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  1. #1
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    "Treating post-traumatic stress disorder: confronting the horror" by Mark Creamer

    "Treating post-traumatic stress disorder: confronting the horror" by Mark Creamer is licensed under CC BY-ND 4.0

    While human beings have always known about the mental health effects of trauma, it was only in 1980 that the term post-traumatic stress disorder, or PTSD, was coined. This acceptance spawned an explosion of research on the causes, vulnerabilities, and optimum treatments for PTSD.

    We have since learnt a great deal about how to help people with this disabling and often chronic condition. Evidence-based treatment guidelines in Australia and the United Kingdom are consistent in their recommendation of "trauma-focused psychological treatment" as the first line approach for PTSD. Of these approaches, the strongest body of evidence supports an intervention known as "prolonged exposure".

    PTSD is a complex disorder, with multiple symptom groups. Avoidance of trauma reminders, persistent hyper-arousal (constantly looking out for potential danger), and negative mood are key features. The hallmark, however, is that of "re-experiencing the trauma" in the form of intrusive images, memories and nightmares.

    It is this inability to move on ? being constantly haunted by the past horror ? that drives the other symptom clusters. Any successful treatment, therefore, must target these traumatic memories and prolonged exposure is designed specifically to do that.

    Prolonged exposure is a common sense approach. We are all familiar with "getting back on the horse" ? confronting what frightens us and not avoiding it. The most successful treatments for all anxiety disorders are built around this concept.

    To treat someone who is very frightened of spiders, for example, we would help them to face their fear.

    Starting with a small spider in a jar across the room, we would gradually get closer and gradually move to bigger spiders. At each step the anxiety would increase but, by staying with it and not running away, it gradually reduces or "habituates" so that we can move on to the next step.

    Treating PTSD is essentially the same process. We help the person to gradually confront situations, places and activities they?ve avoided since the traumatic event because they cause great anxiety; we call this in vivo (or live) exposure. In PTSD, however, the main "feared object" is not outside the person, it is the memory of their traumatic experience.

    People with PTSD ? consciously or unconsciously ? block out and avoid these painful memories. Prolonged exposure helps them to gradually confront the memories and "work through" the experience in a safe and controlled manner; we call this imaginal exposure. Each time they confront the memory without avoiding, and stay with it long enough for the distress to reduce, they make another step towards recovery.

    The first component of prolonged exposure is to explain clearly what we are doing and why; after all, we are asking them to do what they fear most. We explain the rationale and process in detail, often using metaphors to illustrate the mechanisms involved.

    We also teach them strategies to manage distress. These are not to be used during prolonged exposure, but it is important for people to feel confident about controlling their distress at other times.

    We then ask the person to talk through the event. Just as we graded our exposure for the spider phobic, we try to do for the memory. On the first few runs through, the person might talk with their eyes open, in the past tense ("I walked into the park..."), and skip over the worst aspects.

    On later exposures, however, it is important to confront all aspects of the experience, to ensure there are no ?skeletons in the closet? that will cause problems later. So we use eyes closed, present tense ("I am walking into the park?"), focusing on all senses (sights, sounds, smells, tastes, touch), and ? as treatment progresses ? confronting the worst aspects of the experience in detail.

    We monitor the patent?s distress regularly to ensure it is reducing before moving on to the next level.

    Imaginal prolonged exposure is a powerful process for both therapist and client. It results both in reduced distress and in greater understanding of what happened and why. "Putting the pieces of the jigsaw puzzle together" is crucial to recovery and has long been recognised as an effective treatment.

    Early variations on prolonged exposure (such as "abreaction") used drugs to access the memories, while more recent approaches (such as desensitisation) placed a heavy emphasis on relaxation and arousal reduction during exposure. We now know that neither is recommended; people can access the memories, and can tolerate the distress, without these additions.

    While there is a common perception that the best way to recover from trauma is to forget about it and focus on the future, the research and clinical evidence is clear: for trauma survivors with PTSD, that is not the case. Indeed, the evidence is now sufficiently strong that it would be negligent not to offer a trauma-focused psychological treatment to a patient with PTSD.

  2. #2
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    Jerry, I really respect you and you're usually pretty spot on.

    But this article is not correct. Not in the least. And it can be damaging to people who have PTSD.

    Telling someone to get back on the horse, face the spiders in a closed box over and over and it will "eventually get less fearful," does nothing but re-traumatize the person over and over.

    This type of treatment puts the "blame" on the victim and tells the victim they have full control over their body's memories and feelings. A trigger is just that. An involuntary knee jerk when something in our past is hit like a button.

    If this person who wrote the article is thinking that the victim needs to just "do it over and over until they get it right," then all that does is put more guilt and shame on the victim. It's telling the victim that they are the ones "causing" the trigger.

    So Jerry, please don't profess this to be a treatment for PTSD. Unless you are a trauma specialist who has worked with PTSD for years and years, you can't just post this kind of answer. If I ran this past the trauma-specialists I work with, they would say the same thing.

    Remember, that I'm an LPC. Anything that tells a person to keep doing something over and over and it will get better isn't the pat answer to this complex problem.
    Ex. I didn't want to have sex with my ex. Why? Because he was a complete shithole who didn't respect me, he was addicted to porn, and he he lied and blamed me constantly. Let's not discuss the abuse.

    His therapist wanted to do "marriage counseling" with us and told me that all I had to do to get over my disgust of having sex with the man was to have as much sex as possible with him. He said, "after a time, you won't have a fear of having sex anymore."

    First of all, did I say I was afraid of having sex with the man? I said I didn't want to have sex with him. But this jerkface put the dysfunction of the relationship squarely on my shoulders. He basically said that my PTSD (from everything in my life) would be cured if I just "practiced" sex to get over the fear. Uh. Bullshit.

