Of the four categories of PTSD symptoms described in
our text, I believe that alterations in arousal and reactivity
would be the most difficult for a person to cope with.
Sanderson (2013) describes this symptom as an individual
expressing "irritable or aggressive behavior; reckless or
self-destructive behavior; hyper-vigilance; exaggerated
startle-response; problems with concentration; sleep
disturbance" (p. 21). These types of behaviors, especially
if never exhibited by an individual before, could have
lasting impacts in relationships for the individual
experiencing them. If we take parenting as a brief
example when exploring these symptoms, an individual
experiencing heightened anger or irritability may easily
express these emotions when engaging with a child
(Sherman et al., 2016, p. 402). Research has found that
parental anger can be related to increased parenting stress,
unhappiness, and negative attribution bias for child
behaviors, as Sherman et al. (2016, p. 402) presented.
When working with military veterans, for example, these
behaviors are not uncommon. When working with a client
who has children, they often express difficulty coping
with aggression and irritability. In my experience, clients
have voiced that this is one area they want to improve
because it impacts their ability to have a conversation or
react positively to a stressful situation. Furthermore,
managing other symptoms can be exhausting for an
individual due to the lingering impact on their day to day
routine. When an individual does not get proper sleep, for
example, this can cause them to be at risk of being more
irritable or quick to respond aggressively (Kamphuis,
Meerlo, Koolhaas, & Lancel, 2012, p. 327). Kamphius et
al. (2012) continue to discuss how sleep impacts an
individual's emotional state, not only from the amount of
sleep but also regarding the quality of sleep (p. 328).
While night terrors may be an essential category of PTSD
symptoms to focus on due to the extent that alterations in
arousal and reactivity can have for an individual,
addressing the symptoms would be of greater importance
before addressing other symptoms. When working with
clients who have experienced trauma or have a PTSD
diagnosis, it can be empowering to pull strength from the
Lord. Lamentations 3:21-24 reminds us, "But this I call to
mind, and therefore I have hope: The steadfast love of the
Lord never ceases; his mercies never come to an end; they
are new every morning; great is your faithfulness. "The
Lord is my portion," says my soul, "therefore I will hope
in him" (Bible Gateway, 2016).
TRMA 8 Discussion 1-PTSD Symptoms
Sanderson (2013) discusses four symptoms associated
with Post Traumatic Stress Disorder
(PTSD). These four symptoms are intrusion symptoms,
avoidance symptoms, alterations in cognition and mood
and lastly, alterations in arousal or reactivity. This writer
believes that avoidance symptoms would be the most
difficult to cope with. Sanderson (2013) describes
avoidance symptoms as "avoidance of distressing
memories, thoughts, or feelings associated with the
traumatic event(s); avoidance of external reminders (i.e.
people, places, conversations, activities, objects,
situations) that arouse distressing memories, thoughts or,
or feelings associated with the traumatic event(s)." (p. 21).
Avoidance is a common reaction to trauma that can be
helpful in some instances. It can assist in assisting an
individual to focus on things that you can immediately
control which can be a beneficial strategy. Another
example of helpful avoidance is its ability to allow the
individual to ground themselves in the moment verses
focusing on past events which enables the person to
complete immediate tasks at hand that are
necessary, such as work or school verses focusing solely
on the traumatic event. (ptsd.va.gov). However, long term
avoidance of a trauma event may create a situation where
the symptoms worsen, delay healing, and make it difficult
for an individual to move on with their life.
Pinelas, Mostoufi, et el advise that "Avoidance has been
theorized to interfere with successful processing of the
trauma memory, habituation of negative emotions
associated with the trauma memory, and extinction of fear
responses conditioned to internal or external trauma
reminders."
