Post Traumatic Stress Disorder

The incidence of post-traumatic stress disorder in the general population is approximately one per cent at any one time. Half of those suffering from PTSD continue to suffer the long term effects of this anxiety disorder.

The DSM-III-R criteria for PTSD are the following:

A. The client must have witnessed or experienced a serious threat to their life or physical well-being.
B. The client must re-experience the event in some way: dreams, invasive thoughts or hallucinations.
C. The client must persistently avoid stimuli associated with the trauma or experience a numbing of general responsiveness.
D. The client must experience persistent symptoms of increased arousal.
E. Symptoms must have lasted at least a month.

Individuals who suffer from PTSD have experienced a traumatic event which has gone beyond their range of normal experience. Examples of this are: -

• war
• car accidents
• natural catastrophes
• physical attacks (rape, murder, shooting, stabbing)
• imprisonment
• torture
• death of a loved one (even a pet).

CBT Treatment for PTSD

Accurate assessment for PTSD can be gauged by a structured clinical interview and a complete battery of diagnostic tests.

CBT is based on the premise that our thinking and beliefs about ourselves, others, our world, and the future has a crucial influence on how we feel. Also, when a person is feeling low in mood they have a sharper recall of memories which are negative in origin.

The reciprocity between negative thoughts (arrow) negative emotions (arrow) and negative behaviours create a vicious cycle.

CBT is problem orientated, active and directive and helps clients by posing specific questions to critically evaluate the source of their distress. Behavioural experiments are set as homework to reality test the validity of clients irrational beliefs.

The two areas usually associated with PTSD are intrusive thoughts/imagery and avoidance of situations which trigger the reaction to previous traumas. CBT for PTSD is designed to desensitise the person to the traumatic event. CBT techniques are used to reprocess the feared event and improve their strategies to decrease the sense of threat. Positive results can occur within two to three weeks.

Clients also can reprocess the trauma by writing a detailed account of what has already transpired. After several detailed reprocessing events the intensity of the trauma starts to diminish.

The next stage is to restructure negative thoughts associated with the event using standard CBT. This is done to help clients to accurately perceive the trauma seeing the whole picture without cognitive distortions. This involves identifying the specific cognitions which illicit the reactivation of the trauma to decrease the degree of threat.

CBT is recognised as an effective treatment intervention for PTSD and is the preferred choice for both clinical and NHS practices.

Post Traumatic Stress Disorder Questionnaire
(Pdf)

Characteristics of PTSD

Clients have recurrent intrusive thoughts, and dreams concerning the event, and may also experience 'flashback' episodes where either a portion or the whole of the traumatic event will be re-experienced.

Avoidance of events which resemble aspects of the original event is quite typical in PTSD. This may manifest itself in an inability to remember a part or the whole of the trauma.

There is also an emotional numbing and the avoidance of intense emotional experience.