5.5: PTSD

What is PTSD?

Posttraumatic stress disorder, or more commonly known as PTSD, is identified by the development of physiological, psychological, and emotional symptoms following exposure to a traumatic event. While the presentation of these symptoms varies among individuals, there are a few categories in which these symptoms present.

One category is recurrent experiences of the traumatic event. This can occur via flashbacks, distinct memories, or even distressing dreams. In order to meet the criteria for PTSD, these recurrent experiences must be specific to the traumatic event or the moments immediately following. The dissociative reactions can last a short time (several seconds) or extend for several days. They are often initiated by physical sensations similar to those experienced during the traumatic events, or even environmental triggers such as a specific location. Because of these triggers, individuals with PTSD are known to avoid stimuli (i.e. activities, objects, people, etc.) associated with the traumatic event.

Another symptom experienced by individuals with PTSD is negative alterations in cognitions or mood. Often individuals will have difficulty remembering an important aspect of the traumatic event. It should be noted that this amnesia is not due to a head injury, loss of consciousness, or substances, but rather, due to the traumatic nature of the event. Individuals may also have false beliefs about the causes of the traumatic event, often blaming themselves or others. Because of these negative thoughts, those with PTSD often experience a reduced interest in previously pleasurable activities.

Because of the negative mood and increased irritability, individuals with PTSD may be quick-tempered and act out in an aggressive manner, both verbally and physically. While these aggressive responses may be provoked, they are also sometimes unprovoked. It is believed these behaviors occur due to the heightened sensitivity to potential threats, especially if the threat is similar in nature to their traumatic event. More specifically, individuals with PTSD have a heightened startle response and easily jump or respond to unexpected noises such as a telephone ringing or a car backfiring.

Memory and concentration difficulties may also occur. Again, these are not related to a traumatic brain injury, but rather due to the physiological state the individual may be in as a response to the traumatic event. Given this heightened arousal state, it should not be surprising that individuals with PTSD also experience significant sleep disturbances, with difficulty falling asleep, as well as staying asleep due to nightmares.

Although somewhat obvious, these symptoms likely cause significant distress in social, occupational, and other (i.e. romantic, personal) areas of functioning. Duration of symptoms is also important, as PTSD cannot be diagnosed unless symptoms have been present for at least one month.

Respondent Conditioning Approaches to Treating PTSD

While exposure therapy is predominately used in anxiety disorders, it has also shown great assistance in PTSD related symptoms as it helps individuals extinguish fears associated with the traumatic event. There are several different types of exposure techniques — imaginal, in vivo, and flooding are among the most common types of exposure (Cahill, Rothbaum, Resick, & Follette, 2009).

In imaginal exposure, the individual is asked to re-create, or imagine, specific details of the traumatic event. The patient is then asked to repeatedly discuss the event in more and more detail, providing more information regarding their thoughts and feelings at each step of the event. With in-vivo exposure, the individual is reminded of the traumatic event through the use of videos, images, or other tangible objects related to the traumatic event, that induces a heightened arousal response. While the patient is re-experiencing cognitions, emotions, and physiological symptoms related to the traumatic experience, they are encouraged to utilize positive coping strategies, such as relaxation techniques to reduce their overall level of anxiety.

Imaginal exposure and in vivo exposure are generally done in a gradual process, with imaginal exposure beginning with few details of the event, and slowly gaining more and more information over time; in vivo starts with images/videos that elicit lower levels of anxiety, and then the patient slowly works their way up a fear hierarchy, until they are able to be exposed to the most distressing images. Another type of exposure therapy, flooding, involves disregard for the fear hierarchy, presenting the most distressing memories or images at the beginning of treatment. While some argue that this is a more effective treatment method, it is also the most distressing, thus placing patients at risk for dropping out of treatment (Resick, Monson, & Rizvi, 2008).