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PTSD

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Post-traumatic stress disorder

We have had many members who have PTSD and found the groups useful. Additionally, although we aren't therapy, there is a lot of research around PTSD and the benefits of talking group therapy PTSD settings and this may somehow relate to why our members find group support useful, in general with other members who find talking and sharing experiences of anxiety generally. 

PTSD is a form of anxiety, which was moved into a section of the Diagnostic & Statistical Manual of Mental Disorders (DSM) under Trauma- and Stressor related- disorders, so it's often viewed separately today. This has benefits because awareness of it is increasing a lot. Such an example would be in December 2016 when Lady Gaga shared publically her experiences which can be seen in this BBC article - warning, may be triggering content. In the DSM-5 which is published by the American Psychiatric Association, the diagnostic criteria for PTSD is one of the longest in the DSM having sections A through to H with several points for most of these sections. Additionally it can present with dissociative symptoms of depersonalization or derealisation. It is a very varied disorder in how it presents itself requiring highly qualified healthcare professionals. The purpose of this page is to provide some information for those who might come to groups and encourage to talk about their symptoms and seek help. Please seek medical opinions off a qualified therapist.  

The ICD-10 which is published by the World Health Organisation is the other main source and is in the public domain and parts about PTSD can be read here under F43.1.

Mythbusting

  • Women are twice as likely to have PTSD as men.  
  • In the UK common causes are physical assault, sexual assault, car accidents, threats of violence, witnessing violence, abuse, traumatic health problems, traumatic childbirth experiences and various other traumatic events too long to list.
  • Whilst many people experience trauma, most of them don't get PTSD.
  • Whilst many people's experiences of trauma may subside, it isn't a matter of it 'going away' as many people think with PTSD.
  • Hyperarousal and anger do not mean the person is just 'a bit sensitive' or is just an 'angry person'. 

Physiology

Due to neuroplasticity in the brain which is shaped by experiences, the architecture in the brain is different for someone with PTSD. This also means that with a huge amount of work through specialised therapy as your experiences change (or processesing of previous memories change) the brain can in theory be 'rewired' and PTSD symptoms subside. It is not known how long this takes for PTSD or anxiety. 

In the limbic system, which is associated with emotional regulation and how these relate to behaviours, two areas have been linked with PTSD. The hippocampus which processes memory, among other things, has been found to be smaller in PTSD patients. In some studies an enlarged amygdala (associated with the fear response) is seen and in some a shrunk amygdala. With a smaller amygdala (especially right sphere) and hippocampus, it is thought memory processing or flashbacks become difficult to process. In an enlarged amygdala it would be hypothesised to mean an oversensitive response to fear. 

Although PTSD still has a lot of research to be done, it's believed to be intimately tied to the HPA axis and stress responses. Cortisol levels in PTSD patients are believed to be low and noradrenaline and dopamine levels to be high. 

CBT

Contrary to some misconceptions on-line , CBT which is trauma-focussed and tailored to the patient is commonly used to treat PTSD and can be effective. This IS NOT the same thing at all as generic low intensity CBT treatments aimed often at 'mild to moderate' anxiety/depression that run for shorter periods of time. Trauma-focussed therapy should typically run 8-12 sessions with more for multiple traumas and booster sessions if necessary around significant dates [1]. Narrative exposure therapy and prolongued exposure therapy are included within this. If residual symptoms remain after trauma-focussed treatment more specific CBT for PTSD on symptoms such as sleep or anger may be offered [1].

EMDR

Eye movement desensitisation and reprocessing is a treatment licenced to treat PTSD on the NHS which there is evidence it can be effective. Contrary to some sources on-line it is not the 'only' or 'best' treatment for PTSD.

The NHS website describes it briefly 

"It involves making side-to-side eye movements, usually by following the movement of your therapist's finger, while recalling the traumatic incident. Other methods may include the therapist tapping their finger or playing a tone. It's not clear exactly how EMDR works, but it may help you change the negative way you think about a traumatic experience."

The National Institute of Clinical Excellence guidance says EMDR should be 8 to 12 sessions, but more if they have experienced multiple traumas and include self-calming techniques for managing flashbacks [1].

For more information on PTSD please see the NHS website https://www.nhs.uk/conditions/post-traumatic-stress-disorder-ptsd/

Refences

[1] Post-traumatic stress disorder, NICE guideline[NG116] Published date: December 2018 https://www.nice.org.uk/guidance/ng116/chapter/Recommendations#management-of-ptsd-in-children-young-people-and-adults