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Post-traumatic stress disorder

Most people are likely to experience traumatic events in their lifetime, and most individuals recover well, given time and adequate social support.

For some individuals, however, the experience of a traumatic event or ongoing exposure to trauma can result in post-traumatic stress disorder (PTSD).

PTSD refers to a set of symptoms that can emerge some time after exposure to a potentially traumatic event involving actual or threatened death, serious injury, or sexual violence. Exposure to such events can be through:

  • direct experience of the traumatic event
  • witnessing the event happening to someone else in person
  • learning that the event has happened to a close family member or close friend or
  • repeated or extreme exposure to the aftermath of trauma (e.g. first responders to emergency situations).

With good psychological intervention, however, the chances of recovery are strong. Without treatment, individuals are at increased risk for developing chronic PTSD and other mental health conditions, such as depression, anxiety and/or problems with alcohol or drug use.

Symptoms

A diagnosis of PTSD is made when symptoms are present for more than one month and cause significant distress, or interfere with important areas of functioning, such as work, study, or family life. These symptoms can include:

A sense of reliving the traumatic event

  • experiencing unwanted and distressing thoughts or images, flashbacks, or nightmares related to the traumatic event.
  •  feeling as though the event is recurring, even when it is not.

Avoidance and numbing

  • avoidance of people, places, thoughts, and activities associated with the traumatic event. 
  • feeling emotionally flat, losing interest in enjoyable activities, or feeling disconnected from friends and family.

Negative thoughts and mood

  • persistent negative thoughts about self, others, and the world.
  • distorted views about the causes and consequences of the event.

Feeling wound-up

  • feeling irritable, angry, over-alert, or edgy.
  • experiencing difficulties concentrating.
  • experiencing difficulties getting to sleep or staying asleep.

Causes

Not everyone who experiences a traumatic event develops PTSD. Research looking at factors related to the causes of PTSD has identified several mechanisms that could contribute to the development of ongoing symptoms including changes to brain and body activity in response to a traumatic event. These models help guide choice of effective interventions.

Risk factors

Known risk factors include: 

  • the type and severity of the trauma – for example, sexual assault and abuse, military combat and terrorist acts are linked to a higher rate of PTSD than motor vehicle accidents and natural disasters
  • lack of social support and
  • subsequent life stress

Treatment

There are several effective psychological treatments for PTSD. These treatments have been shown through research to help reduce the symptoms of PTSD and to help people recover. They include cognitive therapy for PTSD (CT-PTSD), prolonged exposure (PE), eye movement desensitisation and reprocessing (EMDR), cognitive processing therapy (CPT), and psycho-social interventions.

Cognitive Therapy for PTSD (CT-PTSD)

Trauma can be involuntarily re-experienced when an individual is left feeling a sense of serious, current stress and danger from persistent PTSD due to the way the trauma has been processed. CT-PTSD aims to reduce this by addressing unhelpful thoughts and beliefs resulting from the trauma.

CT-PTSD aims to adjust excessively negative judgements and address unhelpful thoughts and problematic behaviours, as well as any subsequent unfavourable beliefs individuals may develop about themselves, others and the world.

Prolonged Exposure (PE)

In PE, the individual is supported to gradually confront the memories of their traumatic experience and situational reminders of that experience that are otherwise avoided. This involves assisting them to change the way they think and feel about the traumatic experience and develop more helpful ways of coping, through: education about common reactions to trauma, breathing retraining, behavioural exposure (to feared situations that individuals avoided due to trauma-related fear), and cognitive processing (discussion of thoughts and feelings related to the exposure exercises).

Eye Movement Desensitisation and Reprocessing (EMDR)

In EMDR, the individual is guided by the therapist to focus on particular images, thoughts, and bodily sensations related to the traumatic experience while being sensorily stimulated. Most commonly this is done by having the client move their eyes back and forth across their field of vision (e.g., by tracking the movement of the therapist’s finger). The theory and research behind EMDR is that doing this helps the person to process the trauma and integrate the memory with existing memory networks.

Cognitive Processing Therapy (CPT)

In CPT, the individual is assisted to identify unhelpful thoughts and beliefs (“stuck points”) and subsequently challenge and replace them with more helpful and realistic alternatives. This is done via an adaptation of standard cognitive therapy approaches. CPT has a smaller exposure component than PE (see above) that is typically restricted to writing an account of the traumatic experience. CPT also helps to address associated problems such as depression, guilt, and anger.

Psycho-social interventions

Support from family, friends, and others after the experience of a trauma has been found to be a highly significant predictor of recovery. As a result, treatment for PTSD is likely to involve building or strengthening the individual’s social support network. Lifestyle changes that address unhelpful habits which have emerged after the traumatic event - such as reducing or eliminating the use of alcohol or drugs or re-establishing normal activities - will also be helpful. Relaxation exercises can help reduce feelings of agitation and “edginess”, while maintaining a balanced diet and engaging in routine exercise supports overall emotional and physical wellbeing and can also aid recovery.

Seeking help

Seeing a psychologist

If the distress associated with a traumatic event has been affecting an person’s work, school, or home life for more than two weeks, psychological assistance should be considered. Psychologists are highly trained and qualified professionals, skilled in diagnosing and treating a range of mental health concerns, including PTSD. A psychologist can help you to identify and manage the factors that contribute to your distress.

Psychologists usually see clients individually, but, where appropriate, can also include family members to support treatment and provide advice for others affected by the individual’s experience of trauma. Psychologists sometimes offer group-based treatment interventions involving a small number of people with similar difficulties.

There are a few ways you can access a psychologist. You can:

  • Use the Australia-wide Find a Psychologist service or call 1800 333 497
  • Ask your GP or another health professional to refer you.

If you are referred to a psychologist by your GP, you might be able to get a Medicare rebate to cover part of your treatment costs. You may also be able to receive psychology services via telehealth so you don’t need to travel to see a psychologist. Ask your psychologist or GP for details.

Additional resources

Head to Health

The Federal Government’s website linking the public to reputable and evidence-based digital mental health services.

www.headtohealth.gov.au

beyondblue

Provides information on anxiety, depression, and related disorders

www.beyondblue.org.au

headspace

Australia’s National Youth Mental Health Foundation, providing assistance for individuals aged 12-25

www.headspace.org.au

Lifeline

A 24-hour counselling, suicide prevention and mental health support service

Telephone: 13 11 14

www.lifeline.org.au

References

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