Rehab 4 Addiction

Post-traumatic stress disorder (PTSD) is an anxiety disorder that can result from a single particularly distressing incident, or a history of stressful occurrences.

It used to be referred to as “shell-shock”, and so there is a common misconception that only soldiers and war veterans experience PTSD.

Nowadays, we understand that traumas of any type or scale can cause post-traumatic stress, and treatment is often focused on easing the co-occurring symptoms while analysing the event that triggered it.

PTSD can cause sufferers to relieve the traumatic event through flashbacks and nightmares. These will often interrupt sleep, affect concentration, and can make it difficult to maintain a healthy social or work life.

Depression commonly occurs with PTSD, as well as generalised anxiety disorders, and phobias relating to the trigger.

It may take some time after the incident for PTSD to develop, and it is not always immediately obvious that new symptoms (commonly depression, anxiety, or irritability) have been caused by a past trauma.

If you seek treatment for any new mental health issues, your GP or therapist will usually ask about your history to see if they have been brought on by something in particular.

Those who have experienced multiple traumatic situations in their past, such as childhood neglect or domestic abuse, may be diagnosed with complex PTSD. The symptoms are much the same as PTSD, but treatment may need to be more involved as there is not an isolated cause.

Symptoms are often more severe if the traumatic experiences occurred during childhood, especially if the signs have not developed until adolescence or adulthood. This would likely mean that the individual’s childhood development was impacted, and the trauma may be deep-rooted before treatment starts.

Stressful situations, like car accidents, will normally leave people feeling rattled for a while after. However, if weeks or months pass and you find that you are being bothered by flashbacks, nightmares, or any new anxiety because of the event (such as when driving), it is worth consulting a GP.

If you have only recently begun to experience the symptoms of PTSD, or if your GP classifies your PTSD as ‘mild’, you may be advised to wait and see how it goes before commencing any treatment, but it is worth getting their input.

The sooner treatment for PTSD begins, the sooner those affected can return to a more comfortable life.

Medications for PTSD

Those suffering from PTSD are usually offered a combination of medication and talking therapies as part of their treatment plan. In order to fully overcome trauma, it usually needs to be processed during therapy.

What medication can do is treat any co-occurring mental health issues, like depression or general anxiety. Medications used to manage PTSD typically fall under the umbrella of antidepressants, as these have been found to be the most effective.

Antidepressants often prescribed for PTSD-related depression include:

  • Paroxetine – a selective serotonin reuptake inhibitor (SSRI), which increases the levels of serotonin (a mood-enhancing chemical) in the brain
  • Mirtazapine – also known by the brand name Zispin SolTab, this antidepressant often makes people feel sleepy, which can help if your PTSD affects your sleep
  • Amitriptyline – while this is commonly used to treat pain, its sedating effects can also help those who struggle to sleep due to PTSD
  • Phenelzine – a monoamine-oxidase inhibitor (MAOI), which was the first type of antidepressant ever developed. These have mostly been replaced by newer medications, but phenelzine is often prescribed to those who have not responded to other treatments

PTSD primarily affects our brain’s neurotransmitters, meaning that threats are perceived and processed differently. Due to this, PTSD can also cause psychosis and hyperarousal (the feeling of being on high alert), and both of these symptoms can be treated using anti-psychotics.

The main purpose of treating PTSD with medications is to rebalance the chemicals in the brain that have been thrown off by the trauma. They help the brain to produce more of the mood-enhancing chemicals, such as serotonin, supporting a brighter outlook which can help to facilitate the effects of therapy and counselling.

Everyone processes trauma differently, and so everyone’s experiences with PTSD are different. For that reason, medications are often prescribed to manage specific symptoms, such as depression or trouble sleeping, as they arise in each individual case.

Doctors may therefore prescribe a type of medication not covered here, or may not feel that medication is the right option in your case.

Whether or not you also have a substance abuse problem – regardless of whether it came about as a result of the trauma, or was pre-existing – will also affect the doctor’s decision to prescribe certain medications.

There are pharmaceutical drugs which can cause dependence or addiction, and so these will be avoided if you have a prior experience with substance abuse.

Common Psychological Therapies for PTSD

Approximately 1 in 3 people who experience a traumatic event will develop PTSD as a result. [1] Because the symptoms of PTSD can take a long time to develop, it is never too late to seek help, and treatment can still be effective even years after the event occurred.

The purpose of therapy for PTSD is to help those affected to manage their emotions, and become more resistant to perceived threats. Therapists and counsellors will teach you techniques that focus your mind during an anxiety attack, helping you to feel more grounded and relaxed.

For this reason, most talking therapies for PTSD are different forms of cognitive-behavioural therapy (CBT), which works on analysing strong feelings and changing the thought patterns that send you spiralling.

