Post Traumatic Stress Disorder

Post-Traumatic Stress Disorder (PTSD) is a type of anxiety which develops after experiencing or witnessing unsettling or traumatic events. It is often understood in context of wars. However, events like natural disasters, serious injury/accidents, separation or loss of a loved one, sexual violence, terrorist attacks can cause trauma or PTSD. Even indirect exposure to threatening events can result in such anxiety, for example, in the case of families of army personnel, police officials or journalists regularly covering rape and abuse, etc.  

Prolonged “Flight or Fight” response in traumatic situations can make adjusting to normal life for a person difficult even after the event has passed. They may experience a range of emotions like shock, sadness, fear, stress or even remorse. While for most people this phase after trauma passes, some develop anxiety due to overwhelming emotions. This anxiety is coupled with other experiences that one must look for to ascertain PTSD.

Some common markers are:

  • Re-experiencing or reliving the traumatic event through recurrent flashbacks, upsetting memories of the event, nightmares or even hallucinations in some cases. These can be triggered by something in their environment or can also be involuntary and unwanted.
  • Avoiding objects, situations or even people that can remind them of the traumatic event. This may lead to isolation. In striking contrast to reliving the event, one may consciously avoid thoughts or feelings associated with the distressing experience. Altering routine to avoid any instance that can remind them of the event can also be symptom of PTSD. For example, after a bad car accident one might resort to public transport or walking for outside activities.
  • Changes in physical and emotional reactions as following become constant. They are often called arousal symptoms and include:
  • Becoming easily startled and strong reactions to stimuli such as accidental touch or noise
  • Constantly being on guard for danger
  • Insomnia
  • Difficulty in concentrating
  • Increased irritability and anger outburst
  • Aggressive and self-destructive behaviour
  • Constant rapid breathing, increased heartrate and blood pressure
  • Trouble expressing or feeling emotions
  • A range of negative changes in mood and cognition are introduced after exposure to the event. There can be repression of key aspects of the traumatic event, distorted belief about self-identity and worth, and overwhelming feelings of blame, guilt or shame associated with the traumatic event or people involved in it. This might lead to detachment from people and loss of interest in normal activities.
  • Symptoms can appear differently in children. After the traumatic event, developmental delays can be noticed in young children’s motor skills and interpersonal skills such as ability to interact or express needs through language. Difficulty in functioning or feeling secure without adult can lead to unusual clinginess. Bedwetting, nightmares, and re-enacting the traumatic part of event during playtime are common markers of PTSD in young children. Teenage children often develop disruptive behaviour patterns and feelings of revenge after the event. In case of loss of a loved one, adolescents can also feel guilty for being unable to prevent the traumatic event.

When do I need help?

It is normal to experience the above-mentioned symptoms for some time after the traumatic event. However, if these symptoms persist long after the event has passed or become worse over time, one should consider help. Occasionally these symptoms develop much later and can persist for months. One must contact a mental health professional if the symptoms interferes with daily functioning and impacts important aspects of life such as work or relationships.

How therapy will help in this situation?

Counselling educates about trauma, its effects and how it led to development of particular symptoms. It helps understand the association of feelings of guilt, shame or blame with the actual traumatic event. It also helps identify triggers and equip with skills to react to it such as relaxation or anger management

Here are some therapies which assist with dealing with PTSD.  Therapists may use any or a combination of these depending on the specific circumstances of their clients.

  • Eye movement Desensitisation and Reprocessing (EMDR): It aims to generate positive associations with that memory through bilateral stimulation. Bilateral stimulations are visual, auditory or tactile stimuli given to both parts of brain which are proven to result in increased relaxation, attention and reasoning abilities.
  • Cognitive Behavior therapy (CBT) has been adapted for PTSD into Trauma Focused Cognitive Behaviour Therapy (TF-CBT). It helps individuals to make sense of trauma by perceiving the distressing memories from a different angle. It also helps deal with distorted beliefs and emotions such as guilt or shame through building a realistic perspective of the event.
  • Exposure Therapy: It exposes individual to symptoms gradually through detailed imagination of traumatic event or recreation of it in a safe and controlled environment. This progressive exposure is meant to reduce the intensity of emotional reaction to the trigger and help learn to cope with the distress rationally.​​
  • Stress Inoculation Therapy: This is a form of CBT which helps one prepare to defend against exposure of triggers or remainders of trauma. It involves learning to identify sources of anxiety and coping or problem-solving skills to deal with them.​
  • Group Therapy: In group therapy people share their struggles with similar kind of trauma in non-judgemental and relaxing environment. This helps with validation of one’s experiences and feelings. It also leads to shared learning of different coping strategies. It encourages social support and boosts self-esteem which are often detrimental to healing in PTSD.​

Anger issues rarely exist in isolation and can be caused by underlying mental health issues such as bipolar disorder. Unresolved, they can result in negative coping strategies such as alcohol or drug dependencies. Working with a counsellor to manage anger can greatly improve a person’s mental health and bring a sense of calm into a person’s life.