Posttraumatic stress disorder

Print this page

Overview

What is PTSD?

Most people are likely to experience a potentially traumatic event in their lifetime, and most individuals recover well, given time and adequate social support.1 For some individuals however, the experience of a traumatic event or chronic exposure to trauma can trigger symptoms of posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) refers to a set of symptoms that can emerge following the experience of a traumatic event that involves exposure to actual or threatened death, serious injury, or sexual violence. Exposure to such events can be through:

  • directly experiencing the traumatic event
  • witnessing, in person, the event happening to someone else
  • learning that the event has happened to a close family member or close friend
  • repeated or extreme exposure to the aftermath of trauma (e.g. first responders to emergency situations).

Symptoms are characterised by a sense of reliving of the traumatic event, avoidance of reminders of the traumatic event, feeling numb, having negative thoughts and mood, and feeling agitated or wound up.2

Without treatment, PTSD can become a chronic condition, and places the individual  at greater risk of developing other mental health problems, such as depression or anxiety, or problems with alcohol or drug use.3 With sound psychological intervention however, the chances of recovery are good.4

Signs and symptoms

Symptoms are characterised by:2, 5

A sense of reliving the traumatic event

  • experiencing unwanted and distressing thoughts or images, flashbacks, nightmares, or feeling as though the event is recurring.

Avoidance and numbing

  • avoidance of people, places, thoughts and activities associated with the traumatic event
  • feeling emotionally flat, losing interest in enjoyable activities, or feeling disconnected from friends and family.

Negative thoughts and mood

  • persistent negative thoughts about self, others, and the world
  • distorted views about the causes and consequences of the event.

Feeling wound-up

  • feeling irritable, angry, over-alert, or edgy
  • experiencing difficulties concentrating
  • experiencing difficulties getting to sleep or staying asleep.

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.2

What causes PTSD?

Whilst traumatic events are the trigger for PTSD, not everyone who experiences a traumatic event goes on to develop PTSD. Research looking at factors related to the causes of PTSD has revealed several explanations for how the disorder develops.2

Biological models - The stress response, by nature, is physiological, and the core symptoms of PTSD such as agitation, a heightened startle response, and memory disturbances, have a basis in how the brain processes and responds to stress. Differences in the sympathetic nervous system, which controls stress hormones such as adrenalin, as well as brain circuitry related to anxiety responses, may differ between individuals with and without PTSD.6-8

Psychological models – In PTSD, previously neutral objects, places, people, sounds and smells can become associated with a traumatic event, and trigger the fear response even in the absence of danger. This association between benign stimuli and a fear response has been found to be the basis for many PTSD symptoms.9

Information processing and memory models - It has been suggested that high stress and arousal at the time of the trauma impacts on the way in which traumatic information is encoded in memory, which may underlie the physical symptoms of PTSD and the experience of ‘reliving’ the event.10-14

Other risk factors include:15

  • the type and severity of the trauma - sexual assault and abuse, military combat, and terrorist acts are linked to a higher rate of PTSD than motor vehicle accidents and natural disasters3, 16, 17
  • lack of social support
  • subsequent life stress.

Evidence-based psychological interventions

There are a range of psychological treatments for adults with PTSD. The two types of treatment that are most effective are called trauma-focused cognitive behaviour therapy (TF-CBT) and eye movement desensitisation and reprocessing (EMDR).4

Trauma-focused Cognitive Behaviour Therapy (TF-CBT)

In Trauma-focused Cognitive Behaviour Therapy (TF-CBT) the psychologist helps the person to confront memories and reminders of the trauma, change the way they think and feel about the traumatic experience, and find more helpful ways of coping, through exposure therapy and cognitive therapy techniques. In imaginal exposure therapy the person is supported to gradually confront their memories of the trauma, whilst within in vivo exposure therapy the person is supported to gradually confront safe situational reminders of the trauma that are otherwise avoided. Repeated imaginal and in vivo exposure, has been found to be highly effective.18, 19

EMDR

EMDR is based on the idea that overwhelming emotions during a traumatic event interfere with normal information processing, resulting in flashbacks, nightmares, and other distressing symptoms. In EMDR, the person is asked to focus on particular images, thoughts, and bodily sensations related to the traumatic event while moving their eyes back and forth across their field of vision, tracking the movement of the therapist’s finger. It is proposed that the dual attention helps the individual to process  the trauma and integrate the memory with existing memory networks.20

Social and behavioural interventions

Social support after a trauma has been found to be the best predictor of recovery.21 As such, treatment for PTSD is likely to involve building or strengthening the person’s social support network.

