Cognitive Healing of Post Traumatic Disorder

Post Traumatic Stress Disorder (PTSD) is a very common mental disorder that is found among women, children, and men. A traumatic event such as rape, combat or a natural disorder causes impairment in concentration and memory, inability to relax, impulsiveness, a tendency to easily get startled, sleep disturbances, anxiety, depression, and also psychic numbing. People suffering from PTSD often lose their interest in activities previously enjoyed. In addition, people often suffer from estrangement from others. The person also has great difficulty keeping the memory of trauma out of mind. They suffer from flashbacks, and experience the pain of trauma over and over. They also have recurring nightmares and dreams of the trauma.

It is important to note that traumatic events shatter the fundamental assumptions of survivors about themselves and their world. Our inner world consists of theories through years of experience beginning in infancy. These include our belief systems about the external world. Initially we all believe that others are nice and benevolence and we are worthy, decent and competent. We assume that bad things happen to those we regard as bad people- not to us. We are usually unaware of these assumptions. However, when we get subjected to trauma like untimely death of loved ones, rape, abuse etc, these assumptions change and the victimization forces us to believe otherwise. It tends to disintegrate the inner world of the trauma victims. The basic trust and confidence is shaken and they feel lost in the absence of an internal guide. They become preoccupied with the thoughts of trauma, images of the gruesome event and meaninglessness of life.

It is difficult to rebuild when old assumptions are invalidated and the new ones are emotionally painful. If the trauma happens to a child, then the inner world created by the trauma may be the only one. Adults, who have greater experience, struggle to assimilate victimization while feeling the constant pull of their previous comfortable assumptions.  Research shows that most adults eventually adjust by counting on their own resources and the help of the family members who happen to confirm their sense of values and the world’s benevolence and meaningfulness. At first they are torn between a need to confront the experience and a need to protect themselves from it. Eventually, most survivors learn to use cognitive strategies and grow from them. They learn to adopt a new viewpoint of the total experience. They use downward social comparison and reevaluation of the experience. They find something to value in the traumatic experience: for example, lessons learned, new priorities, awareness of newly discovered strength. Some survivors even think about helping others by drawing attention to the social problem and increasing their medical knowledge. Most of all, these survivors learn that everyone is vulnerable and that tragedy can happen to anyone at any time. Once the reformulate their belief system, it becomes easier for them to accept misfortune without being depressed and adopting a cynical attitude.   

PTSD may be acute, chronic, or delayed. It has also been found that trauma caused by human beings, like war, physical assault, torture, sexual abuse will cause more severe symptoms of PTSD than the trauma suffered in the course of a natural disaster such as flood, earthquake. Symptoms worsen when the individual is exposed to situations that resemble the original trauma. PTSD has been found very commonly present in the war veterans who have been exposed to the war and thus lived in the continuous fear of losing their lives and survival threats. As survivors, they suffer from the symptoms of the PTSD. It is very important to recognize the early signs of PTSD and treat the disorder. If left untreated, the person will suffer from the agony of illness, risk of it becoming chronic, and above all, living a dysfunctional life style.

Following are some treatment interventions that are being used to treat symptoms of PTSD.

Treatment OF PTSD:

Eye Movement Desensitization and Reprocessing (EMDR) is a very effective mode of treatment for PTSD. It was discovered by Francine Shapiro, a graduate student in clinical psychology, who found that distressing thoughts tended to disappear when she moved her eyes rapidly from side to side. To use this principle in treatment, the therapist asks the patient to recall the image of the traumatic event and describe it while watching the therapist’s fingers move back and forth once every second for five to 15 seconds. The patient is asked to report any changes in the image, description, or accompanying feelings and record his level of anxiety on a scale from zero to ten. The therapist performs this method for each distressing memory until the anxiety level is reduced to two. After Shapiro introduced this technique, it became very wide spread among professionals to treat PTSD with EMDR. She trained a lot of mental health professionals in this technique. It is also being used to treat panic disorder, drug abuse, learning problems, eating disorder, tobacco addiction and dissociative disorders.

Cognitive behavioral approaches have also been found effective in the treatment of PTSD.

