Modern views have changed: it is now believed that normal person encountered an abnormal case. The goal of treatment is activate the patient’s own mechanisms coping with trauma.
The treatment of post-traumatic stress disorder has several directions:
- psychotherapy (this is the main type of treatment!),
- the use of psychotropic drugs,
- work with family (family therapy),
- social assistance measures from the state.
Remember the most important paragraph about post-traumatic stress disorder:
The main (main) treatment is psychotherapiesI, aimed at processing trauma. Medications only help relieve acute or excessive symptoms and create optimal conditions for psychotherapy.
5 principles of treatment
1) the principle of normalization
2) the principle of partnership and personal dignity
Since cruelty, humiliation of human dignity and powerlessness reduce the sense of self, the specialist must restore individual rights people impaired in their dignity and safety (as mentioned earlier, high self-esteem protects against the development of PTSD).
3) the principle of personality
Everyone has own (unique) recovery path after stress, so the task of the doctor is build an individual way to recovery, avoiding possible traps in people with different personality types.
4) the principle of integrity
You need to treat a person as whole. Physical activity, a healthy diet, refusal of psychoactive (alcohol, drugs, smoking) and stimulants (caffeine), spirituality and a developed sense of humor (the ability to relate adversity with a smile) create the basis for a quick and effective recovery.
5) the principle of complexity
In addition to treatment, social support and integration into society. These include:
- family and group therapy,
- development of self-help organizations,
- formation and support of public associations.
We need training in social communication skills, a reduction in irrational (inexplicable) fears, and help in the formation of new relationships.
Pharmacotherapy (drug use)
Medicines are used:
- symptom reduction (anxiety, fears, depression, obsessive memories, disturbances of the nervous system),
- reduction of emotional consequences of psychological trauma, spirit support patient and removal of guilt.
Used groups of drugs:
- tricyclic antidepressants: maprotiline, clomipramine, imipramine, mianserin,
- antidepressants from the group SSRIs (selective serotonin reuptake inhibitors): fluoxetine (Prozac), paroxetine, sertraline (zoloft), fluvoxamine, escitalopram,
- antidepressants from the group monoamine oxidase enzyme inhibitors: moclobemide, pyrazidol, eprobemide, metralindol,
- benzodiazepines (anxiolytics and tranquilizers): alprazolam, diazepam, midazolam, clonazepam, medazepam, phenazepam, chlordiazepoxide,
- antipsychotics (antipsychotic drugs): melleril (sonapax),
- normotimics: lithium carbonate, carbamazepine,
- beta blockers: propranolol, bisoprolol.
Tranquilizers (from lat.tranquillo - calm down) - powerful soothing drugs that have 5 effects: anxiolytic, sedative, hypnotic, muscle relaxant (muscle relaxation) and anticonvulsant.
Sedative drugs (lat.sedatio - reassurance) - mild sedative drugs that facilitate sleep without causing it. Sedatives are considered weaker than tranquilizers, because they soothe less and do not cause muscle relaxation (muscle relaxation).
Treatment is carried out psychotherapist or psychiatrist. Almost all psychotropic drugs are sold only by prescription. Drug treatment should be carried out only in parallel with psychotherapy.
Antidepressants - the most commonly used drugs for PTSD for a number of reasons:
- eliminate depression
- reduce obsessive perceptions and other obsessive-compulsive symptoms (obsessions - obsessive involuntary thoughts, compulsions - obsessive actions that the patient wants to perform in order to feel relief for a while),
- drown out anxiety and fear,
- are safe in terms of the formation of drug dependence and abuse.
Tricyclic antidepressants cheap and previously were first-line drugs in the treatment of depression, but due to the large number of side effects they are now being used less and less (especially in the European Union and the USA), giving way to more modern antidepressants. The effect begins after 2 weeks, the effectiveness of treatment is judged no earlier than 1.5-2 months of admission. The upper limit of the dose is determined either by the improvement of the patient's condition, or the development of undesirable side effects (of which there are many).
