How to Treat with Post Traumatic Stress Disorder - Research Paper Example

PTSD as it Relates to Military Combat Introduction Trauma is a serious condition in psychology. It affects people who have undergone terrible events and causes different levels of stress, depression and grief. American Psychological Association defines trauma as an emotional response to a terrible event such as shooting, accident, natural disaster or rape. After a traumatic event the victim remains with shock, denial and grief. The effects of a traumatic event on the response of individuals differ from one person to another. Some people experience unpredictable emotions, strained relationships, physical symptoms such as nausea and headache and flashbacks. These are common feelings and emotional experiences among people who have experienced trauma, but some people recover faster than others. Some people find it difficult to move on with live. The best way to recover is to receive psychological guidance and counseling. Psychologists help traumatized people to learn ways of managing their emotions. Distressing or traumatizing situations also cause stress. This refers to a reaction to a situation. Traumatic stress may interfere with one’s ability to live normally for a long period of time (White et al, 2015). Stress among victims of trauma may make them feel tired, irritated or unable to concentrate. It may also damage an individual’s physical health. People who have experienced traumatic events may experience upsetting emotions, a sense of constant danger, frightening memories and numbness. Some people may also feel disconnected and lose trust on others. Sometimes it may take long to recover from the pain caused by stressful trauma and to feel safe again. However, trauma can be overcome through the right treatment, self-help strategies and support. Emotional and psychological trauma arises from a distressing event, and damages the psyche (White et al, 2015). It makes an individual to feel insecure, helpless and vulnerable to dangerous situations. Traumatic experiences always include life-threatening and safety situations. Emotional and psychological trauma is caused by events that happen unexpectedly, getting the victims unaware. It also happens when the victim is powerless to prevent it; when it happened repeatedly; if someone was cruel; and if it happened during childhood. Post Traumatic Stress Disorder Trauma may cause extreme anxiety or Post Traumatic Stress Disorder (PTSD). Many people who have experienced trauma develop psychiatric disorders such as PTSD. This disorder leads the victims of distressing situations to re-experience the traumatic event. It also causes avoidance of stimuli that may cause trauma, numbness and hyper-arousal (Zuiden et al, 2011). These symptoms are also suggested by Ahmadizadeh et al (2010) who argue that PTSD is characterised by three symptom clusters: hyper-arousal, re-experiencing and avoidance. Ahmadizadeh et al (2010) define PTSD as complex affective, behavioral, somatic and cognitive effects of psychological trauma. It causes occupational, interpersonal and social dysfunction. These dysfunctions are escalated by nightmares, flashbacks of past trauma, intrusive thoughts, hyper vigilance, sleep disturbance, and avoidance of traumatic stimuli, all of which are characteristic of Posttraumatic Stress Disorder. PTSD is also associated with functional impairment, anxiety, depression and substance abuse. PTSD is also characterized by the impairment of sleep, which includes disturbing dreams and insomnia (Nohi et al, 2010). This shows that disturbed sleep is a hallmark of PTSD. However, laboratory sleep studies have not shown consistent evidence of sleep in PTSD, although there are apparent complaints about it. According to Nohi et al (2010), poor sleep occurs due to irritability, depression, confusion, tension and lower life satisfaction. The diagnosis of posttraumatic stress disorder is difficult due to the heterogeneity of the presentation and high resistance from the affected individuals who are not willing to discuss their trauma (Ahmadizadeh et al, 2010). However, behavioral and cognitive treatments can be effective in reduction of the symptoms of posttraumatic disorders. Diagnosis of PTSD does not require the presence of insomnia or disturbed sleep because it can be done without them. PTSD as Related to Military Combat There are various studies that attempt to find out the traumatic situations of military combat, and their effects in terms of Posttraumatic disorders. Research shows that modern military combats veterans experience few