Please help me welcome two very knowledgeable ladies to my blog today. These ladies share vast knowledge on the topic of Post-traumatic Stress Disorder, more commonly known as PTSD.
Ellen Kirschman, MSW, PhD.
First, welcome back Ellen Kirschman, PhD, Public Safety Writing Association buddy. Ellen has been on my blog before when we discussed Analyzing Cops. She is a PhD who has worked as a police psychologist for over thirty years.
And welcome Kathryn Jane, a Kiss Of Death writing buddy. Kathryn studied Human Psychology, Emergency Preparedness and Public Safety Communications in university and won a national scholarship by writing an extensive research paper on PTSD, Critical Incident Stress and Cumulative Stress Disorder as it relates to Emergency Services. As a certified Public Safety Communicator she trained in Emergency Police, Fire, Ambulance, and Airport dispatch, she has seen first-hand know how Critical Incidents affect everyone differently.
Ladies, thank you both for being on my blog today. There were a couple of reasons why I wanted to do this blog. First, I know there are lots of folks out there who have experienced PTSD at least once in their lives and some who live with PTSD on a daily basis.
PTSD is often associated with soldiers returning from war. But I want everyone to know that it can happen to anyone. Public Safety workers, victims of domestic violence, rape, victims of a natural disaster. I could go on and on with my list, but I think you get the point… It’s not just soldiers who suffer with it.
After my son Eric’s death, I had some PTSD experiences. To this day when I hear a gun going off (and I live in the country, surrounded by avid hunters) I jump out of my skin. And anytime I hear someone has died from suicide, especially someone young, it takes me back to the day he died. I hope this blog will help others out there who are experiencing this and they will know they are NOT alone as well as where they can go for help.
Moving forward, can you ladies tell me, what is PTSD?
Post-traumatic stress disorder is a painful emotional condition that develops in some people following exposure to:
1) A single extremely disturbing event such as combat, crime, an accident, or a natural disaster.
2) A series of such events. The psychological disturbance created by this exposure is so great that it significantly disturbs or impairs a person’s social interactions, ability to work, or to function in general.
The diagnostic criteria for PTSD must include a clearly identified trigger such as the threat of death, serious injury, or sexual violation. This is in contrast to other stress-induced conditions like cumulative stress which is the result of a buildup of what might be called micro-insults.
Further diagnostic criteria require that exposure occurred in one of the following scenarios:
a) The individual experienced the traumatic incident directly.
b) Witnessed it first hand.
c) Learned that a close family member or friend was the victim of a threatened or actual violent or accidental death.
d) Experienced first hand repeated or aversive images of the traumatic event. This last criterion about repeated exposure is especially important for first responders who will attend dozens of disturbing events in their careers.
To quote the academics:
“PTSD consists of three reactions caused by an event that terrifies, horrifies or renders a person helpless.”
1. Recurring intrusive recollections
2. Emotional numbing; constriction of life activity
3. A physiological shift in the fear threshold affecting sleep, concentration, and sense of security.
There are also four distinct clusters of behavioral symptoms that accompany PTSD:
Re-experiencing, Avoidance, Negative cognitions (tapes we play in our minds that are distorted) and moods, and Arousal.
The following composite example adapted from Counseling Cops: What Clinicians Need to Know (written with Mark Kamena and Joel Fay) shows how these four clusters can manifest in a police officer’s life.
“John responded to a call of a suicidal teenager. He talked to the young man who convinced John that the call was a prank and he was not suicidal. Minutes after John left on another call, the young man killed himself. John was devastated but couldn’t show his emotions. He was depressed and blamed himself (negative cognitions and mood). He couldn’t sleep and heard the teenager’s voice in his sleep. He believed the boy was calling to him because he had failed to save him (re-experiencing). At work he was terrified of getting deployed to another suicidal subject call and started missing work (avoidance). He was irritable with the public, his co-workers, and his family and received several complaints for being too aggressive on a mental health call (arousal).”
In less academic terms:
PTSD means that a person is experiencing specific symptoms at least 30 days after a catastrophic incident. It is a NORMAL reaction to a ABNORMAL event, a bone deep reaction that affects mental health, physical health, work, spirit, family and friends.
PTSD can be experienced by someone who has faced a single incident (usually one that made them feel completely helpless in the face of death), or by continuous exposure to psychological trauma such as that experienced by emergency workers, military personnel, public safety workers, or victims of abuse.
Are there different types of PTSD? If so, what are they called?
Critical Incident Stress is often confused with PTSD. CIS refers to the symptoms experienced in the days immediately following an incident.
PTSD refers to symptoms manifesting 30 days or more after the incident.
Critical Incident Stress can precede Post-traumatic Stress Disorder but it isn’t an expected progression.
