WHAT IS THE COURSE OF POST-TRAUMATIC STRESS DISORDER?
Not much is known about the specific course of the post-traumatic stress
disorder (PTSD). Sometimes the symptoms disappear within a few months, resembling recovery from a depressive disorder. But overall until 2001, the prognosis was bleak, particularly for the victims of very severe trauma...
(See the treatment I recommend below...)
As we can see from history, a high percentage of concentration camp victims are still
troubled with anxiety and guilt twenty years later. This also seems to be true
of some veterans of combat. Sixty-two veterans of World War II who suffered
chronic "combat fatigue," with symptoms of exaggerated jumpiness,
recurrent nightmares, and irritability, were examined twenty years later. Irritability,
depression, restlessness, difficulties in concentration and memory,
blackouts, wakefulness, fatigability, and jumpiness persisted for twenty
years. These symptoms were more prominent in the veterans suffering from
combat fatigue than in noncombat patients or in healthy combat veterans.
Combat fatigue victims still jumped when they heard noises of jets and firecrackers.
Three-quarters of these men reported that their symptoms interfered
with providing for their family. Half reported their sex lives were
unsatisfactory, and that they were unduly irritable with their children. A
third of the men were unemployed.
TREATMENT AND PREVENTION
In spite of the fact that so many of our fellow human beings are victims of
extraordinary traumas, almost nothing is known about how to alleviate or
prevent post-traumatic stress reactions. Relatives, friends, and therapists are
inclined to tell the victims of catastrophe to try to "forget it," but it should
be apparent that such painful memories cannot be easily blotted out. Only
small improvement has been reported by either drug therapy or psychotherapy
among victims of trauma. Two important caveats are in order, however.
First, it is difficult to find out what the individuals who suffer stress reactions
to trauma were like before. It is possible that those individuals whose symptoms
persist for years and years also had poor adjustment before the trauma,
whereas those individuals who were in good psychological shape before the
trauma were less hurt by it and therefore didn't show up for long-term follow- up.
We cannot tell if the trauma itself, or the combination of trauma
and a vulnerable individual, produces the reactions that are so devastating
and often permanent. Second, there is the problem of secondary gain: victims
occasionally have some incentive for staying ill for a long time. The
Buffalo Creek victims, for example, were in the process of suing the Pittston
Company (the owner of the dam that collapsed) for millions of dollars. Only
careful longitudinal work will tell us who is most vulnerable to post-traumatic
stress reactions, how long such reactions last, and what therapy can
work. These studies have not yet been done (Chodoff, 1963; Leopold and
Dillon, 1963; Archibald and Tuddenham, 1965; Merbaum, 1971).
Although we know almost nothing about how to treat post-traumatic
stress disorder once it has set in, some steps have been taken to prevent the
reaction once a trauma has been experienced. When a tornado strikes
a town or when soldiers return from combat, therapists have an excellent
opportunity to use preventative procedures. Thus, therapists can try to prevent
a stress reaction from occurring in victims of a trauma. They can try to
prevent the onset of three symptoms-anxiety, numbness, and reliving-in
the victims, or the therapists can attempt to minimize the symptoms
before they take hold. Such an attempt was made by therapists who
worked with the victims of the takeover of the B'nai B'rith national headquarters
in Washington, D.C., after the victims had been freed by their terrorist captors.
From March 9 to March 11, 1977, more than one hundred persons had
been held hostage by members of the Hanafi Muslim sect in a B'nai B'rith
headquarters. During the thirty-nine hours of their captivity, they had been
exposed to physical violence, verbal abuse, threats, severe physical restraints,
hunger, humiliation, and the continual threat of imminent death.
What happened to Shirley is shown in the following case:
Shirley is a forty-two-year-old white, married, Jewish female who was working
as an administrative assistant for the B'nai B'rith on March 9, 1977. She was at her
desk when several Hanafis burst into her work area. She was herded together with
all her colleagues on the floor, and was pushed into the stairwell to be marched up
to the eighth floor conference room that was to serve as their prison for thirty terror-
filled hours. Shirley did not see the actual stabbing of another employee, but
she did hear the screams and did see the bloodied machete of her Hanafi captor.
She remembers her body aching from the damp cold of the concrete floor and her
head aching from repeated crying spells. She recalls vividly the men being separated
from the women and being roughly bound. She also remembers the humiliation
heaped on several of the men because one wept, another wet himself, and still
another behaved too effeminately.
