About 90% of people will experience an event that they would describe as traumatic in their lifetime, such as the unexpected death of a loved one, a physical assault (including rape), witnessing a death, witnessing or being in a serious accident, or a natural disaster.
When talking about PTSD, what we are really referring to is having witnessed an event where there was either a fear of death or physical harm or where the death or physical harm took place. Sometimes, we can experience other types of events that are also traumatic, like finding out about an infidelity or a loved one asking for a divorce with no warning, an active and difficult infertility journey, the sudden loss of a job or position, etc. These can also cause great suffering and have a significant impact on functioning. But rather than being nested under a PTSD diagnosis, the symptoms could fall under an Adjustment Disorder (not PTSD) diagnosis: Please click here for more information on Adjustment Disorder.
It is perfectly normal to experience an initial reaction of shock, strong emotions (and/or numbness), difficulty concentrating (thinking of other things), nightmares, feeling vulnerable, etc., when faced with a traumatic event. For the majority, the intensity and frequency of these decrease over time, which allows us to function normally again and re-engage in our lives. We may be changed, but able to go on.
But for a fair number (about 8%), the symptoms don’t go away and they into develop post-traumatic stress disorder (PTSD).
Who is more at risk? The following factors play a role:
- Directly experiencing the event (versus witnessing someone else experience it): A quarter of those who experience a traumatic event themselves (vs. witnessing) will develop PTSD.
- Being traumatized by an event caused by a person (vs. a natural disaster).
- In the case of an assault: the intent of the assailant and the intrusive or dehumanizing nature of the assault.
- The unexpected and unforeseeable nature of the traumatic event.
- The emotions experienced during the event and whether dissociation was present during the event.
- Resemblance with past trauma or aspects of one’s current life (e.g., seeing a child be hurt who is the same age as our child).
- Pre-trauma factors: how one was doing prior to the event.
What is PTSD exactly? Experiencing the following for a minimum of one months following a traumatic event:
Re-experiencing the traumatic event persistently (e.g., through “flashbacks”, nightmares, etc.).
Responding with psychological distress and/or physiological reactivity when exposed to stimuli that are associated with the traumatic event
Persistently avoiding stimuli associated with the traumatic event (e.g., trying not to think or talk about the event, avoiding places, people or activities that elicit memories of the event, feeling detached or numb to pleasant feelings).
Experiencing:
Increased arousal (different from before the trauma)
Difficulty falling of staying asleep
Irritability or outbursts of anger
Difficulty concentrating
Hypervigilance
Exaggerated startle response
PTSD, if left untreated, can have a devastating impact on one’s life. It is associated with high rates of depression, anxiety and substance abuse. It can impact one’s ability to work and to maintain healthy relationships. CBT is a proven treatment for PTSD.
If you would like help, please contact us for more information or for an appointment.
Treatment
The first step is a careful evaluation to understand how the traumatic event is still affecting you now; how it is affecting your emotions, your functioning in daily life or at work, as well as your relationships.
The thoughts:
We can then provide psychoeducation about PTSD that is tailored to you and your symptoms. The goal of the psychoeducation is to help you understand that you are having a normal reaction to an abnormal event: It is the event that you experienced or witnessed that is not normal and for which we are not well prepared psychologically. You may need a hand to help you off the floor, but it is normal to fall when pushed this hard.
The symptoms make a lot of sense. For example, the nightmares are a way for your brain to try to integrate information that does not easily fit anywhere (as it is not a normal experience), whereas the hypervigilance is your body being on high alert since it was put through such a dangerous situation.
There is also work to be done on the emotions, which can seem to be working on an on-off switch following a trauma, instead of a well-graded one. This can look like either being almost always teary, crying, scared and/or angry, etc. or numb and cut off from one’s emotions. Working on emotions does not mean rigidly controlling them. It means being able to let them come, acknowledge them, name them, and express them; while being able to self-soothe and use self-compassion to respond to the emotions that emerge.
Of course, in CBT, there is always direct work with thoughts, and, in the case of PTSD, whether it is our view of the trauma and our response, or dealing with the views of others, there are many thinking patterns to be reframed. Our world was turned upside-down. There are common thoughts that are perfectly understandable following the experience of a traumatic event, but that are not (or at least entirely) accurate:
“The world/people are extremely dangerous”
“What happened was my fault”
“What happened to me is shameful”
With different cognitive re-structuring strategies, we can help you to challenge these thoughts to be able to hold more realistic and helpful ones.
The behaviours:
Whenever there is anxiety, there is usually avoidance. This can be avoidance of emotions, by numbing, avoidance of thoughts, by distracting, or avoidance of behaviour like going to certain places. In addition, with PTSD, there is the very strong physiological arousal, possibly with a host of thoughts, images, memories, that get activated by different stimuli. If, for instance, you were in a severe car accident, you may strongly react to cars simply passing by. A red car (if such a car was involved), may cause you to be startled and bring back memories (even just the same shade of red on any object may cause this response). It makes sense that in a case of extreme danger, our brain generalizes to associated things and marks them all as potentially dangerous. This is where the technique of exposure or systematic desensitization comes in.
In a very collaborative fashion, we would together make a hierarchy of the situations that elicit fear, from an intensity level of 1 to 10. For instance, driving back through the intersection where the accident happened may be a 10/10, but sitting in a car might be a 2/10. In between could be driving around the block during the day (4/10) versus at night (6/10), if the accident took place at night. We would then, together and on your own, go through these. If you can picture a flight of stairs, the top stair (10/10) may look unreachable when you start. But once you are on the 4th or 6th stair, it is only a few steps away and does not look as far out of reach. We would then progress on the hierarchy together, one step at a time, over a few weeks.
It is important to know that exposure is highly effective and is done at your own pace. We would never ask you to do anything that poses a clear danger, that you do not see the necessity or usefulness of, or that you are not up to doing. CBT is collaborative in nature, and we always do the exercises with you first and then together decide on next steps.
The same is true for exposure that is done in imagination (using your script), as for certain fears or for the traumatic memory itself, exposure cannot be done in-vivo. In this case, we would together write a script of the event or memory (what happened) and engage in a desensitization program together, whereby with repetition, the script/memory loses its ability to elicit a strong emotional debilitating reaction. This exposure can also be performed gradually in different ways: we can “cut” the story of the event in a few pieces (e.g., getting to the site of the event, the event itself, the time right after) and take it one piece at a time; or we can gradually immerse ourselves into it more (e.g., starting with only facts, then using the present tense, then adding the sensory elements that are part of that memory). In the hands of a well-trained CBT therapist, this exposure is highly effective.
Work on PTSD is demanding, but with the help of a compassionate, kind, calm and competent therapist, you can get over the strong emotions, distressing memories, flashbacks and nightmares, so that you can get back into your life. You may be changed, but post-traumatic growth is possible.
You don’t have to suffer alone. Let us help you with your PTSD.