Understanding and treating PTSD
Welcome to Priory Bitesize. This month we spoke to Dr Angela Marston, Sessional Therapist at Priory Wellbeing Centre Southampton. We discussed the mental health condition post-traumatic stress disorder, otherwise known as PTSD.
PTSD is a psychiatric condition that may be suffered if an individual experiences a particularly traumatic occurrence outside normal experience. The condition can cause significant distress in a person's life and can interfere with one's ability to go about normal everyday tasks. PTSD can also affect an individual’s ability to maintain relationships, concentrate on work and in some cases, interact with their environment and those around them.
Support and treatment for PTSD
It is estimated that 1.5% of England’s adult population suffers from PTSD. That's over 700,00 people and research shows that much less than half this number will go to their GPs for help.
This article discusses the importance of finding the correct support and treatment for PTSD. It also explores the different types of therapy available once an individual has been diagnosed, which can help to significantly improve symptoms of PTSD.
As mentioned above, PTSD occurs when someone experiences or is witness to a traumatic event. Exposure to such an event can also happen if a person is repeatedly exposed to graphic details of a traumatic event (for example first response to the scene of a traumatic event).
Signs and symptoms of PTSD
It is important to recognise the signs and symptoms of PTSD as early as possible. They usually occur within six months of the traumatic event. Symptoms can be both psychological and physical and include:
- Reliving experiences of the traumatic event, such as having distressing memories
- Having upsetting dreams about the event
- Experiencing flashbacks as if you were experiencing the traumatic event again
- Experiencing ongoing or severe emotional distress
However, symptoms can manifest up to a year later and may include:
- Trying to avoid situations or things that remind you of the traumatic event
- Not remembering important parts of the event
- Viewing yourself and others in a negative way
- Losing interest in activities you used to enjoy
- Feeling detached from family and friends
- Feeling irritable or having angry outbursts
- Engaging in dangerous or destructive behaviour
- Feeling as if you are constantly on guard or alert for signs of danger and startle easily
- Having trouble sleeping or concentrating
- Headaches, dizziness and chest pains
Essentially, it is important to source the correct support for someone who is suspected of having PTSD. Psychotherapy is usually recommended first. A combination of medication may be recommended if you have severe or persistent PTSD.
Therapy options available
The main types of therapy used to treat people with PTSD are:
Eye movement desensitisation and re-processing(EMDR)
EMDR uses the natural healing ability of the body, using repeated eye movements to help the brain process the memory in such a way that it loses its painful intensity. While concentrating on a traumatic experience, special rapid eye movements will help a person through the healing process and improve their confidence.
Trauma-focused cognitive behavioural therapy (CBT)
This treatment uses a range of psychological treatment techniques to help the individual come to terms with the traumatic event. CBT helps them understand their thought processes and how to change feelings and reactions to symptoms.
One other form of CBT is exposure therapy, which is unique to treating trauma. This involves a person imagining the trauma in a safe, controlled environment to help them face their fears. This enables our specialists to examine reactions to the event and help the individual overcome anger, shame or guilt. This will enable them to deal with the post-traumatic memories and feelings without becoming overwhelmed or emotionally numb.
As some people find it helpful to speak about their experiences with other people who also have PTSD, group therapy can be used to teach ways to manage symptoms and help the individual understand the condition.
Medication can be a useful adjunct to psychological therapy for the treatment of PTSD or in place of psychological treatment if the patient is unwilling or unable to engage in therapy. Selective serotonin reuptake inhibitors (SSRIs) such as Paroxetine and Sertraline can be useful and are licensed for use in PTSD. The evidence base for drugs is limited, however there is proof to support the use of Mirtazapine, Amitriptyline and Phenelzine.
In addition, high levels of anxiety and disturbed sleep can be treated with short-term anxiolytics such as Benzodiazepines and other hypnotics.
If the sufferer does not respond to drug treatment then consideration over changing the antidepressant to a different class should be taken. Following that, consideration should be given to augmentation with Olanzapine.
National Institute for Health and Care Excellence (NICE) guidance suggests that once a person has responded to antidepressant treatment, the antidepressant should be continued for at least 12 months then gradually withdrawn.
Priory has a nationwide network of hospitals and wellbeing centres that are well placed to support those who are suffering from PTSD and we offer fast access to therapy to help improve our patients’ lives.