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The Reality of Post-Traumatic Stress Disorder: Knowing the Signs and Treatment Options

By Sakina Rizvi, PhD Candidate in Pharmaceutical Sciences and Neuroscience

PTSD can occur following any traumatic event, from learning of the death of a loved one to witnessing a terrorist attack. However, not everyone who experiences trauma will develop PTSD. Researchers have found certain factors may predispose one to developing the disorder. Exposure to a previous trauma can sensitize the stress system in your brain, causing vulnerability to PTSD if a future trauma occurs. Additional risk factors include the simultaneous occurrence of other life stressors, pre-existing mental illness (e.g., depression, anxiety), and poor social support at the time of the event.

Signs and symptoms
When a traumatic event is followed by intense fear or helplessness, this is the first sign that PTSD could develop. Dissociative symptoms can also occur, where a person feels detached from themselves and their environment, has disruptions in body awareness and sensations that surroundings are not real, or experiences emotional numbing. An affected person may begin to experience nightmares or may frequently relive the traumatic experience during the day through flashbacks. They may experience trouble relating to family or friends and begin avoiding them as well as any situation that reminds them of the trauma they experienced, since these situations cause them intense physical and emotional distress. They may also find themselves with a lack of interest in things they used to enjoy, unable to concentrate, and prone to sudden outbursts of anger and irritability.

PTSD can comprise many physical, cognitive, emotional, and behavioural symptoms. Collectively, these symptoms can be distilled into three categories: (1) re-experiencing the trauma (e.g., nightmares), (2) avoidance of things or people related to the trauma and an overall numbing (e.g., estrangement from family/friends), and (3) increased arousal (e.g., anger). To be considered “current,” these symptoms would have to be ongoing within the last month. Importantly, symptoms may not emerge for weeks after the trauma.

Treatment for PTSD
Unlike other psychiatric disorders, PTSD is often not treated with medication unless other strategies fail (although medications can be helpful in treating particular symptoms, such as anxiety, depression, and sleep disturbance). The World Health Organization (WHO) recently published guidelines for treatment (requires Adobe Reader) that include individual or group cognitive behavioural therapy (CBT) with a trauma focus, eye movement desensitization, and stress management as first-line treatments. Non-invasive brain stimulation, called repetitive transcranial magnetic stimulation (rTMS), a Health Canada–approved treatment for depression, is also being explored as a therapy for PTSD—with the potential for promising results. It is important to speak to your doctor about the best course of treatment for you or your client.

First-line treatment

Cognitive behavioural therapy (CBT)
CBT is the most common treatment for PTSD and is recommended before medication is prescribed or alternative forms of therapy are discussed. In general, the goal of CBT is to address negative thought patterns and behaviours. During therapy, you will develop coping strategies and learn effective ways to deal with stress and problems in your life. This therapy has been effectively used for many years to treat depressive and anxiety-related disorders. CBT with a trauma focus has been adapted for the needs of individuals suffering from PTSD and aims to desensitize the individual to the fear and anxiety provoked by the traumatic event. In particular, exposure therapy, which involves re-experiencing the trauma in a safe space, helps patients work through the event and reduce fear associated with its memory; this may be included as a segment of CBT or used on its own.

CBT can be offered on an individual basis or in a group. Group sessions would include others with PTSD and provide a safe space to share and learn from other group members’ experiences.

Alternative forms of therapy

Other forms of therapy are being explored for PTSD. As they are still considered experimental, they are not widely available and must be provided by highly trained clinicians.

Eye movement desensitization and reprocessing (EMDR)
The goal of EMDR is to reprocess the memories associated with trauma and reduce their negative effects while developing more effective coping mechanisms. During therapy, an individual is led through the re-experience of trauma while moving the eyes side to side (desensitization) and then replacing negative self-perceptions related to the trauma with positive ones (installation). The use of EMDR remains controversial in Canada (requires Adobe Reader) due to lack of information regarding why it works. Visit the EMDR Canada website to find a trained therapist.

Repetitive transcranial magnetic stimulation (rTMS)
While PTSD is an anxiety-related disorder that is experienced both psychologically and physically, some researchers are working on resolving it at the level of brain circuitry. PTSD can result in overactive brain regions that are important in your fear response and for inhibiting distressing thoughts. The goal of rTMS is to alleviate this overactivity by using a magnet centred on a frontal region of the brain and delivering electrical stimulation. Although still undergoing research trials, the use of rTMS for PTSD has demonstrated promise (Aleman, 2013) and is associated with minimal side effects such as minor headaches and scalp pain (Loo et al, 2008). In Canada, this treatment can be received by referral to the MRI-Guided rTMS Clinic at the University Health Network in Toronto, Ontario. Other centres across Canada are also exploring rTMS for PTSD, including Vancouver Coastal Health in British Columbia.

Take home message
If you or a client have gone through a traumatic event and are experiencing symptoms of PTSD, it is never a good idea to suffer alone. Sharing the experience with a trusted individual and, more importantly, speaking with a doctor about available treatment options is the first step to recovery.