POST TRAUMATIC STRESS DISORDER (PTSD)
PTSD occurs after witnessing a life-threatening experience. This condition is prevalent among veterans, and is also common in victims of violent crimes, abuse, accidents, natural disasters, and other psychologically traumatic events.
Symptoms of PTSD may occur immediately after the event, or several months later. It is expected to be in shock for a few hours to a few days after any highly stressful experience. However, if the symptoms interfere with your daily life to a significant degree, or if the symptoms persist for more than 4 weeks, professional treatment may be necessary.
People with PTSD often have difficulty sleeping, may feel more “on edge” than normal, and can have flashbacks or disturbing thoughts that interrupt their daily activities. Some people will block out memories of the traumatic event, or become emotionally “numb” in an attempt to avoid the stress caused by the experience. Many people with PTSD will feel depressed or detached from others, and often turn to alcohol or substance abuse to medicate their depression or anxiety.
PTSD occurs after witnessing a life-threatening experience. This condition is prevalent among veterans, and is also common in victims of violent crimes, abuse, accidents, natural disasters, and other psychologically traumatic events.
Symptoms of PTSD may occur immediately after the event, or several months later. It is expected to be in shock for a few hours to a few days after any highly stressful experience. However, if the symptoms interfere with your daily life to a significant degree, or if the symptoms persist for more than 4 weeks, professional treatment may be necessary.
People with PTSD often have difficulty sleeping, may feel more “on edge” than normal, and can have flashbacks or disturbing thoughts that interrupt their daily activities. Some people will block out memories of the traumatic event, or become emotionally “numb” in an attempt to avoid the stress caused by the experience. Many people with PTSD will feel depressed or detached from others, and often turn to alcohol or substance abuse to medicate their depression or anxiety.
Can PTSD be "Simple" or "Complex"?
By Dr. Olivia Valdez, ND
When most people think of post-traumatic stress disorder (PTSD), they may imagine a war veteran, a tsunami survivor, or a car accident victim -- someone who can trace their symptoms back to a single traumatic event or period in their lives. This is the classic form of PTSD as defined in the DSM-5, also known as "typical" or "simple" PTSD (SPTSD) [1, 2]. But did you know there is another category of PTSD emerging in contemporary literature? Though not yet officially included in the DSM-5, it is a cousin of the SPTSD we may be more familiar with. And though they share certain roots, they also have branches that stretch in entirely different directions. It is our hope that one day this is acknowledged by the leading institutions of psychology, but for now, here are the highlights.
In contrast with SPTSD, "complex" PTSD (or CPTSD) occurs after prolonged trauma over a period of months to years and can be more enduring than that seen with SPTSD. [3] Dr. Judith Herman, MD, introduced this term in the 1990s when she researched the trends of prolonged trauma that women experience versus men (10% versus 5%, respectively). This type of chronic trauma can stem from various forms of repetitive exposure: childhood physical and sexual abuse, chronic spousal abuse, human trafficking, prolonged combat trauma, or any extended period of extreme instability with chronic lack of safety. CPTSD is characterized especially by somatization (experiencing medical symptoms without organic causes), dissociation (disconnecting from thoughts, memories, actions, or surroundings), and affect dysregulation (reacting excessively to negative emotional stimuli). [4] The survivor's sense of self can be damaged leading to personality disorders, their sense of purpose and meaning in life can be blunted, and interpersonal relationships become difficult.
SPTSD lacks these kinds of chronic personality changes and manifests more commonly with forms of intrusive symptoms of which the survivor is aware: nightmares, flashbacks, and unwanted memories [5]. These intrusive symptoms produce active maneuvers of avoidance (such as evading certain environments, people, or online content) and changes in mood and reactivity. But these mood changes are less personally identifying and deep-seated than in CPTSD. Both forms pose intense challenges for the survivor, and at Integrative Mental Health Center (IMHC), we recognize the unique roads to recovery for all. No mental health condition is defining, and there are many therapeutic modalities we can use as naturopathic physicians to facilitate your healing journey.
So what are these tools? The very first idea we integrate is working within your "Window of Tolerance" (WoT) [6]. Being inside your window means you can function healthfully: you are oriented to self, place, and time and can feel present and mindful without experiencing traumatic triggers. Being outside your window manifests with any level and/or combination of traumatic-stress responses. These could include anything from mild anxiety and a fast heart rate to emotional numbing, panic attacks, and dissociation (among others). As we help you create and develop tools to stabilize traumatic stress responses, an initially small WoT will expand. With time and patience, physical and emotional resilience increases and traumatic stress triggers become less intrusive. Though CPTSD has a more difficult WoT to identify than SPTSD, this concept can be applied for both forms.
Cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) can both be used to grow the WoT. CBT focuses on the relationship between thoughts, feelings, and behaviors and how any one domain can affect the other two. In PTSD treatment, CBT can help identify and reframe unhelpful thought and emotion patterns (called "distortions") [7]. Stress management and crisis planning also fall under the skill-building of CBT. DBT, which may be especially helpful for CPTSD, brings practitioner and patient together under the concept of "integration of opposites." This can be very helpful for management of suicidal or self-harming impulses, coping with severe anxiety, and shifting out of persistent depressive thought spirals. With DBT, both the practitioner and the patient practice collaboration and compassion to facilitate the goals of the patient productively. DBT also strives to balance complete acceptance of the patient as they currently are while also facilitating growth and change [8].