Some lifestyle changes might also be helpful, such as reducing or eliminating the use of alcohol or drugs which can increase certain PTSD symptoms and slow recovery.22-24

Relaxation exercises can help reduce feelings of agitation and being on edge25, 26 whilst maintaining a balanced diet and engaging in routine exercise supports general emotional and physical wellbeing which can also aid recovery.27-29

How a psychologist can help

Through discussion with the client and the possible use of questionnaires and monitoring tools, the psychologist develops an understanding of the potential factors involved in the onset and maintenance of the individual’s symptoms. A treatment plan is then developed by the psychologist together with the individual, drawing on evidence-based treatments for PTSD and an understanding of the client’s specific needs.

The psychologist may also assist their client to address any lifestyle factors which may be getting in the way of their capacity to manage their difficulties, and reduce symptoms of PTSD. They may also suggest involving a supportive family member or friend to assist in the understanding of the individual’s situation and to support treatment.

Other professionals who may be involved

A medical review with a GP or another mental health specialist such as a psychiatrist may be suggested to determine whether another condition could account for the individual’s symptoms. Trauma-focused CBT or EMDR are usually the best treatments for PTSD, but medication can sometimes help the recovery process.30 A GP or psychiatrist would oversee this aspect of the individual’s treatment. A social worker or another community-based professional may also help to manage housing or social needs that have arisen as a result of a traumatic event. Other health specialists might be involved in rehabilitation if a physical injury has occurred.

When to seek professional help

If the distress associated with a traumatic event has been affecting a person’s work, school, or home life for more than two weeks, psychological assistance should be considered. The APS Find a Psychologist service can be used to locate a psychologist in your local area: call 1800 333 497 or visit www.findapsychologist.org.au. A GP can also organise a referral to an APS psychologist under the Better Access to Mental Health Care items.

More information

Australian Psychological Society
Australia’s largest professional association for psychologists
www.psychology.org.au

Australian Centre for Posttraumatic Mental Health
Information about the impact of trauma and treatment for PTSD
www.acpmh.unimelb.edu.au

beyondblue
Information on anxiety, depression, and related disorders
www.beyondblue.org.au

headspace
Australia’s National Youth Mental Health Foundation, providing assistance for individuals aged 12-25
www.headspace.org.au

Lifeline
A 24-hour counselling, suicide prevention and mental health support service
Telephone: 13 11 14
www.lifeline.org.au

Psychosocial Support in Disasters
Resources on coping for people who have been directly affected by disaster or their loved ones
www.psid.org.au/public

  • Contributor(s)
    APS Member Resources Team

    Australian Centre for
    Posttraumatic Mental Health
    Department of Psychiatry
    University of Melbourne
  • Publish date
    07 Oct 2013
  • References
    View

