POST-TRAUMATIC STRESS DISORDER (PTSD)

Post-Traumatic Stress Disorder (PTSD) is a mental health disorder that can occur in people who have experienced or witnessed one or more traumatic events. People with this disorder are always in a state of prolonged anxiety and fear after facing traumatic events, and there is seemingly no sign of it ending without treatment. 

What Is Post-Traumatic Stress Disorder?

Trauma is a person's emotional response to a traumatic event - life-threatening events, serious injury, or sexual violence. Some common traumatic events are traffic accidents causing serious bodily injury; being abused or violated in all forms; disasters; serious illness and so on.

Post-Traumatic Stress Disorder (PTSD) is a mental disorder that can occur when a person has experienced or witnessed one or more traumatic events. Depending on the severity and intensity, during the first period after a traumatic event, people experience feelings of fear, sadness, guilt, anger, or grief. These feelings may subside over time with appropriate treatments and the support of family and peers. However, for those with PTSD, these negative feelings may never go away or take a significant amount of time to do so, causing great disturbance in their daily activities.

Causes Of Post-Traumatic Stress Disorder

As mentioned above, PTSD can develop after a very stressful, scary, or sad event, or after a prolonged traumatic experience. The incidence of PTSD has been reported to be 6 - 25% and approximately 25 - 30% of people who experience psychological trauma may develop symptoms of PTSD. In Vietnam, research on a population that lived in war zones before 1975 in Ho Chi Minh City showed that the rate of PTSD was 6%, of which up to 60% of cases had symptoms that existed for 40 years.

There is still insufficient evidence to explain why some people have this disorder while others do not. However, some physiological and psychological factors may make some people more likely to develop PTSD:

• Psychosocial factors: If a person has had a depressive disorder or anxiety disorder in the past, or has not received much support from family or friends, they will have a high chance of developing PTSD after a traumatic event.

• Genetic factors: Having a parent with mental health problems is thought to increase the risk of developing this disorder.

• Hormone abnormalities: Normally, when faced with traumatic events, the body will produce stress hormones to trigger a response in the body, helping to numb the senses and reduce pain. However, people with PTSD continue to produce high levels of stress hormones even when there is no danger. This may be responsible for the numbing emotions and hyperarousal in some people with PTSD.

• Brain changes: Brain areas responsible for memory and emotions in people with PTSD are smaller than normal. This can prevent the proper processing of flashbacks and nightmares, therefore, anxiety and stress after the traumatic event do not lessen over time.

Symptoms And Diagnosis Of Post-Traumatic Stress Disorder

People with PTSD often show one or more symptoms related to traumatic events, starting after they are traumatized:

1. Reliving the traumatic event: Traumatic events are re-lived through recurring and intrusive memories, nightmares, or flashbacks of the event. Flashbacks can be so vivid that the individual feels they are reliving or seeing the traumatic experience before their eyes.

2. Cognitive and mood changes: The individual's inability to remember important aspects of the trauma event, leading to distorted and persistent beliefs about self or others (e.g., “I am bad”, “No one can be trusted”). They may have distorted thoughts about the causes and consequences of events, leading to wrongly blaming themselves or others and prolonged negative emotional states (e.g., fear, horror, anger, anger, guilt, or shame). They are less interested in previously enjoyed activities, feel separate or alienated from others, or are unable to experience positive emotions (no joy or satisfaction).

3. Avoiding reminders of the traumatic event: The individual tries to avoid activities, places, people, thoughts, or feelings that may bring back painful memories. They may resist talking about what happened or how they feel about the traumatic event.

4. Alterations in physical reactions: Individuals frequently feel irritable and have angry outbursts; behave recklessly or in a self-destructive manner; and are overly alert to their surroundings. They are also easily startled; or have difficulty concentrating or sleeping.

Many people immediately after exposing a traumatic event will experience symptoms similar to those described above. However, for a person to be diagnosed with PTSD, the symptoms must last more than a month and must cause significant distress or problems in the individual's daily functioning. These symptoms usually appear within three months of the event, but they can also appear later and often persist for months, sometimes years.

WARNING: The symptoms listed are for reference only. If you suspect that you have PTSD, see a psychologist for an accurate diagnosis.

Effects Of Post-Traumatic Stress Disorder

PTSD often occurs with other related conditions like depression, substance use, memory problems, and other physical and mental health problems.

Signs Of Functional Impairment

Statistics show that the impact of PTSD on functional impairment is clear, specifically: Having difficulty in activities, having problems at work, self-rated health at a normal or low level, had thoughts and/or intentions of suicide. In other words, people with PTSD are at significantly increased risk for the above problems. Therefore, they are not only affected by symptoms of PTSD but also by functional and social symptoms. 

Risk Of Mental Disorders

PTSD is closely linked to many other mental disorders. Studies show that the rate of chronic PTSD leading to mental disorders is 73%, of which the most common is depression. In addition, PTSD also has the risk of leading to anxiety disorders (such as panic disorder, generalized anxiety disorder, or phobias). The rate of women with anxiety disorders is higher than that of men; however, men with anxiety disorders are likely to develop a depressive disorder.

