Identifying, Treating, and Accepting Post-Traumatic Stress Disorder

Jun 17, 2019

Over the past thirty years, there has been a significant shift in the identification, treatment, and socal stigma of PTSD, or post-traumatic stress disorder. Murray State professor of psychology, Michael Bordieri, Ph.D., visits Sounds Good to discuss this surprisingly common mental health condition.

The Mayo Clinic defines post-traumatic stress disorder (PTSD) as a "mental health condition that's triggered by a terrifying event - either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares, and severe anxiety, as well as uncontrollable thoughts about the event." These terrifying, scary, or shocking events can include "natural disasters, motor vehicle accidents, combat exposure, [and] physical or sexual assault," says Bordieri. "90% of Americans in their lifetime will experience at least one traumatic event." While only an estimated 10% will go on to develop symptoms of PTSD, this is a substantial minority that will develop sometimes severe psychological problems that need treatment. 

Bordieri explains that the societal shift towards better understanding and accepting PTSD is in part due to the change in attitude towards mental health in general. "[This] is part of the broader shift we've seen towards recognizing that mental illnesses are medical disorders. This is not a question of willpower or strength. It's something that all of us could be susceptible to," Bordieri explains. "I think that's a really important thing to get out front. There's this persistent belief of psychological difficulties as a moral failing. If people were stronger, if they were more resolved, then it wouldn't happen to them. And nothing could be further from the truth." 

While PTSD is often seen in members of the armed forces, the police, and firefighters, an individual of any occupation, age, race, or socioeconomic background can experience the disorder. PTSD can even show up in individuals who believe they're 'strong enough' to handle their emotions and past experiences. "We know that PTSD and other psychological disorders really can show up across all individuals," says Bordieri. "And in fact, sometimes it's the 'strength' that might make someone more at risk in a way. We know that one of the core mechanisms of PTSD is the idea of avoidance. After a traumatic event, it's natural not to want to talk about it or reexperience it, put it in the past. But sometimes, one way we can see PTSD develop or sort of worsen is that the more someone works to push it away or not have that experience, the more power those memories and experiences start having in their life. This isn't something that you can will away, or if you were just strong enough, it wouldn't be there; it's an unfortunate psychological reaction to trauma."

In order for an individual to undergo proper treatment, they must first be properly diagnosed as having PTSD. Sometimes, symptoms of this disorder are mistaken for other illnesses. "Historically, we've certainly had some challenges with [misdiagnosis]. Often individuals with PTSD are incredibly frightened, their world is incredibly distressing. These memories and experiences of trauma are coming back," Bordieri explains. "Even sleep may not be safe, because nightmares could bring back the trauma. It's not unsurprising, then, that many individuals might seek out alcohol or other drugs to help numb or push away. [They] might have real intense anger or fear and anger reactions to this sort of experience. I think sometimes we fixate on the wrong set of symptoms." 

The first key to treating PTSD with therapy is to have an open and honest relationship with the therapy provider. Since PTSD does not affect each individual in the same way, unique treatment plans must be formed for each patient. Typically, therapy is done in two formats: prolonged exposure and cognitive therapy. The former treatment option can be uncomfortably intense, as it involves retelling details of the trauma over and over until the words, memories, and associated feelings lose their power over the individual. This helps treat intrusive reexperiencing, which is a common symptom of PTSD in which the individual suffers severe psychological disorders from repeatedly reliving their traumatic memory. Prolonged exposure helps those suffering from PTSD learn new things about the event (often traumatic memories are fragmented, making it difficult to fully understand and come to terms with what happened). This can include learning how the event actually took place, reanalyzing the individual's role within the event, and finding new perspectives of their lives in order to reengage and reconnect with them. 

Before this intense form of therapy is done, patients often learn grounding techniques to combat dissociation, or the mental process of disconnecting from one's thoughts, feelings, memories, or sense of identity. Different methods of handling stress are discussed so that patients can better deal with their day to day lives after their appointment is over. These smaller, less daunting goals can significantly help a patient process their trauma via prolonged exposure in a healthier, more manageable way. 

PTSD therapy tends to be brief - usually around 3 or 4 months. In that time, individuals can "reconnect with their life, see their PTSD related symptoms go down, spend more time with people they love, and go back into the world - maybe even in places that were off limits to them because of the trauma," Bordieri explains. "That's one of the key things we work on, helping people really reclaim their life after trauma and get connected back into the world that matters most to them."

You can learn more about PTSD on the National Institute of Mental Health's website. "If there are veterans listening," Bordieri concludes, "The National Center for PTSD that's run from the Veterans Administration is a wonderful website that gives resources. The VA has wonderful treatments that are available, and calling your local VA or getting connected can find a way to get you connected with a provider who can provide those treatments."