The last therapeutic modality discussed here is called eye movement desensitization and reprocessing (EMDR) therapy. A mouthful indeed, but EMDR also boasts a powerful therapeutic effect. By combining bilateral eye movements with a brief focus on the traumatic event or repetitive exposure, trauma-related emotions and vividness reduce [8]. The wonderful thing about EMDR is that it was initially developed specifically for PTSD and helps patients fully process memories that would otherwise go unseen. Processing a specific memory uses an 8-phase approach beginning with a thorough history-taking and ending with a practical evaluation of treatment results.
Any of the therapies discussed here are great ways to initiate healing and we regularly refer to trusted counselors who offer EMDR, DBT, and CBT, to complement the naturopathic therapies that we offer for PTSD. We can work collaboratively with your therapist or psychiatrist for a team approach that will yield faster and better results. Here at IMHC, we provide further naturopathic options that can be used adjunctively with those discussed above.
In our experience, homeopathy, acupuncture, and targeted nutritional or herbal supplementation can all contribute to a well-rounded treatment plan for those with S/CPTSD. We have seen empowering and positive results from even simply prescribing the right homeopathic remedy. Homeopathy can not only help soothe the nervous system and strengthen resilience in a trauma patient, but improve overall quality of life so the patient can function more efficiently and still tackle their daily activities with less interference from triggers. This modality can also act adjunctively with CBT, EMDR, DBT, or other counseling techniques, by creating a healthier foundation for the treatments to build upon. Acupuncture has also proved helpful with protocols which calm the mind and body, downregulate organ systems which are hyperactive, and tonify organ systems which are deficient from the trauma. Certain acupuncture points like Anmian and Heart 7 can even help with insomnia, which is a common problem in S/CPTSD. Supplements and nutrients which target the endocrine and nervous systems often have a powerfully supportive effect. In a fight-or-flight scenario, acute or chronic, cortisol pathways are the first to become imbalanced. This is why cortisol-modulating and supporting herbs and nutrients such as Withania somnifera, Glycyrrhiza glabra, L-theanine, B vitamins, Vitamin C, and certain trace minerals are so crucial to include. We can also utilize prescription medications if needed, to act as additional support for mood, sleep, or other symptoms, while your nervous system heals.
At Integrative Mental Health Center, we recognize and respect each and every patient's story. We honor the strength and struggle that exists in every trauma patient, and though the DSM-5 has not put a label on CPTSD as it has with typical PTSD, this does not make your experience any less real. We treat many with symptoms under the vast umbrella that is trauma and want you to know that you are not alone. There are a number of arrows in the quiver of healing, and we are here to guide you on how to use them. If you or someone you know is experiencing symptoms of simple or complex trauma, do not hesitate to reach out. And if you've made it all the way to the end of this article, we are proud of you -- awareness is the first step towards recovery.
References:
By Dr. Olivia Valdez, ND
When most people think of post-traumatic stress disorder (PTSD), they may imagine a war veteran, a tsunami survivor, or a car accident victim -- someone who can trace their symptoms back to a single traumatic event or period in their lives. This is the classic form of PTSD as defined in the DSM-5, also known as "typical" or "simple" PTSD (SPTSD) [1, 2]. But did you know there is another category of PTSD emerging in contemporary literature? Though not yet officially included in the DSM-5, it is a cousin of the SPTSD we may be more familiar with. And though they share certain roots, they also have branches that stretch in entirely different directions. It is our hope that one day this is acknowledged by the leading institutions of psychology, but for now, here are the highlights.
In contrast with SPTSD, "complex" PTSD (or CPTSD) occurs after prolonged trauma over a period of months to years and can be more enduring than that seen with SPTSD. [3] Dr. Judith Herman, MD, introduced this term in the 1990s when she researched the trends of prolonged trauma that women experience versus men (10% versus 5%, respectively). This type of chronic trauma can stem from various forms of repetitive exposure: childhood physical and sexual abuse, chronic spousal abuse, human trafficking, prolonged combat trauma, or any extended period of extreme instability with chronic lack of safety. CPTSD is characterized especially by somatization (experiencing medical symptoms without organic causes), dissociation (disconnecting from thoughts, memories, actions, or surroundings), and affect dysregulation (reacting excessively to negative emotional stimuli). [4] The survivor's sense of self can be damaged leading to personality disorders, their sense of purpose and meaning in life can be blunted, and interpersonal relationships become difficult.
SPTSD lacks these kinds of chronic personality changes and manifests more commonly with forms of intrusive symptoms of which the survivor is aware: nightmares, flashbacks, and unwanted memories [5]. These intrusive symptoms produce active maneuvers of avoidance (such as evading certain environments, people, or online content) and changes in mood and reactivity. But these mood changes are less personally identifying and deep-seated than in CPTSD. Both forms pose intense challenges for the survivor, and at Integrative Mental Health Center (IMHC), we recognize the unique roads to recovery for all. No mental health condition is defining, and there are many therapeutic modalities we can use as naturopathic physicians to facilitate your healing journey.