cases of injuries, but they go through extreme traumatic events which cause significant psychological problems. Chapman and Diaz-Arrastia (2014) suggest that exposure to emotional trauma and the development of posttraumatic brain disorder is highly likely in military combat theater. The researchers also argued that PTSD affects military personnel deployed to combat zones than those who remain within the civilian population because the deployment causes stress and exposure to trauma. Studies on military troops serving in the wars in Afghanistan and Iraq indicate that there is a server health impact of these wars on the veterans. The study of Hoge et al (2004) shows that 9% of the military veterans who were assigned to Iraq and Afghanistan had prevalence of probable PTSD prior to deployment and post-deployment prevalence rates of 12%-18%. This shows that deployment to military combat increases the prevalence of PTSD among combat troops. Veterans returning from combat also experience circumstances that affect their family functioning. Combat and other threatening and catastrophic events cause high levels of stress and posttraumatic stress disorder which disrupt their functioning when they are in the field and when they are back to the civilian population (Pearrow and Cosgrove, 2009). Exposure to combat also causes disabling symptoms and anxiety, which can easily be transmitted to the other close people including children, partners and friends. Some of the military combat operations that have caused a lot of trauma include the Vietnam War and the operations in Iraq and Afghanistan. Roadside bombs and improvised explosives have affected a lot of combatants in these operations, causing trauma, stress and post-traumatic disorders. Demographic Factors of PTSD in Military Combat Prevalence of PTSD varies in different demographics. For instance, age affects the chances and severity of PTSD among military combat veterans. According to Pearrow and Cosgrove (2009), the youngest veterans who served in the Vietnam, Afghanistan and Iraq aged between 18 and 24 years experienced higher risks of PTSD diagnosis than older veterans aged over 40 years. PTSD also affects nurses operating in a military combat environment. Alhajjar (2014) suggests that the combination personal experiences and hospital environment during war may expose nurses to trauma and eventually cause Posttraumatic stress disorders. The study used the IES-R inventory method to provide information about trauma on Gaza hospital nurses (Alhajjar, 2014). The study showed that two out of three nurses in Gaza hospital experienced trauma. Posttraumatic stress disorders are caused by the sympathy that nurses feel on their patients. Nurses in Gaza hospital were also not prepared to deal with war situations, so they are not able to develop coping strategies that would give them resilience for experiencing victims of war and attacks. The experience of nurses when taking care of victims of war changes their emotions and causes chronic posttraumatic stress disorders. Nurses with longer period of service experience fewer traumas than those who have served for a shorter period. Furthermore, nurses working in private hospitals experience more trauma than those working in public hospitals. The levels and prevalence of posttraumatic stress disorder is also affected by gender differences. Studies show that about 15% of military personnel are women. According to Polusny et al (2014), women soldiers who were exposed to combat in Iraq or Afghanistan suffered greater posttraumatic stress disorder than men, although there were no significant differences before deployment. Only 12.2% of men experienced posttraumatic stress disorder while 22.5% of women experienced PTSD after deployment. This is consistent with studies which show that women have higher prevalence of PTSD than men in the civilian population. Men experience direct combat experience while women experience sexual stressors. This exposure to sexual stressors was associated with symptoms of posttraumatic stress disorders. One of the reasons for more prevalence of posttraumatic stress disorder in women than men is because women experience pre-deployment interpersonal victimization which predicts greater symptoms of post-deployment PTSD. Prior interpersonal victimization for men did not have significant impact on post-deployment symptoms of PTSD. Due to poor unit support, women are less likely to rely on their military units for support, but rely on outside resources including family. Common Symptoms and Risk Factors of PTSD in Relation to Military Combat