With inefficiency or intolerance to tricyclic antidepressants, sometimes antidepressants from the group of monoamine oxidase inhibitors.
Tranquilizers prescribed for the treatment of severe anxiety and nervous regulation disorders (cllorazepate, alprazolam, diazepam etc.), as well as with significant sleep disorders (triazolam, midazolam) These drugs can cause drug dependence. Good anti-anxiety effect gives antipsychoticmelleril (sonapax).
In cases of impulsiveness and imbalance, in case of drug abuse normotimics (lithium carbonate or carbamazepine).
To reduce the symptoms of increased activity of the nervous system, beta-blockers are used (propranolol, bisoprolol etc.) or alpha-adrenergic agonists (clonidine).
What is post-traumatic syndrome?
The psychology of post-traumatic stress implies the presence of traumatic events in a person's life that affect the mental sphere. Such events differ from previous experience or cause severe suffering to a person, which causes a violent negative reaction. The psyche, which does not have deviations, tries to reduce discomfort: people who have experienced such reactions completely change their attitude to what is happening around.
Causes and types
People often face psychological disorders, which may be caused by the following situations:
- Act of terrorism,
- violence of a sexual, moral, physical nature,
- disasters and natural disasters,
- fatal disease,
- the death of a loved one.
All cases leading to the development of post-traumatic syndrome, combine strong mental suffering, which is difficult to cope on their own.
Post-stress disorders, the formation of which results from the action of a traumatic situation, are classified into several types:
- Acute, accompanied by a pronounced symptomatic picture. Duration does not exceed 3 months.
- Chronic, proceeding for more than six months and characterized by changes in character, an increase in mental exhaustion.
- Deformation, associated with changes in the psyche, the development of phobias and neurosis.
- Delayed in time - is formed after 6 months in the event that a person finds himself in an emotionally similar situation.
The clinical types of post-traumatic stress syndrome are represented by the following classification:
- Anxious - manifested by regularly occurring obsessive memories, nervous strain, social maladaptation. A person suffers from insomnia, nightmares, feelings of horror and lack of air.
- Asthenic - characterized by weakness, fatigue, decreased performance, loss of interests, a sense of one’s own inferiority.
- Dysphoric - detected in people who are depressed, accompanied by outbreaks of unmotivated aggression.
- Somatophore - is determined by the patient having complaints about the dysfunction of various body systems. Such people are concerned about intestinal colic, pain in the heart and head, heartburn and other negative symptoms. During the examination, organic disorders are not detected in patients.
Symptoms of Post-Traumatic Stress Disorder
A specific sign of this syndrome is the presence of obsessive memories of the event that caused the psychological trauma. Such memories are characterized as unusually vivid, but in the form of fragments - pop-up pictures from the past. In most cases, the appearance of these images is accompanied by a strong sense of constant wariness, longing, horror, and helplessness.
An attack of negative experiences entails changes in the functioning of the autonomic nervous system, manifested in the form of an increase in blood pressure, changes in heart rate, excessive sweating, and frequent urination.
Some patients feel that the past is returning to life. For these people, the formation of illusions, consisting in the pathological perception of external stimuli, is characteristic. The occurrence of visual and auditory hallucinations is also possible. Such manifestations provoke aggression, inappropriate actions, suicide attempts.
In addition to obsessive memories, people who have experienced severe mental trauma are characterized by the following conditions:
- excessive vigilance
- high level of anxiety
- sleep disturbance,
- emotional coldness
- difficulties in thought processes, memory and attention.
The patient does not tolerate loud sounds, darkness and other factors that accompany a traumatic situation. Some people may start drinking alcohol or chemicals, with the goal of forgetting a sad event.
