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Posttraumatic Stress Disorder 

Michael Romano

Argosy University 

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What is Posttraumatic Stress Disorder?

Post-Traumatic Stress Disorder is a mental health issue that develops after a person has experienced a life changing/threatening event.

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Not every person who experiences a traumatic event has chronic or acute PTSD. Persons might not even have symptoms until a year or more after the event, although, most experience symptoms within the first three months after the traumatic event has occurred. 

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Demographics

The NCS-R estimated the lifetime prevalence of PTSD among adult Americans to be 6.8%

Current past year PTSD prevalence was estimated at 3.5%

The lifetime prevalence of PTSD among men was 3.6% and among women was 9.7%. The twelve month prevalence was 1.8% among men and 5.2% among women

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The above data was retrieved from a study done by U.S. National Comorbidity Survey Replication. They conducted an interview in a nationally representative sample of 9,282 Americans aged 18 years and older over the course of 2 years. The statistics seemed to be very similar to a study done in the 1990s by  the first National Comorbidity Survey. 

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Diagnosis

In order to be diagnosed with PTSD, the person must have the following for at least 1 month:

 - one re-experiencing symptom

 - one avoidance symptom

 - two arousal or reactivity symptoms

 - two cognition and/or mood symptoms

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Re-experiencing symptoms include :

Flashbacks—reliving the trauma over and over, causing the heartrate to elevate or excessive sweating

 Bad dreams/nightmares 

Frightening thoughts causing severe fear in certain situations resembling the accident. 

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These symptoms can have a very drastic effect on a person's life. When ones very own thoughts are compromised, it can become hard to function in societal situations. Even particular words may trigger one of these symptoms not to mention the physical harm that a lack of sleep can put on the body.

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Avoidance symptoms include:

Not going near places, events, or objects that may create a reminder for the traumatic event 

Avoiding thoughts and feelings that may be associated with the traumatic event 

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Avoidance symptoms are symptoms that may change up a person's normal routine. For example: a person who experienced a traumatic car accident may choose not to drive any more. An athlete example would be an athlete who had a traumatic injury on a particular field, in which they avoid going to that field or any near by palce associated with it. 

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Arousal and reactivity symptoms include:

Being easily startled

Feeling tense or “on edge”

insomnia 

angry outbursts out of proportion to the current situation 

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More often than not, these particular symptoms are constant and not random. These particular symptoms are where it is most likely that an addition diagnoses of a sleep, anxiety, or personality disorder. These disorders can really disrupt a person's daily life style in the way that they can affect their diet and sleep, two essential aspects of our body and mind to function properly. 

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PTSD in Athletics 

Athletes may have symptoms of PTSD if experiencing:

   - Coming back from a traumatic injury 

   - Career ending traumatic event or performance

   - Stress and depression from feelings of burnout

   - Post career depression and anxiety 

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Athletes going through the rehabilitation process after a traumatic injury is among the most popular for potential PTSD candidates. Often having nightmares where they relive the injury, as well as, severe stress and anxiety when returning to the playing field. Some athletes even feel pain in the area of injury, even after it has fully healed. Olympic athletes who have terrible performances also deal with trauma, nightmares, and post career depression and anxiety. This may effect an athlete so much, they cannot find or keep employment after their playing career is over. 

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Medication Treatments

selective serotonin reuptake inhibitors: 

 - Sertraline (Zoloft)

 - Paroxetine (Paxil)

 - Fluoxetine (Prozac)

serotonin-norepinephrine reuptake inhibitors:

 - Venlafaxine (Effexor)

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All the medications named above are antidepressants. Person's experiencing PTSD may have a chemical (neurotransmitter) imbalance. The antidepressant drugs are prescribed to help create the chemical balance found in persons who have not experienced PTSD.

The risks associated with these drugs are mild-moderate such as: upset stomach, headache, sweating, and dizziness. 

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Psychotherapy Treatment

psychotherapy in group or on-on-one

Psychotherapy typically lasting between 6-12 months but may continue longer

Exposure therapy

Cogitative restructuring 

Eye Movement Desensitize and Reprocessing

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Exposure therapy has been very popular for PTSD as it helps the client face and deal with their fears. It is a gradual exposure process that helps them experience the event in a safer way. Exposure therapy can be writing, visualization, or even visiting the site of trauma. 

Cognitive restructuring is another popular treatment method to PTSD. This helps with the clients memories of the event. Often times people who have experienced a traumatic event, may remember the event differently. They sometimes may even remember the event in a more dramatic way. This style of therapy may relieve the client of any guilt felt over the event. 

EMDR helps you process and make sense of your trauma while paying attention to a back-and-forth movement or sound (like a finger waving side to side, a light, or a tone) (U.S. Department of Veteran Affairs, 2017). 

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Relapse prevention

PTSD symptoms can come and go over the span of many years. 

