Reflection on Understanding and Treating PTSD Xxxxxxx xxxxxx EmpireState College

I have read and am aware of the university requirements regarding academic honesty

Instructor: Bernard Wakely
December 21, 2012

Introduction
What is now known as Posttraumatic Syndrome Disorder has a long history and list of names. It has been suggested that Homer form the Odysseus described symptoms of PTSD upon his return from the Trojan War. More recently it has been given many names. During the civil war it came to be known as Soldiers heart. During WWI it became known as “shell shock” and “war neurosis”, changing again during WWII to “battle fatigue” and ‘combat neurosis”. During this war the condition was so severe during this war psychiatric discharged soldier outnumbered new recruits. The name once again morphed during the Vietnam War to “post-Vietnam syndrome” and finally settling to its current moniker Posttraumatic syndrome disorder. Despite the many name changes one thing has remained constant and that is the condition causes suffering

Over View
Post Traumatic Stress Syndrome is an anxiety disorder that is caused by exposure to a situation or environment that is violent or life threatening to an individual or others. Its symptoms include flashbacks, hyperarousal and avoidance. It was originally believed that PTSD represented a natural and normal response at the extreme end of a response continuum based on the severity of the trauma. This response is the flight or fight survival mechanism gone haywire. The,flight or fight reaction is meant to protect a person from harm. However, in PTSD, this reaction is compromised or damaged. As a result people who have PTSD may feel stressed or frightened even when they’re no longer in danger. Researchers have learned that this response to a trauma is not solely based on stressors but also on the factors unique to the individual. The select minority of people have who suffer trauma provoked by the experience of extreme threat lead to PTSD. PTSD was officially identified in the DSM-III in 2008. It has been identified in the DSM- IV as the only mental health condition officially defined to be caused by a single external event. (American Psychiatric Association, 2000) The early days of diagnosing and understanding PTSD was simple, you were either considered sick with PTSD or you were fine. Now the response and range of understanding has become layered and deeper and funding for further research and treatment has increased. However understanding of PTSD is still limited and broadly associated with other risky behavior and aggression that does a disservice to veterans who aren't sick, but aren't quite fine either.New research for a better understanding of the effects PTSD has on the brain and brain chemistry are still going on, and treatments are still being tested. It has come to be understood that Post-traumatic stress disorder affects multiple areas of the brain, and that, in turn, affects an individual’s ability to function properly, including sensory input, emotional expression, memory formation and stress responses. Further research has taught that there is a measurable difference in the right temporal lobes of people suffering from PTSD, and something similar to epilepsy happening in the gray matter there, a change in the electrical transmission of brain cells in that part of the brain.
Further understanding of the process of the reenactment revealed the fear centers of the limbic system seem to be more active in people who have been traumatized. This active limbic system makes the frontal cortex unable to tell the brain that the threat is gone and allow the individual become rational again. Further understanding of the chemical changes in the brain showsthat In PTSD once the brain goes through the chemical ‘rewiring’ to survive trauma, the wiring stays that way. The chemicals in the brain, noradreneline, dopamine, serotonin, the opioid systems, insulin, and cortisol all play complex roles in the PTSD symptom producing process. (Sherin & Nemeroff, 2011) Any level of exposure to trauma can cause PTSD to surface and the longer PTSD is left untreated the worst it will get.
Treatments
Over the years much advancement in treatment options has come to surface. The treatments for PTSD can comein the form of therapy, medication or both. Some of the therapies available for post-traumatic stress disorder are cognitive processing therapy, prolonged exposure therapy and group therapy. In cognitive processing therapy, or CPT, a therapist works with an individual to help them understand and change how they feel about the trauma. In exposure therapy is a type of behavioral therapy. It focuses on the learned avoidance behaviors that people might engage in response to anxiety provoking event, memory or thought. Little by little this therapy exposes them to the thing they avoid. The ultimate goal of exposure therapy is to help reduce a person's fear and anxiety. Lastly there is group therapy. A major benefit of group therapy is validation. Being in a group with others struggling with the similar issues, shows the individual that they are not alone in their struggles. Pharmacotherapy(medication) is the other option for treating PTSD. A vast variety of medicines have proven to be quite successful in managing symptoms. Some of the most effective medications are, Selective Serotonin Reuptake Inhibitors 0020(SSRIs), other antidepressants, atypical antipsychotics, benzodiazepines, and other medications. SSRIs, primarily affect the neurotransmitter serotonin. They are the only FDA approved medications for PTSD. . Serotonin regulates mood, anxiety, appetite, sleep, and other functions. SSRIs work by preventing the reuptake of serotonin, thereby forcing the neurotransmitter to stay in the synaptic gap for longer than normal. Much more research has been done on the efficiency of drugs in the treatment of PTSD. The selective serotonin reuptake inhibitors (SSRIs) have been investigated more than any other family of drugs. Another thing to consider in understanding the treatment of PTSD is comorbid disorders. Treatment of PTSD patients is often complicated by the presence of comorbid psychiatric diagnoses in at least half of cases. Alcohol and substance dependence and abuse are also frequently present with PTSD.

