PTSD

Conventional therapy for PTSD typically spans several years and involves both individual and group therapy. Of the many varieties of therapy available for PTSD, almost all emphasize exposure to the frightening stimulus. This is a common treatment among many anxiety disorders.

The four most common treatments for PTSD include psychodynamic, cognitive-behavior therapy, pharmacotherapy, and group therapy. And, there is eye-movement desensitization and reprocessing therapy (EMDR). Therapy can be divided into three phases:

• Establishing trust, safety, and "earning a right to gain access" to carefully guarded traumatic material.
• Trauma-focused therapy, exploring traumatic material in depth, reducing intrusive recollections with avoidant/numbing symptoms.
• Helping the patient disconnect from the trauma and reconnect with family, friends , and society.

Therapeutic methods might include Psychodynamic Therapy (talk therapy), Cognitive-Behavioral Therapy (designed to manage anxiety), Pharmacotherapy (medications to reduce anxiety symptoms while allowing individual and group therapies to work), Group Therapy (mutual support from others with the same experiences), and Eye-Movement Desensitization Reprocessing (EMDR) for developing more appropriate understanding of the trauma to help in managing the trauma.

PTSD and Being a Veteran
As the wars in Iraq and Afghanistan wear on, thousands of veterans are at risk for a particularly distressing and impairing mental health syndrome: Posttraumatic Stress Disorder (PTSD). PTSD becomes a serious risk when a service member experiences, witnesses, or is confronted with an event involving actual or threatened death or serious injury, or a threat to the physical integrity of self or others.

What does PTSD look like? Members of the military community should be alert for the following key symptoms among the combat veterans:

• Recurrent and intrusive distressing recollections of the event, including images, thoughts and perceptions (seeing a comrade's dead body or experiencing flashbacks of the sounds of explosions and screaming)
• Recurrent and distressing nightmares of the traumatic event
• Intense psychological distress when exposed to cues or reminders of any aspect of the trauma
• Extreme physical reactivity (e.g., racing pulse, sweating, intense fear) when exposed to any cues or reminders of the trauma
• Persistent avoidance of any reminder (e.g., conversations, thoughts, activities, places, and people) of the traumatic event
• A general numbing in responsiveness; the person feels detached and estranged from others and may have little range in emotion and few strong feelings
• A sense of a foreshortened future; having come close to death, the person sees it as immanent
• Hypervigilance (constantly scanning the environment for danger)
• Exaggerated startle response (especially to sudden movement or loud noises)
• Poor concentration
• Irritability/anger
• Disturbances in one's ability to sleep

Not all of the symptoms will be present in every case, and veterans may mask the symptoms through nondisclosure or self-medication with alcohol and other drugs. Further, some service personnel are at greater risk for developing PTSD than others. Beyond the severity of the traumatic event itself, key risk factors include poor social support after the trauma, additional life stressors, adverse childhood events, lower education, prior traumatic exposure, and gender -- women are at greater risk. One particularly distressing feature of PTSD is a sense of shame or guilt associated with beliefs that one should have or could have done more during the traumatic period. If comrades died, then survivor guilt can add powerful fuel to PTSD fire.

Army soldiers surveyed three to four months after returning from Iraq, a full 30% had developed stress-related mental health problems. This is not because PTSD sometimes manifests itself months, sometimes even years, after the traumatic event. Called “delayed onset PTSD,” this sleeper version of the disorder makes accurate diagnoses a challenge to mental health providers. What's worse, service members often refuse to disclose disturbing symptoms common of PTSD, either due to distrust of the mental health establishment or because they are embarrassed to seek help.

My practice provides psychotherapeutic care for combat veterans. Service members suffering the symptoms of PTSD need to understand their symptoms as part of a medical and psychological syndrome, and appropriate treatments can significantly reduce symptom intensity.

My office accepts TriCare Insurance. To use your insurance, you will need a “Letter of Referral” from a military physician or psychiatrist.