Treating Post-Traumatic Stress Disorder
Post-traumatic disorder needs psychotherapeutic and drug correction. The therapist makes a decision on the need for complex therapy to eliminate the traumatic factor, the following are used:
- group psychotherapeutic classes,
- self-help methods.
When eliminating the post-traumatic syndrome, drug treatment is used in the following cases:
- prolonged nervous tension,
- anxiety accompanied by a pronounced reaction of fright,
- sharp inhibition of the emotional background,
- constant bouts of memory accompanied by vegetative malfunctions,
- the formation of hallucinations.
Drug therapy is not used as an independent method for the correction of post-traumatic condition. With a mild course of the syndrome, sedatives are prescribed. The expressed symptomatic picture needs to be corrected by antidepressants that increase mood, reduce anxiety, attacks of obsessive images and fear of memories, stopping irritability and the need for alcohol.
If a specialist reveals signs of nervous tension, then the patient needs to use tranquilizers. For vegetative failures, beta-blockers are used, and for hallucinations, antipsychotics with a calming effect.
Psychotherapy for Post-Traumatic Stress Disorder
This type of treatment of a psychogenic disorder is a mandatory component of an integrated approach.
Psychotherapy is performed in several stages:
- Establishment of trusting relationships, the patient's mood for a favorable outcome.
- Conducting psychotherapeutic sessions based on re-experiencing the situation of domestic violence or other cases that caused stress. Also, the psychologist can apply the methods of behavioral psychotherapy, the technique of rapid eye movements.
In parallel, work is carried out with guilt, bouts of aggression. Psychocorrectional sessions can be carried out both in individual and in group form, including family counseling. In some cases, it is advisable to use neuro-linguistic programming methods. Additional methods of psychotherapeutic effects are:
- auto training,
- relaxation exercises
- art therapy.
Due to the fact that one of the manifestations of a post-traumatic disorder is the lack of plans for the future, the final stage of psychotherapy is to help the patient to create a model of a new life. With the assistance of a doctor, the patient forms life guidelines, makes the choice of immediate goals and ways to achieve them. After the completion of the final stage, many patients continue to visit a psychologist to consolidate therapeutic results and to help people who find themselves in a similar situation.
A bit of history
The ancient Greek historians Herodotus and Lucretius in their writings described the signs of PTSD. They watched the soldiers, who after the war became irritable and anxious, they were tormented by the influx of unpleasant memories.
Many years later, when examining former soldiers, increased excitability, obsession with heavy memories, immersion in one’s own thoughts, uncontrollable aggression were discovered. The same symptoms were detected in patients after a railway accident. In the mid-19th century, a similar condition was called "traumatic neurosis." Scientists of the 20th century have proved that the signs of such a neurosis increase over the years, rather than weaken. Former prisoners of concentration camps voluntarily said goodbye to an already calm and well-fed life. Similar changes in the psyche were also observed in people who became victims of man-made or natural disasters. Anxiety and fear entered their daily lives forever. The experience gained over decades has allowed us to formulate the modern concept of the disease. Currently, medical scientists associate PTSD with emotional experiences and psychoneurotic disorders, caused not only by extraordinary natural and social events, but also by social and domestic violence.
There are four types of post-traumatic syndrome:
- Acute - the syndrome lasts 2-3 months and is manifested by a pronounced clinic.
- Chronic - the symptomatology of the pathology increases over 6 months and is characterized by exhaustion of the nervous system, a change in character, a narrowing of the circle of interests.
- The deformation type develops in patients with a long-term chronic mental disorder, leading to the development of anxiety, phobias, and neurosis.
- Delayed - symptoms appear six months after the injury. Various external irritants can provoke its occurrence.
The main cause of PTSD is a stress disorder that occurs after a tragic event. Traumatic factors or situations that can lead to the development of the syndrome:
- armed conflicts,
- terrorist attacks
- physical violence,
- severe beating and robbery,
- theft of children
- incurable disease,
- death of loved ones
Post-traumatic syndrome has a wave-like course and often provokes a persistent personality change.