There is also a category of trauma known as complex trauma. In simplest terms this refers to people who have histories of childhood abuse. John, in the prior example, grew up in an abusive, sometimes violent, home. As the oldest child, he believed it was his role to protect his younger siblings. The terrible burden John carried in childhood amplified the shame and failure he felt for not preventing the teenaged boy from killing himself. His feelings of helplessness were an echo of the helplessness he felt as a child.
What are the Symptoms of PTSD:
Symptoms fall into four categories: emotional, physical, behavioral and cognitive.
Emotional symptoms might include: numbness, irritability, depression and so on.
Physical symptoms can range from elevated blood pressure to a variety of medical problems with no diagnosable medical cause.
Behavioral symptoms involve sleeping problems, changes in personal habits, eating patterns, or use of drugs and alcohol.
Cognitive symptoms include difficulty concentrating, poor memory, problems with mental tasks and details, difficulty making decisions.
The range of PTSD symptoms is wide and diverse.
- Debilitating flashbacks or slide-show type memories
- Trouble with concentration and problem solving
- Suicidal thoughts and feelings
- Feeling alienated and alone
- Anger and irritability
- Guilt, shame, or self-blame
- Feelings of mistrust and betrayal
- Avoiding activities, places, thoughts, or feelings that remind you of the trauma
- Inability to remember important aspects of the trauma
- Loss of interest in activities and life in general
- Feeling detached from others and emotionally numb
- Insomnia – Difficulty falling or staying asleep
- Difficulty concentrating
- Feeling jumpy and easily startled
- Feelings of intense distress when reminded of the trauma
- Intense physical reactions to reminders of the event
- Sense of a limited future, don’t expect a normal life span
- Questioning the meaning of life
- Questioning of faith
What types of treatments are out there for folks who have PTSD?
There are a wide variety of treatments. Among them, Cognitive-Behavioral therapy and EMDR seem to be quite successful. The use of service dogs has become very popular for people dealing with PTSD.
Cognitive behavioral therapy (CBT) is especially helpful in the treatment of trauma. In simplest terms, the central hypothesis of CBT is that our thoughts or cognitions cause our emotional reactions. The goal of CBT is to challenge these negative thoughts and distorted beliefs, rescript them into positive cognitions, and gradually help clients reengage in activities they have been avoiding. CBT requires active participation by the client, including systematic desensitization (approaching the feared object or situation in gradual steps), tracking triggers and negative thoughts, journaling, relaxation, and meditation.
Prolonged exposure therapy (PE) is based on the principle that anxiety diminishes in the absence of danger. This is a structured treatment, lasting 8-15 sessions of 90 minutes each during which time the client retells the story of her traumatic experience over and over. It includes homework, journaling, education and breathing exercises.
Eye movement desensitization and reprocessing (EMDR) is based on the theory that traumatic memories are stored in the brain differently than non-traumatic memories. Under the direction of a therapist, the client processes the carefully targeted memory by stimulating both sides of the brain using alternating hand tappers, ear tones, or light bars or the therapist’s hand as it moves from left to right.
Virtual environment (VE) uses technology to create visual, auditory and olfactory reproductions of a traumatic event using lifelike avatars. It seems to work well with combat vets by recreating field experiences.
Post-traumatic growth (PTG) involves the client reappraising his or her experience in terms of growth and resilience. This is accomplished by employing some of the building blocks of positive psychology such as listing the positive consequences of the disturbing event and keeping a gratitude journal. Rather than focusing on the negative, PTG theorizes that many people become stronger, more compassionate, and more appreciative of life after a traumatic incident.
Two other recognized approaches to trauma do not necessarily include mental health professionals. Psychological first aid is an approach for assisting people in the immediate aftermath of disaster and terrorism. The goal is to reduce initial distress and to foster short- and long-term adaptive functioning. The Red Cross, the community and faith based organizations are often trained to provide this service.
Peer support offers victims the opportunity to talk with others who have survived similar traumas and are willing to assist the newly victimized.
Are there any medications that can help with PTSD symptoms?
There are many medications that can help. I recommend seeing a psychiatrist or a prescribing psychologist because they are the experts in medication used to treat psychological conditions. Some medications provide relief very quickly while others take several weeks to get into the system. There are also medications that help with sleep difficulties and nightmares. Be patient. Because everyone has a unique metabolism and neurological structure, it can take time to find the right medication at the right dose. Don’t be afraid to tell your prescribing doctor about side effects because they can be adjusted.
Are there any studies out there to predict what types of people may become more affected by PTSD than others?
In the last 10-15 years there have been several studies done that looked for predictors of PTSD among emergency personnel (Police, Paramedics, Firefighters, etc.), and some interesting trends and risk factors have been identified.
1. People who deal with trauma by mentally disengaging, using wishful thinking and practicing dissociative tactics may be at risk of developing PTSD.
