| Imagine, if you will, that you are walking alone at night in | | | | problems.PsychotherapyOnce medications relieve the |
| an unfamiliar neighborhood. You think you hear | | | | most distressing symptoms a patient can then |
| footsteps behind you so you walk a little faster. | | | | concentrate on psychotherapy. A key element to |
| Suddenly someone steps out from behind a bush. You | | | | success here is beginning the initial medication |
| turn around but someone is behind you as well. They | | | | treatment within two weeks of the trauma. Then the |
| are both bigger than you and you are scared to death. | | | | goal of therapy, breaking the pattern of self-defeat by |
| Possibly you are mugged or raped. Maybe you | | | | reexamining the traumatic event and the patient |
| escape harm, but you've still had a harrowing | | | | responses to it, can begin. Education about the disease |
| experience. You could end up suffering from | | | | and recognition of cues or situations that trigger |
| Posttraumatic Stress Disorder (PTSD) if you have an | | | | symptoms are invaluable. Complete education and |
| experience like this or have exposure to any real or a | | | | healing consists of:* ExposureExposure to the event |
| perceived life-threatening trauma where you | | | | via imagery allows you to reexperience the event in a |
| responded with intense fear.PTSD is a medically | | | | safe, controlled environment where your reactions can |
| recognized anxiety disorder that occurs in normal | | | | be monitored.* ExaminingExamining feelings such as |
| individuals under extremely stressful situations. | | | | anger, shame, guilt, etc. allows you to work on resolving |
| Symptoms may appear immediately and then | | | | these feelings.* New Coping SkillsNew coping skills |
| disappear after several months. At other times | | | | teach you how to handle reminders, reactions and |
| symptoms may take up to 6 months to emerge and | | | | feelings without becoming overwhelmed or emotionally |
| may never completely go away. Half of those who | | | | numb. This can help foster your relationships with |
| meet the DSM-IV criteria for PTSD will still suffer from | | | | others. Some of the techniques used are:* Relaxation |
| symptoms a year after diagnosis and 1/3 will still have | | | | (i.e. breathing techniques, visualization)* Biofeedback* |
| weekly symptoms ten years after the | | | | Cognitive restructuring* Managing Anger* Preparing for |
| trauma.CRITERIA FOR PTSD* Exposure to a | | | | stress reactions* Addressing urges to use alcohol or |
| traumatic event marked by intense fear, helplessness | | | | drugs* Communications and relating effectively with |
| or horror* Symptoms from each of the three | | | | peopleGroup treatment has also proven to be quite |
| symptom clusters:* Intrusive recollections (evoke panic, | | | | helpful for PTSD sufferers. This type of setting allows |
| fear, dread, nightmares, grief, despair, daytime | | | | you to share with others who are more empathetic to |
| fantasies, etc.)* Avoidant/numbing symptoms | | | | your feelings. Being able to share instills more |
| (avoidance of trauma related stimuli, trouble leaving the | | | | confidence and helps you to trust again. After being |
| house, cannot tolerate strong emotions, etc.)* | | | | allowed to share your trauma you are freer to engage |
| Hyperarousal symptoms (symptoms resemble panic | | | | proactively in current relationships.Eye Movement |
| attacks, generalized anxiety, insomnia, irritability, startle | | | | Desensitization and Reprocessing (EMDR)This is a |
| response, hypervigilance that may come across as | | | | relatively new treatment that combines elements of |
| paranoia)You may also use the mnemonic | | | | exposure therapy, cognitive behavior therapy and then |
| "DREAMS"D = DETACHMENTR = | | | | uses techniques (eye movements, hand taps, sounds, |
| REEXPERIENCING THE EVENTE = EVENT HAD | | | | etc.), which creates an alteration of attention back and |
| EMOTIONAL EFFECTSA = AVOIDANCEM = | | | | forth across the person's midline. Fourteen controlled |
| MONTH IN DURATIONS = SYMPATHETIC, | | | | studies have been done on EMDR. The last five done |
| HYPERACTIVITY OR | | | | on trauma patients (abuse, rape, accident victims, etc.) |
| HYPERVIGILANCESTATISTICSCertain populations | | | | have found that 84-90% of the individuals suffered no |
| are more at risk than others. Here are just a few | | | | PTSD after only three sessions. In a study for combat |
| examples:* 2% in post-partum women* 18% in | | | | veterans, 77% showed no PTSD symptoms after |
| professional fire fighters* 34% in adolescent survivors | | | | twelve sessions. Like all therapy the progress rate |
| of car accidents* 48% in female rape victims* 67% in | | | | depends on the individual and the type of trauma. To |
| prisoners of warUp to 80% of patients with PTSD will | | | | administer EMDR, therapists must undergo special |
| have a comorbid psychological or psychiatric disorder. | | | | training.Although PTSD manifests itself in a wide |
| The most common diseases that occur with PTSD | | | | variety of symptoms there is a common factor. If you |
| are:* major depression* substance abuse* dysthymia* | | | | have lived through any type of experience that has |
| bipolar disorder* generalized anxiety disorder* panic | | | | caused you to feel threatened by death (either real or |
| disorder* phobias* dissociative | | | | perceived) or threatened serious physical injury to |
| disordersTREATMENTSMedicationsTypical first line | | | | yourself or to others, and you felt intense fear, horror |
| treatment is with selective serotonin reuptake inhibitors | | | | or helplessness, you could be suffering from PTSD |
| (SSRI's) such as Prozac, Paxil, Zoloft or Lescol. | | | | and may not even be aware of it. If you have |
| Trazadone and nefazadone (Serzone) are being | | | | experienced a traumatic event, lived an abused life, or |
| re-studied since the have SSRI properties and they | | | | cannot deal with something that you were confronted |
| also reduce or suppress REM sleep, thus reducing or | | | | with, please seek the help of a professional. No one |
| eliminating nightmares. Tricyclic antidepressants and | | | | should have to live a life in constant fear or |
| MAOI's have been tried but there is no proven | | | | helplessness.Terry J. Coyier is a 37-year-old college |
| efficacy for these types of | | | | student studying for an Associates of Applied |
| medications.Benzodiazepines were once the first line | | | | Sciences degree. She is also a freelance writer who |
| of treatment but the efficacy has not been proven in | | | | writes about bipolar disorder and other mental illnesses. |
| controlled studies. They can also cause dependency | | | | Terry was diagnosed with bipolar ten years ago. She |
| problems for people who must deal with substance | | | | lives with her son in the Dallas/Ft. Worth Metroplex. |
| abuse issues. These types of medications also come | | | | Terry is an author on which is a site for Writers and |
| with a variety of discontinuation | | | | her personal portfolio can be viewed here. |