The alarming news of another military service member going on a shooting rampage killing and wounding other service members on a military base is unnerving. For us Latinos it is especially upsetting to know that Iván López, a Latino, perpetrated the recent Ft. Hood shooting. I do not care for highlighting a person’s ethnicity or culture in these tragic events, but I feel that I have a responsibility as a Latina, a veteran, and a mental health professional to state the obvious that others are already commenting on.

http://latino.foxnews.com/latino/opinion/2014/04/04/opinion-people-link-killing-rampages-to-ptsd-due-to-colossal-misinformation/

 

While psychotherapy remains the gold standard for treatment of post traumatic stress disorder (see for example, Foa EB et al, Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies. New York: Guilford Press; 2008), medications are often used to alleviate the symptoms of the illness. Since we last visited the topic of pharmacologic treatment for PTSD (TCPR, June 2007), there’s been some interesting research on this subject, including the use of antibiotics, steroids, and even the drug of abuse, ecstasy.

http://pro.psychcentral.com/2013/update-on-medications-for-ptsd/004658.html

 

Only a minority of individuals exposed to trauma will develop PTSD.  In attempting to determine the individual risk factors for PTSD, researchers have begun to observe natural recovery from trauma. One potential difference between those who recover naturally and those who continue to experience distressing symptoms might have to do with avoidance: cognitive, emotional and behavioral.

The cognitive model suggests that the belief that the world is excessively dangerous coupled with beliefs about personal incompetence is important in the development of PTSD (Foa & Rothbaum, 1998). Following a traumatic event, such beliefs might be reinforced and therefore lead to avoidance of everyday, previously normal tasks such as grocery shopping, socializing, and traveling by car. Additionally, beliefs about the importance of maintaining strict control over distressing emotions and thoughts might also be factors mediating the development of PTSD (Ehlers & Clark, 2000).  Following a traumatic event, these beliefs might lead to attempts to avoid thoughts and memories of the traumatic event and the associated upsetting emotions.

In contrast, natural recovery from trauma might be enhanced by a willingness to return, over time, to normal activities. This behavior may strengthen beliefs about personal ability to manage difficulty, that other people are not generally dangerous, and that even extremely uncomfortable emotions are manageable.

One CBT approach for PTSD systematically and strategically recreates this recovery process by targeting the tendency to avoid feared situations and distressing recollections and emotions.  By systematically approaching the avoided stimuli, the individual can learn the same lessons as the person who recovers without intervention.  With the assistance of a skilled cognitive behavior therapist, individuals can acquire more accurate and helpful beliefs about themselves, others, and the world following the experience of a traumatic event.

References:

Ehlers, A., & Clark, D.M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319-345.

Foa, E.B., & Rothbaum, B.O. (1998). Treating the trauma of rape: Cognitive-behavioral therapy for PTSD. New York: Guilford Press.

Both David Burns (bestselling author of “Feeling Good: The New Mood Therapy“ and Abraham Low (founder of Recovery, Inc.) teach techniques to analyze negative thoughts (or identify distorted thinking — what psychologists call “cognitive distortions”) so to be able to disarm and defeat them. This is one of the major precepts of cognitive behavioral therapy.

Since Low’s language is a bit out-dated, I list below Burns’ “Ten Forms of Twisted Thinking,” (adapted from his “Feeling Good” book, a classic read) categories of dangerous ruminations, that when identified and brought into your consciousness, lose their power over you. They have been helpful in my recovery from depression and anxiety. After I identify them, I consult his 15 Ways to Untwist Your Thinking.

http://www.everydayhealth.com/columns/therese-borchard-sanity-break/10-cognitive-distortions/?pos=1&xid=nl_EverydayHealthEmotionalHealth_20130903

What is Post Traumatic Stress Disorder (PTSD)? 

June is Post Traumatic Stress Disorder (PTSD) Awareness Month. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), PTSD is classified as an anxiety disorder. The forthcoming new DSM has reclassified it as a trauma based condition. PTSD includes features of anxiety such as generalized anxiety and dread. However, experiencing major stress is significant in developing PTSD. PTSD has a clear cause which is a specific, extreme trauma such as rape, violence, natural or man-made disasters such as hurricanes or 9/11, combat war, death of a loved one, car or other accidents, and humanitarian crisis. This extreme trauma is a horrifying and exceptionally stressful experience or event which is usually perceived as life threatening and not within the normal boundaries of day to day living. It leads to severe and uncontrollable psychological symptoms. It is extremely important that the general public understand that PTSD is a NORMAL response to an extremely ABNORMAL situation. Neuroscience has shown that trauma causes specific changes in the brain that requires treatment. It does not mean an individual is insane, dangerous, immoral, has a character flaw, or any other unfounded stigma that is unfortunately associated with PTSD due to misinformation or ignorance. Read more at http://newlatina.net/post-traumatic-stress-disorder-ptsd-what-is-it/

Anxiety is a normal, predictable part of life,” said Tom Corboy, MFT, the founder and executive director of theOCD Center of Los Angeles, and co-author of the upcoming book The Mindfulness Workbook for OCD.

However, “people with an anxiety disorder are essentially phobic about the feeling state of anxiety.” And they’ll go to great lengths to avoid it.

Some people experience generalized

http://psychcentral.com/lib/2013/15-small-steps-you-can-take-today-to-improve-anxiety-symptoms/

Anxiety disorders are complex, and their occurrence can be influenced by factors that are genetic, behavioral and developmental. Generalized Anxiety Disorder (GAD) is a common one – the main symptom is feeling more than the normal anxiety people experience day-to-day. GAD is typified by chronic and exaggerated worry and tension that arises easily and persists for little or no reason. Some signs and symptoms of GAD include:

http://www.drweil.com/drw/u/TIP04825/Suffering-From-Anxiety.html

As I sit across from a new client in his early thirties, who survived an assault while at college, he begins to tell me about his previous treatments.  He describes a string of therapies addressing many of the problems that followed the traumatic event, such as chronic drug use, sleep problems, depression, rage, suicidal ideation, and risky behaviors. He tells me, “The therapists were so nice, supportive and knowledgeable.  I went week after week.  I felt better at each session, but I never got better. I just figured, “there must be something wrong with me that I can’t get better.”

Clients with PTSD often present with multiple complaints and problems, as comorbidity with other psychiatric disorders is highly prevalent (79%-88.3%; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995).  The therapist needs a well-formulated, efficient strategy for change to help the individual recover from PTSD and associated difficulties. The strategy should be based on a research-informed understanding of PTSD and a tailored conceptualization of the individual’s problems.  Guided by conceptualization and strategy, the therapist is better able to respond to the individual’s unique challenges, which can include extensive avoidance, shame, guilt, anger, substance use, suicidality, interpersonal disturbances, and more.  The ability to communicate this strategy to the individual can provide hope for the future and a framework for understanding an experience that feels frightening and chaotic.

Considering that survivors present with multiple, trauma-associated problems and many evidence-based therapies are available, the therapist can become overwhelmed with decisions such as where to begin therapy, which interventions to select, and how to respond when obstacles arise.  These decisions are even more difficult when coupled with the unsubstantiated opinions existing in the mental health field about the treatment of trauma and PTSD.  The use of an individualized, theoretically grounded, cognitive-behavioral conceptualization and strategy provides a guide for the therapist when planning treatment and helps the therapist maintain focus on an efficient course of treatment.

The conceptualization-driven course of therapy incorporates any of the possible presenting problems, with the goal of recovery from PTSD and a return to a meaningful life.

Aaron Brinen, PsyD
Beck Institute Adjunct Faculty