Andrew L. Martin, PsyD
After retiring from the military, I thought I would see fewer patients with posttraumatic stress, but I’m actually seeing a lot more. I think there are a few of reasons for this. First, the COVID-19 pandemic has brought with it numerous traumatic experiences, such as loss of loved ones, serious personal illness, and financial hardship and ruin. I’ve also seen the general stress of the pandemic bring up older trauma memories. Finally, I’ve learned that my main treatment focus – chronic pain – is strongly associated with a history of traumatic events1.
So it seems like a good idea to write about posttraumatic stress. Since posttraumatic stress is such a complex topic, I will write a series of articles, beginning with this overview of the diagnosis PTSD, or posttraumatic stress disorder.
PTSD is an anxiety problem that develops in some of us after extreme events, such as combat, crime, an accident or natural disaster. Those of us with PTSD may relive the event through intrusive memories or nightmares. We may work hard to avoid anything that reminds us of the event including people, places, objects, or even our own thoughts and feelings. Finally, we may experience distress, and depressive and anxious feelings that weren’t present before the event2. If these problems cause significant distress, or interfere at work, in relationships, or with leisure time, a PTSD diagnosis may be appropriate.
Anyone may develop PTS symptoms, regardless of age, race, gender, intelligence, or other characteristics, such as bravery or mental toughness (for example, PTS is seen in first responders and members of the military). The chance of developing PTSD is increased by prior traumatic experiences, especially during childhood.3
TREATMENT & PROGNOSIS. Untreated PTS symptoms sometimes go away on their own, but then resurface during stressful times. If you experience longstanding depression and anxiety that have never responded to counseling or medication, those symptoms may actually represent PTS. They need to be addressed directly and specifically.
Prognosis with treatment is good. About 70% of people who participate in a treatment specifically designed for PTS experience long-term relief4. Typical treatment involves a thorough psychological assessment, building a trusting and non-judgmental therapeutic relationship, then addressing the trauma. Some of the treatment involves talking about the traumatic event, and some involves learning about and changing the effects the trauma has had on our thoughts, feelings, and behavior. The trauma only needs to be discussed long enough to allow associated feelings to arise and finally run their course. That way we needn’t relive a traumatic event each time we’re reminded of it. Then we focus on how the trauma affected how we think about ourselves, others, and the world, in terms of safety, trust, power and control, esteem, and intimacy. Along the way, we learn to see some of our thoughts we weren’t previously aware of, learn how to challenge them if they are unhelpful or painful, and learn to replace them with balanced and realistic thoughts. Most treatments involve 8-16 weekly, hour-long sessions.5
In the next article in this series, we’ll look more closely at the types of events associated with PTSD, and how PTSD symptoms develop after those events.
1Lumley MA, Schubiner H, Lockhart NA, et al. Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: a cluster-randomized controlled trial. Pain. 2017;158(12):2354-2363. doi:10.1097/j.pain.0000000000001036
4 Committee on the Assessment of Ongoing Efforts in the Treatment of Posttraumatic Stress Disorder; Board on the Health of Select Populations; Institute of Medicine. Washington (DC): National Academies Press (US); 2014 Jun 17.
5Resick, P. A., Monson, C. M., & Chard, K. M. (2016). Cognitive processing therapy for PTSD: A comprehensive manual. Guilford Publications.