Post-Traumatic Stress Disorder (PTSD)

External, harmful incidents can hurt us psychologically in the same way physical injuries can harm the body. The overwhelming amount of stress resulting from trauma can exceed the ability of the individual to cope and can lead to developing a wide range of symptoms. The nature of traumatising incidents can range from extremely shocking events to ongoing stressful circumstances. The sudden loss of a loved one, a car accident, victim of crime or nature catastrophes are examples for single events of traumatising nature. Ongoing stressful circumstances can include adverse childhood experience, such as constant criticism, neglect, emotional abuse or living with addicted parents. Bullying at school or at the workplace can hurt so much that sometimes a Post-Traumatic Stress Disorder (PTSD) is the result. Other very stressful circumstances that can lead to PTSD are migration, exclusion from the family or deportation. Stressful circumstances always contain an encounter or the anticipation of death or serious injury. Some clients present with a combination of both kinds of traumata.

Symptomatology of PTSD

People with PTSD show a variety of distress related symptoms which fall into roughly three groups:

  • Stressful re-experiecing the trauma (e.g. flashbacks, nightmares, intrusive thoughts)
  • Avoidance of trauma related stimuli (e.g. not leaving home, avoiding certain places or media, inability to recall some important aspects of the trauma)
  • Heightened physiological arousal (e.g. Difficulty falling or staying asleep, irritability, hyper vigilance, exaggerated startle response, difficulty concentrating)

Post-Traumatic Stress Disorder (PTSD) can be quite a debilitating disorder. PTSD often coincides with a depressive symptomatology, with other symptoms of anxiety like panic attacks or chronic pain. Therefore, clients often seek counselling only after they have become depressed or have other issues that are difficult to deal with. For example, a client came to treatment for “chronic pain” after two motor vehicle accidents. The pain was believed to be a result from the injuries, however, the client did not recover from the injuries as predicted and treatment was sought to look into the PTSD side of his suffering. In other words, PTSD can be the foundation of other clinical symptoms, but remains invisible until assessed properly. Particularly childhood trauma stays under the radar and comes to the surface as relationship difficulties or substance-related problems, reduced functioning or physical symptoms (psychosomatic problems).

Psychological treatment of PTSD

Treatment of Post-Traumatic Stress Disorder (PTSD) requires flexibility from the therapist and a trust-worthy therapeutic alliance. It is pivotal that treatment follows an individual case formulation as the symptomatology varies over different individuals and everyone has a specific history. For instance, a client suffering mainly from flashbacks requires a different approach than a client who mainly avoids stimuli. As a general guideline, trauma therapy aims at reducing the emotional and physiological response to trauma memory. I often use a metaphor for the process: “How do you open a shaken coca-cola bottle? Answer: Open the lid a bit, close it, open it a bit again, etc until it is safe to remove the lid completely. This is at the same time the quickest possible way, if you want to avoid spillage.”.

Clients learn how the trauma reaction is created and maintained. PTSD is a reaction to abnormal circumstances and is not an expression of madness or weakness. Clients learn to drop avoidance, learn to proactively manage trauma memory and to create a safe place within themselves. They learn to re-orient to the present and to the future, in other words, clients really can hone their problem solving skills which help them manage possible future traumatic events more effectively. If indicated, psychological treatment can include clinical hypnosis, activity planning, implementing self-care, cognitive-restructuring, biographical work with significant others.

The physical body plays an important role as a lot of trauma tension is stored in big muscle groups, but also in deep tissues that are around organs. Many people with a trauma background have difficulties with breathing because the big muscle that drives our breathing motions (the diaphragm) is chronically tense. Often, this hyper tension is not noticed by clients and they are surprised when they discover how tense they are. Psychological treatment can incorporate exercises to improve natural bodily functioning.