Post Traumatic Stress Disorder (PTSD) Treatment
What Is Post Traumatic Stress Disorder (PTSD)?
People exposed to the same traumatic event such as sexual assault/abuse, military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults react differently. Some will develop severe psychological distress while others will not. Psychological distress is a normal reaction to an abnormal event.
PTSD is a serious psychological condition and the most common psychiatric diagnosis that a person can be given as a result of experiencing or witnessing a traumatic event. PTSD may develop when a person exposed to traumatic events reacts with intense fear, helplessness, or horror (Friedman, 2001). Typical adaptations or reactions of PTSD are: reliving the experience through nightmares and/or flashbacks, having difficulty sleeping, feeling numb or detached, avoiding situations which are reminiscent of the trauma; being jumpy, nervous or being "on alert" most of the time. To avoid these painful adaptations or reactions, people sometimes engage in unhealthy or unsafe behaviors like taking drugs or drinking, having unprotected sex, or hurting themselves. These adaptations or reactions can be severe enough and last long enough to significantly impair the person's daily life. Sometimes, PTSD occurs in conjunction with other (or related) diagnosis such as depression, substance abuse, problems of memory and cognition, and other problems of physical and mental health. It may also be associated with impairment of the person's ability to function in social or family life, including occupational instability, marital problems and divorces, family discord, difficulties in parenting, and difficulty with trust and self care.
About 25% of persons who are exposed to catastrophic events will develop PTSD, and the adaptations or reactions are often chronic. It is possible that persons diagnosed with a severe mental illness have an elevated risk of PTSD if they are exposed to a traumatic event. Recent estimates of lifetime prevalence of PTSD in the U.S. population range from eight to 12% (Rosenberg et al., 2001). Among people diagnosed with a serious mental illness, studies have found that at least 50% of the women and 25% of the men have experienced the significant trauma of childhood physical and/or sexual abuse (Rose, 1991).
Effective Treatments for PTSD
- Individual therapy
- Family education and therapy
- Social rehabilitation therapy
- Individual therapy and medications
- Treatment aimed at both current trauma and the past
- Treatment of comorbid disorders targets adaptations or reactions of each diagnosis simultaneously
- Referral to peer and trauma self-help groups and advocacy services
Source: Rosenberg et al. 2001.
Why Is PTSD Treatment Important?
Because of the high prevalence of PTSD among recipients of mental health services, the New York State Office of Mental Health launched a Trauma Initiative in 1995 (Chassman, 2001). The mission of the Trauma Initiative is to identify trauma issues among people diagnosed with a mental illness and to provide effective treatments. Anecdotal evidence suggests that trauma-related adaptations or reactions are often overlooked during the psychiatric evaluation. As a result, the treatment plan does not include trauma-based services. Many assume that targeted trauma services will increase the rate of recovery among people diagnosed with a serious mental illness who are trauma survivors (Tucker, 2002).
PTSD is a complex condition that can impair life functions. There is a growing body of evidence about effective treatment of PTSD. In response to the traumatic incidents of September 11, 2001 New York State has looked to these treatments as it expands its role in public mental health to meet the trauma-related needs of people who have not traditionally been served in the public mental health system. Treatment for PTSD typically begins with a detailed evaluation and development of a treatment plan that meets the unique needs of the survivor. Research has shown that the most effective interventions for PTSD are based on cognitive therapy approaches. Cognitive therapy involves working with the affected individual to change her/his emotions, thoughts, and behaviors regarding the traumatic event.
Project Liberty of the New York State Office of Mental Health is providing free crisis counseling services, outreach and information (counseling) to people in NYC and surrounding counties affected by the September 11 terrorist attacks.
Common Components of PTSD Treatment- Educating trauma survivors and their families about how persons develop PTSD, how PTSD affects survivors and their loved ones, and other problems that commonly accompany PTSD adaptations or reactions. Understanding that PTSD is a medically recognized anxiety diagnosis that occurs in normal individuals under extremely stressful conditions is essential for effective treatment.
- Exposure to the traumatic event via imagery allows the survivor to re-experience the event in a safe, controlled environment, while also carefully examining their reactions and beliefs in relation to that event.
- Examining and resolving strong feelings such as anger, shame, or guilt, which are common among survivors of trauma.
- Teaching the survivor to cope with post-traumatic memories, reminders, reactions, and feelings without becoming overwhelmed or emotionally numb. Trauma memories usually do not go away entirely as a result of therapy, but become manageable with new coping skills.
- For people with serious mental illness, common components of treatment for trauma-based diagnosis include education on trauma issues, skill-building programs aimed at assisting the survivor in identifying symptom triggers and self-soothing strategies. Exposure treatment, described above, is not recommended for people diagnosed with a serious mental illness, those who self- injure or are suicidal, or who are otherwise more vulnerable (Foa, 1999).
Source: National Center for Post-Traumatic Stress Disorder, 2001
Who Benefits from PTSD Treatment?
Many people treated for PTSD can make a full recovery. People exposed to a traumatic event, their family members, and friends, people with past exposure to trauma, and people with co-occurring adaptations or reactions of psychiatric diagnoses and/or chemical dependency can benefit from PTSD treatment.
Family, Recipient, Cultural PerspectivesThe development of the descriptions for these OMH Priority Evidence-Based Practices included extensive involvement from clinical experts, recipients of mental health, family members, and people who represent culturally diverse viewpoints. Their perspectives are critical to the understanding of these important practices and programs in mental health.
