by Bisson and Andrew Jennings,

Friedman, Taylor and Ahmadizadeh Aslani et al.)

This has shown that patients in group CBT for the benefit of cognitive-behavioral

skills (and based on the shock) could overcome the problems through cognitive restructuring

and reflection to provide answers / projection of emotions during exposure to the damaging

event. In this method, patients were taught to think in dealing with the problems causing the

patient to achieve self-efficacy in dealing with problems and potentially solve them know. On

the other hand, the results obtained EMDR to treat PTSD be shown to be effective for the

recovery of emotional shocks in the short term.

Thus, it can be concluded that there was virtually no difference between the efficacy

of both treatment methods, both showing be similar achieve recovery and reduction of

symptoms.

Monson & Rodriguez & Warner (2005), in their study Cognitive-Behavioral

Therapy for PTSD in the Real World they pretended to show if interpersonal relationships

make a real difference in treating Vietnam Veterans (VV) with PTSD and the purpose of the

study was to investigate the role of pretreatment in interpersonal relationship functioning in


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two forms of group cognitive-behavioral treatment (CBT) for veterans with PTSD and the

role of interpersonal relationship functioning in treatment outcomes.

In short the researchers found that despite pretreatment did not contribute to the

prediction of PTSD, only the violence associated with PTSD in VV decreased. These

findings run contrary to concerns that trauma-focused treatments increase the potential for

dangerous behavior due to symptom exacerbation. In fact, there was no difference in violence

perpetration by treatment type at lower levels of intimate relationship functioning, and

violence perpetration was less likely in the trauma-focused group with better intimate

relationship functioning. Similarly, there were no differences in alcohol abuse at follow-up

between the two treatments.

Discussion

In our paper our goal was to show what PTSD was, how it begins and manifests, their

biological bases and how it works, how some people of certain age and gender react to it and

their possible treatments through different methods. We showed how some treatments

worked and some trials made by foreign Psychologists

In summary, PTSD is an anxiety disorder that some people get after seeing or living

through a dangerous event because when we are in danger, it is natural to feel afraid and this

fear triggers many split-second changes in the body to prepare to defend against the danger or

to avoid it. This fight-or flight response is a healthy reaction meant to protect a person from

harm. But in PTSD, this reaction is changed or damaged. People who have PTSD may feel

stressed or frightened even when they are no longer in danger.

In the U.S. military PTSD is recently called and recognized by the Pentagon as

an invisible wound because we cannot see at the naked eye due to concussions or trauma to

the forehead because of explosions and stress environments of war, that has their original

bases in the hormonal system such as the levels of cortisone and serotonin in your body.


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PTSD occurs frequently in the military domain since the physical, emotional,

cognitive and psychological demands of a combat environment place enormous stress on

military personnel. Rizzo, Reger, Gahm, Difede, and Rothbaum (2009) have argued for the

use of a Virtual Reality (VR) system for PTSD treatment that can be offered to veterans

returning from combat. VR can be used as a gradual exposure therapy treatment for PTSD

since imaginal therapy has been shown to be ineffective since some patients refuse to

participate and while other patients are willing they cannot express their emotions or senses

(Difede & Hoffman, 2002). Rizzo et al. (2009) designed a Virtual Iraq PTSD VR from the

virtual assets that were initially developed for a combat tactical training simulation, which

then served as the inspiration for the X-Box game entitled "Full Spectrum Warrior". This VR

therapy enables the therapist to adapt the therapy to the individual patients needs by creating

some trigger stimuli which interact with relevant patient feedback throughout his life within

the VR. The results from their studies indicated post-treatment improvement on all PTSD

measures and maintenance of these gains at a 6-month follow-up (Rizzo et al., 2009.

Additionally, VR exposure treatment has been used in previous treatments of PTSD patients

with reports of positive outcomes.

In our opinion this work is quite extensive with a lot of things to talk about and write

but anyway, is very curious and informative, there is just too much information online and we

had to make a short version of this subject because we did not had the space and time to

cover all branches of PTSD.

References

Ahmadizadeh, Eskandari, Falsafinejad, Borjali(2010). In Iranian Journal of Military

Medicine Fall 2010, Volume 12, Issue 3; 173-178

Frueh, Grubaugh, Cusack, Matthew, Kimble, Elhai,Knapp(2009). In Anxiety Disord. 2009

June; 23(5): 665675. doi:10.1016/j.janxdis.2009.02.005


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Hellhammer, Wst, Kudielka(2009). In Psychoneuroendocrinology (2009) 34, 163171

Hinton, Pham, Tran, Safren, Otto,Pollack(2004). In Trauma Stress. 2004 October ; 17(5):

429433. doi:10.1023/B:JOTS.0000048956.03529.fa

Monson, Rodriguez, Warner (2005). InJournal of Clinical Psychology, vol. 61(6), 751761

(2005)

Rizzo, A. A., Reger, G., Gahm G., Difede, J., & Rothbaum, B. O. (2009). Virtual reality

exposure therapy for combat related PTSD. In P. Shiromani, T. Keane, & J. LeDoux

(Eds.), Post-traumatic stress disorder: Basic science and clinical practice (pp. 375

399). New York: Humana Press.

Yehuda, Bierer, Schmeidler, Aferiat, Breslau, Dolan (2000). Low cortisol and risk for PTSD

in adult offspring of Holocaust survivors. Am J Psychiatry 157: 1252-59.

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PTSD- Milestone 3