The formation of PTSD is facilitated by:
- moral trauma and shock arising from the loss of a loved one during the conduct of hostilities and other traumatic circumstances,
- guilt before the dead or guilt about the deed,
- the destruction of old ideals and ideas,
- reassessment of personality, the formation of new ideas about their own role in the world.
According to statistics, the risk of developing PTSD is most affected by:
- victims of violence
- witnesses to rape and murder,
- persons with high susceptibility and poor mental health,
- doctors, rescuers and journalists who are present on duty at the scene,
- women subjected to domestic violence
- persons with burdened heredity - psychopathology and suicide in a family history,
- socially lonely people - without family and friends,
- persons who have received serious injuries and injuries in childhood,
- police officers
- Persons with a tendency to neurotic reactions
- people with antisocial behavior - alcoholics, drug addicts, psychiatric patients.
In children, the cause of the syndrome is often the divorce of parents. They often consider themselves guilty of this, worry that they will see less with one of them. Another urgent cause of the disorder in today's violent world is conflict at school. Stronger children can scoff at the weak, intimidate them, threaten reprisals if they complain to the elders. PTSD also develops as a result of child abuse and neglect by relatives. Regular exposure to traumatic factors leads to emotional exhaustion.
Post-traumatic syndrome is a consequence of severe mental trauma, requiring medical and psychotherapeutic treatment. Psychiatrists, psychotherapists and psychologists are currently studying post-traumatic stress. This is an actual direction in medicine and psychology, the study of which is devoted to scientific papers, articles, and seminars.Modern psychological trainings increasingly begin with a conversation about the post-traumatic stress state, diagnostic features and the main symptoms.
To stop the further progression of the disease will help the timely introduction of someone else's traumatic experience into their lives, emotional self-control, adequate self-esteem, social support.
With PTSD, a traumatic event is obsessively repeated in the consciousness of patients. Such stress leads to an extremely intense experience and causes thoughts of suicide.
Symptoms of PTSD are:
- Anxiety-phobic conditions, manifested by tearfulness, nightmares, derealization and depersonalization.
- Constant mental immersion in past events, unpleasant sensations and memories of the traumatic situation.
- Obsessive memories of a tragic nature, leading to insecurity, indecision, fear, irritability, short temper.
- The desire to avoid everything that can remind you of stress.
- Impaired memory.
- Apathy, bad family relationships, loneliness.
- Lack of contact with needs.
- Feeling of tension and anxiety, not passing even in a dream.
- Pictures of the past, "flashing" in the mind.
- Inability to verbally express your emotions.
- Asocial behavior.
- Symptoms of central nervous system depletion - the development of cerebral growth with a decrease in physical activity.
- Emotional coldness or dullness of emotions.
- Social exclusion, decreased reaction to surrounding events.
- Agedonia - lack of a sense of pleasure, joy of life.
- Violation of social adaptation and exclusion from society.
- Narrowing of consciousness.
Patients cannot escape from haunting thoughts and find their salvation in drugs, alcohol, gambling, extreme entertainment. They constantly change their place of work, often conflict with family and friends, and have a tendency to vagrancy.
Symptoms of ailment in children are: fear of parting with parents, development of phobias, enuresis, infantility, distrust and aggressive attitude towards others, nightmares, isolation, low self-esteem.
Types of post-traumatic syndrome:
- Alarm type characterized by bouts of unmotivated anxiety, which the patient is aware of or feels bodily. Nervous overstrain does not allow to fall asleep and leads to frequent changes in mood. At night, they do not have enough air, sweating and fever occurs, followed by chills. Social adaptation is caused by increased irritability. To alleviate the condition, people seek communication. Patients often seek medical help themselves.
- Asthenic type manifested by appropriate signs: lethargy, indifference to everything that happens, increased drowsiness, lack of appetite. Patients are oppressed by their own failure. They easily agree to treatment and are happy to respond to the help of loved ones.