Family Perspective
Families must remember that most persons diagnosed with a serious mental illness cope fairly well during times of crisis and that their reaction are more similar, rather than different, from others in the community. Families need to listen and convey their own sense of confidence in their family member's ability to cope with stress. It is important that they communicate honest and accurate information to their relative about what happened, and that they provide opportunities to talk about "normal responses" to these abnormal events.
Families should monitor television usage reporting significant crises to make sure that their relative isn't watching television or listening to the radio about the crises excessively. If the individual has few friends or outside contacts, families may want to increase the frequency of their visits and phone calls for a period of time.
They will want to make sure that their relative gets rests, exercises, eats well and takes one day at a time. One of the most important tasks that families can perform is being alert to changes in the severity and frequency of symptoms or in observing new symptoms. They will need to differentiate normal from prolonged responses lasting more than 4-6 weeks. If symptoms do not abate, they will want to encourage their family member to talk to their clinician about a careful assessment, review of psychotropic medication, and possible screening for PTSD.
Recipient Perspective
Peer self-help can be effective in the recovery of those with PTSD. Meeting other people with similar trauma experiences who role model effective coping skills may restore hope and recovery for the recipient. Peer self-help, peer advocacy, "warm lines", and other supports help establish a sense of safety; trust, and sense of community- one is not alone.
Cultural Perspective
There are barriers to healing,
hope, and recovery for many individuals, families, and communities. These barriers
include historical factors as well as basic differences in language, cultural
values, economic barriers, views of illness and help seeking, the impact of
stigma and the lack of information about the possibility of healing. Often there
are misunderstandings about expressions of distress or the belief that distress
is to be tolerated as a demonstration of strength. Therefore, people are unaware
or underestimate mental health concerns, not recognizing the need or availability
of assistance. Clinicians need to recognize a host of factors that will shape
the individual's experience with both trauma and trauma treatment. In response
to September 11, outreach included deliberate effort to reaching people in their
home communities and facilitating connection to naturally occurring sources
of support and information sharing. Materials were provided in the languages
present in the community and using the media most familiar. There efforts provided
a gateway to access trauma services. In treating PTSD, it is necessary for a
strongly established atmosphere of safety to exist. In addition to addressing
language access needs, time spent with attention to norms, values, and expectations,
particularly those involving economic factors, family connection, community
ties, and previous trauma experience, will assist in establishing that sense
of safety.
Quality Measures for the Treatment of Schizophrenia
The above hyperlink directs you to schizophrenia measures and data sources, organized by domain of quality. These quality measures for schizophrenia may be found with further discussion in the research article: Hermann RC, Finnerty M, Provost S, Palmer RH, Chan J, Lagodmos G, Teller T, Myrhol BJ. (2002). Process measures for the assessment and improvement of quality of care for schizophrenia. Schizophrenia Bulletin, 28 (1), 95-104.
Description of Quality Measures for PTSD Treatment
|
PTSD Treatment |
|
|
Description |
Percent of adults assessed and diagnosed with Post Traumatic Stress Disorder |
|
Numerator |
Number of persons in the denominator who reported experiencing PTSD symptoms within last year |
|
Denominator |
All persons age 18 and older who reported history of traumatic event(s) |
|
Data Source |
Assessment or diagnostic tools (i.e. Diagnostic and Statistical Manual, Version V) |
|
Developer |
- |
Researchers indicate that adherence to specific programmatic standards (referred to as fidelity to implementation) is required to produce desired outcomes for recovery. Fidelity scales are intended for use by the mental health program leaders and public mental health authorities, allowing the program leaders to evaluate their own programs. For more information see Torrey, W.C., Drake, R.E., Dixon, L., Burns, B.J., Flynn, L., Rush, A.J., Clark, R.E., & Klatzker, D. (2001). Implementing evidence-based practices for persons with severe mental illnesses. Psychiatric Services, 52 (1), 45-50.
PTSD Internet ResourcesThis link provides further information on the Internet regarding PTSD programs and educational links.
ReferencesChassman, J. (October 2001). Frontline reports: New York State Office of Mental Health trauma initiative. Psychiatric Services, 52 (10), 1392-1393.
Foa, E.B., Dancu, C.V., Hembree, E.A., Jaycox, L.H., Meadows, E.A., Street, G.P. (1999). The efficacy of exposure therapy, stress inoculation training and their combination in ameliorating PTSD for female victims of assault. Journal of Consulting and Clinical Psychology, 67, 194-200.
Friedman, M.J. (2001) Post traumatic stress disorder: The latest assessment and treatment strategies. Compact Clinicals: Kansas City.
National Center for Post-Traumatic Stress Diagnosis, Department of Veteran Affairs. Treatment of PTSD. Retrieved January 3, 2001 from http://www.ncptsd.org/facts/treatment/fs_treatment.html
Rose, S.M., Peabody, C.G., Sratigeas, B, (May 1991). Undetected abuse among intensive case management recipients, Hospital and Community Psychiatry, 42 (5), 499-503.
Rosenberg, S.D., Mueser, K.T., Friedman, M.J., Gorman, P.G., Drake, R.E., Vidaver, R.M., et al. (2001). Developing effective treatments for posttraumatic disorder among people with severe mental illness. Psychiatric Services, 52 (11), 1453-1461.
Tucker, W.M. (Summer 2002). How to include the trauma history in the diagnosis and treatment of psychiatric inpatients. Psychiatric Quarterly, 73 (2), 135-144.