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Post-Traumatic Stress Disorder Counseling in Broken Arrow for Tulsa Area Residents

By Alina Morrow, LPC

Disclaimer: The article below is for informational purposes only and should not be considered as direct advice, a personal diagnosis, or as an individual treatment plan. Always consult with a mental health professional or medical doctor if you have concerns.

Introduction and Overview

Definition: Post-traumatic stress disorder (PTSD) is an anxiety disorder that can develop after exposure to a traumatic event. A traumatic event is a highly unpredictable and unpleasant incident that produces intense feelings of distress, fear, horror, and helplessness. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), a traumatic event that can trigger post-traumatic stress disorder includes:

(1) direct personal experience with an event that involves actual or threatened death, physical harm, or serious injury,

(2) being witness to an event that involves death, injury, or threat to the physical integrity of another person, or

(3) learning about an unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or friend.

Initially, post-traumatic stress disorder symptoms were identified in war veterans as early as the American Civil War and were associated with events experienced during war (such as combat, being taken prisoner, torture, war conditions). However, the term that refers to the condition had changed over the years until it was formally accepted as post-traumatic stress disorder in 1980.

PTSD Triggers

Post-traumatic stress disorder can be triggered by a wide variety of incidents. The most common traumatic events besides combat and war exposure include:

  • being the victim or the witness of a violent attack (sexual or physical attack, robbery, mugging),
  • being the victim or witness of a terrorist attack,
  • being kidnapped,
  • being kept hostage,
  • being tortured,
  • being witness and victim of a natural or man-caused disaster (flooding, hurricane, tornado, earthquake, bombing, fire),
  • being the victim or witness of a severe car accident, train wreck, plane crash,
  • being diagnosed with a life-threatening illness or learning that a significant person (child, parent) was diagnosed with a life-threatening illness, or
  • finding out about the unexpected death of a family member or close friend.

When exposed to traumatic events, it is normal for individuals to experience intense feelings of fear, distress, horror, and helplessness, but when the event is over these feelings usually go away. Post-traumatic stress disorder is diagnosed when the traumatic event and its related distress feelings are re-experienced in the mind for a period longer then four weeks.

Individuals with post-traumatic stress disorder are easily startled, irritable, can be more aggressive and violent than normal, and manifest a lack of interest in activities that were previously enjoyable. They also experience an emotional numbing in relations with people they used to be close to and have difficulty feeling affectionate. Some individuals with PTSD describe painful feelings of guilt about surviving in conditions where others were unable to make it, or about the circumstances that help them survive. They have a hopeless perception about their future by expecting to not have a career, marriage, family, children, or a normal life.

An essential characteristic of post-traumatic stress disorder is experiencing "flashbacks" of the traumatic event. A flashback is usually a brief episode of "intrusive recollections of the event", either through thoughts during the day, or nightmares during the night. In rare cases, individuals can experience dissociative states (that can last between a few seconds to several hours or days) where the individual relives the traumatic event and acts as though the event is happening at that moment.

These flashbacks can be triggered by stimuli such as anniversaries of the traumatic event, or triggering events that resemble or symbolize an aspect of the traumatic event (being in an elevator for a woman that was raped in an elevator), and causes prolong psychological distress and physiological reactivity. These symptoms seem to be more severe or long-lasting if the traumatic event was deliberately initiated by another person.

Individuals with PTSD usually engage in deliberate avoidance behaviors such as avoiding thoughts, feelings, conversations, activities, situations, and even people that are connected to the traumatic event. When avoiding reminders of the traumatic event, the individual can develop amnesia (are unable to recall an important aspect of the event).

Post-traumatic stress disorder can affect the person's quality of life leading to marital conflicts, deteriorated interpersonal relationships, and occupational problems.