- Dysphoric type characterized by excessive irritability, turning into aggression, resentment, revenge, depression. After outbursts of anger, abuse and fights, patients regret it or experience moral satisfaction. They do not consider themselves in need of medical assistance and avoid treatment. This type of pathology often ends with the transition of protest aggressiveness to inadequate reality.
- Somatophore type manifested by clinical signs of dysfunctions of internal organs and systems: headache, interruptions in the work of the heart, cardialgia, dyspeptic disorders. Patients get hung up on these symptoms and are afraid to die during the next attack.
Diagnosis and treatment
Diagnosis of post-traumatic syndrome consists in collecting an anamnesis and interviewing a patient. Specialists should find out if the situation really threatened the life and health of the patient, whether it caused stress, horror, feelings of helplessness and moral experiences of the victim.
Specialists should identify at least three symptoms characteristic of the pathology in the patient. Their duration should not be less than a month.
PTSD treatment is comprehensive, including medication and psychotherapeutic effects.
Specialists prescribe the following groups of psychotropic drugs:
- sedatives - “Valocordin”, “Validol”,
- tranquilizers - “Klozepid”, “Atarax”, “Amizil”,
- beta-blockers - Obzidan, Propranolol, Metoprolol,
- Nootropics - Nootropil, Piracetam,
Psychotherapeutic methods of exposure are divided into individual and group. During the sessions, patients are immersed in their memories and relive the traumatic situation under the supervision of a professional psychotherapist. With the help of behavioral therapy, patients are gradually accustomed to trigger factors. For this, doctors provoke attacks, starting with the weakest keys.
- Cognitive-behavioral psychotherapy - correction of negative thoughts, feelings and behavior of patients, avoiding serious life problems. The purpose of this treatment is to change your stereotype of thinking. If you can’t change the situation, then you need to change your attitude towards it. PPC allows you to stop the main symptoms of mental disorders and achieve stable remission after a course of therapy. At the same time, the risk of relapse of the disease is reduced, the effectiveness of drug treatment is increased, erroneous attitudes of thinking and behavior are eliminated, personality problems are solved.
- Desensitization and processing with eye movements provides self-healing in psycho-traumatic situations. This method is based on the theory that any traumatic information is processed by the brain during sleep. Psychological trauma disrupts this process. Instead of the normal dreams of patients, nightmares and nightmares often torment. Repeated series of eye movements unlock and accelerate the process of assimilating the information received and processing the traumatic experience.
- Rational psychotherapy - an explanation to the patient of the causes and mechanisms of the disease.
- Positive therapy - the existence of problems and diseases, as well as ways to overcome them.
- Supporting methods - hypnotherapy, muscle relaxation, auto-training, active visualization of positive images.
Folk remedies that improve the functioning of the nervous system: infusion of sage, calendula, motherwort, chamomile. With PTSD, blackcurrant berries, mint, corn, celery and nuts are considered beneficial.
The following remedies are used to strengthen the nervous system, improve sleep and correct increased irritability:
- infusion of oregano, hawthorn, valerian and peppermint,
- a decoction of leaves of a bluish blackberry,
- infusion based on centaury,
- herbal baths with celandine, string, chamomile, lavender, oregano,
- Melissa bath
- potato broth,
- infusion of lemons, eggshells and vodka,
- medicine of horseradish, golden mustache and oranges,
- walnuts with honey.
The severity and type of PTSD determines the prognosis. Acute forms of pathology are relatively easy to treat. Chronic syndrome leads to pathological personality development. Drug and alcohol addiction, narcissistic and avoiding personality traits are unfavorable prognostic signs.
Self-healing is possible with a mild form of the syndrome. Using medication and psychotherapy reduces the risk of negative consequences. Not all patients recognize themselves as being ill and visit a doctor. About 30% of patients with advanced forms of PTSD commit suicide.