She remembers many moments of overwhelming fear-the worst seemed to
coincide with appearances of Khaalis, the Hanafi leader, who repeatedly threatened
grisly death to specific individuals and then the entire group. She recalls
images of bodies pressed against each other for comfort and protection and her
annoyance at the petty grumbling about the sharing of food and floor space for sleeping....
Shirley's ordeal was not over, however, once she was released by the Hanafis.
For several months she experienced a number of symptoms related to the extreme
stress she had undergone while held prisoner. Shirley had great difficulty returning
to work; she found herself crying without explanation and intolerant of others.
She felt considerable anxiety and mild, persistent depression. She associated this
emotional state with a sense of being exhausted much of the time, as if she "had
mononucleosis." Shirley slept poorly at first, reliving scenes of the building takeover,
bloodied faces and clothes. (Sank, 1982)
The Health Maintenance Organization of Washington decided to seek
the victims out and offer care immediately, rather than wait for calls for help
from the victims well after their release. The idea was to prevent post-traumatic
stress disorder which, as we have seen, frequently occurs in the weeks
and months following extraordinary stress. The treatment format was short
term and was derived from the multi model behavior therapy of Lazarus.
You will recall that this therapy uses a variety of
techniques, both behavioral and cognitive, to treat neurotic problems. Therapy
sessions were held in the building that had served as the work site of the
victims and as their prison, and approximately half of the B'nai B'rith hostages
came to therapy. Systematic desensitization was used to curb phobic
reactions; group sharing of the experience was used to counteract numbness.
Substituting calming imagery for fantasies of the takeover was used to
prevent and counteract reliving the trauma repeatedly. This shows
the different forms of behavioral and cognitive therapy for dealing with the
symptoms that the victims already had or for symptoms that the therapists
believed would arise in the victims in the future.
No systematic follow-up of the victims was carried out, but a few anecdotal
reports show that some were doing quite well in 1982, but others still had
trauma-related problems (Sank, 1982). Without such follow-up, we cannot
know if this treatment prevented post-traumatic stress reactions, but it is a
unique and exemplary use of preventative procedures for fear disorders.
disorder (PTSD). Sometimes the symptoms disappear within a few months, resembling recovery from a depressive disorder. But overall until 2001, the prognosis was bleak, particularly for the victims of very severe trauma...
(See the treatment I recommend below...)
As we can see from history, a high percentage of concentration camp victims are still
troubled with anxiety and guilt twenty years later. This also seems to be true
of some veterans of combat. Sixty-two veterans of World War II who suffered
chronic "combat fatigue," with symptoms of exaggerated jumpiness,
recurrent nightmares, and irritability, were examined twenty years later. Irritability,
depression, restlessness, difficulties in concentration and memory,
blackouts, wakefulness, fatigability, and jumpiness persisted for twenty
years. These symptoms were more prominent in the veterans suffering from
combat fatigue than in noncombat patients or in healthy combat veterans.
Combat fatigue victims still jumped when they heard noises of jets and firecrackers.
Three-quarters of these men reported that their symptoms interfered
with providing for their family. Half reported their sex lives were
unsatisfactory, and that they were unduly irritable with their children. A
third of the men were unemployed.
TREATMENT AND PREVENTION
In spite of the fact that so many of our fellow human beings are victims of
extraordinary traumas, almost nothing is known about how to alleviate or
prevent post-traumatic stress reactions. Relatives, friends, and therapists are
inclined to tell the victims of catastrophe to try to "forget it," but it should
be apparent that such painful memories cannot be easily blotted out. Only
small improvement has been reported by either drug therapy or psychotherapy
among victims of trauma. Two important caveats are in order, however.
First, it is difficult to find out what the individuals who suffer stress reactions
to trauma were like before. It is possible that those individuals whose symptoms
persist for years and years also had poor adjustment before the trauma,
whereas those individuals who were in good psychological shape before the
trauma were less hurt by it and therefore didn't show up for long-term follow- up.
We cannot tell if the trauma itself, or the combination of trauma
and a vulnerable individual, produces the reactions that are so devastating
and often permanent. Second, there is the problem of secondary gain: victims
occasionally have some incentive for staying ill for a long time. The
Buffalo Creek victims, for example, were in the process of suing the Pittston
Company (the owner of the dam that collapsed) for millions of dollars. Only
careful longitudinal work will tell us who is most vulnerable to post-traumatic
stress reactions, how long such reactions last, and what therapy can
work. These studies have not yet been done (Chodoff, 1963; Leopold and
Dillon, 1963; Archibald and Tuddenham, 1965; Merbaum, 1971).
