Posttraumatic Stress Disorder (PTSD)

Diane McGeachy

Psychologist
Gestalt Psychotherapist
Hobart, Tasmania

What is Posttraumatic Stress Disorder?

Posttraumatic Stress Disorder (PTSD) is a serious mental health condition comprised of a set of reactions/symptoms that occur in response to a traumatic event or series of traumatic events. A traumatic event is defined as an event that is life threatening and when a person experiences a threat to their physical, psychological or spiritual integrity that overwhelms their capacity to cope. It often induces a state of terror and helplessness. Examples of traumatic events include; animal attacks, motor vehicle accidents, natural disasters, being present during an armed robbery, assault, sexual violence, a violent death of someone close to you, childhood abuse, terrorism or combat during war. 

Exposure to a traumatic event can be through:

• Directly experiencing the traumatic event
• Being a witness to the event happening to someone else
• Learning that the event has happened to someone close to you
• Repeated or extreme exposure to the aftermath of trauma (i.e. first responders to emergency situations).

PTSD Symptoms 

The symptoms of posttraumatic stress disorder involve the experience of reliving the traumatic event, avoiding reminders of the traumatic event, feeling numb, having negative thoughts and mood, and experiencing a state of agitation or being on edge.  

A diagnosis of PTSD is made when these symptoms are present for more than one month and cause significant distress, or interfere with important areas of functioning, such as work, study, or family life.  

Types of PTSD:

• Acute: symptoms last less than three months
• Chronic: symptoms last longer than three months
• Delayed: symptoms start at least six months after the actual event

Fight, Flight, Freeze and Immobilisation Responses

People can experience deep shame in the aftermath of a traumatic event, in relation to how they responded during the event. They can become angry and berate themselves for not acting differently such as calling for help, fighting/protecting/defending or running away. A person can also feel deep shame; for example, reacting with a fight response and harming others, or a person who becomes immobilised when being sexually assaulted and later condemning themselves for not fighting or running away. It is important to understand the physiology that occurs in the body when under duress. Research shows us that our bodies automatically respond in a way that allows us to best protect ourselves and enable us the greatest chance of survival in the given situation. 

The fight-flight-freeze-immobilisation response is the body’s natural reaction to danger. It is a stress response that helps a person to react to perceived and real threats. Many physiological changes occur during a stress response. The reaction begins in the part of the brain called the amygdala, (responsible for detecting fear). The amygdala responds by sending signals to the hypothalamus, which stimulates the autonomic nervous system (ANS). The ANS consists of the sympathetic and parasympathetic nervous systems. The sympathetic nervous system drives the fight-or-flight response, while the parasympathetic nervous system drives freezing. How a person reacts depends on which system dominates the response at the time.

The body releases the stress hormone, adrenaline and cortisol. These are released rapidly, which can affect the following: 

• Heart rate. Heart beats faster to bring oxygen to your major muscles. During freezing, heart rate might increase or decrease. 
• Lungs. Breathing speeds up to deliver more oxygen to your blood. In the freeze response, you might hold your breath or restrict breathing.
• Eyes. Peripheral vision increases, able to notice your surroundings. Pupils dilate and let in more light, which helps you to see better.
• Ears. Ears “perk up” and hearing becomes sharper.
• Blood. Blood thickens, which increases clotting factors. This prepares the body for injury. 
• Skin. Skin might produce more sweat or get cold. May look pale or have goosebumps. 
• Hands and feet. As blood flow increases to major muscles, hands and feet might get cold.
• Pain perception. Temporary reduction in perception of pain.

Nunez, K. (2020). Healthline. Fight, Flight, Freeze: What This Response Means. Retrieved from https://www.healthline.com/health/mental-health/fight-flight-freeze 

Immobilisation is one of the most common bodily responses when faced with life threat. It has been described as the inability to move, the loss of being able to function and feeling numb. This is the most primal response, where the body’s organ’s literally shut down to raise the body’s pain threshold, anticipating the oncoming threat to life. In some cases, survivors of traumatic events have been blamed for not fighting or fleeing. Fight-flight-freeze-immobilisation is not a conscious decision. It is an automatic reaction that cannot be chosen or controlled, but is based on the bodies rapid decision making of which response will result in the best chance of survival or, if death seems imminent, the least degree of pain. 

Common Psychological Treatment Approaches

Trauma-focused Cognitive Behaviour Therapy (TF-CBT) and Eye Movement Desensitisation and Reprocessing (EMDR) are two approaches used to treat PTSD. TF-CBT involves the therapist supporting the client to confront their intrusive memories and to find ways of thinking and feeling about the trauma that involve the client experiencing more agency and therefore building their tolerance levels of reminders. EMDR is based on the idea that overwhelming emotions that occur from a traumatic event interfere with normal information processing, resulting in flashbacks, nightmares, and other unprocessed distressing symptoms. In EMDR, the person is asked to focus on specific details related to the traumatic event while moving their eyes back and forth, tracking the movement of the therapist’s finger. It is suggested that the dual attention helps the individual to process the trauma and integrate the memory. 

Social and relaxation interventions also have a key role in treatment. This can include emphasis on building up social supports with family and friends as well as various forms of relaxation skill building to assist in calming the heightened nervous system. 

Taking Care of Yourself 

Many people who experience a traumatic event are able to recover with time and good social support. However, some people require specific psychological treatment to recover and to reduce the impacts the traumatic event has been having on their life. Some ways you can look after yourself include; 

• Reach out to supportive family and friends and let them know what you are experiencing. 
• Try to establish or maintain a regular routine that is predictable and can feel like an anchor. 
• Focus on the basics; balanced diet, exercise, adequate sleep and enough rest. 
• See your GP if you are struggling with your mood or with sleep. 
• Engage in activities that help your body to lower its arousal level and that supports rest and relaxation (some possibilities include; yoga, mindfulness practice, meditation, remedial massage, acupuncture, reading, gardening, spending time with your pet, listening to something calming such as music or an audiobook). 
• Acknowledge to yourself that you have experienced a traumatic or distressing event and that having strong reactions and responses is understandable. 
• Look after yourself and reach out for professional support if you are concerned about how you are coping. 

If you have experienced a traumatic event or you believe you may have Posttraumatic Stress Disorder, talking to an experienced Psychologist for an assessment and counselling can be beneficial.  If you would like to book an appointment contact Diane McGeachy.  

Diane McGeachy
Psychologist
Accredited Gestalt Psychotherapist

Phone: (03) 6285 8592
Email: enquiries@hobartcounselling.com.au

Hobart Counselling Centre
Level 1,
181 Elizabeth Street Hobart TAS 7000
www.hobartcounselling.com.au

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington DC: Author.

Creamer, M., Burgess, P., & McFarlane, A. C. (2001). Post-traumatic stress disorder: Findings from the Australian National Survey of Mental Health and Well-being. Psychological Medicine, 31(7), 1237-1247.

Pole, N. (2007). The psychophysiology of posttraumatic stress disorder: A meta-analysis. Psychological Bulletin, 133(5), 725-746. doi: 10.1037/0033-2909.133.5.725