Selfhelp for PTSD

You may have probably noted (link) that there are many symptoms of PTSD, and very few people have all of them. Also, it is normal to experience times of greater anxiety in your life, particularly when you are under a lot of stress. Some of the symptoms of PTSD, such as sleep or concentration problems, for example, are also seen in other anxiety disorders. So how do you know if you might have PTSD? Here are two tips that might be helpful: (1) If you have at least one symptom in each of the major categories, and your symptoms only started after a traumatic event, then you might have PTSD. If your anxiety symptoms were already present before the trauma, then it is probably not PTSD. (2) It is normal to feel more anxious right after a trauma. But over time, these anxious feelings will settle down. Not everyone who lives through a trauma will develop PTSD. But if your symptoms have been present for over one month, and you find that they are interfering significantly in your life, then you might have PTSD.

Some facts. Several studies have shown that a majority of people will likely experience at least one traumatic event in their lives; but many of them will NOT develop PTSD. The chance of developing PTSD goes up if the trauma was very severe, chronic (that is, lasted a long time), or you were physically close to the event, that is, if the trauma happened right next to you or in front of you. Certain traumas are more likely to lead to PTSD than others. For example, you are more likely to develop PTSD if the trauma you experienced was a rape/sexual assault, combat exposure, or childhood neglect/physical abuse. If you develop PTSD symptoms within one month of a traumatic event, this is called acute PTSD. If you don't develop any symptoms until at least six months after the trauma, this is called delayed onset PTSD. Adults with PTSD can have other problems as well, including depression, drug and alcohol abuse, or other anxiety problems (for example, panic disorder, social anxiety).

How can I recognize if I have PTSD? Many adults with PTSD have strong feelings of shame, guilt, or despair about what happened. It is also not uncommon to have increased feelings of hostility or anger, this is sometimes directed towards entire groups of people (for example, you might find yourself being very angry and suspicious of men if you were raped, or you might get extremely angry at drivers who speed if you were in a serious car accident). Because living through a trauma can be such a life-changing experience, some adults with PTSD find that their relationships with others are different after a trauma. For instance, you might have difficulty maintaining a romantic relationship or trusting other people and their intentions following a sexual assault, or you might have some sexual or intimacy problems. Adults with PTSD can sometimes feel like they are "going crazy" or are "broken" following a trauma. But it is important to keep in mind that PTSD is a treatable anxiety disorder. No matter how bad you feel or how hopeless it seems, there is help for PTSD.

Treatment options. Many forms of psychotherapy have been advocated for trauma-related problems such as PTSD. Basic counseling for PTSD includes education about the condition and provision of safety and support. Cognitive therapy shows good results, and group therapy may be helpful in reducing isolation and social stigma. Cognitive-behavioral therapy for PTSD and trauma involves carefully and gradually “exposing” yourself to thoughts, feelings, and situations that remind you of the trauma. Therapy also involves identifying upsetting thoughts about the traumatic event–particularly thoughts that are distorted and irrational—and replacing them with more balanced ones. The psychotherapy programs with the strongest demonstrated efficacy include psychodynamic therapy, cognitive behavioral programs, variants of exposure therapy, stress inoculation training, variants of cognitive therapy, eye movement desensitization and reprocessing (EMDR), and many combinations of these procedures. EMDR incorporates elements of cognitive-behavioral therapy with eye movements or other forms of rhythmic, left-right stimulation, such as hand taps or sounds. Eye movements and other bilateral forms of stimulation are thought to work by “unfreezing” the brain’s information processing system, which is interrupted in times of extreme stress, leaving only frozen emotional fragments which retain their original intensity. Once EMDR frees these fragments of the trauma, they can be integrated into a cohesive memory and processed. Exposure treatment involves assisting trauma survivors to therapeutically confront distressing trauma-related memories and reminders in order to facilitate habituation and successful emotional processing of the trauma memory. Most exposure therapy programs include both imaginal confrontation with the traumatic memories and real-life exposure to trauma reminders. Early intervention after a traumatic incident, known as Critical Incident Stress Management is used to attempt to reduce traumatic effects of an incident, and potentially prevent a full-blown occurrence of PTSD. Some benefit was found from being connected early to cognitive behavioral therapy, or for some medications such as propranolol. 