References

  1. Kessler, R. C., Sonnega, A., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the national comorbidity survey. Archives of General Psychiatry, 52, 1048-1060.
  2. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington DC: Author.
  3. 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.
  4. Australian Centre for Posttraumatic Mental Health. (2013). Australian Guidelines for the Treatment of Acute Stress Disorder and Posttraumatic Stress Disorder. Melbourne, Victoria: ACPMH.
  5. World Health Organization. (2008). ICD-10: International Statistical Classification of Diseases and Related Health Problems (10th Rev.). New York, NY: Author.
  6. 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
  7. Karl, A., Schaefer, M., Malta, L. S., Dörfel, D., Rohleder, N., & Werner, A. (2006). A meta-analysis of structural brain abnormalities in PTSD. Neuroscience & Biobehavioral Reviews, 30(7), 1004-1031. doi: http://dx.doi.org/10.1016/j.neubiorev.2006.03.004
  8. Vasterling, J., & Brewin, C. (2005). The Neuropsychology of PTSD: Biological, Cognitive and Clinical Pperspectives. New York: Guilford Press.
  9. Keane, T. M., Zimering, R. T., & Caddell, J. M. (1985). A behavioral formulation of posttraumatic stress disorder in Vietnam veterans. Behavior Therapist, 8(1), 9-12.
  10. Janoff-Bulman, R. (1985). Criminal vs. non-criminal victimization: Victims' reactions. Victimology: An International Journal, 10(1-4), 498-511.
  11. Horowitz, M. J. (1976). Stress response syndromes. Oxford, England: Jason Aronson.
  12. Foa, E. B., & Rothbaum, B. O. (1998). Treating the trauma of rape: Cognitive-behavioral therapy for PTSD. New York: Guilford Press.
  13. Brewin, C. R., Dalgleish, T., & Joseph, S. (1996). A dual representation theory of posttraumatic stress disorder. Psychological Review, 103(4), 670-686.
  14. Ehlers, A., & Clark, D. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319-345.
  15. Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 68(5), 748-766.
  16. O'Toole, B. I., Marshall, R. P., Grayson, D. A., Schureck, R. J., Dobson, M., Ffrench, M., . . . Vennard, J. (1996). The Australian Vietnam veterans health study: III. Psychological health of Australian Vietnam veterans and its relationship to combat. International Journal of Epidemiology, 25(2), 331-339.
  17. Lee, A., Isaac, M., & Janca, A. (2002). Post-traumatic stress disorder and terrorism. Current Opinion in Psychiatry, 15(6), 633-637.
  18. Hembree, E. A., Rauch, S. A. M., & Foa, E. B. (2003). Beyond the manual: The insider's guide to Prolonged Exposure therapy for PTSD. Cognitive and Behavioral Practice, 10(1), 22-30. doi: http://dx.doi.org/10.1016/S1077-7229(03)80005-6
  19. Powers, M. B., Halpern, J. M., Ferenschak, M. P., Gillihan, S. J., & Foa, E. B. (2010). A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Clinical Psychology Review, 30(6), 635-641. doi: http://dx.doi.org/10.1016/j.cpr.2010.04.007
  20. Shapiro, F. (1989). Efficacy of the Eye Movement Desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 2(2), 199-223. doi: 10.1002/jts.2490020207
  21. Schnurr, P. P., Lunney, C. A., & Sengupta, A. (2004). Risk factors for the development versus maintenance of posttraumatic stress disorder. Journal of Traumatic Stress, 17(2), 85-95.
  22. Back, S. E., Sonne, S. C., Killeen, T., Dansky, B. S., & Brady, K. T. (2003). Comparative profiles of women with PTSD and comorbid cocaine or alcohol dependence. The American Journal of Drug and Alcohol Abuse, 29(1), 169-189.
  23. Read, J. P., Brown, P. J., & Kahler, C. W. (2004). Substance use and posttraumatic stress disorders: Symptom interplay and effects on outcome. Addictive Behaviors, 29, 1665-1672.
  24. Perconte, S. T., & Griger, M. L. (1991). Comparison of successful, unsuccessful, and relapsed Vietnam veterans treated for posttraumatic stress disorder. Journal of Nervous and Mental Disease, 179(9), 558-562.
  25. Taylor, S., Thordarson, D. S., Maxfield, L., Fedoroff, I. C., Lovell, K., & Ogrodniczuk, J. (2003). Comparative efficacy, speed, and adverse effects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training. Journal of Consulting and Clinical Psychology, 71(2), 330-338.
  26. Vaughan, K., Armstrong, M. S., Gold, R., O'Connor, N., Jenneke, W., & Tarrier, N. (1994). A trial of eye movement desensitization compared to image habituation training and applied muscle relaxation in post-traumatic stress disorder. Journal of Behavior Therapy and Experimental Psychiatry, 25(4), 283-291. doi: 10.1016/0005-7916(94)90036-1
  27. Lang, A. J., Rodgers, C. S., Laffaye, C., Satz, L. E., Dresselhaus, T. R., & Stein, M. B. (2003). Sexual trauma, posttraumatic stress disorder, and health behavior. Behavioral Medicine, 28(4), 150-158. doi: 10.1080/08964280309596053
  28. Rutter, L. A., Weatherill, R. P., Krill, S. C., Orazem, R., & Taft, C. T. (2011). Posttraumatic stress disorder symptoms, depressive symptoms, exercise, and health in college students. Psychological Trauma: Theory, Research, Practice, and Policy. doi: 10.1037/a0021996
  29. Zen, A. L., Whooley, M. A., Zhao, S., & Cohen, B. E. (2012). Post-traumatic stress disorder is associated with poor health behaviors: Findings from the Heart and Soul Study. Health Psychology, 31(2), 194-201. doi: 10.1037/a0025989
  30. Van Etten, M., & Taylor, S. (1998). Comparative efficacy of treatments for posttraumatic stress disorder: A meta-analysis. Clinical Psychology and Psychotherapy, 5, 126-144.

We welcome your feedback.

How easy is it to find information on EQIP on a scale of 1-5 (1 being NOT EASY to find information and 5 being VERY EASY to find information)?
How useful was the information you found on a scale of 1-5 (1 being NOT VERY USEFUL information and 5 being VERY USEFUL information)?
If you have a suggestion for how EQIP might be improved or if you would like to suggest a new EQIP topic, please use the space below. If you would like a response to a query or suggestion, please email EQIP directly at eqip@psychology.org.au