PTSD

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.

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.

 

Kathryn Jane

Kathryn Jane

 

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.

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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?

Ellen:

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.

 

Kathryn:

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.

 

Ellen:

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.

 

Counseling Cops, What Clinicians Need to Know       “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).”

Kathryn:

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?

Kathryn:

 

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.

Ellen:

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.

Kathryn:

The range of PTSD symptoms is wide and diverse.

  1. Debilitating flashbacks or slide-show type memories
  2. Trouble with concentration and problem solving
  3. Suicidal thoughts and feelings
  4. Feeling alienated and alone
  5. Anger and irritability
  6. Guilt, shame, or self-blame
  7. Hyper-vigilance
  8. Feelings of mistrust and betrayal
  9. Avoiding activities, places, thoughts, or feelings that remind you of the trauma
  10. Inability to remember important aspects of the trauma
  11. Loss of interest in activities and life in general
  12. Feeling detached from others and emotionally numb
  13. Insomnia – Difficulty falling or staying asleep
  14. Difficulty concentrating
  15. Feeling jumpy and easily startled
  16. Nightmares
  17. Feelings of intense distress when reminded of the trauma
  18. Intense physical reactions to reminders of the event
  19. Withdrawal
  20. Irritability
  21. Sense of a limited future, don’t expect a normal life span
  22. Questioning the meaning of life
  23. Questioning of faith

What types of treatments are out there for folks who have PTSD?

Kathryn:

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.

Ellen:

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?

Ellen:

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?

Kathryn:

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

e. Introversion

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:

Counseling Cops, What Clinicians Need to KnowscOw9ilac_cover_smilaff_cover_sm

 

 

 

 

 

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,

Happy Writing

Diane Kratz

 

Helpful Resources

Websites:

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.

http://www.elementsbehavioralhealth.com/trauma-ptsd/animal-therapy-ptsd-treatment/

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.

http://ptsdusa.org/what-is-ptsd/

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.

http://www.recoveryranch.com/treatment-programs/trauma/

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.

http://www.nlm.nih.gov/medlineplus/magazine/issues/winter09/articles/winter09pg10-14.html

Timberline Knolls Residential Treatment Center is a residential treatment center for women that offers therapeutic interventions for trauma.

http://www.timberlineknolls.com/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.

http://www.ptsd.va.gov/professional/PTSD-overview/dsm5_criteria_ptsd.asp

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.

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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/battlebuddyThe Battle Buddy Foundation (TBBF) was founded by Veterans to Serve Veterans suffering from PTSD and other war related injuries.

https://www.facebook.com/ptsdusaFoundation 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.

Books

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: authordianekratz@gmail.com and I will add them to my list.

Blog edited by: Sally Berneathy

 

 

 

 

 

 

 

 

43 thoughts on “PTSD

  1. Lani says:

    Great post! I’d love to know your experts’ opinions on EFT treatment? I have not read very much on it and just wondering if there are clinical studies for it? Also, I’m a firm believer in Nada Yoga and have worked with Yoga Warriors as well–great for all PTSD sufferers.

    • Hi Lani: you can read about evidence based treatments for PTSD in Counseling Cops, including yoga and meditation. We use yoga and meditation at the FRSN spouse and significant others’ retreats. Would like to incorporate them for first responders too but we’re constrained by time. Thanks for all you do. Yoga warriors sounds fascinating.

    • dianekratz says:

      Lani,
      Send me links on Nada Yoga and I’ll include them in this post.
      Diane

  2. crimeprof says:

    Diane…great idea for a blog topic and a great choice of people to interview. Ellen is awesome (We’re still buddies after all of our PSWA conferences!!), and Kathryn Jane is equally amazing, altho I don’t know her. Yet. And Ellen, I’ll definitely MISS YOU @ the conference. But….Diane and I will be there to terrorize those who need to be terrorized, so worry not. Hope we’ll see you @ the next one. Great job by all three of you.

