Post Traumatic Stress - a cognitive approach

Post Traumatic Stress is generally the result of a person being exposed to traumatic events which the person cannot cope with. It has been first diagnosed in Vietnam Soldiers but obviously the issue itself existed before but unrecognized. The trauma itself can be triggered off by any event the person affected cannot comprehend or make sense of. Examples of such events are accidents, terror assaults, rape, abuse, hospitalization, seeing a ghost (not that they exist, but someone might make us want to believe this and dresses up as a ghost) or the sudden change in a person who had been close to us (death, dementia or sudden violent behavior). The point is that it is triggered of by something which is beyond anything we can comprehend. This means, someone who expects abuse will probably not suffer from post traumatic stress while a person who does not expect it, will suffer from it.

What happens next is that this person will attempt to make sense of it and this has three effects. As the mind is constantly trying to make sense of it, the person affected by pts will be very tried. The second effect is that because the person cannot make sense of it, the person will be hypertense. Thirdly, because neither the thoughts make sense nor the combination of being tired and hypertense, the person will be in fear.

The symptoms are fairly well understood and include nightmares, raising heart beat, shaking, tiredness, exaggerated startle response (jumpiness), loss of motivation and sex drive and avoidance reactions. This is, the person will avoid anything which reminds this person of the traumatic event. If not treated properly, the person will become reclusive, possibly alcoholic, will start to stutter and be paranoid. However, so my claim, the treatment of pts is not well understood at all, and many people affected by it go through a period of unnecessary suffering.

In my opinion it is no good to prescribe medication which controls the heart beat. The use of sedatives is necessary. Why? Because, the affected person is stressed during the day and then gets even more stressed during the night because of nightmares. Patients need to be put into controlled periods of induced coma (maybe for several days at a time) where they rest and where the hypertension can dip down to normal levels. The patient has to be supervised when coming out of a coma because the initial disorientation adds to the stress. Recreational drugs such as hallucinogens (e.g. LSD) must under no circumstances be used. Alcohol is a sedative but highly addictive. Self-medication ought to be avoided. During the periods of awaking the patients have to be psychologically supervised in the following manner:

Once the patient has learned to re-engage in normal life, the sedation has to be decreased and this is the time when the patient will experience a certain amount of nightmares but can cope with those nightmares because regular life has returned. The dreams ought to be talked about (not in a psychoanalytical way, but in a Freudian fashion) until the patient feels that (s)he can makes sense of these dreams. If these nightmares are too heavy and interfere with the daily routines, the patient needs to be sedated again with the reassurance that things will return back to normal. Eventually, the nightmares will disappear.

I would be grateful for any comments, ideas and corrections to this approach.

Dr. Ludger Hofmann-Engl 15.03.06


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