An extremely frightening or distressing event such as a serious accident, assault, or rape can sometimes inflict a psychological injury that lasts much longer than the event itself. The emotional shock which follows is called post-traumatic stress disorder, or PTSD. The symptoms of this disorder fall under three categories:
- Avoidance – After exposure to a traumatic event, many people begin avoiding situations and activities that remind them of the event. Additionally, you might begin to avoid emotional experiences that remind you of the trauma, and this can produce feelings of emotional numbness or difficulty remembering important parts of the traumatic event.
- Hyperarousal – This includes a lot of more common anxiety symptoms like feeling jumpy, tense, or irritable; being easily startled; and having trouble sleeping or having poor quality sleep.
- Re-experiencing – This can come in the form of nightmares; recurrent, intrusive thoughts or images; or suddenly feeling like you’re back in that traumatic experience.
A Neurological Explanation of PTSD
There are two memory centers in the brain, one of which controls the storage of sequential, autobiographical memories (the hippocampus) and another which controls the storage of emotional memory (the amygdala). Ordinarily, the two work in tandem, producing rich memories that unite the details of an event with its emotional flavor. However, severe stress causes problems in the hippocampus, preventing clear memories from being formed there. This results in powerful emotional memories that are dissociated from the context in which they were experienced. Therefore, the feelings of terror become generalized, and you begin to respond to a variety of loosely-connected situations as if they were a part of the traumatic experience.
The Role of Personality in Post-Traumatic Stress
Going by that neurological theory alone, the severity of the stressor should determine the severity of the PTSD symptoms. But the reality is that some people are more susceptible than others, and personality factors seem to be more predictive of PTSD severity. The characteristic ways that a person relates to themselves, the world, and other people — the attachment style — can either exert a protective effect or create a heightened susceptibility to traumatic stress. Therefore, in my opinion a comprehensive treatment for PTSD should address not only the symptoms of trauma, but also the underlying vulnerability which allowed those symptoms to develop.
Approaches to Treating PTSD
While much of my clinical training focused on the assessment and treatment of complex and childhood trauma, I have also worked with combat veterans both within the VA system and in private treatment settings. recently spent a year training in a VA hospital where I gained a lot of experience working with veterans suffering from PTSD after exposure to acute trauma. The PTSD treatments in widest use at the moment are Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy (PE). In practice, I prefer to incorporate aspects of these treatments into a more comprehensive and holistic treatment approach that includes attachment-based and relational psychotherapy. In cases where it is appropriate, hypnosis can often help to dramatically accelerate the healing process.
- Cognitive Processing Therapy aims to re-integrate dissociated traumatic memories, so that the feelings connected to them will no longer generalize to other situations. This is done by examining the details of the traumatic event and the symptoms associated with it while in a relaxed state of mental detachment.
- Prolonged Exposure Therapy is based on the behavioral principle of habituation, which just means that you can get used to the feelings of anxiety and so they won’t bother you as much. People experiencing PTSD avoid thoughts, emotions, and situations that remind them of the traumatic event because they fear they will not be able to withstand the intense anxiety these stimuli trigger. PET aims to help patients to confront their fears in a gradual, structured, and supportive way. I’m not a fan of exposure-based therapies for trauma, as in my experience many people are re-traumatized by them, causing symptoms to worsen. My work with PTSD focuses on fostering feelings of safety and security, rather than trying to extinguish fear and avoidance.
- Attachment-focused and Relational Psychotherapy address problems with the way a person relates to self and other, by helping to reshape the social preconceptions formed in early life. This helps not only to relieve symptoms of PTSD, but to open the doors to more lively, spontaneous, and satisfying social interactions in daily life.
- Hypnosis is a powerful psychological tool which can be used to enhance other types of therapy described above by eliminating mental distractions, interrupting habitual patterns of thought, and producing corrective internal experiences.
I believe strongly in the idea of treating the whole person, not just a collection of symptoms. That’s why, when I begin working with a person, I don’t just assess the symptoms. I need to know about their early life, core beliefs, and social and emotional functioning so that I can develop a customized treatment. Then you can address all the related factors — including the immediate symptoms, but also the underlying causes, and any systemic weaknesses that would be likely to cause more suffering in the future.