Bespoke Therapy & Training has had a wide and varied experience of working with PTSD due to over 10 years of working with clients who have DID and other trauma related experiences. As well as an integrative approach to PTSD we offer EMDR, Mindfulness and some sensory Motor therapy.
PTSD is the term for a severe and ongoing emotional reaction to an extreme psychological trauma. The latter may involve someone`s actual death or a threat to the client`s or someone else`s life, serious physical injury, or threat to physical and/or psychological integrity, to a degree that usual psychological defences are incapable of coping. It is important to make a distinction between PTSD and Traumatic Stress, which is a similar condition, but of less intensity and duration. Formerly the condition was sometimes known as shell shock or post-traumatic stress syndrome (PTSS).
PTSD is thought to be primarily an anxiety disorder, possibly closely related to panic disorder and should not be confused with normal grief and adjustment after traumatic events.
PTSD symptoms may include nightmares, flashbacks, emotional detachment or numbing of feelings (emotional self-mortification or dissociation), insomnia, avoidance of reminders and extreme distress when exposed to the reminders ("triggers"), loss of appetite, irritability, hyper vigilance, memory loss (may appear as difficulty paying attention), excessive startle response, clinical depression, and anxiety.
A person suffering from PTSD may also exhibit one or more co morbid psychiatric disorders. These may include clinical depression (or bipolar disorder), general anxiety disorder, and a variety of addictions.
According to DSM-IV, symptoms that appear within the first month of the trauma are not called PTSD but Acute stress disorder. If there is no improvement of symptoms after a month, PTSD is diagnosed. PTSD is divided into three categories: Acute PTSD subsides within three months. If symptoms persist, the diagnosis is changed to chronic PTSD. The third category, delayed-onset PTSD, may occur months, years or even decades after the traumatic event.
Birth can be traumatic in different ways.
First, medical problems can result in interventions that can be frightening. The near death of a mother or baby, heavy bleeding, and emergency operations are examples of situations that can cause psychological trauma.
Second, emotional difficulties in coping with the pain of childbirth can also cause psychological trauma. Lack of support, or insufficient coping strategies to deal with the pain are examples of situations that can cause psychological trauma. Even if others perceive the birth as normal, if the mother perceives it as traumatic, it was traumatic. Childbirth related PTSD can be caused even by a normal birth and should be diagnosed based on symptoms of the mother, not by the events.
Third, in the process of a medically-managed birth, doctors and nurses who are there to aid the birthing mother may touch or insert things into her genitals without or even against her consent (women are sometimes held down if they protest, verbally berated into submitting, or coerced with false reports that if they do not submit the baby will be endangered). This can very very traumatic, since the vagina is penetrated by an object without consent.
There have been a growing number of reports of PTSD among cancer survivors and their relatives. Most studies deal with survivors of breast cancer and cancer in children and their parents and show prevalence figures of between five and 20%. Characteristic intrusive and avoidance symptoms have been described in cancer patients with traumatic memories of injury, treatment, and death.
Symptoms can include general restlessness, insomnia, aggressiveness, depression, dissociation, emotional detachment, and nightmares. A potential symptom is memory loss about an aspect of the traumatic event. Amplification of other underlying psychological conditions may also occur. Young children suffering from PTSD will often re-enact aspects of the trauma through their play and may often have nightmares that lack any recognisable content.
One patho-psychological way of explaining PTSD is by viewing the condition as secondary to deficient emotional or cognitive processing of a trauma. This view also helps to explain the three symptom clusters of the disorder:
Since the sufferers are unable to process the extreme emotions brought about by the trauma, they are plagued by recurrent nightmares or daytime flashbacks, during which they graphically re-experience the trauma. These re-experiences are characterised by high anxiety levels and make up one part of the PTSD symptom cluster triad called intrusive symptoms.
PTSD is also characterised by a state of nervousness with the patient being prepared for "fight or flight". The typical hyperactive startle reaction, characterised by "jumpiness" in connection with loud unexpected sounds or fast motions, is typical for another part of the PTSD cluster called hyper arousal symptoms and could also be secondary to an incomplete processing, similar to a reflex.
The hyper arousal and the intrusive symptoms are eventually so distressing that the individual strives to avoid contact with everything and everyone, even their own thoughts, which may arouse memories of the trauma and thus provoke the intrusive and hyper arousal states. The sufferers isolate themselves, becoming detached in their feelings with a restricted range of emotional response and can experience so-called emotional detachment ("numbing"). Many Veterans with PTSD may also use avoidance as a technique to avoid losing control and harming others. This avoidance behaviour is the third part of the symptom triad that makes up the PTSD criteria.
Dissociation is another "defence" that includes a variety of symptoms including feelings of depersonalisation and derealisation, disconnection between memory and affect so that the person is "in another world," and in extreme forms can involve apparent multiple personalities and acting without any memory ("losing time").
There have been scores of treatments suggested for the treatment of PTSD. One psychotherapeutic (non-medical) method, specifically targeted at the disorder PTSD, is Eye Movement Desensitisation and Reprocessing (EMDR).
Now recognised by NICE, EMDR is probably the most effective psychotherapeutic treatment for PTSD. Other forms of talk therapy have proved useful, insofar as the individual sufferer is enabled to come to terms with the trauma suffered and successfully integrate the experiences in a way that does not further damage the psyche. Forbes, et al, (2001) have shown that a technique of "rewriting" the content of nightmares through imagery rehearsal so that they have a resolution can not only reduce the nightmares but also other symptoms.
Bespoke Therapy treats PTSD using a combination of counselling methods, (multi-modal) including attachment therory, cognitive-behavioural therapy,(CBT), EMDR, Mindfulness, Imagery, Sensory Motor and so on.
PTSD displays biochemical changes in the brain and body, which are different from other psychiatric disorders such as major depression.
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