As a clinician, working with clients who may be avoiding
their trauma, it is important to
remember that each client is different and each client will
utilize coping mechanisms that help them manage their
trauma and memories of the trauma. Ferentz (201) also
discussed the many self-
destructive behaviors that are exhibited by survivors of
trauma. Ferentz advises "the challenge for us as helping
professionals is to accept that until the behavior is
translated, understood, and put into the context of a
chronic cycle, and until our clients have successfully
integrated alternative coping strategies and self-soothing
techniques, the behavior will continue." (p. 9). Strategies
for addressing the avoidance behavior with a client should
first involve building a level of trust and safety. Next a
clinician can provide psychoeducation about trauma,
avoidance and how avoidance affects the healing process.
It is also importance to incorporate variations of Cognitive
behavior therapy (CBT) with the client by engaging the
client in learning and utilizing affect regulation and coping
strategies to manage emotions once the client is ready to
explore and process their trauma. Once these steps are
completed, the clinician can begin working on gradual
exposure with the client. (Kliethermes, Drewry &
Wamser-Nanney, 2017). As a Christian counselor, there
are several scriptures that can be shared with a client
regarding healing. Jeremiah 30:17 reminds us "But I will
restore you to health and heal your wounds,' declares the
LORD." (NIV). Philippians 4:9 reminds us "And my God
will meet all your needs according to the riches of his
glory in Christ Jesus." (NIV). And Matthew 11:28-30
advises, "Come to me, all you who are weary and
burdened, and I will give you rest. Take my yoke upon
you and learn from me, for I am gentle and humble in
heart, and you will find rest for your souls. For my yoke is
easy and my burden is light." (NIV).
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PTSD can be a debilitating mental health
condition that affects survivors of traumatic
events. The four symptom categories listed in
the DSM-V include intrusion, avoidance,
alterations in cognitions and mood, and
alterations in arousal and reactivity
(Sanderson, 2014). Any symptom falling
within any of the four symptom groups can be
unbearable depending on the severity and
frequency of the occurrence. However, I feel
that intrusion symptoms such as nightmares
and especially flashbacks, can prove to be
especially debilitating for some. Intrusive
thoughts can wreak havoc on sleep hygiene
which can drastically affect mood. Also,
flashbacks can be crippling and dangerous
not just for the trauma survivor but also those
around them. If a flashback elicits memories
of terror and/or danger the survivor may
dissociate and act as if they are under attack
which actives the sympathetic nervous
system and the fight-flight-flee-or-freeze
response along with other activity related to
managing a perceived threat. Such as the
case for emergency workers and first
responders that are usually first to arrive on
the scene of multiple traumatic events as
called for in their line of work. Images of
injuries and suffering can become encoded.
The prevalence rate of PTSD among
firefighters is astonishingly three times
greater than the general population (Lee,
2019). Other vulnerable populations that are
most likely to experience especially difficult
intrusive symptoms are veterans and sexual
abuse victims. Women are more often
diagnosed with PTSD as compared to men
however the numbers can be closely related
to men’s usual inability or desire to express or
come forward about the truth of the severity
and associated symptoms until it is more
deleterious in nature (Sanderson, 2014). A
study of 545 firefighters concluded that a
majority of firefighters will engage in an
excessive amount of rumination about past
events (Sanderson, 2014). This excessive
rumination, coupled with the inability or
desire to come forward in a timely manner
regarding symptoms of repeated exposure to
trauma may result in intrusive rumination.
The article also addresses the issue of
“macho culture” that prevails with male
firefighters and how this culture further
impedes the ability of men to come forward in
a timely manner in an effort to either stave off
or lessen the severity and impact of intrusive
thoughts (Sanderson, 2014). Firefighters
reported that the most prevalent form of
intrusive thoughts are regarding entrapment
such as when fighting a fire within a facility
and feeling a sense of inescapability
(Sanderson, 2014). The most reported
reactions include extreme anxiety and
feelings of breath constriction (Sanderson,
2014). These reactions also resulted in an
increase in the likelihood of suicidality
amongst the firefighters that participated in
the study (Sanderson, 2014).
