Post-Traumatic Stress Disorder

On November 11, we remember the Canadian soldiers who fought in battles and sacrificed their lives. But many soldiers who return from war face a new battle: post-traumatic stress disorder (PTSD). While media reports tend to focus on combat veterans, many other Canadians also struggle with unresolved trauma and PTSD.

How common is it?

According to a 2008 study, the lifetime prevalence rate of PTSD in Canadians is 9.2 percent. Slightly more than 76 percent of survey respondents reported being exposed to a trauma severe enough to trigger PTSD. Roughly one in 10 Canadians will experience this debilitating condition at some point in their lives.

What is it?

Simply put, PTSD is how your body and brain respond to extreme stress or trauma. To receive a diagnosis of PTSD, patients must meet a list of criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and these symptoms must last longer than a month.

David Ravvin, MA (Counselling Psychology) and a registered clinical counsellor, incorporated trauma work into his practice about five years ago.

“Trauma affects people at a very deep level, not just the physical symptoms but the psychological symptoms: the impact on the sense of self and the sense of dignity. When trauma work is successful, it has a big impact on people’s lives,” says Ravvin.

A variety of events can result in trauma or PTSD, including

• sexual and physical abuse as a child
• rape, assault, or another serious crime
• serious car accidents, including multiple car accidents
• complicated grief due to the manner of a loved one’s death
• witnessing a traumatic crime or death
• surviving natural disasters
• war trauma as a soldier or a civilian living in a war zone

“Trauma symptoms and life events from 40 or 50 years ago are still affecting some people, and they aren’t aware of it,” says Ravvin. “For example, clients who have been affected by childhood abuse don’t fully recognize the impact of those events on their lives.”

Symptoms

These are some of the symptoms people with PTSD struggle with:

• lowered mood, often accompanied by depression and anxiety
• negative thinking
• recurring thoughts about an incident
• nightmares
• flashbacks
• avoidance of any stimuli associated with the event
• forms of dissociation
• fatigue
• addictions

“On the other side, hyperarousal symptoms, hypervigilance, and the startle response are activated,” says Ravvin. “Sometimes there’s aggression associated with PTSD. There’s really a wide range of symptoms that look like a lot of other conditions as well, so it’s not obvious that a person’s suffering from trauma or PTSD.”

Relationships with spouses, families, co-workers, and friends are adversely affected when a person suffers from PTSD.

Treatments

Counsellors can use a variety of techniques to help people from all walks of life cope with—and in many cases, overcome—PTSD.

Cognitive behaviour therapy (CBT)

CBT focuses on people’s thoughts and actions. The way we think about a situation influences how we feel about it and how we act. Our feelings may not be realistic, and the actions we take in a given situation, such as avoidance, may not be healthy. Through CBT, a counsellor helps patients explore new, healthier ways to replace unhelpful thoughts, feelings, and behaviours so they can move forward in their lives.

A 2011 review of CBT found that it effectively treats acute (sudden onset) and chronic (long-term) PTSD in adults and children. CBT was found to be useful for treating PTSD as a result of sexual abuse, natural disasters, war trauma, and car accidents. Nonresponse rates by patients can be as high as 50 percent, according to some studies, but overall CBT was found to be as effective as other psychological therapies for treating PTSD.

Eye movement desensitization and reprocessing (EMDR)

This therapy is a cornerstone of Ravvin’s trauma work. In 1987, American psychologist Francine Shapiro discovered that certain eye movements appeared to reduce the power of troubling thoughts. She began using EMDR to treat trauma victims.

According to Ravvin, “Trauma is an event that was so overwhelming in the first place that it didn’t get fully processed [by] so that when there’s a reminder of it—some external or internal cue—the brain and the body react as if it’s happening again.”

In EMDR a light bar is used. The client sits in front of it, recalls the event, and allows their eyes to follow the lights as they move back and forth across the light bar.

“While researchers aren’t really sure why it works, it seems to mimic rapid eye movement, the deep rejuvenating sleep that humans have that allows us to process the day’s events,” says Ravvin. “The event comes up and it kind of unravels the neural network associated with it.”

The counsellor asks the client “what are you getting?” and then the client reports. Results vary from client to client. EMDR isn’t hypnosis, but a re-experiencing of the event.

“I like to think that the core of the person is present during the session, observing the event and experiencing the event the way that part of the brain was not present at the time of the trauma,” says Ravvin. EMDR helps the client to free and integrate the event that’s been locked up in the brain.

CBT and EMDR are endorsed by the World Health Organization as PTSD treatments.

Group therapy

Group therapy (a type of psychotherapy involving one or more therapists working with several people at the same time) can also be effective for survivors of various types of trauma, such as sexual assault.

Therapy enactment

Ravvin uses this method to allow a client to re-enact a traumatic experience, such as a sexual assault, process it, and “do” the things they wished they’d done at the time.

A history of trauma, such as childhood abuse, neglect, or sexual abuse makes it more difficult for adults to recover from PTSD. But it’s never too late to process and heal the effects of painful traumatic events with professional counselling help.

Mind-body therapies

Research into these alternative treatments has found them to be useful for treating PTSD.

Yoga

A 2013 study found that veterans who practised yoga twice a week for six weeks had improved quality of sleep and a significant improvement in hyperarousal symptoms.

Mindfulness-based stretching and deep breathing

A group of nurses who participated in 60-minute sessions twice per week for eight weeks had normalized cortisol levels and reduced PTSD symptoms.

Meditation

Loving-kindness meditation was taught to a group of veterans during a 12-week study in 2013. At three-month follow-up, reductions were seen in depression and PTSD symptoms.

PTSD: Battle on the home front

Timothy Black, PhD, is an associate professor of counselling psychology at the University of Victoria. He’s also a cofounder and national clinical director of the Veterans Transition Network. This organization helps Canadian combat veterans reintegrate successfully into civilian life. With the help of counsellors and other veterans, many discover new educational or career paths and deal with the demons of PTSD.

Number affected

Despite the extensive amount of research being done on PTSD, it’s difficult to estimate how many veterans return with this condition.

“We’ve heard anywhere from 10 percent to a full 50 percent of combat veterans. But it’s really hard to find good numbers. Even the best stats we have in Canada are still a range,” says Black.

Black says transitioning from active combat to civilian life creates a kind of culture shock. A soldier can go from active duty fighting the Taliban, and within weeks be walking the streets of his or her hometown.

Life adjustment

One of the hardest things in adjusting to life back home is leaving war torn places where, for example, girls have acid thrown in their faces because they want to get an education, and returning home to hear Canadians complain about petty problems. “They really get angry and upset with how people in Canada live because we’re one of the most privileged countries in the world, and that really bothers them. They struggle with that,” explains Black.

“Alcohol and drugs are also a huge issue for dealing with their symptoms and family relationships. The research I did at the University of Victoria found one of the biggest things they struggle with is establishing friendships,” says Black.

Black gave up his private practice to focus on group work with veterans because it’s proved to be so successful.

“We hear over and over again that it’s the group aspect of what we do that makes the biggest difference. Having military people in a group [is] because they’re trained to feel most comfortable and safest in a group environment. I find it’s effective to just get people to tell their stories to a group of people who understand what they’ve been through,” he says.

For more information on this program, visit vtncanada.org or call 604-559-8155.