Cognitive Problems One of the effects of PTSD among military personnel in a combat is that they experience dementia more than other people. Dementia refers to the decline in mental ability so that it interferes with daily life. The study of Meziab et al (2014) carried a study to determine the relationship between the status of Prisoner of War, posttraumatic stress disorder and dementia. Using a total of 484 veterans with POW status, the study found out that 31% of the veterans with Prisoner of War status also had PTSD. When the study was adjusted for medical and psychiatric comorbidities, demographics, competing risk of death and period of service, the risk of dementia was found to be higher in military combats with POW status alone or PTSD alone (Shubina, 2014). This shows that traumatic conditions and posttraumatic stress disorders experienced in military combat causes dementia. The aspect of dementia in PTSD was also studied by Vincent et al (2014). There study suggests that traumatic experiences of the military in a combat lead to Traumatic Brain Injury (TBI) which puts them at a risk of dementia later in their lives (Vincent, 2015). Traumatic Brain Injury leads to chronic effects on cognitive and neurobehavioral functioning. The level of dementia for the military veterans affected by traumatic brain injury varies according to the timing of injury, severity and mechanics. Military members with PTSD have a particular risk for TBI. This affects monitoring programs to detect injuries at their onset and monitor long term effects. Vincent et al (2014) also suggest that co-occurring disorders such as PTSD affect cognition and symptom reporting, leading to dementia among military service members. Sleep Disturbances Posttraumatic disorders also cause low quality of sleep. Noohi et al (2010) carried out a study about sleep disturbance among Italian military combat veterans with PTSD. Seven components of sleep were measured in combat veterans diagnosed with PTSD. These components include sleep latency, sleep duration, habitual sleep efficiency, sleep medication, subjective sleep quality, daytime functioning, and sleep disturbances. The results showed that these components were higher among combats diagnosed with PTSD. Therefore, PTSD is considered to be characterised with poor sleep, and they should undergo pharmacotherapy and other treatment modalities. Stress The understanding of PTSD in war-zone veterans became prominent after the Vietnam War. Male veterans from the Vietnam War were examined to examine the interpersonal difficulties and stress factors that affect their family life. Some of the stress factors and symptoms associated with PTSD among veterans from military combat include domestic/partner violence, intimacy, sociability, hostility, disclosure and anger. Pearrow and Cosgrove (2009) noted that military from combat in Iraq have demonstrated higher rates of firefights, combat experiences and contact with the enemy than those from Afghanistan. Physical Morbidities and Psychiatric Comorbidities The study carried out by Britvi´c et al (2015) suggests that somatic diseases such as gastritis and ulcerative colitis are more common in combat veterans with PTSD than those without it. Cardiovascular diseases were also found to be more prevalent in combat veterans than in the overall population. Myocardial infarction and arrhythmia are also prevalent in combat veterans with PTSD. There were also some dermatological diseases which affected combat veterans more than civilian population, including allergies and alopecia. Furthermore, all musculoskeletal diseases and metabolic diseases were also common among combat veterans with exposure to PTSD. From the study, it was also established that 62% of the combat veterans suffering from PTSD also experienced psychiatric comorbidity (Britvi´c et al, 2015). This occurs due to personality change as a result of traumatic experiences of military personnel in combat. 