Approximately 7.8 million American adults suffer from PTSD at some point in their life. About 3.6 percent of U.S. adults age 18 to 54 will suffer from post-traumatic stress disorder during a given year. According to the Canadian Mental Health Association, 1 in 10 people are affected by PTSD. Both, adults and children, can develop post-traumatic stress disorder. It affects more women (10 percent) than men (5 percent), and is often associated with depression, substance abuse, and one or more of the other anxiety disorders.

Symptoms of PTSD

Symptoms and signs of post-traumatic stress disorder typically begin within the first three months of the traumatic event, but in some cases, can develop a few years later. In order for a diagnosis of PTSD to be established, these signs and symptoms must last for more then one month. When they occur for less then one month, then it is called Acute Stress Disorder.

Post-traumatic stress disorder symptoms are divided into three categories:

1. Flashbacks or recurrent re-experiences of the traumatic event. The traumatic event can be relived through upsetting memories or flashbacks. Flashbacks are usually brief episodes of "intrusive recollections of the event" (1) that can occur during the day or the night, as nightmares. During these flashbacks, the person breaks away from reality and relives the experience once again. These memories or flashbacks can be triggered by a sound, feeling, image, smell, or object that resembles or reminds the person of the traumatic event.

2. Avoidance patterns and emotional numbing. Individuals with PTSD avoid encountering any scenario that can trigger a recall of the traumatic event. This can include avoiding thoughts, feelings, activities, locations, conversations, situations, and people connected or associated with the traumatic event.

Individuals with PTSD experience a general numbing of emotional responsiveness that usually begins soon after the event. Initially, this symptom is more obvious for the individual itself than for those around them. They may withdraw from friends and family, experience hard time being a loving family member, feel detached and estranged from other people, and have difficulties feeling emotions, especially those associated with intimacy, tenderness, and sexuality. It is common for individuals with PTSD to experience a lack of interest or participation in activities that used to produce pleasure.

3. Chronic physical signs of hyperarousal. Individuals with PTSD have persistent symptoms of anxiety or hyperarousal. These symptoms include:

  • Sleep problems (difficulties falling or staying asleep due to recurrent nightmares)
  • Hypervigilance (they scan the environment as if looking for danger)
  • Irritability
  • Outbursts of anger
  • Exaggerated startled responses
  • Difficulties concentrating or completing tasks

In many cases, individuals with PTSD develop other psychological problems such as depression, substance abuse (either alcohol, or drugs), other anxiety disorders, and even suicidal thoughts.

PTSD Causes and Risk Factors

Researchers are still trying to understand what causes and increases the risk of developing post-traumatic stress disorder. However, it is believed that PTSD is caused by a combination of several factors including environmental, biological and psychological,

Environmental factors: post-traumatic stress disorder is associated with exposure to a traumatic event. Approximately, 60.7 percent of men and 51.2 percent of women have experienced at least one traumatic event during their life. However, encountering one traumatic event or more during the life span does not necessarily mean that the person will develop the disorder. According to statistics, only 5 percent of men and 10 percent of women are affected by PTSD.

The risk of developing the disorder seems to be influenced by:

  • The severity of the traumatic event.
  • The duration of the traumatic event
  • The proximity to the traumatic event (whether was experienced directly or witnessed).
  • The type of the traumatic event.
  • Whether the traumatic event was deliberately planned or accidental.
  • Whether the person was previously exposed to other traumatic events.

Biological Factors:
There are several biological theories that try to explain why people develop post-traumatic stress disorder.

Some researchers suggest that PTSD symptoms can be caused by dysfunctions of the amygdala. The amygdala is a structure of the brain and part of the limbic system that is involved in the expression of emotions (such as fear), autonomic reactions (such as increased heart rate and blood pressure, the startle response) and emotional memory. Dysfunctions in the limbic system can affect the functions of other brain structures such as hypothalamus and neocortex. Hypothalamus and neocortex are two brain structures that control regulatory functions such as sleep, rest, activity, feeding, and reproductive cycle, and monitor and assess what is new, dangerous, and gratifying.