References
Lee, J.-S. (2019). Perceived social support
functions as a resilience in buffering the
impact of trauma exposure on PTSD
symptoms via intrusive rumination and
entrapment in firefighters. PLOS ONE, 14(8).
https://doi.org/10.1371/journal.pone.0220454
Sanderson, C. (2014). Counselling skills for
working with trauma: healing from child
sexual abuse, sexual violence and domestic
abuse. Jessica Kingsley Publishers.
Posttraumatic stress disorder (PTSD) is one of
the main disorders that someone may
experience after a traumatic event (Bryant,
2019). When an individual experiences a
traumatic event, their body's response to the
traumatic event can be so overwhelming that
it affects their ability to cope. Not everyone
who experiences trauma gets PTSD. FThe four
categories of PTSD listed by Sanderson are
intrusive memories/re-experiencing, alteration
in arousal/hyperarousal, avoidance, and
negative thoughts or feelings (Sanderson,
2013). I believe intrusive memories/ re-
experiencing would be extremely difficult for
an individual to cope with. My rationale is that
these intrusive memories would make the
individual feel as though they are reliving the
traumatic event. According to Iyadurai et al.,
(2019), "Intrusive memories involve mental
imagery-based impressions that intrude into
the mind involuntarily and are emotional."
Symptoms of intrusive memories include but
are not limited to, unwanted memories of the
traumatic event that are distressing like
flashbacks, dreams, or nightmares. An
individual can also experience physical and/or
emotional discomfort from a stimulus that
triggers a memory of a past traumatic event
(Mayo Clinic, 2022). Because intrusive
memories about the traumatic event
oftentimes happen involuntarily, this means
the individual has little to no control over it
which makes it difficult for them to function
effectively in their daily activities (Iyadurai et
al., 2019). For example, someone who has
experienced sexual abuse may experience
intrusive memories in many different forms
such as mental images, smells, sounds,
tastes, or even bodily sensations. Another
example would be someone who was in a car
accident may have intrusive memories of
hearing the noise from the bang, the airbag,
(people screaming if they were), or seeing the
dust and smoke from the accident (Iyadurai et
al., 2019).
F
I think that intrusive memories of the
traumatic event not only allow the individual
to re-experience the traumatic event by
making it difficult for them to cope. I believe it
makes it difficult for them to process their
trauma and healing. I like to think that just
like a physical wound is to the body, so is an
emotional wound to the brain. When an
individual is reliving these traumatic
experiences, it is like reinjuring the brain
which is being traumatized all over again.
They go through the exact emotions and
feelings they felt the first time they
experienced the trauma. As a visual person, I
looked at this as poking or pulling off the
scabs of a physical wound that the body is
trying to heal. This leaves me with a question.
Can someone truly heal from PTSD or are the
tools and techniques they used are just to
help them cope and learn how to manage
their intrusive memories?
F
F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F
References
Bryant R. A. (2019). Post-traumatic stress
disorder: A state-of-the-art review of evidence
and challenges. Journal of the World
Psychiatric Association (WPA), 18(3), 259-269.
https://doi.org/10.1002/wps.20656
F
Iyadurai, L., Visser, R. M., Lau-Zhu, A.,
Porcheret, K., Horsch, A., Holmes, E. A., &
James, E. L. (2019). Intrusive memories of
trauma: A target for research bridging
cognitive science and its clinical application.
Clinical Psychology Review, 69, 67-82.
https://doi.org/10.1016/j.cpr.2018.08.005
F
Mayo Clinic (2022). Post-traumatic stress
disorder. Retrieved October 30, 2022, from
https://www.mayoclinic.org/diseases-
conditions/post-traumatic-stress-disorder/
symptoms-causes/syc-20355967
F
Sanderson C. (2013). Counseling skills for
working with trauma: Healing from child
sexual abuse, sexual violence, and domestic
abuse. Jessica Kingsley Publishers.