Why do I have flashbacks and upsetting intrusive thoughts? When you live through a traumatic experience, your mind processes and stores the memory a little differently than it stores regular experiences. Sensory information about the trauma, that is, smells, sights, sounds, tastes, and the feel of things, is given high priority in the mind, and is remembered as something threatening. Once this happens, whenever you are faced with a touch, a taste, a smell, a feel, or a sight that reminds you of your trauma, the memory (and the feeling of threat) comes back up and you might have vivid memories or flashbacks about the trauma. This is just the way the mind works. It is not dangerous or a sign that you are going crazy. Following are some selfhelp strategies to deal with PTSD. 

Strategy 1: Educate yourself. Learning about anxiety & PTSD. No matter what type of anxiety problem you are struggling with, it is important to know the facts about anxiety. Anxiety is a normal and adaptive system in the body that tells us when we are in danger. This means that dealing with your anxiety NEVER involves eliminating it, but rather managing it. Anxiety can become a problem when our body tells us that there is danger when there is no real danger. As an important first step, you can start by understanding that all of your fears and physical feelings have a name: ANXIETY. Because PTSD can include scary symptoms such as nightmares, flashbacks, or dissociation (that is, acting or thinking as if you are living the trauma all over again), you might be worried that you are going crazy. For this reason, it is so important to educate yourself about all of the feelings that are common to PTSD. The problem is not that you are crazy. Rather, the problem is that you have anxiety because of a traumatic event you have experienced. The good news is that there are skills that you can learn to help you cope with this anxiety.

Strategy 2: Building your Anxiety Management Skills. Learning to calm anxiety by slowing down your breathing (see How to do Relaxation). If you have PTSD, you might find that you are anxious throughout the day. Calm breathing is a quick and portable tool that you can use to “bring the volume down” on some of those anxious feelings. If you experience flashbacks or dissociation, it is a good idea to keep your eyes open when doing calm breathing. Learning how to calm your anxiety by relaxing the muscles in your body is also very useful because many people with PTSD are tense and jumpy throughout the day, it can be very helpful to learn how to relax your body.

Strategy 3: Grounding techniques. Grounding is a very helpful technique if you are experiencing flashbacks and you find yourself sometimes losing touch with the present moment. Having this symptom of PTSD is not only terrifying for you, but it can also be scary for people around you, such as friends and family. Grounding teaches you to stop losing touch with the present moment by concentrating and focusing on the present or by directing your attention to something else. Here's how to do Grounding. (1.) Eyes open. When doing grounding techniques, make sure to keep your eyes open, so that you can see and focus on what is around you right now. It is also a good idea to speak out loud, describing what you are seeing and doing. (2.) Practise: Like any other skill, it is important to practise grounding techniques. It will be most useful if you have tried using this skill when you were calm, and you practised it often. That way, when you find yourself needing to use it, you already know how. (3.) Enlist help: Teach a friend or family member about grounding and why you need to use it. If someone you trust understands when grounding is useful, they can remind you to use it (and do it with you) if you are starting to lose touch with the present. For example, they might say, “I think you might want to do some grounding now… can you describe what you are wearing? What am I wearing? Where are we right now?” Some examples of Grounding - Touch objects around you, and describe them (texture, colour)... “I’m sitting on a black chair, and the fabric is very smooth; it’s soft cotton... The carpet is brown, and there is a painting in the corner.” Run water over your hands, and describe aloud how it feels... Name all the different types of animals you can think of (e.g., lion, tiger, cat, dog, cow, etc…), or types of flowers, name of all cities, etc… Say the alphabet backwards...

Strategy 4: Getting back into your life. Sometimes adults with PTSD will stop doing the things that they used to enjoy, and isolate themselves by avoiding friends and family. Although this is an understandable reaction after living through a trauma, it is not helpful. Even though it might be difficult, it is important to get back into the normal routine of your life as soon as possible; this includes going to work, socializing with friends, and keeping up with hobbies or sports that you enjoy. It is also important that you take proper care of yourself. Some people with PTSD stop paying attention to what they eat, when they sleep, or whether they are getting enough. If it feels too difficult to get back to your usual activities, such as going to work, start with short pleasant activities that will take you out of the house for a brief period of time. These might include: going for coffee with a friend, going to see a movie or renting a movie, or going out for a walk. Even a small step toward getting back into your life is a positive step forward!