38% of the combat veterans also experienced depressive disorder, anxiety and addiction. From these studies, it is clear that military veterans experience physical and psychiatric comorbidities more than civilian populations due to the combat traumatizing experiences of veterans in warfare. These diseases were influenced by demographic factors such as length of combat and warfare and age of military veterans. Military personnel with PTSD and psychiatric comorbidities spent a long time in war, but did not suffer significantly from cardiovascular diseases. PTSD influences the occurrences of physical illnesses among combat veterans. Somatization in PTSD also influences neurological diseases such as headaches (Britvi´c et al, 2015). These diseases are caused by tension among combat veterans with PTSD. Due to combat trauma, military personnel become tensed, and the combination of such tension with PTSD leads to neurological diseases that affect the body. Treatment and Prevention of Chronic Posttraumatic Stress Disorder in Military Combat Studies show that behavioural and cognitive treatments are effective in reducing depressions and symptoms of PTSD. Problem solving approach also helps in the treatment of PTSD due to exposure to military combat. Cognitive and Behavioural Treatment (CBT) Cognitive-behavioural treatment (CBT) is a form of psychotherapy which includes cognitive restructuring, interactive psychoeducation, and anxiety management training (shubina, 2015). Exposure-based behavioral treatment can also be used to desensitize the patient to the feared stimuli. In this case, the patient is exposed repeatedly to the feared situation. The patient is then taught some strategies on how to adapt or cope with traumatic situations. Problem-solving approaches Problem solving therapy is a form of cognitive behavioral intervention which provides a systematic approach of solving current and future problems (Ahmadizadeh et al, 2010). Through problem-solving therapy, patients are able to develop skills needed to overcome interpersonal difficulties. The problem solving skills are developed in a series of steps. First, the general situation should be identified. The second step involves formulation of the problem and setting of goals. Thirdly, novel solutions are generated, chosen and implemented. Fourthly, the decision making process is carried on until the end. Lastly, the outcomes are reviewed and evaluated. Ahmadizadeh et al (2010) suggest that if these steps are implemented consistently, military veterans exposed to combat situations will be able to cope successfully to new challenges and traumatizing combat situations. The method used by Ahmadizadeh et al (2010) involved 15 therapy sessions including 7 group sessions and 8 individual sessions. The military patients included in the study were trained about the five steps of problem solving therapy. Post-therapy tests were then done after the completion of all 15 sessions at the end of 3 months. The results indicated that the total scores of post-test phase increased significantly. All interventions were therefore important in improving the scores. Generally, problem solving therapy helped in solving reducing PTSD symptoms and effects of military combat. Pharmacotherapy This involves administration of drugs to reduce PTSD symptoms. Antidepressants are the common medications in this category. For instance, sertraline and paroxetine have been approved by the US food and drug administration as suitable treatments for posttraumatic stress disorder. Combat militants can use these medications to reduce the effects of PTSD symptoms. Schnurr and Friedman (2008) suggest that there is a positive effect of antidepressants on military veterans. This can be improved further if the medication is provided along exposure therapy Shubina (2015). Antiadrenergic agents have also been developed recently to treat posttraumatic stress disorders. Such drugs including Prazosin have proved to be successful in prevention of traumatic nightmares and reduction of PTSD. Benzodiazepines and mood stabilizers may also be used to treat PTSD. These pharmacotherapy alternatives help combat military officers to reduce symptoms of PTSD. Secondary Transmission of PTSD Symptoms There are various risk factors that cause the transmission of PTSD symptoms from military combat veterans to other members of the civilian population, including friends, partners, children and relatives. The transmission of trauma from parents to offspring is also referred to as intergenerational, vicarious, or empathic traumatization. According to Pearrow and Cosgrove (2009), the transmission of trauma and PTSD to children is occasioned by the high rates of partner violence for combat PTSD veterans. Children exposed to this violence also develop PTSD. Secondary traumatic stress also occurs when one takes care of a traumatized person or helps him or her. These third parties end up experiencing emotional upset and becoming indirectly affected by traumatic events. In this case, the impact of PTSD as a result of traumatizing combat event does not just affect veterans but also extends to their children and partners who get closer to them trying to help or taking care of them (Ahmadi et al, 2010). Research shows