Studies conducted on the influence of neurotransmitters in the development of PTSD symptoms suggest that the human brain, when exposed to trauma, undergoes intense bio-chemical changes that can lead to permanent impairments of the normal functions of the nervous system.

A traumatic event can alter the normal secretion of certain neurotransmitters, such as epinephrine, cortisol, norepinephrine, serotonin, and endorphins.

Epinephrine and cortisol are two neurotransmitters produced by the adrenal gland and they play an important role in the body's reaction to stress. Epinephrine is known as the "fight or flight" hormone, because it helps the body to cope with stressful events. Cortisol, also known as the "stress hormone", is produced when the individual faces threatening situations by increasing the blood pressure and the sugar level in the blood.

Norepinephrine is a neurotransmitter that helps the brain to be alert and solve problems, but together with epinephrine are also known as stress hormones. They are released in the brain when the body is exposed to stressful situations or trauma, but when present in high amounts can cause PTSD symptoms to develop. Increased levels of stress hormones also affect the memory. Researchers believe that amnesia, common in individuals with PTSD, is caused by excessive levels of norepinephrine released in the brain during trauma.

Serotonin is another neurotransmitter that can play an important role in PTSD symptoms. Reduced amounts of serotonin is associated with hyperarousal when exposed to new stimuli. Serotonin is also associated with hostility, impulsivity, and self-directed aggression.

Some studies also suggest a possible bio-chemical component involved in emotional numbing, a symptom common among individuals with PTSD. Emotional nonresponsivness can be caused by increased amounts of endogenous opiates (endorphins and enkephalins) which inhibit the pain and reduce panic. Opiates are released in the brain when individuals exposed to prolonged or repeated trauma encounter stimuli that trigger memories of the traumatic event.

Some individuals with PTSD have high levels of free tyrosine and total thyroxine, two thyroid hormones. These hormones are produced during extremely stressful events such as an earthquake, fire, or combat, and can increase the rate of metabolism.

Psychological Factors:
An important role among the risk factors of PTSD is the mental health status of the individual. The risk of developing PTSD increases if the person:

  • Was previously diagnosed with borderline personality disorder or dependent personality disorder.
  • Has a pre-existing anxiety disorder or is depressed.
  • Experienced pervious traumas.
  • Has a low self-esteem.

Also, studies suggest a possible connection between certain personality traits and PTSD symptoms. A study conducted on soldiers revealed that PTSD symptoms seemed to be more severe when the individual was exposed to a higher number of stressful events (shooting or dead people), but those that scored high on personality traits such as negativism and paranoia prior to deployment tend to show more signs of PTSD. Researchers believe that these results suggest that a hostile person perceives more "personal menace" in traumatic events and an anxious person may cope less effective with stressful events.

Another study conducted on firefighters suggested that traits such as high levels of hostility and low levels of self-efficacy can influence the development of stress-related symptoms. According to the study, "individuals with low levels of hostility may have better social coping abilities than those with high levels. Also, individuals with high levels of self-efficacy and confidence may be able to impose meaning on their traumatic experiences, thereby fostering recovery for them"

Counseling & Treatment

Post-traumatic stress disorder is a complex disorder that if left untreated can impair life functions. However, individuals with PTSD can regain control over their life and treat their symptoms with two effective treatment options, psychotherapy and medication.

I. Psychotherapy:
The psychotherapeutical intervention focuses on several key elements such as: re-exposure to trauma-related memories and stimuli, cognitive restructuring of the traumatic experience, expression and management of emotion, and stress management.

Some of the psychotherapeutical approaches effective in treating PTSD symptoms include:

A. Cognitive-behavioral therapy (CBT). Cognitive-behavioral therapy is one of the most effective psychological treatments for PTSD. It is a structured form of psychotherapy that combines methods from behavioral and cognitive therapies. The core beliefs of CBT is that our thoughts and not the external situations, people or events, trigger the behavior and feelings. For individuals with PTSD, cognitive-behavioral therapy aims to modify those behaviors and cognitions that were developed in response to the trauma and maintain the symptoms. CBT focuses around three important elements:

Psychoeducation, a step when the individual learns about the cognitive-behavioral model and the cause of their disorder.