The following is not a comprehensive list of therapies for PTSD, but does include the ones that are the most common.

1. Trauma-focused cognitive behavioural therapy (TF-CBT)

As the name suggests, this is a form of cognitive behavioural therapy (CBT) that is designed to help those suffering from PTSD. It supports trauma survivors by recognising their unique needs during treatment, and has been found to be most effective for children and adolescents.

2. Brief Psychodynamic Therapy

This focuses on how our subconscious processes trauma, thereby increasing our self-awareness of how the past affects our present. It is therefore a common therapy for those with PTSD or a substance abuse disorder. Psychodynamic therapy has been around longer than modern cognitive-behavioural therapy, but shares a lot of the same principles.

3. Cognitive Processing Therapy (CPT)

CPT is a type of cognitive behavioural therapy that is usually delivered over a 12-week period, during which patients will learn how to identify and challenge distressing thoughts and feelings relating to their trauma. It is one of the most common treatments for PTSD.

4. Prolonged Exposure Therapy (PE)

PE can be a slightly more intense type of therapy, as it encourages patients to confront triggers of anxiety rather than try to avoid them. This can mean recounting the traumatic event to the therapist multiple times, so that you can learn to control your emotional response. You will be taught breathing exercises to help ease your anxiety, and slowly break down the triggers in order to learn how to cope with them.

5. Stress Inoculation Training (SIT)

SIT is similar to PE as you will have to think in detail about your traumatic experience, but will often take place in a group setting. You’ll sit quietly and learn breathing and self-massage techniques that will prevent the negative thoughts from turning into negative feelings.

6. Eye Movement Desensitization and Reprocessing (EDMR)

Having been designed in 1989, EDMR is a relatively new therapy for PTSD. It is based on the principle that emotional healing does not need to take years of therapy, and that, in fact, the mind can heal from trauma as quickly as skin heals from a paper cut.

The therapist helps the individual to identify a vivid visual related to the trauma, and asks them to hold the image in their mind. The therapist will then engage in ‘bilateral stimulation’, such as moving their hand from side to side, making tapping sounds, or playing alternating tones.

This bilateral stimulation enhances memory processing surrounding the visual the patient is keeping in mind, often prompting negative feelings, which the therapist will then teach them to manage.

7. Complementary and Alternative Medicine (CAM)

Complementary and alternative medicine refers to treatments that are substituted for, or integrated with, traditional Western medicine, including acupuncture, yoga, and meditation.

The efficacy of CAM is a topic of hot debate, as there is a lot of anecdotal evidence that supports it, but there have not been many standardised investigations into its use [2].

Still, many people find that incorporating some alternative techniques to their treatment plan is beneficial, particularly yoga and meditation.

Yoga

A study [3] that took place in 2004 supported theories that yoga practice can have a positive impact on those with PTSD. Similar to CBT, yoga helps practitioners to be more in-tune with their mind and body, and so it makes sense that many with PTSD find that it helps. It focuses on regulating emotions, clearing your mind of negative thoughts, and being present in the moment.

Meditation

As with yoga, practising meditation can teach those with PTSD how to centre themselves when their anxiety flares up. Learning how to ground oneself and regulate emotions is a large part of many PTSD treatments, and meditation can help people to achieve this without needing to consult a therapist.

Acupuncture

There have been many studies into the effectiveness of acupuncture for treating physical ailments, but in recent years it has also been found [4] to help with emotional and mental health issues. It was discovered that, when certain acupuncture points are stimulated during psychological therapy, it was possible to curb intense emotional reactions to traumatic memories.

How to Access Treatment for PTSD

Acknowledging your PTSD can be scary, but it is a necessary step to recovery. Seeking help needn’t be daunting, and there are several ways you can access treatment. These include:

  • Your GP – if you are seeking treatment via the NHS, your GP will usually be your first port of call. They can then make a referral to the relevant NHS service
  • Self-referral – if you don’t want to speak to your GP, for whatever reason, it is possible to self-refer to most NHS treatments, as well as private treatments
  • Private therapies – as wait times on the NHS can be long, you may wish to seek out private therapists in order to access treatment more quickly, and while this typically costs money, it might be covered by health insurance
  • Mental health organisations – organisations like Mind [5] have centres all over the UK, and also offer many services online

References

[1] https://www.nhs.uk/mental-health/conditions/post-traumatic-stress-disorder-ptsd/overview/

[2] https://www.ptsd.va.gov/publications/rq_docs/v23n2.pdf

[3] https://www.ptsduk.org/yoga-and-ptsd/

[4] https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/3458-post-traumatic-stress-disorder.html

[5] https://www.mind.org.uk/information-support/types-of-mental-health-problems/post-traumatic-stress-disorder-ptsd-and-complex-ptsd/about-ptsd/