Strategy 5: Facing your fears. Some adults with PTSD will find themselves avoiding situations that are associated with the trauma they experienced. Some examples of this avoidance include: If you were in a car accident, you might be avoiding driving, being in cars, walking in areas where there is a lot of traffic, or being in the neighbourhood where the accident took place; Avoiding general places, situations or people associated with your trauma, such as parks, crowded places, and people of a particular ethnicity, age, or gender; Avoiding trauma reminders such as movies, TV, conversations. The best way you can help yourself to deal with these fears is by facing them, rather than avoiding them. Normal activities such as driving or being in a car or reading the newspaper are best addressed by gradually approaching these situations. 

Strategy 6: Building on bravery. Remember that any progress you make in managing your anxiety and PTSD symptoms comes from a lot of hard work. If you are noticing improvements, take the time to give yourself some credit: reward yourself! The best way to see your progress is to record all the work you are doing with your PSTD management skills. For example, write down how often you use relaxation or grounding techniques, and how effective it was each time. If you are trying to get out and socialize more, keep a record of the activities you have participated in each week. Set realistic goals for yourself, and reward yourself when you achieve those goals. 

Strategy 7: Avoid alcohol and drugs. When you’re struggling with the difficult emotions and traumatic memories, you may be tempted to self-medicate with alcohol or drugs. But while alcohol or drugs may temporarily make you feel better, they make post-traumatic stress disorder worse in the long run. Substance use worsens many symptoms of PTSD, including emotional numbing, social isolation, anger, and depression. It also interferes with treatment and can add to problems at home and in your relationships.   

Strategy 8: Challenge your sense of helplessness. Overcoming your sense of helplessness is key to overcoming post-traumatic stress disorder. Trauma leaves you feeling powerless and vulnerable. It’s important to remind yourself that you have strengths and coping skills that can get you through tough times. One of the best ways to reclaim your sense of power is by helping others: volunteer your time, give blood, reach out to a friend in need, or donate to your favorite charity. Taking positive action directly challenges the sense of helplessness that contributes to trauma.

Strategy 9: Knowing when to ask for help. Although the skills listed here can be very effective in helping you to manage your anxiety, sometimes they are not enough. For example, you might feel completely unable to be around others or to face some of your fears by yourself. This is understandable, since dealing with PTSD can feel like an overwhelming struggle. If this is the case for you, it might be a good idea to consult with your family doctor, or a qualified psychologist to get some help in dealing with your PTSD. Working with someone trained in dealing with PTSD can also give you a chance to talk about any feelings of guilt, shame, or self-blame you might have because of your traumatic experience. Many people with PTSD think that they are either responsible for what happened in some way, that they could have prevented it, or that others would blame them if they knew “the whole story”. For example, it is not uncommon for people who have been sexually assaulted to think that they didn’t “fight back” enough, or that they acted in a careless way that invited or encouraged the attack. Thoughts of guilt about a traumatic event can lead to strong negative feelings of sadness, depression, and shame.

Strategy 10: Practise! Practise! Practise! The PTSD management skills presented above are designed to teach you new and more effective ways of dealing with your anxiety. If you practise them often, they can become new habits that are a part of your daily routine. Like an exercise program, it is important to “keep in shape” even when you are feeling better and you have reached your goals. 

Remember: Early treatment is better. Symptoms of PTSD may get worse. Dealing with them now might help stop them from getting worse in the future. Finding out more about what treatments work, where to look for help, and what kind of questions to ask can make it easier to get help and lead to better outcomes. PTSD symptoms can change family life. PTSD symptoms can get in the way of your family life. You may find that you pull away from loved ones, are not able to get along with people, or that you are angry or even violent. Getting help for your PTSD can help improve your family life. PTSD can be related to other health problems. PTSD symptoms can worsen physical health problems. For example, a few studies have shown a relationship between PTSD and heart trouble. By getting help for your PTSD you could also improve your physical health.

This is a Compiled Article 

1 comment:

elizabeth said...

I specialize in CISM and often respond to Critical Incidents. When I find a particular person is suffering from PTSD, from a prior incident, I often refer them to do EMDR. EMDR is great stuff.

Many individuals who have suffered from PTSD for years even benefit from EMDR.

Great post.