Although we know almost nothing about how to treat post-traumatic
stress disorder once it has set in, some steps have been taken to prevent the
reaction once a trauma has been experienced. When a tornado strikes
a town or when soldiers return from combat, therapists have an excellent
opportunity to use preventative procedures. Thus, therapists can try to prevent
a stress reaction from occurring in victims of a trauma. They can try to
prevent the onset of three symptoms-anxiety, numbness, and reliving-in
the victims, or the therapists can attempt to minimize the symptoms
before they take hold. Such an attempt was made by therapists who
worked with the victims of the takeover of the B'nai B'rith national headquarters
in Washington, D.C., after the victims had been freed by their terrorist captors.
From March 9 to March 11, 1977, more than one hundred persons had
been held hostage by members of the Hanafi Muslim sect in a B'nai B'rith
headquarters. During the thirty-nine hours of their captivity, they had been
exposed to physical violence, verbal abuse, threats, severe physical restraints,
hunger, humiliation, and the continual threat of imminent death.
What happened to Shirley is shown in the following case:
Shirley is a forty-two-year-old white, married, Jewish female who was working
as an administrative assistant for the B'nai B'rith on March 9, 1977. She was at her
desk when several Hanafis burst into her work area. She was herded together with
all her colleagues on the floor, and was pushed into the stairwell to be marched up
to the eighth floor conference room that was to serve as their prison for thirty terror-
filled hours. Shirley did not see the actual stabbing of another employee, but
she did hear the screams and did see the bloodied machete of her Hanafi captor.
She remembers her body aching from the damp cold of the concrete floor and her
head aching from repeated crying spells. She recalls vividly the men being separated
from the women and being roughly bound. She also remembers the humiliation
heaped on several of the men because one wept, another wet himself, and still
another behaved too effeminately.
She remembers many moments of overwhelming fear-the worst seemed to
coincide with appearances of Khaalis, the Hanafi leader, who repeatedly threatened
grisly death to specific individuals and then the entire group. She recalls
images of bodies pressed against each other for comfort and protection and her
annoyance at the petty grumbling about the sharing of food and floor space for sleeping....
Shirley's ordeal was not over, however, once she was released by the Hanafis.
For several months she experienced a number of symptoms related to the extreme
stress she had undergone while held prisoner. Shirley had great difficulty returning
to work; she found herself crying without explanation and intolerant of others.
She felt considerable anxiety and mild, persistent depression. She associated this
emotional state with a sense of being exhausted much of the time, as if she "had
mononucleosis." Shirley slept poorly at first, reliving scenes of the building takeover,
bloodied faces and clothes. (Sank, 1982)
The Health Maintenance Organization of Washington decided to seek
the victims out and offer care immediately, rather than wait for calls for help
from the victims well after their release. The idea was to prevent post-traumatic
stress disorder which, as we have seen, frequently occurs in the weeks
and months following extraordinary stress. The treatment format was short
term and was derived from the multi model behavior therapy of Lazarus.
You will recall that this therapy uses a variety of
techniques, both behavioral and cognitive, to treat neurotic problems. Therapy
sessions were held in the building that had served as the work site of the
victims and as their prison, and approximately half of the B'nai B'rith hostages
came to therapy. Systematic desensitization was used to curb phobic
reactions; group sharing of the experience was used to counteract numbness.
Substituting calming imagery for fantasies of the takeover was used to
prevent and counteract reliving the trauma repeatedly. This shows
the different forms of behavioral and cognitive therapy for dealing with the
symptoms that the victims already had or for symptoms that the therapists
believed would arise in the victims in the future.
No systematic follow-up of the victims was carried out, but a few anecdotal
reports show that some were doing quite well in 1982, but others still had
trauma-related problems (Sank, 1982). Without such follow-up, we cannot
know if this treatment prevented post-traumatic stress reactions, but it is a
unique and exemplary use of preventative procedures for fear disorders.
Post-Traumatic Emotional Pressure Problem (PTEPP)
Symptoms, Treatment and Self-Help for PTSD
More at:
http://social-anxiety-treatment-cure.weebly.com/
Of course you know the PTSD treatment method I recommend!
http://theliberatormethod.com/Welcome.html
END
Symptoms, Treatment and Self-Help for PTSD
More at:
http://social-anxiety-treatment-cure.weebly.com/
Of course you know the PTSD treatment method I recommend!
http://theliberatormethod.com/Welcome.html
END