1. Progressive Muscle Relaxation: This technique has been described in detail on the blog written by the author on Panic Disorder. Please refer to this blog to learn the exact method of conducting progressive muscle relaxation. Practice of relaxation for about 30 minutes daily can alleviate the anxiety and remove muscle tension caused by stress and anxiety. Racing thoughts and corresponding feelings of anxiety and depression can leave a lasting effect on the muscle groups of the body, like neck, shoulder, back, and jaws. When you tense each muscle group for 10 seconds and relax them for 15-20 seconds, you can achieve relaxation response, a state that Herbert Benson had discussed many years ago. People who suffer from PTSD can benefit from eliciting a relaxation response by tensing and relaxing each muscle group, focusing on the breathing and visualizing a relaxing scene.
2. Visualization with Guided Imagery: In this technique the patient is asked to relax and imagine a relaxing scene like a beach or a garden. The patient is asked to use all the five senses to recreate the peaceful scene. This helps generate the alpha wave activity in the brain, which promotes relaxation, in turn. Practice of visualization helps the patient deal with intrusive thoughts of the traumatic event. The power of imaging has been found to be extremely effective in treating a variety of mental illnesses, especially anxiety disorders. Writer has also written blogs on the power of imaging and I recommend that the readers read this blog to get more details on the technique.
3. Cognitive Restructuring: Refers to the process of reframing one’s thoughts. When the self talk is negative, it also incorporates a variety of cognitive distortions like overgeneralization, fortune teller error, mind -reading, jumping to conclusion, magnification, minimization, absolute thinking, self blame, minimization, mental filter and many more. The therapist tries to make the patient aware of these errors in their thinking and helps him in coming up with a counterstatements corresponding to each cognitive distortion. The patient is given home work assignments to make counterstatements for negative self talk. This practice helps in reducing the intensity of anxiety caused by the traumatic event.
4. Use Thought Stopping Technique: Since victims of PTSD suffer from racing thoughts that make them difficult to concentrate. These intrusive thoughts tend to change the affect of the person and lead to anxiety and depression. The Behavioral technique of thought stopping can be used effectively to stop these thoughts from ruminating. All you have to do is Visualize a big RED STOP Sign in front of your eyes. When the thoughts are racing, take a deep breath and say the word STOP or CANCEL loud. This helps interrupt the thought pattern. Then replace these negative thoughts with an affirmation or positive statement. It is important to know that the negative thoughts have a tendency to return if you do not replace them with coping statements or affirmations. It might be helpful to make a list of affirmations and coping statements and use them as needed to replace negative thoughts about the painful event. 
5. Imagery Desensitization: Behavior therapists use this technique to help the patients counter stressful situations by preparing them to relax in the various hierarchies of the stressful event by asking them to first visualize themselves in the relaxing scene one by one, and then coming back to the scenes of stressful situations. Thus by alternating between the relaxing scene and stressful situation, the person learns to associate positive feelings of relaxation with the scenes of stressful and painful events. This technique has also been discussed in the blog written on Panic Disorder and I would recommend the readers to refer to that blog to get more details.
6. Challenging Mistaken Beliefs: People with PTSD also tend to form mistaken beliefs about people, events and their circumstances. They tend to form opinions, judgments and begin to perceive each situation in the light of these beliefs, opinions and judgments. They base their conclusions on the trauma and pain that they have endured. It is important for the therapists to develop adequate insight in the patients and make them aware of their mistaken beliefs. By using The Rational Emotive Therapy (RET) method, they will be able to challenge the irrational beliefs and come up with logical and rational belief system. Writer has written a blog on RET and I would recommend the readers to read this blog on the exact way of using this technique.
7. Work on Self Esteem: Victims of PTSD lose their self esteem when they endure a trauma and begin to lose confidence in things that they could do well. A feeling of inadequacy becomes generalized and they become pessimistic in their outlook. They should be encouraged to engage in activities that will give them a sense of accomplishment. They also need to revive their old hobbies and recreational activities and engage in self nurturing activities like joining a gym, exercising, meditation, sports, and humor. By engaging in these activities, they can reduce the anxiety level caused by the traumatic event. After all, it is useless to occupy the mind in worries and thoughts about the pain when nothing can be done about the past. It is wise to focus on the present and make each moment full of pleasure. It is not advisable to punish oneself when the person did not do anything wrong. Why should he or she suffer from pain? People who caused the pain, like the perpetrators of the sexual and physical abuse should be the ones suffering from the guilt pain for what they did to the victims. So self esteem is an important element in the treatment of PTSD. When the self esteem is high, the person is less likely to put the blame on self. Instead, they will have the satisfaction for accomplishing their goals and thus regain their confidence level.
8. Change your perception of being a victim and become a survivor: Folks, who have been subjected to traumatic events like rape and abuse, tend to feel like victims and thus become very hopeless and feel helpless too. Their self talk is often “victim” type, which tends to make them feel helpless and blame themselves for what happened to them. It is important for the therapist to point out to them that they are not to be blamed for what happened and thus reduce their feelings of guilt and self blame which tend to obstruct their growth. Once these feelings are resolved, it becomes easier to accept the outcome and move on. Victim type thinking leads to negative self talk and patients begin to feel victimized and believe that there is no hope for them. It is important to challenge this type of thinking with positive and reassuring statements to help them feel like a survivor and have adequate ego strength again to deal with the challenges of life.  
9. Develop Spirituality:  Spirituality helps in the process of survival. Having faith in a Higher Power helps the person decrease the negative self talk, and replace doubt with faith and optimism. Spirituality also helps in building self confidence as the person begins to develop faith and this automatically decreases the negativity and pessimism. This also helps in alleviating the anxiety and prepares the person to face the challenges of life with strength and endurance. Going to church and listening to the sermon of clergymen, and priest sometimes can change one’s outlook, reinforce beliefs about the Higher Power, and improve mental health. Forgiveness is also something that will help the person grow and be able to move on with life. For some people, forgiveness is not easy and it is alright to feel anger towards the perpetrator until the person is ready to forgive. Writer has written a blog on Ending Resentment and covered this topic in detail. Readers are recommended to read this blog to get more details.
10. Join the Area Support Group: There are support groups in each city to help the survivors of sexual and physical abuse. There are support groups for war veterans too. It is important to join these support groups as it helps the person see that he or she is not alone in the process. By discussing their issues and venting their feelings, they feel relieved and this aids in the healing process, as well.

In this way we see that there are many alternatives that a person can take to survive the trauma. As healing begins, patients begin to move on and change their assumptions again about life, events, world, and people. They are then motivated to help others as they feel empathic to the victims because they have been there. Sometime, survivors can be the best guides for the victims.