Exposure, a step that targets the avoidance patterns encouraging the individual to identify feared stimuli and to confront them.

Cognitive restructuring, a step when the individual becomes aware of the dysfunctional cognitions by observing their own thoughts, identifying and challenging their maladaptive thinking patterns, and formulating new adaptive responses.

B. Eye movement desensitization and reprocessing (EMDR): Eye movement desensitization and reprocessing is a fairly new treatment approach for PTSD. It is a form of cognitive therapy that allows the individual to access and process the traumatic memories and the associated disturbing feelings while focusing on an external stimulus such as eye movement, hand-tapping, or aural stimulation. EMDR is a brief therapy where individuals with PTSD achieve emotional stress desensitization, physiological arousal relief, and cognitive restructuring.

C. Exposure Therapy: Exposure therapy is another form of cognitive behavioral therapy where individuals with PTSD are gradually exposed to the disturbing memories of the trauma in a safe setting. This form of therapy follows four steps:

Psychoeducation, a step where the individual learns about normal reactions to traumatic events and the cause of the PTSD symptoms.

Breathing retraining and relaxation, a step when the individual is taught a relaxation technique that allows a better control of the anxiety symptoms.

Imaginal exposure (exposure in vitro), a step when the individual confronts the traumatic memories using their imagination.

Real exposure (exposure in vivo), a step when the individual gradually approaches reminders or resembling stimuli of the traumatic event.

Exposure therapy seems to be effective in women that were victims or rape, assault, and child abuse, and in women and men that participated in combat and are victims of traffic and industrial accidents or violent crimes.

D. Cognitive Processing Therapy (CPT): Cognitive processing therapy is a treatment specially designed for individuals with PTSD due to a sexual assault. This form of therapy believes that PTSD symptoms are the result of a conflict between pre-trauma beliefs about self (such as "nothing bad can happen to me") and world and post-traumatic information (such as "the world is not a safe place").

In cognitive processing therapy, the conflict is called a "stuck point" and is approached by writing about the trauma. The individual has to write about their trauma using as many details as possible and then repeatedly read it loud during and outside the therapy sessions. The therapist helps the individual to identify the resistance points and dysfunctional cognitions.

II. Medication
In addition to the psychological treatment, certain medications can also be effective in treating post-traumatic stress disorder symptoms.

Antidepressants: Antidepressant medication can be prescribed for individuals with PTSD. Some of the most prescribed antidepressants for PTSD are Selective Serotonin Reuptake Inhibitors (SSRI's), such as Prozac, Celexa, Paxil, Luvox, Effexor, and Zoloft. This type of medication corrects the serotonin imbalance by blocking the reuptake of the serotonin from the synapse to the nerve and artificially increasing the serotonin that is available in the synapse. Serotonin is a neurotransmitter that controls the mood. The treatment with Selective Serotonin Reuptake Inhibitors seems to be effective in reducing the risk of relapse if is followed for a year.

Benzodiazepines (Tranquilizers): Benzodiazepines (such as Valium, Xanax, Ativan) are an anti-anxiety medication used because of their sedative effect. Unfortunately, benzodiazepine was not found to be significantly effective in treating PTSD symptoms, and was associated with several side effects, such as:

(1) the addictive effect and withdrawal symptom,

(2) the risk of overdose, and

(3) can interfere with some forms of psychotherapy (it affect the mental sharpness). However, in some patients benzodiazepines seem to help with sleep problems and bring improvements to the day-to-day functioning.

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Do you suffer from PTSD? Tired of what it is doing to your life? Contact Tulsa Therapist Alina Morrow, LPC, today to make an appointment and get the help and relief you deserve. You can reach me by texting or calling 918-403-8873 or by Email.

Page Last Updated: October 30, 2016

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