All of us at some point in our lives have ourselves gone through or have witnessed someone close to us go through something that literally changes us forever. Considering the challenging time we have all been going through- Covid Crisis , we can’t even fathom the personal losses people have gone through – isolation , hospital admissions , the tough situations the frontline & the healthcare workers are braving through every single day. Even besides this, certain events like wars , sexual assaults, torture , serious accidents etc. which can scar us not only physically but also emotionally for the rest of our lives.
No one’s invisible pain should be unnoticed – Lady Gaga
These are the words of one of the greatest pop icons of our time on her struggle with PTSD.
So, what exactly is it? This disorder arises as a delayed and /or protracted response to an exceptionally stressful or catastrophic life event or situation (ICD 10).
Often times, we fail to understand the huge impact it can have on various areas of our lives – our activities of daily living , social and occupational functioning. Since, we’re all wired differently, we all react and respond to such situations differently.
- Recurrent, involuntary, intrusive , distressing memories of traumatic event in the form of Images, Thoughts, Perception.
- Persistent avoidance or efforts to avoid stimuli associated with traumatic event. Eg – people, places, conversations, objects, activities , situations, thoughts & memories
- Marked Alterations in Arousal & Reactivity Eg- Reckless/Self destructive behaviours , Sleep disturbances, Hyper vigilance, exaggerated startle response, Attention & Concentration problems
- Negative Alterations in Mood & Cognition Eg- Partial Amnesia related to stressful event , Negative beliefs about oneself & others , Feelings of fear/anger/guilt/shame/horror , inability to experience positive emotions like happiness , Feelings of detachment or estrangement from others
The individual symptoms can also be accompanied by Depersonalization (feeling detached from self) & Derealizationation (Feeling unreality of surroundings).
In children, the above symptoms are often reflected in their Play Behaviors.
COURSE AND DEVELOPMENT
Symptoms typically develop within the first 3 months after the trauma , although maybe delayed by months or even years. Various Temperamental , Environmental, Genetic & Physiological factors are risk factors which can predispose an individual to developing symptoms of PTSD.
1.Impact/Emergency –Individual is struggling to come to terms with the shock
2.Denial – Individual makes attempts to consciously or unconsciously avoid facing the reality
3.Recovery- Duration of symptoms varies & so does recovery. Some individuals have complete recovery within 3 months whereas others might continue to remain symptomatic for years altogether.
The path to recovery is more often than not, not a straight line and the ongoing stressors, reminders and other co morbidities can cause Relapses.
It is more common in War veterans, emergency responders, females, minority groups as compared to the rest of their counterparts.
- Selective Serotonin Reuptake Inhibitors (SSRI)
- Serotonin Norepinephrine Reuptake Inhibitors (SNRI)
- Atypical Antipsychotics
- Anti hypertensives alpha blockers etc. continue to be used.
NON PHARMACOLOGICAL TREATMENTS
- Cognitive Processing Therapy – A type of CBT that focuses on how trauma is perceived and eventually Education on how to cope by working through the Stuck Points
- Eye Movement Desensitization and Reprocessing (EMDR) – EMDR institute describes it as a type of psychotherapy which utilizes bilateral sensory input such as side to side eye movements to help process the trauma
- Virtual Reality Exposure(VRET)- An additional and innovative treatment which is being considered is exposure therapy. VRET administered by a trained clinician continues to offer graded exposure to traumatic event and over time the emotional response to the same decreases.
- Professional Counselling to talk about the pent up thoughts, feelings and emotions.
While an expert opinion is always recommended, some general strategies which can be incorporated are
- Emotional Support- Providing emotional support by listening and acknowledging their thoughts and feelings and assuring them that you’re there for them.
- Journaling – Writing down the thoughts, feelings ,flashbacks can help one become aware & organize their true feelings and emotions .Gradually, can be used to document the progress over a period of time. Also, writing about the Triggers and the possible solutions which helped reduce symptoms can give them an insight into managing their own symptoms for future reference.
- Art Based Therapy – Mandalas, Zentangles or any form of creative expression that one is comfortable with – dance, poetry etc. Can help in calming & composing oneself and at the same time can also be fun and enjoyable.
- Support Groups/ Group Therapy – It is a great way to help individuals vocalize and at the same time make them realize that they’re not alone in their struggle . It can help instill feelings of hope, universality and also acts as a source of motivation.
- Relaxation Techniques- Deep Breathing, Guided Relaxation, Progressive Muscle Relaxation, Meditation, Biofeedback, Yoga etc. can be used whenever one is feeling two overwhelmed and consumed by negative emotions and thoughts to calm oneself down and stabilize the vital parameters.
- Listening to encouraging and motivational podcasts, movies , videos etc. Can also be particularly helpful as it can help them become hopeful and optimistic about the future.
- Positive Reinforcements and celebration of small victories will motivate them to further stick to their journey of coping.
- Mindfulness, Gratitude Journal & Positive Self Affirmations daily which will help immensely to boost self esteem , body image and self confidence.
More importantly, it is important to make individuals suffering from PTSD realize that it’s okay to take their own time for coping as there is ‘No one size that fits All’ Giving them the time , support, encouragement & space without judgment and bias will help them address their issues and eventually tackle them heads on.
Let us all Remember to Focus on one step at a time & not the entire staircase and eventually we’ll reach there.
Our traumas and sufferings do not define us and we can change our lives at any point of time if provided with the right resources, determination, perseverance and hard-work.
- DSM V
- AK Ahuja Psychiatry Textbook