that wives of military veterans with PTSD are victims of psychiatric symptoms and morbidities, social problems, loneliness and other negative emotions Pearrow and Cosgrove (2009). Their children also have higher levels of behavioral problems than children of civilians. Veterans who have been engaged in combat-related violence have children with disruptive behaviors, low self-esteem, emotional disturbances, and poor relations and academic performance. Conclusion Military combat have significant effects on emotional, psychological and mental health of military veterans and their families. Military combat veterans usually experience traumatizing events which lead to posttraumatic stress disorder. Some of the symptoms and risk factors of PTSD include sleep disturbance, dementia, morbidities, stress, disruptive behaviour and social problems such as violence. These symptoms are often transmitted through vicarious traumatization to children and partners of military combat veterans. PTSD usually affects female military veterans than male combatants due to their pre-deployment historic emotional and sexual experiences. It is also common among people who have less experience in the military combat and those who are younger. The disorder can be treated using cognitive and behavioural treatment, pharmacotherapy, problem solving therapy, and exposure therapy. References list Ahmadi, K., Reshadatjoo, M., Karami, G., Sepehrvand, N., and Ahmadi, P. (2010). Vicarious PTSD in Sardasht chemical warfare victims' offspring. Social and Behavioral Sciences, 5, 170–173. Ahmadizadeh, M.J., Ahmadi, K., Eskandari, H., Falsafinejad, M.R., Borjali, A., Anisi, J., and Teimoori, M. (2010). Improvement in quality of life after exposure therapy, problem solving and combined therapy in chronic war-related post traumatic stress disorder. Social and Behavioral Sciences, 5, 262–266. Alhajjar, B. (2014). 4th World Conference on Psychology, Counseling and Guidance WCPCG- 2013 Gaza Nurses After War: Are They Traumatized? Social and Behavioral Sciences, 114, 802 – 809. Britvi´c, D., Antiˇcevi´c, V., Kaliterna, M., Luˇsi´c, L., Beg, A., Brajevi´c-Gizdi´c, I., Kudri´c, M., Stupalo, Z., Krolo, V. and Pivac, N. (2015). Comorbidities with Posttraumatic Stress Disorder (PTSD) among combat veterans: 15 years postwar analysis. International Journal of Clinical and Health Psychology, 13(2), 1-12. Chapman, J. and Diaz-Arrastia, R. (2014). Military traumatic brain injury: A review. Alzheimer’s & Dementia, 10, S97-S104. Hoge, C.W., Auchterlonie, J.L., & Milliken, C.S. (2006). Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. Journal of the American Medical Association, 295, 1023-1032. Meziab, O., Kirby, K.A., Williams, B., Yaffe, K., Byers, A.L. and Barnes, E.B. (2014). Prisoner of war status, posttraumatic stress disorder, and dementia in older veterans. Alzheimer’s & Dementia, 10, 236-241. Noohi, S., Azarb, M., and Jahangiri, S. (2010). Sleep disturbance among Iranian combat veterans with Chronic PTSD due to combat trauma. Social and Behavioral Sciences, 5, 255–257. Pearrow, M. and Cosgrove, L. (2009). The Aftermath of Combat-Related PTSD: Toward an Understanding of Transgenerational Trauma. Communication Disorders Quarterly, 30(2), 77-82. Polusny, M.A., Kumpula, M.J., Meis, L.A., Erbes, C.R., Arbisi, P.A., Murdoch, M., Thuras, P., Kehle-Forbes, S.M. and Johnson, A.K. (2014). Gender differences in the effects of deployment-related stressors and pre-deployment risk factors on the development of PTSD symptoms in National Guard Soldiers deployed to Iraq and Afghanistan. Journal of Psychiatric Research, 49, 1-9. Schnurr, P.P. and Friedman, M.J. (2008). Treatments for PTSD: Understanding the Evidence, PTSD Research Quarterly, 19(3), 1-11. Shubina, I. (2015). Cognitive-behavioral therapy of patients with PTSD: literature review. Social and Behavioral Sciences 165, 208 – 216. Vincent, A.S., Roebuck-Spencera, T.M, and Cernich, A. (2014). Cognitive changes and dementia risk after traumatic brain injury: Implications for aging military personnel. Alzheimer’s & Dementia, 10, 174–187. White, S.F., Costanzo, M.E., Blair, J.R., and Roy, M.J. (2015). PTSD symptom severity is associated with increased recruitment of top-down attentional control in a trauma- exposed sample. NeuroImage: Clinical, 7, 19–27. Zuiden, M., Kavelaars a, A., Rademaker, A.R., Vermetten, A., Heijnen, C.J., and Geuze, E. (2011). A prospective study on personality and the cortisol awakening response to predict posttraumatic stress symptoms in response to military deployment. Journal of Psychiatric Research, 45, 713-719. Read More