So what are these tools? The very first idea we integrate is working within your "Window of Tolerance" (WoT) [6]. Being inside your window means you can function healthfully: you are oriented to self, place, and time and can feel present and mindful without experiencing traumatic triggers. Being outside your window manifests with any level and/or combination of traumatic-stress responses. These could include anything from mild anxiety and a fast heart rate to emotional numbing, panic attacks, and dissociation (among others). As we help you create and develop tools to stabilize traumatic stress responses, an initially small WoT will expand. With time and patience, physical and emotional resilience increases and traumatic stress triggers become less intrusive. Though CPTSD has a more difficult WoT to identify than SPTSD, this concept can be applied for both forms.
Cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) can both be used to grow the WoT. CBT focuses on the relationship between thoughts, feelings, and behaviors and how any one domain can affect the other two. In PTSD treatment, CBT can help identify and reframe unhelpful thought and emotion patterns (called "distortions") [7]. Stress management and crisis planning also fall under the skill-building of CBT. DBT, which may be especially helpful for CPTSD, brings practitioner and patient together under the concept of "integration of opposites." This can be very helpful for management of suicidal or self-harming impulses, coping with severe anxiety, and shifting out of persistent depressive thought spirals. With DBT, both the practitioner and the patient practice collaboration and compassion to facilitate the goals of the patient productively. DBT also strives to balance complete acceptance of the patient as they currently are while also facilitating growth and change [8].
The last therapeutic modality discussed here is called eye movement desensitization and reprocessing (EMDR) therapy. A mouthful indeed, but EMDR also boasts a powerful therapeutic effect. By combining bilateral eye movements with a brief focus on the traumatic event or repetitive exposure, trauma-related emotions and vividness reduce [8]. The wonderful thing about EMDR is that it was initially developed specifically for PTSD and helps patients fully process memories that would otherwise go unseen. Processing a specific memory uses an 8-phase approach beginning with a thorough history-taking and ending with a practical evaluation of treatment results.
Any of the therapies discussed here are great ways to initiate healing and we regularly refer to trusted counselors who offer EMDR, DBT, and CBT, to complement the naturopathic therapies that we offer for PTSD. We can work collaboratively with your therapist or psychiatrist for a team approach that will yield faster and better results. Here at IMHC, we provide further naturopathic options that can be used adjunctively with those discussed above.
In our experience, homeopathy, acupuncture, and targeted nutritional or herbal supplementation can all contribute to a well-rounded treatment plan for those with S/CPTSD. We have seen empowering and positive results from even simply prescribing the right homeopathic remedy. Homeopathy can not only help soothe the nervous system and strengthen resilience in a trauma patient, but improve overall quality of life so the patient can function more efficiently and still tackle their daily activities with less interference from triggers. This modality can also act adjunctively with CBT, EMDR, DBT, or other counseling techniques, by creating a healthier foundation for the treatments to build upon. Acupuncture has also proved helpful with protocols which calm the mind and body, downregulate organ systems which are hyperactive, and tonify organ systems which are deficient from the trauma. Certain acupuncture points like Anmian and Heart 7 can even help with insomnia, which is a common problem in S/CPTSD. Supplements and nutrients which target the endocrine and nervous systems often have a powerfully supportive effect. In a fight-or-flight scenario, acute or chronic, cortisol pathways are the first to become imbalanced. This is why cortisol-modulating and supporting herbs and nutrients such as Withania somnifera, Glycyrrhiza glabra, L-theanine, B vitamins, Vitamin C, and certain trace minerals are so crucial to include. We can also utilize prescription medications if needed, to act as additional support for mood, sleep, or other symptoms, while your nervous system heals.
At Integrative Mental Health Center, we recognize and respect each and every patient's story. We honor the strength and struggle that exists in every trauma patient, and though the DSM-5 has not put a label on CPTSD as it has with typical PTSD, this does not make your experience any less real. We treat many with symptoms under the vast umbrella that is trauma and want you to know that you are not alone. There are a number of arrows in the quiver of healing, and we are here to guide you on how to use them. If you or someone you know is experiencing symptoms of simple or complex trauma, do not hesitate to reach out. And if you've made it all the way to the end of this article, we are proud of you -- awareness is the first step towards recovery.
References:
- https://www.medicalnewstoday.com/articles/322886
- https://psychnews.psychiatryonline.org/doi/full/10.1176/pn.45.23.psychnews_45_23_040
- https://www-sciencedirect-com.libproxy.chapman.edu/science/article/pii/S0887618505000630?via%3Dihub#bib10
- https://www.nami.org/Blogs/NAMI-Blog/October-2020/7-Tools-for-Managing-Traumatic-Stress
- https://www.apa.org/ptsd-guideline/treatments/cognitive-behavioral-therapy
- https://behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/