Post Traumatic Stress Disorder (PTSD)

TREATMENT OF PTSD

Treatment of PTSD must target the symptoms of re-experiencing, avoidance/numbness, hyper-arousal and the other psychiatric disorders that emerge post trauma. At present, there is no one treatment for PTSD. Pharmacotherapy used alone or simultaneously with psychological therapies is considered the most efficacious approach. Psycho-education is fundamental with emphasis on educating the “why” of symptoms.

DRUG ASSISTED THERAPY

Pharmacotherapy ought to be commenced early and long - term treatment is often the norm. For some, treatment response is slow. The Selective Serotonin Reuptake Inhibitors (SSRIs) listed in Table 5 are the most extensively investigated, widely used and viewed as the most effective medications in the treatment of PTSD.

The SSRIs are an attractive choice of antidepressants in that they not only treat PTSD but also the other psychiatric disorders that may emerge with PTSD. Efexor - XR (Venlafaxine), a serotonin noradrenaline re - uptake inhibitor (SNRI) has also been shown to be effective. The benzodiazepines, Xanax (Alprazolam) and Rivotril (Clonazepam), widely used in combination with an antidepressant are particularly helpful with controlling the hyper-arousal symptoms listed in Table 1. Disadvantages of the benzodiazepines are the development of physical dependence and withdrawal symptoms on discontinuation. An advantage is the rapid onset of action, a factor often appreciated by the sufferer.

PSYCHOLOGICAL THERAPIES

Historically, it was considered that talking about your trauma, often repeatedly, was an effective treatment, this is now disputed. You need to take action, action that will overcome your sense of helplessness, despair and restore your coping abilities and sense of wellness. It is the psychological therapies listed below that are most helpful in this restorative process.

Psychological Debriefing/Psychoeducation

Studies into debriefing immediately post trauma have been shown to be without effect in preventing PTSD. Some studies do suggest, however, that this intervention maybe helpful in the sufferer learning that they are not alone in their symptoms and reactions. Education about symptoms is imperative.

COGNITIVE BEHAVIOURAL THERAPY (CBT)

Cognitive Therapy
Those who develop PTSD see the world as threatening and dangerous and doubt their ability to cope. Cognitive therapy, initially, is directed at identifying the thoughts and beliefs, which contribute to the sufferer viewing the world as dangerous. The second step is to challenge those thoughts and beliefs, recognising that the cognitions stem from the trauma. The third step is to replace the thoughts with ones that are more realistic. The outcome of cognitive therapy enables the world to appear less dangerous and enhances ones coping ability. Studies show that cognitive therapy can achieve a 60% reduction in symptoms.

Behavioural Therapy

a. Stress Inoculation Training
Stress Inoculation Training is the acquisition of techniques to minimise anxiety and enhance coping skills. These techniques include thought stopping, relaxation training particularly diaphragm breathing and progressive muscle relaxation, techniques that minimise and enable one to manage the anxiety symptoms associated with PTSD.

b. Exposure Therapy
This therapy seeks to discontinue the overwhelming fear associated with the trauma, to minimise the impact of emotional or physical cues that may trigger the fearfulness and to recognise that we can again become comfortable with the situation we perceive as dangerous, a process called habituation. When habituation occurs, the situation is no longer fearful and anxiety symptoms remit. The individual can cope recognising that the fears are just fears and the situation need not be avoided. Exposure therapy can be undertaken either using imaginational strategies or "invivo" in which the site of the traumatic event is entered or features of the trauma confronted. Exposure, regardless of kind, is undertaken in a graded manner, the least threatening component exposed first. These modes of therapy require that the therapist is fully aware of all aspects of the trauma.

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