Routine therapy sessions are encouraged to help correctly identify If a client is having these symptoms come back. 

Medications are also used to help regulate and diffuse future outburst of symptoms related to PTSD.

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It is no uncommon for a person to experience symptoms of PTSD throughout the life span. Therapy is suggested periodically to help decrease the chances of an outburst or major episode. 

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Treatment Goals

Learn coping techniques to reduce symptoms of PTSD and Give the diagnosed person the necessary mental equipment to handle future stressful situations. 

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Treatment for PTSD is focused around decreasing stress and anxiety with the combination of medications deemed necessary to help with these feelings and to aide in regulating sleeping patterns. A person diagnosed may not fully get over the traumatic event however, than can learn to cope with it in a way that helps them return to a normal functioning life. 

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Case Presentation:

Age: 26 years old

Gender: Male

Occupation: Professional Football Player

Reason for Therapy Visit: Mental Issues following a traumatic knee injury

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The hypothetical case presentation I have chosen is about a 25 year old professional football player who experienced a traumatic knee injury during competition. This scenario is seen in all sports however, they are much more common in contact sports such as football. 

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Case Presentation Symptoms:

Nightmares in which they relive the event, sometimes reporting feelings of pain in the injury area upon waking up.

Severe anxiety about returning to practice

Avoids social settings involving his team or social media

Feelings of depression caused by his inability to overcome the injury

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Case Presentation Diagnosis:

The athlete is suffering from multiple symptoms of PTSD as well as a secondary diagnosis of social and performance anxiety disorder. 

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The athletes nightmares, feeling of pain, and, anxiety and avoidance of situations pertaining to their occupation gives way to the diagnosis of PTSD. Given that the anxiety over performance and their social situations is so severe, an anxiety disorder diagnosis may be necessary as well. 

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Case Presentation Treatment Plan:

Exposure therapy

Cognitive Processing therapy 

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Exposure therapy would be instrumental in helping the athlete return to normalcy around his career. This type of therapy will help the client deal with his avoidance and fear issues. Gradually exposing the client in a positive manner to the environments and situations associated with his profession will help rid him of his fears and anxieties.  a sample prolonged exposure treatment is: getting to know the client, teaching breathing techniques to deal with anxiety, learning which particular places and situations trigger the anxiety, then a gradual exposure to the places and situations listed. 

Cognitive Processing Therapy is a therapy that essential works on changing the clients thought process about certain memories pertaining to the traumatic event. If they can change the particular thought pattern that causes symptoms of PTSD than this may help relieve the stressors involved with the client. A sample treatment process of CPT is: learning about the traumatic event in great detail, learning more specifics about how the event has effected the client, talking about the unhealthy and negative thoughts you have on the event, providing worksheets and other exercises to help reshape the thoughts into more positive ones. 

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PTSD Overview: 

Mental Health Issue related to a person who has experienced a traumatic event 

Symptoms typically appear within 3 months of the event but may not arise until years later

Treatment is largely trauma-focused psychotherapy  but may incorporate medication (antidepressants)

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Posttraumatic Stress Disorder is most popular within the military community however, it is found in anyone who has experienced a traumatic event (e.g. car accident, injury, loss of family member). The disorder has the ability to create many secondary disorders such as: substance use, addiction, depression, and anxiety disorders. Trauma-based psychotherapies are still the most influential in healing persons with PTSD. Antidepressants are prescribed in cohesion with psychotherapy sessions. The US Department of Veteran Affairs is one of the biggest supporters of educating and helping treat persons with PTSD. 

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References 

PTSD: National Center for PTSD. (2007, January 01). Retrieved November 18, 2017, from https://www.ptsd.va.gov/public/PTSD-overview/basics/what-is-ptsd.asp 

Shearer, David & Mellalieu, Stephen. (2011). Sport psychology support to an athlete undergoing treatment for Post-Traumatic Stress Disorder: A case study. Journal of clinical sport psychology. 5. 134-147. 

R. (2017, July 11). Mind, Body and Sport: Anxiety disorders. Retrieved November 05, 2017, from http://www.ncaa.org/sport-science-institute/mind-body-and-sport-anxiety-disorders

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References Continued:

Schupp, L. J. (2015). Assessing and Treating Trauma & PTSD. Eau Claire, WI: PESI Publishing & Media.

Bergland, C. (2013, November 5). The Neuroscience of Post-Traumatic Stress Disorder. Retrieved November 5, 2017, from https://www.psychologytoday.com/blog/the-athletes-way/201311/the-neuroscience-post-traumatic-stress-disorder

Cleere, M. (2012, June 6). SIMILARITIES OF BURNOUT AND PTSD. Retrieved November 5, 2017, from https://drmichellecleere.com/blog/similarities-of-burnout-and-ptsd/

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