    Pete Klismet, FBI (Retired)
    Author: “FBI Diary: Profiles of Evil”

  3. This is a wonderful blog and very helpful not just to writers, but to those who love people who serve in traumatic situations. Thanks for the information!

  4. Thanks Pete. Enjoy the conference.

  5. Arlee Bird says:

    Very thorough coverage of an interesting topic. I’ve got a novel in progress where the main character is suffering from what I would consider to be a sort of PTSD and is going through therapy treatment. This story takes place in 1965.

    My question is when was PTSD actually recognized by the psychologic community and would there have actual treatment at that time to address the issue of PTSD?

    Lee
    Tossing It Out

    • Kathryn Jane says:

      I’ll jump in here and say that I’m not sure when actual treatments began as I’m sure psychologists didn’t wait for the DSM (Diagnostic and Statistical Manual of Mental Disorders), to hang a label on the disorder before treating patients. But here is a bit of my research that may help you with this question 🙂

      “As veterans of World War I returned from battle seriously traumatized and experiencing symptoms such as disassociation, sleep disruption and poor concentration which were later recognized as those associated with Posttraumatic Stress Disorder, labels such as ‘shell shock’ and ‘combat fatigue’ were often used as identifiers.

      The event of World War II, (the return of similarly emotionally traumatized soldiers), led to the formal naming of the diagnostic category, Gross Stress Reaction, which was included in DSM-I – the first Diagnostic and Statistical Manual of Mental Disorders – published in 1952, by the American Psychiatric Association.

      Unfortunately, and due perhaps to the broad nature of cause and effect coupled with the fact that America was not currently at war, Gross Stress Reaction was dropped from the manual when the DSM-II was published in 1968.

      DSM-III was crafted in 1980, post-Vietnam when vast numbers of young men were struggling with symptoms which didn’t fit within DSM-II parameters….. Post-Traumatic Stress Disorder in two forms, Acute PTSD and Delayed PTSD were added.”

      Hope that helps!
      Kathy

      • Arlee Bird says:

        Excellent. Thank you! And now that I think of it I do recall seeing old post war films where there was reference to some of these issues though PTSD was not used. I think I even recall reading something about problems with some soldiers after the Civil War.

        Lee
        Tossing It Out

      • Hi Arlee: Kathy has said it all re the history of what we now know as PTSD. You mention the civil war. Have you seen Ken Burn’s documentary about the civil war? We use a portion of it at the West Coast Post Trauma Retreat. (Sorry I can’t give you a specific reference.) If you have a chance to see it, look for the letter written by a young soldier to his family. He gives a blow by blow description of his descent from idealistic soldier to a man wracked with deadly PTSD.

    • dianekratz says:

      Back in your time period the most common therapy used by most clinicians was psychoanalysis given to us by Mr. Sigmund Freud. Electric Shock Therapy may have also been used. PTSD has been called many different names though out the years: Nostalgia, Battle Shock, irritable heart, shell shock, and so on. Here is an interesting timeline on PTSD http://historyofptsd.wordpress.com/timeline-2/ . I hope it helps Arlee!
      Diane

      • Arlee Bird says:

        Good stuff. Thank you!

        Lee
        Tossing It Out

      • Arlee Bird says:

        Kathy, I have seen most of the Ken Burns series if not all. Just never in sequential order. This is probably one of the places where I had heard about the PTSD from the Civil War. It’s an excellent documentary.

        Lee

      • Arlee Bird says:

        Sorry, I meant to address my last comment to Ellen.

        Lee

  6. Great post! As a college instructor, I see increased rates of PTSD in my students because of returning vets. This was extremely helpful.

  7. dianekratz says:

    Thank you Ellen and Kathryn for visiting my blog today! You two are awesome!