    So no. PTSD is not cured by prolonged exposure. Shooting at me more to the point of everyday will not get me to stop flinching and ducking when people shoot at me. I'm sure any soldier would tell you the same thing. The only desensitizing that happens is you go further and further within yourself because you give up trying to deal with the feelings. That may look like you're getting better, but what's really happening is you're withdrawing from the world. Then everybody around you believes "oh he or she is better."

    I think the reality is that people want what people want and if they want sex or anything from someone else, they will put the blame of the relationship on that other person and then find some bogus psychology to back it up. This article puts the blame squarely on the victim's shoulders. Relationships are 50/50.Unless both partners agree to not ever put any blame on each other, the relationship will not work. If one partner is trying to "fix" the other, then that tells me that relationship is already doomed. Yes, I know you're just talking some "treatment" for PTSD, but let's face it, much of PTSD is from one person mind-fucking another into doing what they want to meet their needs. That includes war.

    How about we all live and let live and stop trying to convince someone else to be the person we want them to be? I'm sure if we did that, there wouldn't even be a PTSD diagnosis. We would just say, "I can understand why that person is jumpy because they got hurt from that action. I'm sorry they got hurt." And then just decide from that fact whether you want to be around the person or not. If you can't take the jumpiness, you need to find somebody less jumpy. If you can't live with a person who's afraid of spiders, then don't expect that person to deal with their fear. Just leave if you can't live with that fact.

    I think people with PTSD are hurt most by people who overstep boundaries and look for articles like the above one, to put the blame of a relationship squarely on our shoulders.
    The Hokey Pokey IS what it's all about

  3. #3
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    Quote Chantellabella View Post
    ...
    I agree with you, there isn't a one size fit all treatment for PTSD, but what I want to do is post resources, and whether or not people agree or disagree is completely up to them. And something I very much want members to post their own views, experience, and even challenge the resources, because that is what is going to help others.

    I would only post something if I knew there was at least some science and experience behind it. The author of the article is Prof. Mark Creamer, he is a Professor of the Department of Psychiatry at University of Melbourne. He studied psychology in the UK and Australia, and completed PhD in PTSD. He is also the director of the Australian Centre for Posttraumatic Mental Health, and runs his own clinic for PTSD.

  4. #4
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    Believe me. I know a lot of PHD's who do more damage than good. I object to his wording. Yes, he's basically saying what "they" do, but his articles makes it sound like it's God's truth. First year counseling students learn that nothing is God's truth. Also where's this guy's research? He has an article on the subject. I want correlations, subjects, years of research. I hear him saying, "We do this and it's the end all of how to treat PTSD." I know first hand that it's damaging to someone with PTSD. The article in it's raw form is not a treatment for the disorder.

    But that's the problem with cyberspace. We have Wiki, Medline, and other articles out there that anybody can post and others believe them. PTSD is not something to mess around with. I'm living proof that so-called "experts" can [BEEP] up people more than help them. I had 2 therapists who knew "a little" about the subject and because they touted themselves to be knowledgeable in the field, they set me back decades in recovery.

    Unfortunately cyberspace is overrun with people's opinions on how to deal with PTSD and stubbed toes. Luckily your life can't be easily ruined with a stubbed toe. People who know little about a subject but write that they have the answer to a problem are seriously dangerous to people. Yes, it's the responsibility of people to not take cyberspace articles as God's truth, but who actually will go into databases and read the actual research of a hypothesis?

    And even if research showed positive results or any correlation, that still doesn't mean it's "the answer." I used to do psychological, educational, intellectual, and developmental testing when I was in private practice. Even if the entire battery of tests I performed gave me a result that seemed pretty conclusive, there was still the window that the person was having a non-typical day. If I didn't know all of the facts, the results could also be skewed.

    We are also taught in counseling school to never present findings as the truth. We used "may," "likely," "evidence to support," etc, rather than "will." This guy touts that he knows the answer and pooh poohs the other approaches. The only think I even find remotely close to an open-mind is his statement " it is important to confront all aspects of the experience, to ensure there are no “skeletons in the closet” that will cause problems later." Uh, ya think?

    I'm not knocking you for posting this. My beef is your title of "treating" PTSD and no disclaimer that you found this article on the internet and well, here's one guys opinion of what would help.

    Personally, my opinion of treating PTSD is to find a trauma-specialist and talk with him or her about "why" it frightens you and then get to the root of the problem taking into consideration the present environment which the client must react with everyday. If someone or something in their life is keeping them stuck in their trauma, then maybe deal with that environmental issue before attacking what's "wrong" with the patient. Also, telling them there's something wrong with them in the first place is damaging.

    And also ask the patient if they feel it's a problem. Maybe being wary of being shot in my backyard is a good thing. It keeps me from looking over the fence when I hear gunshots. A soldier will hit the ground when he or she hears an air raid horn. That's PTSD, but it's also called self preservation. It only becomes a problem if I don't want to flinch in my backyard or the soldier doesn't want to hit the ground in a grocery parking lot. But it has to be a problem for the client and not because someone around them says "it's a problem." See the difference? We flinch for self preservation. We hesitate or react to protect ourselves. Until we actually say "hey this is a problem for me," then it's not a problem. Yes, people around the client have the right to say it's a problem for them if they are being affected. But if the client doesn't want to give up that self protection, then making them feel guilty or finding articles like the one above by some guy with a piece of paper on his wall isn't the answer. Believe me, that only compounds the problem. You're basically saying, "It's wrong for you to protect yourself." How selfish is that?
    The Hokey Pokey IS what it's all about

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