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Post-traumatic stress disorder (PTSD) assessment and therapy techniques

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Post-traumatic stress disorder (PTSD) assessment and therapy techniques

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What is post-traumatic stress disorder?

Post-traumatic stress disorder (PTSD) is a mental health condition that develops after a stressful, frightening or life-changing negative experience. This could include witnessing an act of violence, experiencing abuse, the death of a loved one, or living through a disaster or accident.

People who experience a traumatic event may have difficulties coping, and may need a period of time for recovery—that’s completely normal. However, if symptoms worsen or linger for months, that may be a signal it’s PTSD. Sometimes, symptoms don’t even start until years after an event. 

Symptoms

Symptoms associated with what we now know to be PTSD have been documented throughout history, from ancient Greek battles to Shakespeare to the Civil War. The mental health of veterans after WWI—a condition known as shellshock—pushed PTSD into a modern mental health understanding.

Symptoms of PTSD fall into some common categories:

  • “Re-experiencing” or intrusive memories: flashbacks, upsetting dreams or nightmares about the event, emotional or physical reactions (triggers) to something that reminds you of the event.

  • Avoidance: avoiding people or places that might remind you of the event, trying to avoid feelings associated with the event. Sometimes this causes people to drastically change their routines, such as avoiding driving altogether after a car accident.

  • Arousal: feeling constantly on edge, being startled easily, irritability that lingers, self-harming or numbing coping choices like drugs or alcohol, difficulty sleeping or concentrating.

  • Cognitive (thinking) and mood changes: distorted or unfair feelings of guilt or blame, negative feelings about yourself or the world, feeling emotionally numb or difficulty feeling joy, feeling detached from family/friends or difficulties maintaining close relationships.

These four symptom areas are defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that licensed mental health professionals use to diagnose disorders.

Typically, a therapist or medical professional will check if these symptoms are persisting for at least a month. Children may also experience PTSD, and their symptoms could include reenacting the event through play, frightening and disruptive nightmares, being clingy, forgetting developmental skills like toilet training or speaking.

Assessment

If you’re experiencing symptoms associated with PTSD, you may seek treatment yourself, or be prescribed medication or therapy (or both) from a medical professional. A therapist will run a screening assessment by asking a series of questions associated with the four symptom groupings listed above, and questions about your personal history. 

If a certain number of these symptoms are met, it may lead to a PTSD diagnosis. Everyone is different and everyone’s experiences are different. If symptoms of PTSD are due to an ongoing trauma, like abuse, there may also be symptoms of depression, anxiety, or other mental health conditions present, which could be diagnosed or addressed in treatment as well. 

Treatment

People with PTSD can benefit from a holistic approach to therapy, meaning the therapist will look at the full picture of these symptoms. For example, someone who is experiencing abuse may need tools and resources to remove themselves from that environment before addressing the repercussions of that experience. 

While some patients may be prescribed medication, many patients are treated very effectively with various modalities of psychotherapy, such as cognitive behavioural therapy (CBT). CBT addresses distorted thinking and helps us build healthier connections between our thoughts, emotions and behaviours. 

Some people may benefit from a form of CBT called prolonged exposure (PE). This treatment specifically targets avoidance, guiding patients through confronting the memories and therefore diffusing their fear of them. This helps people learn there is no current danger present.

There are also somatic therapies (body-focused) that have shown promise for treating symptoms of PTSD, such as eye movement desensitization and reprocessing (EMDR). A therapist will guide a patient through recalling the traumatic memory while they move an object in front of their eyes. By following those eye movements while addressing the memory, the brain creates new neurological connections to the memory and we can better cope or process that trauma in the present moment. 

People suffering from PTSD may have thoughts of suicide or death. If you or someone you know may be in danger of self harm or suicide, please get help. Call 911 for emergencies or contact the Canada Suicide Prevention Service hotline at 1-833-456-4566 (24/7) or text 45645 (4pm to 12am ET).

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