  8. marsharwest says:

    Great post, Ellen and Kathryn. While I’ve read some on the subject and certainly seen my share of TV shows & movies that deal with this, your presentation was one of the clearest I’ve come across. Not to mention the extra links you included. Just returned from NYC and while the 9/11 museum wasn’t yet open the garden and fountains were. I encourage everyone to visit. It was quite moving.
    The husband of the heroine in my current WIP died when one of the buildings was hit. She left NYC and never returned despite the fact she has a daughter who now works there. I feel stupid that I never thought in terms of PTSD with her. Will need to give this more thought. Thanks for such an excellent presentation. I’ll be sharing.

    • dianekratz says:

      Marsha your the reason why I wanted to do this post. Most people see PTSD as a soldiers problem. It’s not just soldiers who suffer from this. I went to NY while they were building the New Towers.Just sitting there and looking at all the rubble beside I was amazed there wasn’t more damage than what there was. Very humbling experience. Thank you so much for stopping by and leaving a comment. Your friendship means so much!
      Diane

    • Kathryn Jane says:

      Don’t feel bad Marsha, not very many people know the labels or the details, but they do know that there is suffering.

      Your character clearly has issues, you’ve recognized that, which is the main thing! Now, if you want to explore that further, you have some new tools 🙂

      One of my favorite authors has a series heroine who clearly suffers from PTSD. She has flashbacks, nightmares, etc etc from an abusive childhood, yet, the author never ever mentions PTSD, which I think is brilliant!

    • Hi Marsha: PTSD is the core of my WIP, the second in the Dot Meyerhoff series. Dr. Dot Meyerhoff is helping a traumatized officer recover emotionally and psychologically after a tragic accident. When the officer attempts to apologize to the victim’s family, the results are catastrophic. As Dot tries to control the resulting damage, she risks everything, including her life.

  9. Kathryn Jane says:

    I should also mention that I’m teaching an online class — PTSD for fiction writers — in August, through the Outreach International Romance Writers chapter of RWA

  10. Grace says:

    Thank you for this post. I’d experienced PTSD after the army, and years later, after a traumatic family emergency (similar to Diane’s), and it took me a long time to recognize the symptoms. Just wanted to add that art therapy worked well for me, and that writing had been very helpful.
    ~Grace
    BTW… Wanted to add that Kathryns’s classes are amazing 🙂

    • Kathryn Jane says:

      aw, thanks so much Grace! And I’m glad you’ve been able to find help along your traumatic journey. Art is always a great way to express bottled up emotions. And as Ellen said, journaling is another great choice.

      I recently spent an afternoon talking about journaling with teenaged girls in a program called Empowered by Horses. It was wonderful to work with girls and help them develop coping tools. I gave them a goal to find positives as well as negatives by creating a sandwich pattern.

      For every negative or bad thing they wrote about they’d make note of two good things they were grateful for. Simple stuff like warm sun on their back, or hearing the birds singing when they woke up.

      • stgrace says:

        That’s a great tool you gave them, and I hope it’ll help them be more positive about themselves. The sandwich pattern reminds me of Julia Cameron’s affirmation technique to battle what she calls blurts (the negative thoughts), in her book the Artist’s Way. I started using this book recently, and found it very helpful.

  11. Hi Grace: Journaling is a known evidence based treatment for PTSD. Glad you found it helpful. Your post is an important reminder that traumatic events stack up. A current trauma will almost always trigger the memories and emotions connected to an earlier trauma.

  12. Such a great blog post, Diane! I’ve been contemplating a novel about a serial killer with PTSD from a childhood abuse history with a recent trigger that reinitiates the PTSD symptoms and his killing spree. The information and resources in this blog are outstanding and will provide much needed research for my novel. Thanks, Ellen and Kathryn, for sharing your expertise and a “hats off” to Diane for constructing this fabulous presentation.

  13. Kathryn Jane says:

    Diane, I’ve just finished my online course on PTSD, and I’ve shared the link to this blog, as well as listed the links you provided… thanks!

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