2. A wide range of organizational and job stressors that could increase the risk among emergency workers were identified as:
a. Management inadequacies in the areas of training provided
b. Lack of recognition of a job well done and fairness in promotion
c. Personal disquiet over media reports
d. Long shift hours versus familial demands
f. Emotional fatigue
g. Lack of outside interests such as hobbies
h. Social detachment outside of the job
I’ve learned a bunch from you ladies! Thank you both so much for appearing on my blog and talking about a very important topic that affects a lot of folks.
Books by Ellen Kirschman include:
And Ellen’s website www.ellenkirschman.com where you can catch up on all of her appearances and new books she has in the works!
Be sure to check out Kathryn Jane’s Emergency Preparedness Class being offered through KOD. http://goo.gl/v3dZ7p Books by Kathryn Jane include:
Daring to Love is being offered on Brenda Novak Auction for Diabetes Research. Here’s the link: http://goo.gl/WND1VZ Kathryn Jane’s website is: http://kathrynjane.com
Below are some resources the three of us put together.
Until next time,
The American Psychological Association offers a great deal of information about trauma and other topics in psychology. They also can connect you with psychologists in your area. www.apa.org .
The Battle Buddy Foundation is funded by veterans to serve veterans. The Battle Buddy Foundation will pair veterans with service dogs and assist veterans suffering from PTSD with the many challenges they face on a daily basis. The Battle Buddy Foundation will also promote the reintegration of Combat Veterans back into society and the work force. http://www.tbbf.org/
Element Behavioral Health Creating Extraordinary Lives is a facility that offers treatment programs for PTSD and other mental health problems.
The First Responders Support Network (www.frsn.org) sponsors six day retreat for first responders suffering with post traumatic stress injuries. The program is peer driven and clinically guided. They have graduated more than 700 first responders. FRSN also sponsors three retreats for the spouses and significant others of first responders. More info about both is available at www.wcpr2001.org.
PTSD Foundation of America Providing Healing For The Unseen Wounds Of War is a website that offers programs like Warrior Groups, fellowships for combat veterans and their families to share their experiences, testimonies of healing, compassion and hope in overcoming the invisible wounds of war. Participants are required to be military combat veterans or family members of those who have served in combat and be willing to face the challenges of managing post-traumatic stress and related conditions. Camp Hope provides interim housing for our Wounded Warriors, veterans and their families suffering from combat related PTSD in a caring and positive environment, one-on-one mentoring by trained mentors, and a national outreach program for PTDS sufferers and their families.
Saddles For Soldiers Program is a program for veterans to reduce the suicide rate, provide a safe place to relax, learn new skills, assist in reintegration, provide life skills, provide referral, establish a bond with an animal, and to provide short and long term care in an holistic approach. This is a free service for veterans and their families. http://saddlesforsoldiers.org
The Ranch Treatment Center provides comprehensive trauma treatment for survivors of childhood and/or adult trauma of all types, including PTSD.
The Refuge Treatment Center offers a12-step based program that treats each person as a unique individual. They believe trauma is centered in the nervous system and telling the story in a nature setting helps the nervous system process the trauma.http://www.therefuge-ahealingplace.com/ptsd-treatment
The National Institutes of Health is a website that offers up to date information and statistics on PTSD.
Timberline Knolls Residential Treatment Center is a residential treatment center for women that offers therapeutic interventions for trauma.
Veterans and PTSD is a website that offers Veterans statistics from a major study done by the RAND Corporation: PTSD, depression, TBI, and suicide. http://www.veteransandptsd.com/PTSD-statistics.html
US Department of Veterans Affairs on The National Center for PTSD– revisions in the DSM5. This is helpful for researchers, providers and helpers.
The National Center for Telehealth and Technology, www.T2health.org, offers a number of free mobile apps that assist those with PTSD or stress management.
Facebook Support Groups and Pages:
https://www.facebook.com/HeroesAreHuman Canadian and they deal with emergency service workers and Canadian military.
https://www.facebook.com/battlebuddy – The Battle Buddy Foundation (TBBF) was founded by Veterans to Serve Veterans suffering from PTSD and other war related injuries.
https://www.facebook.com/ptsdusa – Foundation of America is a non-profit organization dedicated to supporting combat veterans and their families with post- traumatic stress.
https://www.facebook.com/ptsd.home – PTSD support and global awareness.
Guilford Press: If you know a first responder with PTSD, you might find Ellen’s books helpful: I Love a Cop: What Police Families Need to Know and I Love a Fire Fighter: What the Family Needs to Know. Both are available in print or as e-books from your favorite vendors.
Therapists working with police officers may be interested in Counseling Cops: What Clinicians Need to Know. Guilford also publishes Life after Trauma: A workbook for Healing by Dena Rosenbloom and Mary Beth Williams, Guilford Press. (www.guilford.com).
New Harbinger (www.newharbinger.com) publishes self-help books for the lay reader. They have several titles on trauma.
If any of my readers know of a PTSD resources they feel was useful, please e-mail me at: firstname.lastname@example.org and I will add them to my list.
Blog edited by: Sally Berneathy