Good evening,
Sanderson (2013) discusses the four symptoms
associated with PTSD, which include: Alterations in arousal
and activity, intrusion symptoms, avoidance, and alterations
in mood or cognition. With respect to the remarkable
difficulties each of these categories may cause, I believe that
intrusion symptoms would present the greatest challenge in
symptom management and healing. Intrusion symptoms may
manifest in the form of: Unwanted and distressing memories,
recurring nightmares, dissociative flashbacks, reliving the
traumatic event (re-experiencing), and distressing
physiological reactions and emotional discomfort
(Sanderson, 2013). Due to these intrusion symptoms
happening involuntarily, the individual has limited to no
control over when manifestations occur (Iyadurai et al.,
2019). In understanding this, I imagine that the individual’s
baseline would remain at a state of hypervigilance, working
to avoid the next trigger or amygdala hijack that derails their
state of being. Bardeen (2020) explains that, comparatively,
vigilance is beneficial to an emotionally regulated individual
in that it helps the person remain alert to their surroundings.
Meanwhile, hypervigilance is a “hallmark symptom” in
PTSD, as the individual grants bias to threats and remains in
a state of extreme alertness. This hypervigilance causes the
individual to continue searching for hidden threats (real and
perceived) in non-threatening environments, in efforts to
keep themselves safe (Bardeen, 2020).
An individual with PTSD may choose to avoid certain
places, sounds or events that they know will cause a trigger,
as they come to learn that their ability to manage the
physiological and emotional overpowering is limited. A
personal example is my uncle Bill, who was a Vietnam
veteran. He avoided family functions for many years, as his
intrusion symptoms caused him to become verbally and
physically aggressive, with no ability to re-regulate within
the environment. In mentioning my uncle, I believe it is
important to note that a trigger is not limited to visual or
auditory cues, but can also be activated by olfactory senses
(smell), which have been linked to stronger symptoms of re-
experiencing and hallucinations (Toh et al., 2020). My
family did not discover until after my parents’ divorce that
the smell of my father’s cigarettes reminded my uncle of
being overseas. He scarcely spoke of his time in Vietnam and
did not know how to verbalize what was happening within
him in those moments of intrusion. Bill struggled with
cognitive dissonance of his brain and body living in the past,
while his eyes were seeing present-day surroundings.
I believe that intrusion from traumatic events would also
be challenging to the healing process, as the individual could
be impacted while awake and asleep. The body would not get
the rest it needed to adequately recharge and properly
function, which could cause strain on the person’s ability to
successfully employ any coping skills learned in therapy.
While not all individuals suffer with every symptom of
PTSD, I do believe that night terrors and many other
symptoms require pharmaceutical assistance to aid in the
healing process and allow the individual to reach a lessened
state of distress. I once had a therapist advise me that one
cannot conduct therapy in a burning building. I now realize
that the burning building can be representative of one’s
mental state, as well as external environment.
Reference
Bardeen, J. R. (2020). The regulatory role of attention in
PTSD from an information processing
perspective.GEmotion in Posttraumatic Stress
Disorder, 311-341. https://doi.org/10.1016/B978-0-
12-816022-0.00011-9
Toh, W. L., Thomas, N., Robertson, M., & Rossell, S. L.
(2020). Characteristics of non-clinical hallucinations:
A mixed-methods analysis of auditory, visual, tactile
and olfactory hallucinations in a primary voice-
hearing cohort.GPsychiatry Research,G289.
https://doi.org/10.1016/j.psychres.2020.112987
Iyadurai, L., Visser, R. M., Lau-Zhu, A., Porcheret, K.,
Horsch, A., Holmes, E. A., & James, E. L. (2019). Intrusive
memories of trauma: A target for research bridging cognitive
science and its clinical application. Clinical Psychology
Review, 69, 67-82. https://doi.org/10.1016/j.cpr.2018.08.005
Sanderson, C. (2013).GCounseling skills for working with
trauma: Healing from child sexual abuse, sexual violence,
and domestic abuse. Philadelphia, PA: Jessica Kingsley
Publishers. ISBN: 9781849053266.
