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:

• Deconditioning: This is, the patient has to learn to face again the things (s)he fears. If this, for instance, is the sound of gun fire, (s)he has to be re-introduced to the sound and learn that this is safe. Another instance is to return to the place where the traumatic event took place.
  
• Forced regression: This is, the patient has to try to remember things from the past which made the patient feel good. If this is sleeping with cutely toys, fine so, be it. If it is building model boats, fine too. Anything which the patient enjoyed especially from childhood (if the childhood was not too traumatic itself). If the trauma occurred during childhood, childhood has to be avoided, until the patient can be deconditioned about the childhood trauma. Psychotherapy is the worst thing a traumatized patient can go through because it adds to the fear rather reduce it.
• Re-Motivation: The patient needs to be encouraged to return to doing things the patient enjoyed before the trauma had taken place. This is not an easy process, because the patient is convinced that this will not work. If  we talk about an exclusive childhood trauma, the patient should focus on the good things which happened after childhood and brought back to childhood at a point when the patient feels safe. Psychoanalysts are playing with fire. How do they know how a patient will cope when send back to childhood without the appropriate safety?
  
• Interrupting automatic thoughts: As the patient is trying to make sense of what happened, the patient is preoccupied thinking about the traumatic event. The patient has to be encouraged to interrupt such thoughts from time to time and with increasing frequency.
• Additional stress has to be avoided, especially from family, relatives and friends. Quite often they are secondarily traumatized and might need help too. Financial burdens have to be taken off the patient.
  
• Sympathy and Reassurance: The patient needs to be listened to when the patient wishes to and feel sympathy and reassurance, that this event was an exception and will not reoccur again. This can be a very difficult task especially if the trauma was stretched over a long period of time. I have been approached by a sufferer who reported that she had been raped by her boyfriend on a daily basis between the age of 13 to 16. At the age of 30 she still suffers from black-outs and the inability to recognize her husband.The patient also can profit from knowing how to protect her/himself in the future (e.g. a rape victim ought to learn self-defense techniques).