Download Dr Dion Goodland

What the heck is PTSD?
And what do I do if I have it?
Dr. Dion Goodland, Psychologist
Goodland Psychology
May 2016
Outline for today
• What is Posttraumatic Stress Disorder (PTSD)?
• How do I get it?
• Can I get rid of it?
• Stigma
PTSD
• It has been written about for centuries
• There have been many names used
• PTSD in the DSM is relatively new…1980
• Much research has been done about causes and treatments
PTSD
• The DSM-5 identifies several criteria required for a diagnosis:
•
•
•
•
•
•
•
•
A. Trauma
B. Re-experiencing/Intrusion
C. Avoidance
D. Negative alterations in cognitions and mood
E. Hyperarousal
F. Duration > 1 month
G. Symptoms cause impairment in functioning
H. Symptoms are not related to physiological effects of a substance or
medical condition
Trauma
• Exposure to actual or threatened death, serious injury, or sexual
violence
•
•
•
•
To you
Witnessing, in person, events happen to others
Learning it happened to your loved ones
*Repeated or extreme exposure to aversive details of traumatic events*
Re-experiencing/Intrusion
• Re-experiencing unpleasant parts of the trauma
•
•
•
•
Recurrent distressing memories of the event(s)
Recurrent distressing dreams/nightmares
“Flashbacks”
Psychological and/or physiological reactions to reminders
Avoidance
• Because we are human, we try to avoid feeling badly and seek
feeling good – Pleasure Principle
• Re-experiencing/Intrusion is unpleasant, so people try to avoid
• Avoid thoughts, feelings, and memories about trauma
• Avoid people, places, conversations, and things that remind of trauma
Negative alterations of cognition/mood
• Because of the significance of the experience, effects on how
one thinks and feels are possible.
•
•
•
•
•
•
•
Inability to recall some aspects of the events
Persistent and exaggerated negative beliefs (self, world, others)
Persistent and distorted thoughts about the cause (self-blame)
Persistent negative emotional state (fear, horror, anger, guilt, shame)
Decreased interest
Feeling emotionally detached from others (family, friends)
Inability to experience positive emotions
Hyperarousal
• Often described as the switch gets flicked on but can’t turn it off
•
•
•
•
•
•
Irritable and/or angry outbursts
Reckless or self-destructive behaviour
Hypervigilance
Exaggerated startle
Poor concentration
Sleep disruptions
The other stuff…
• Symptoms have to be present more days than not for over 1
month
• Symptoms must cause clinical impairment in functioning
• Sometimes the start of symptoms can be delayed
• Sometimes dissociative symptoms can be present
Complications/Comorbid Conditions
• Depression
• Anxiety
• Substance abuse
• Chronic pain
Co-morbidity with PTSD
Comorbidity (%)
Males
Females
Major depressive episode
47.9
48.5
GAD
16.8
15.0
7.3
12.6
Social anxiety disorder
31.4
28.4
Agoraphobia
16.1
22.4
Alcohol abuse/dependence
51.9
27.9
Drug abuse/dependence
34.5
26.9
Panic disorder
Who can get PTSD?
• Anyone and everyone!
Myths about PTSD
• Only weak people get PTSD
• PTSD makes you violent and/or dangerous
• Bad things only happen to bad people
• I’m alone
• People should just get over it by now.
• I should be able to handle this myself
• Only military veterans get PTSD
• Nothing can be done to treat PTSD (stay tuned)
Asking for help…
• Is difficult!
• Takes courage!
How do I find out if I have it, “officially”?
• Assessment by a licensed professional
• Most often the assessment is done by a psychologist or a
psychiatrist
• VAC can help with the process
• Assessment can take several hours
• Clinical interview
• Psychological testing (sometimes)
• Spouse/partner asked to participate (sometimes)
“The Dr. confirmed what my friends/family
have been telling me for ages. Now what?”
• This is the first step to getting better!
• Treatment tends to be successful
• Often treatment is a combination of psychotherapy (“talk
therapy”) and medication
• Treatment takes time
Psychotherapy
• Talk therapy
• Sessions tend to be weekly and typically last 60 to 90 minutes
• Cognitive Behavioural Therapy (CBT)
• Including Prolonged Exposure
• Cognitive Processing Therapy (CPT)
• Eye Movement Desensitization and Reprocessing (EMDR)
Medication
• Can be prescribed by family physician or a psychiatrist
• Some commonly prescribed medications:
•
•
•
•
Sleep medication
Medication to reduce dreaming/nightmares (e.g., prazosin, nabilone)
Anti-depressants
Anxiolytics
Other strategies…
• Mindfulness-based psychotherapy
• Service dogs
• Equine therapy
• Yoga
• Marijuana
• Logosynthesis
• Virtual Reality
• Neurofeedback
For the spouses…
• Often the first to see the changes
• Often have to deal with the symptoms more than anyone else
• Save face at work and more irritable at home
• One of the most often heard statements: “Walking on eggshells”
Spouses…
• Challenges because often not allowed to talk with others – keep
the secret!
• Feeling isolated
• Important to take care of you and your needs
• Cell phones/oxygen masks on airplanes
• Research has shown that there are impacts from living with
someone suffering with chronic illness/PTSD
• Caregiver Burnout
• Vicarious Traumatisation
Stigma
• Often the reason people do not seek help
• Fear of being identified
• Fear of consequences
• Fear of being labelled
• Exists because people
• Are uninformed/misinformed
• Are afraid
Summary
• If you are wondering if your friends/family are right, ask for help.
• If you are diagnosed, then you can be treated.
• If you get treated, life can become more enjoyable and fulfilling
again.