Post-traumatic Stress Disorder

What is Post-traumatic Stress Disorder?

Post-traumatic stress disorder (PTSD) is a psychiatric disorder that develops after an intense physical or emotional event in which a person may have been harmed or frightened or witnessed harm to another. Traumatic events may include but are not limited to such incidents as kidnapping, rape, abuse, bombings, natural disasters, or car accidents. After the traumatic event, the person may develop a cluster of symptoms characterized by reliving a trauma via nightmares or flashbacks, startling easily, avoidance of situations that remind the person of the trauma, or increasing irritability or even violent reactions. Not every person exposed to trauma develops symptoms of PTSD; however, symptoms usually develop within three months of the incident but sometimes years later. Risk factors for developing PTSD include having limited social supports, feeling helpless at the time of the event, having a prior history of mental illness such as depression and anxiety, and experiencing a trauma resulting in physical injury. Factors that reduce the risk of developing PTSD after a trauma include having close social supports, finding a support group after a traumatic event, and having healthy coping skills to manage distress resulting from trauma. Additionally, current research is suggesting there may be a genetic link to developing PTSD after trauma in addition to some environmental factors such as head injury or early childhood trauma.

 

In order to receive the diagnosis of PTSD, a person can be evaluated by a psychiatrist or a psychologist. The person must meet criteria for PTSD including having multiple symptoms of re-experiencing (nightmares or flashbacks), avoidance, and hyperarousal (feeling on edge) that last for at least 1 month. Additionally, symptoms lead to impairments in social or occupational functioning such as limiting one’s ability to go to work or maintain relationships with friends and family. After making a diagnosis of PTSD, treatments typically include both a combination of medications and psychotherapy. Medications may include anti-anxiety medications, antidepressants, and medications to treat nightmares. There are multiple types of psychotherapy that can be used including cognitive processing therapy, exposure therapy, cognitive behavioral therapy, and acceptance and commitment therapy. For many people, PTSD often occurs with substance and other psychiatric illnesses such as depression or anxiety. These co-occurring psychiatric disorders are treated in addition to treating PTSD. Although PTSD can be significantly impairing for persons with the disorder, effective treatments are available and can be sought with healthcare professionals.

What does psychodynamic psychotherapy look like in the treatment of personality disorders?

In psychodynamic psychotherapy for PTSD, the patient and therapist typically meet once a week for at least several months with the goal of improving symptoms of PTSD. Through the creation of a supportive environment, the patient will begin to understand the intense emotions and thoughts that often accompany traumatic events. Many times the emotions and thoughts resulting from traumatic events are expressed in various behaviors or patterns that the patient may not completely understand. For example, a patient has intense feelings of guilt or shame but are unsure as to what causes these feelings. Through the process of psychotherapy, the patient may begin to identify the emotions and ways of coping so that they may have more control over their life. It is important that the symptoms of PTSD and the traumatic event itself are examined in a safe and thoughtful way as some patients may find it extremely emotionally challenging to examine prior traumas. Furthermore, the psychotherapist and patient will identify healthy ways of coping with these intense emotions that may periodically arise. As opposed to other types of psychotherapies, psychodynamic psychotherapy also focuses on how early childhood experiences, patterns in relationships, and ways of coping with stressors (defense mechanisms) may contribute to symptoms of PTSD.

Is psychodynamic psychotherapy effective in the treatment of personality disorders?

At this time, there is insufficient evidence to conclude that psychodynamic psychotherapy is effective for post-traumatic stress disorder. In regards to clinical evidence, there has been one limited study conducted by Brom et al. in which roughly eighteen sessions of psychodynamic psychotherapy lead to improvement in symptoms of PTSD.1 Improvement in symptoms was evidenced by significant reduction in intrusive thoughts (nightmares and flashbacks) and avoidance symptoms (avoidance of things that remind the person of the trauma).

Although anecdotal evidence exists for patient improvement with psychodynamic psychotherapy, various other reviews evaluating the use of psychodynamic psychotherapy have been performed which have concluded that there is insufficient evidence to comment on its efficacy.2-4 To be fair, many other psychotherapeutic treatments have also not achieved the threshold of being fully evidence-based. Exposure therapy, perhaps the most common is being called into question as there seem to be as many failures as there are successes. Some report an increase in symptoms of PTSD associated with treatment, specifically in regards to worsening emotion regulation.5 However, the concepts of psychodynamic psychotherapy may prove to be particularly helpful in PTSD as the theory relies on understanding patterns in relationships and ways in which one manages stress. Further research will help to clarify how effective psychodynamic psychotherapy is in treating PTSD.

Citations:

  1. Brom D, Kleber RJ, Defares PB. Brief psychotherapy for posttraumatic stress disorders. J Consult Clin Psychol. 1989; 57(5): 607-12.
  2. Gillies D, Taylor F, Gray C et al. Psychological therapies for the treatment of post-traumatic stress disorder in children and adolescents. Evid Based Child Health 2013;8:1004-116.
  3. Ponniah K, Hollon SD. Empirically supported psychological treatments for adult acute stress disorder and posttraumatic stress disorder: a review. Depress Anxiety 2009;26:1086-109.
  4. Gerger H, Munder T, Gemperli A et al. Integrating fragmented evidence by network meta-analysis: relative effectiveness of psychological interventions for adults with post-traumatic stress disorder. Psychol Med 2014;44:3151-64.
  5. D’Andrea W and Pole N. A naturalistic study of the relation of psychotherapy process to changes in symptoms, information processing, and physiological activity in complex trauma. Psychological Trauma: Theory, Research, Practice, and Policy. 2012; 438-446.