Therapy
There are various approaches to treat post-traumatic stress disorder.
- The order of the imagined (presented) events must correspond to the order of the actual events.
- The events described are told in the “I-form” and in the “present”.
- In the description of the events, feelings, thoughts and other impressions should also be communicated.
- Emotions must not be suppressed.
- The patient is always in control of the speed with which the experience and the description is made
- Imparting the disorder model: The aim here is to make the factors that are highly frightening for the patient more tangible. By explaining the disorder and its typical symptoms to the patient, the therapist simultaneously creates understanding for further therapeutic approaches.
If a person’s memory represents a closet, the thoughts could be called clothes. Normally, the clothes are neatly folded and stored in certain shelves and compartments. Whenever one is looking for a particular memory now, one usually knows quite well where to find it.
The disease model of PTSD also understands the trauma as a memory that is stored in this cupboard. However, since the experiences and memories are often felt to be so strange and horrible, and since it also happened so unexpectedly, this memory is not folded and ironed. One simply “throws” it as it is into the cupboard and slams the door shut.
The problem with such cupboards, however, is that if they are not tidy, they sometimes give their contents away again without being asked, for example if you want to go to a completely different compartment of the cupboard. For the patient this means that memories can unintentionally flood in. In order to protect oneself from this, it is essential to tidy up the cupboard sooner rather than later.
To do this, one must remove all the individual pieces of clothing (splinters and fragments of memories of the trauma), look at them, fold them up and put them in the closet.
- Mental reliving of the trauma: Earlier opinions thought that memories or references to traumatic events could lead to a worsening of the whole disorder. This opinion is no longer tenable today (with some exceptions). Therapeutic reliving of the trauma is a very strenuous, but at the same time promising way to bring about improvement, if it is carried out by a therapist experienced in trauma therapy and if some important rules are observed by both patient and therapist.
The sequence of imagined (presented) events must correspond to the sequence of events that actually happened. The described events are told in the “ego-form” and in the “present”. In the description of the events, feelings, thoughts and other impressions should also be communicated.
Feelings must not be suppressed. The patient is always in control of the speed with which the events are experienced and described
- The order of the imagined (presented) events must correspond to the order of the actual events.
- The events described are told in the “I-form” and in the “present”.
- In the description of the events, feelings, thoughts and other impressions should also be communicated.
- Emotions must not be suppressed.
- The patient is always in control of the speed with which the experience and the description is made
The therapist supports the patient during the post-exercise experience and discusses what has been described, especially after the session. The goal of this therapeutic step is the so-called habituation, but also the processing of the trauma, as well as the correct storage in the memory.
This means that the whole event is put into a context with the own person and therefore a permanent decrease of the anxiety feeling is achieved. The trauma becomes part of the past. Trauma-specific stimuli (smells, colors etc.)
can also be found and processed.
- Dealing with the trauma on the spot (in vivo exposure): The aim of this method is that a patient learns to accept the trauma as part of his past.For this purpose, the therapist will visit the place of the event with your patient. This step in the therapy will on the one hand help to sharpen the perspective between “now in the moment” and “at that time during the trauma” and on the other hand it will also help to work on the understanding of your own “guilt” (e.g. the accident could not have been prevented here).
The patient can also make the experience that the catastrophe does not repeat itself when he is in the same place (e.g. driving past an accident site or stopping there).
- Cognitive Restructuring:As with many other mental disorders, PTSD also involves a change in thinking. Often people with trauma experiences feel isolated from others, change their view of the world or themselves, or even feel that the trauma has made them no longer viable. Also, people with PTSD often tend to have a pronounced tendency to brood or even strong outbursts of anger.
Changing these thought patterns and thus improving the patient’s quality of life must therefore also be the goal of trauma therapy. In this case, the therapist may logically analyze stuck thought patterns or develop alternative thought patterns. (e.g. thoughts like “The world is dangerous”, “You can’t trust anybody” or “I always have bad luck”)
- Stress management training: This term includes relaxation techniques (progressive muscle relaxation, autogenic training etc), breathing techniques, self-piercing training, “thought stop” training.
These techniques should be used in addition to those mentioned above in order to reduce the general state of arousal (insomnia, nervousness or jitteriness)
- Hypnotherapy: Hypnosis allows an access to the “unconscious” and is therefore a way to the unremembered parts of the trauma. There is, however, the danger of dissociation. Dissociation:Dissociation describes a change in one’s own perception, one’s own thinking but also one’s own controlled movement.
Patients often get into this state, which is perceived as very strange by the environment, without a concrete trigger. They are not “completely in the world”. For example, they are not responsive and cannot move.
After some time these symptoms disappear again and patients often cannot remember what happened.
- Eye movement – desensitizationEMDR: This is a quite new method of trauma therapy. During the therapy the patient follows with his eyes the finger of the therapist who sits in front of him. The patient is asked to recall various trauma-related situations, including the thoughts and feelings associated with them.
Although the actual mechanism is still unclear, the eye movements that are performed simultaneously with the trauma thoughts apparently lead to an improved processing of the experience. Author’s note: The whole thing sounds a bit like “voodoo”, but the author of these lines has actually had some experiences of his own and must therefore say that it works. A trauma can lose its horror.
- Medication: Antidepressants (SSRI or tricyclics) are typically used today in supportive trauma therapy (see also Antidepressants). Benzodiazepines (Valium ®, Tavor ®, Oxazepam) should only be used for a short period of time in hospital. Under no circumstances should they be used in outpatient therapy, as there is an increased risk of addiction.