Despite the vast understanding of the process of PTSD and the advancement in therapy and pharmacology there are still many challenges in understanding. Some of these challenges include the struggle to determine who will get PTSD, how to identify them as soon as possible then get them in for treatment. .PTSD can strike anyone at any age. This includes war veterans and survivors of physical and sexual assault, abuse, accidents, disasters, and many other serious events not everyone with PTSD will go through a dangerous event. Some people get PTSD after a friend or family member experiences danger or are harmed. The sudden, unexpected death of a loved one can also cause PTSD. However, not everyone who lives through a dangerous event will develop PTSD. In fact, the majority will not get the disorder. It is now understood that there are risk factors that make a person more likely to get PTSD. Risk factors for PTSD include: Living through dangerous events and traumas, Having a history of mental illness, Getting hurt, Seeing people hurt or killed, Feeling horror, helplessness, or extreme fear, Having little or no social support after the event, Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home. On the other side, resilience factors can help reduce the risk of the disorder. Resilience factors that may reduce the risk of PTSD include Seeking out support from other people; such as friends and family; Finding a support group after a traumatic event; Feeling good about one’s own actions in the face of danger, Having a coping strategy, or a way of getting through the bad event and learning from it; Being able to act and respond effectively despite feeling fear.
Researchers have learned a lot in the last decade about fear, stress, and PTSD, also learning about how people form memories. This is important because creating very strong fear-related memories seems to be a major part of PTSD. Researchers are also exploring how people can create “safety” memories to replace the bad memories that form after a trauma. This research will improve treatment and find ways to prevent the disorder.

Using powerful new research methods, such as brain imaging and the study of genes, to find out more about what leads to PTSD, when it happens, and who most at risk is; trying to understand why some people get PTSD and others do not. Knowing this can help health care professionals predict who might get PTSD and provide early treatment; Focusing on ways to examine pre-trauma, trauma, and post-trauma risk and resilience factors all at once; Looking for treatments that reduce the impact traumatic memories have on our emotions; Improving the way people are screened for PTSD, given early treatment, and tracked after a mass trauma; Developing new approaches in self-testing and screening to help people know when it’s time to call a doctor; Testing ways to help family doctors detect and treat PTSD or refer people with PTSD to mental health specialists.

Though treatment is readily available, it is often hard to convince some sufferers of PTSD, mainly war veterans, to come in for treatment. There is a stigma attached to having mental health problems and seeking help for mental health problems. It exists in our society as a whole. Within the military there is a certain perceived stigma on the part of the soldiers that they're not going to get promoted; they won't be trusted; their buddies will make fun of them; they won't be a real man if they need mental health care. There's a perception on the part of the soldiers that if they seek mental health care, if they express emotion that they're going to be perceived as weak or as a failure, or that they're not going to be reliable, that they can't do their job.

Overall the treatment of PTSD is heading in the right direction. Although many issues still exist great strides have been made in the understanding of the condition. Thirty years ago, we didn’t know how to treat PTSD. As of a result of new outreach and treatments, vets are beginning to seek treatment. The proper and consistent diagnosis and treatment of PTSD is needed but not "over-labeling” returning veterans with diagnoses that may no longer be applicable as these men and women move forward and readjust. The Department of Defense has stepped up efforts to remove the stigma of PTSD treatment, by changing its security-clearance procedure so that applicants need not disclose past mental health care that was was the result of service in a military combat environment. This hopefully will bring even more veterans to seek help.

We are beginning to understand the distinct neurobiology and associated features of PTSD however we have a long way to go in identifying treatments that will reduce the frequency and perhaps preventing its development in traumatized individuals. (Tucker & Trautman, 2000)Research on improving treatment outcome and disseminating CBT has begun. Health professionals are steadily working on finding methods to improve treatment and identifying individuals in need of treatment. (Cahill & Foa, 2007) Though the types of trauma may evolve they will not disappear. New traumas may alter the epidemiology and treatment need in the future. This possibility brings a major challenge to researchers and clinicians to think about it.

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References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association.
Cahill, P. S., & Foa, E. B. (2007, March 1). PTSD: Treatment Efficacy and Future Directions. Psychiatric Times, 24(3).
Cash, A. (2006). The Wiley Concise Guides to Mental Health Posttraumatic Stress Disorder. (I. B. Weiner, Ed.) Hoboken: John Wiley.
Levinson, N. (2012, June 28). What PTSD means for soldier's in a time of shadows war. Retrieved from Mother Jones: http://www.motherjones.com/politics/2012/06/iraq-ptsd-soldiers-military#13557312027941&action=collapse_widget&id=4887427
Sherin, J. E., & Nemeroff, C. B. (2011, September 13). Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues Clin Neuroscience, 13(3), 263-278.
Sword, R. K., & Zimbardo, P. ,. (2012, November 22). Why Reliving Your Trauma Only Goes So Far. Psychology Today.
Tucker, P., & Trautman, R. (2000, 09 20). Understanding and treating PTSD: Past, present, and future. Bulletin of the Menninger Clinic, 64((3,SupplA), A37-A51.