Post Traumatic Stress Disorder (PTSD) ...

"I try not to think about my terrible experience and put it behind me, yet nothing has been the same since."

Post Traumatic Stress Disorder (PTSD) occurs when a person experiences a traumatic and frightening event in which he fears he may die, or witnesses another person die. Images of the trauma are re-experienced, dreams of the trauma occur, and a long-standing sense of dread takes over. PTSD can occur from witnessing the WTC disaster on September 11th, from rape, from sexual or physical abuse, from surviving an earthquake, and from other catastrophes. More specifically;

1. The person has been exposed to a traumatic event in which the following were present:

The person experienced, witnessed, or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity or others; and

The person’s response involved intense fear, helplessness, or horror.


2. The traumatic event is reexperienced in one, or more, of the following ways:

Recurrent and intrusive distressing memories of the event, including images, thoughts, or perceptions (in children this is often expressed through repetitive play in which aspects of the trauma are expressed).

Recurrent distressing dreams of the event (in children there can be frightening dreams, but the content may not be remembered).

Acting or feeling as if the traumatic event were recurring. This includes a sense of reliving the experience, illusions, or flashbacks.

Intense distress at exposure to things that remind the person of aspects of the traumatic event.


3. There is a persistent avoidance of things associated with the trauma, and a numbing of feelings, as indicated by three of the following:

Efforts to avoid thoughts, feelings, or conversations associated with the trauma.

Efforts to avoid activities, places, or people that remind the person of the trauma.

Inability to recall an important aspect of the trauma. • Markedly diminished interest or participation in significant activities.

Feeling of detachment or estrangement from others.

Restricted range of feelings (e.g. unable to have loving feelings).

Sense of a shortened future (e.g. does not expect to have a career, marriage, children or a normal life span).


4. Symptoms of increased arousal, as indicated by two or more of the following:

Difficulty falling or staying asleep.

Irritability or outbursts of anger

Difficulty concentrating

Hypervigilance (e.g. looking around for threats)

Exaggerated startle response

Cognitive-behavioral model of PTSD:

The cognitive-behavioral model proposes that in individuals who have PTSD, a traumatic event is recorded as fragmented, raw, and sensory-based memories associated with strong emotions, including an acute sense of danger and alarm. Initial protective responses adapted for immediate survival, such as hypervigilance and avoiding trauma-related cues persist after they are no longer adaptive. Those protective responses preserve the memories and emotions in their raw, fragmented state and prevent recovery. Trauma also has a disillusioning and powerful impact on people's view of themselves, their future, the world, and others.

Cognitive-behavior therapy for PTSD:

Cognitive-behavior therapy for PTSD includes several types of interventions designed to promote "emotional processing" of the fragmented trauma memories into a coherent memory that is integrated with the person's other memories, thoughts, and beliefs and to help people reconcile the effects of the trauma on their beliefs about themselves, their future, the world, and others. Interventions include:

Education to learn and understand the triggers for trauma reactions, memories, and emotions.

Coping skills to better manage strong emotions (such as fear, shame, helplessness, and panic), to ground yourself when trauma memories overtake you, to improve sleep, and to manage anger and improve interpersonal effectiveness.

Systematic and controlled exposure to trauma-related memories and cues; through systematic and gradual exposure, people become less reactive and reclaim these areas of life.

Cognitive strategies to understand and reconcile the effects of trauma-based beliefs (for example, the world is dangerous) on beliefs about oneself, others, and the world, and on personal goals and relationships.