Physical Problems

PTSD is often related to the risk of physical problems, including 6 groups of symptoms: (1) Digestive symptoms; (2) Pain symptoms; (3) Cardiopulmonary symptoms; (4) Neurological symptoms; (5) Sexual symptoms; (6) Reproductive symptoms. Studies show that people with PTSD tend to have cardiopulmonary diseases; problems with hearing, musculoskeletal (such as back pain), and neurological problems (such as headaches).

Risk Of Substance Abuse

Rates of alcohol dependence or drug abuse are significantly higher in people with PTSD than in people who have experienced a traumatic event without the disorder. Among them, the risk of abuse of prescribed psychiatric drugs is highest, which may be the result of efforts to minimize symptoms of post-traumatic stress disorder or maladaptive coping mechanisms.

Psychological Therapies for Post-Traumatic Stress Disorder

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

Cognitive-Behavioral Therapy (CBT) is remarkably effective in the treatment of PTSD, in which Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is commonly used. People with PTSD will learn about common reactions when faced with trauma and ways to control them, thereby learning how to think in more helpful ways. During treatment, the person with PTSD will slowly confront the situation they fear by imagining themselves in that situation or approaching it in everyday life. The psychologist will teach them how to control their anxiety and how to cope with fearful situations.

Prolonged Exposure (PE)

Prolonged Exposure (PE) is a therapy that focuses primarily on teaching clients to cope with trauma, by having them exposed to situations of various intensity that the person with PTSD is avoiding in life between sessions. They are also encouraged to recount traumatic memories or describe parts of their trauma in detail, hence gradually becoming accustomed to the triggers and traumatic stimuli. Afterward, the psychologist will help them “process” traumatic experiences by discussing thoughts and feelings related to exposure exercises.

Cognitive Processing Therapy (CPT)

Cognitive Processing Therapy (CPT) helps people who are "stuck" in their thoughts about the trauma in some ways. As mentioned above, people with PTSD may have distorted beliefs about themselves and the world after trauma, and this hinders their recovery. The psychologist will help them identify and resolve stuck points and unhelpful thoughts. Clients will also learn skills to gather evidence to support and counteract these distorted thoughts or stuck points. Thereby, they can change their way of thinking about their trauma.

Trauma-Focused Cognitive Therapy

For people with PTSD, thoughts and memories about the trauma will make them feel uneasy or threatened. Still, the measures they are using to try to prevent those feelings of insecurity contribute to making PTSD more prolonged and severe. Using Trauma-Focused Cognitive Therapy, a psychologist helps the client identify thoughts and memories about their trauma and coping strategies. From there, people with PTSD can identify "triggers" - things that remind them of what happened before or during the trauma. Through talking or writing about their trauma, clients can gradually confront any situations they are avoiding or fearing.

Eye Movement Desensitisation And Reprocessing (EMDR)

Eye Movement Desensitization And Reprocessing (EMDR) helps relieve distressing emotions related to traumatic memories. The client will be asked to select a mental image related to the traumatic memory. The client will also have to focus on any negative beliefs about themselves, or negative emotions associated with the traumatic event. The therapist will move the fingers back and forth in front of their eyes and ask them to follow the finger movements. At the same time, the therapist will ask specific questions about traumatic memories, such as asking the client to recall emotions and physical sensations that go along with the traumatic event. Gradually, the therapist will guide the client to shift their thoughts or feelings about the event to more positive ones.

If you feel you are having symptoms of PTSD, go to a medical facility for a timely examination and diagnosis, or contact the Vietnam - France Psychology Institute via Hotline: 0979.158.463 for specific advice. Early intervention is key to improving health and quality of life.

References:

[1] Tâm bệnh học. Đặng Hoàng Minh (chủ biên)

[2] Đánh giá hiệu quả điều trị rối loạn stress sau sang chấn (PTSD) bằng châm cứu phối hợp liệu pháp nhận thức hành vi tâm lý tại tỉnh Thừa Thiên Huế. http://jmp.huemed-univ.edu.vn/BBao/2020/5/PDF_2020m05d012_10_11_19.pdf

[3] Causes - Post-traumatic stress disorder. https://www.nhs.uk/mental-health/conditions/post-traumatic-stress-disorder-ptsd/causes/

[4] What is Posttraumatic Stress Disorder (PTSD)?. https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

[5] Rối loạn Căng thẳng sau Sang chấn (PTSD) là gì, và làm thế nào để bạn hồi phục?. https://www.phoenixaustralia.org/wp-content/uploads/2022/10/SYLABA-JOB22-0396_What-is-PTSD_VIETNAMESE_10122022.pdf

[6] Outcomes of Posttraumatic Stress Disorder. https://www.psychiatrist.com/wp-content/uploads/2021/02/15713_outcomes-posttraumatic-stress-disorder.pdf

[7] Điều trị rối loạn căng thẳng sau sang chấn (PTSD). https://www.phoenixaustralia.org/disaster-hub/wp-content/uploads/2022/06/PTSD-Patient-Treatment-Guide-Vietnamese.pdf

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VIETNAM - FRANCE PSYCHOLOGY INSTITUTE

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