Many people have a traumatic experience at some time in their lives. Trauma can result from experiencing an event (or events), being a witness to one or being confronted with its immediate aftermath. Most people manage to recover from the effects and are able to get on with their lives without any lasting problem. Others find that while they may have been able to cope initially, they find themselves afflicted by distressing symptoms related to the traumatising event(s). In some cases this is a few months later while in others, it may be longer.* The diagnosis of Post-Traumatic Stress Disorder recognises the potential delay in the onset of mental and physical reactions and their life-disrupting nature. It is not necessarily confined to a single episode but can recur, sometimes without warning.
What is trauma?
What makes experiences traumatic is that they deliver an overwhelming degree of concentrated stress to the nervous system. This can take the form of a substantial acute shock or a prolonged or recurring assault on the nervous system, impairing the capacity to cope. Any sense of control is weakened or lost in the face of sensory, cognitive and emotional overload. It is now recognised that the impact of trauma can be so severe as to alter areas of the brain that mediate emotion and behaviour.
Experiences that are most obviously traumatic include warfare and natural catastrophes like floods, earthquakes, or fires. On a smaller scale, events such as serious accidents — especially those causing injury — as well as violent assault, life-threatening health problems, sudden death of a loved one and in some cases childbirth, are potentially traumatising experiences. Being a witness to such events, especially if occurring to people close to us, may have a traumatic impact. Exposure after the fact to the aversive aspects of a traumatic event can also be traumatising, something commonly experienced by first responders. Refugees experience the traumatic disruption of life, with families often torn apart and members sometimes trafficked.
Responses and reactions – the onset of Post-Traumatic Stress Disorder
While not everyone reacts to traumatic experiences in the same way, the effects can be profound, lasting and life changing. Some people experience a strong initial reaction but with help and support manage to process it and move on. Others are not so fortunate, suffering from a range of troubling symptoms that in meeting the diagnostic criteria, indicate PTSD and therefore require treatment.
Perhaps the symptom with which people tend to associate PTSD are flashbacks to the traumatising event or situation. Sufferers tend to have great difficulty sleeping and flashbacks may come in the form of nightmares. While awake, certain stimuli can involuntarily trigger intrusive memories of the trauma. Panic attacks are not uncommon. A person may become hyper-vigilant, permanently attuned to potential threat and generally irritable, if not angry and aggressive. They may be easily startled or indulge in reckless behaviour. This, coupled with more general difficulty in regulating emotion, may adversely impact interpersonal relationships. Negativity often becomes a pervasive state of mind, including being overcome with feelings of being less-than or worthless, expecting little of themselves as a result. Sufferers may ruminate as to why the trauma happened to them and why they couldn’t or cannot do anything about it. They may report becoming emotionally numb and feeling detached from themselves, other people and activities that they may once have enjoyed. They may be troubled by a sense that things are not real. As a way of lowering the risk of trauma memories being triggered isolation and avoidance of situations may follow.
PTSD may be masked by other disorders
When considering a diagnosis of PTSD, clinicians take into account seemingly unexplained physical symptoms which might include various aches and pains, skin complaints and gastro-intestinal problems. It is also necessary to assess for PTSD when treating people who present with an anxiety disorder, depression or addictive disorders. It is quite likely that people with undiagnosed PTSD self-medicate with substances and/or behaviours.
Following thorough psychiatric assessment, the preferred treatment methods for PTSD are so-called talking therapies like Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitisation and Reprocessing (EMDR), which are sometimes combined with careful and limited use of medication such as a selective serotonin re-uptake inhibitor (SSRI) when symptoms are particularly severe and persistent. The opportunity is taken to initiate recovery from any co-existing addiction which, if ignored, would not only hinder recovery from PTSD but might well exacerbate it.
For some people, what is referred to as active or watchful monitoring may be all that is required as trauma-related problems often improve within a few weeks. A subsequent check-in for reassurance is essential, however. For those needing more, CBT sessions will focus on re-shaping thought patterns and beliefs that may be identified as unhelpful. Through increasing insight about the effect of the trauma and how they have reacted to it in more or less helpful ways, the person can assume greater control rather than feeling at the mercy of the trauma and its related symptoms. Learning stress management techniques may also play a part in restoring resilience and confidence. Group sessions with fellow sufferers can help to reverse the tendency to isolate through identification and mutual support.
The therapeutic environment
The chances of recovery from PTSD may be enhanced by leaving the pressures of everyday life for a while and entering an environment such as the one provided by our luxury private treatment centre, here at Clinic les Alpes. The consistently high quality of care and support that is offered by empathic and highly skilled clinicians and therapists in a safe, secure, comfortable and calm environment is likely to prove reassuring, enabling the individual to take the time needed to focus on recovery. A holistic approach is possible given the resources available, ranging from mindfulness, equine assisted therapy, art therapy, all the physical therapies of a fully equipped spa, as well as expert help with sleep hygiene and nutrition. Beautiful natural surroundings add a special therapeutic dimension of their own to ease tension and distress while refreshing the spirit.
*While children may suffer from PTSD and require treatment, it is generally when symptoms consistent with the diagnostic criteria occur quite close to the traumatic event or circumstance. It is nonetheless understood that childhood trauma may have a lasting harmful impact, leading to a range of problems in adulthood, including addiction and psychiatric disorders. These psychological reverberations, however, are not generally classified as PTSD.