Introduction
The DSM-IV-TR defines a PTSD patient as an individual who has either witnessed or experienced a significant event(s) or trauma, serious injury, either to oneself or others, or one who has been faced with threatening near- death experience. The anxiety reaction of an individual with PTSD to trauma is different from the normal anxiety reaction that has the tendency to dissipate (Brodwin et al, 2009), as time goes by.
In the case of PTSD, the patient still continues to experience intrusive, recurrent, and distressing recounts of the actual event in the form of nightmares or flashbacks. The presence of any cues within the immediate environment of such an individual, and which could resemble or symbolize an element of the actual traumatic experience has the potential to arouse in them profound psychological distress.
For clients in need of rehabilitation counseling, Post Traumatic Stress Disorder still remains a leading anxiety disorder that they are more likely to experience. In recent years, PTSD has gained a lot of attention as a result of the high number of the Vietnamese War Veterans who have manifested the symptoms of the condition.
Further attention to the disorder has been called following the recent combats in both Iraq and Afghanistan. The New England Journal of Medicine carried the report of a study that showed the prevalence of PTSD to be 9. 3% (Kolb, 1986, p. 642). For Marines and soldiers deployed to Iraq, and who had encountered between one and two combats.
In addition, for these marines and soldiers who had encountered between there and five combats, the prevalence of PTSD was 12.7 %. Above five combats, the prevalence of PTSD was 19.3% (Lande, Marin & Ruzek, 2004).
These statistics appear to somewhat match those released by a study undertaken on the marines and soldiers deployed to Afghanistan whereby the prevalence rates of 8.2 %, 8.3%, and 18.9% (Reeves, 2007, p. 183) , in that order, were recorded for the different categories of firefight experience.
Other forms of PTSD
Besides the veterans, individuals seeking for refugees’ status in the United States have also been seen to present with PTSD symptoms (Brodwin et al, 2009).
For instance, a majority of the Americans of Southeast Asian descent were seen to have developed this disorder following their traumatic encounter with war and socio-political unrest back home, not to mention their traumatic experiences as refugees, on their way to the United States.
Other than war experiences, individuals that have been afflicted with major violent crimes, serious and life threatening experiences, and personal trauma, are also more likely to experience PTSD as well.
Further, PTSD may also come about due to upheavals of a large scale, normally affecting an entire region or community, including such natural disasters as hurricanes, earthquakes, and floods. In addition, such distressing events as acts of terrorism and riots could; also trigger the PTSD condition.
There is a wide variation in terms of the prevalence of PTSD. In this case, projections range between 2 and 15 % (Brodwin et al, 2009), owing to the variations in exposure to trauma from one community to another.
Etiology
Learning theories on the causes of PTSD argue that the main symptoms attributed to this condition can be attributed to the patient’s classical conditioning to fear. On the basis of this model, there is the likelihood of a patient suffering from PTSD experiencing enhanced fear or anxiety following a car accident that remains quite traumatic, or at a time when they are travelling in a car (Schoenfeld, Marmar, & Neylan, 2004).
Should the patient resolve to avoid traveling in motor vehicles, this only act to reinforce the fear that such a patient may have for cars, in a negative way. Accordingly, in the absence of a car, the anxiety also fades. Explored from a biological context, patients who have already been diagnosed with PTSD have been seen to experience lasting changes in their brain chemistry.
There is the tendency for PTSD patients to manifest increased psychological reactions towards both physical stress and physiological reactions as well. When we are faced with a traumatic event, such an emergency, this in effect acts to activate the sympathetic nervous system (Schoenfeld, Marmar, & Neylan, 2004).
As a result, epinephrine and norepinepherine, the two catecholamine neurotransmitters, are released by the “locus coeruleus” region in the brain. A majority of the studies indicates that those patients who have been diagnosed with PTSD could also manifest characteristics of catecholamine abnormalities.
In this case such studies reveals when the cortisol/norepinephrine ration tends to be high, this serves as a valuable sign of PTSD (for example David et al, 2004). Completely mindful of individual exposure to traumatic experiences, there are important PTSD predictors that we need to address. They include early separation from one’s parents, family history, being female, parental history, child abuse, or divorce.
Medical management/intervention
Social and psychologic interventions could still be the first choice form of treatment for a majority of the patients who have diagnosed with PTSD. At times, such interventions have proved quite valuable in comparison with medications. The interventions ought to constitute a vital element of the treatment regimen of the patients.
The first step while starting any form of treatment often entails a cultivation of a relationship built on trust between on the one hand, the healthcare provider and on the other hand, the patient (Brodwin et al, 2009).
However, this may not be an easy thing to do for patients who have already gone through a traumatic experience. There is the need for physicians to make use of a patient-center context while evaluating the current patients’ concerns.
Psycho- educational interventions
Patient education is important in order to eradicate any form of misconception that the patients may have about PTSD, and enhance the levels of understanding of the patients, along with an improvement on their ability to recognize symptoms associated with of the disorder (Brodwin et al, 2009). Moreover, educating the patient on the condition that is affecting them acts to reduce shame and fear that they could be faced with.
Psycho-educational interventions are not only useful in empowering the patients, but they are also a source of valuable information on the possible symptoms of the disorder and their causes. In addition, patients also get to learn what the treatment regimens for the condition entails, and the ensuing recovery program (Brodwin et al, 2009).
During the psycho-education session, counselors are normally encouraged to dwell more on stress as a potential cause of a majority of the symptoms manifested by patients with PTSD. Accordingly, healthcare providers are called upon to assist patients with PTSD in interpretation of the reactions that they encounter, possibly as a result of elevated level of stress, and not due to personal weaknesses.
Coaching the patients in other mechanism of coping could also provide them with practical skills that would allow them to adequately handle the strong emotional problems they could be faced with (Brodwin et al, 2009).
We have quite a number of coping skills that could be introduced to patients with PTSD. This form of training is valuable to patients as it enables them to reclaim the control they once had over their emotions, along with the associated symptoms.
Due to the convoluted involvement of families in the lives of patients with trauma, the patients as well as the rest of the family could also benefit enormously from family counseling session (Brodwin et al, 2009). Furthermore, the presence of members of the family to patients with PTSD during therapy is vital. This is because they might provide useful information on the medical history of the patients.
Such relevant history includes previous involvement of the patient in drug abuse, social relations, and sleep habits, among others. In this case, it is important to note that patients may either be unwilling ro lacking the capacity to report such issues.
Through cognitive restructuring, it is intended that patients with PTSD shall be guided on how best to evaluate their condition, and the most suitable remedial actions that they ought to take regarding erroneous beliefs that are usually linked to the issue of trauma. Normally, this happens when the existing relationship between their though processes and emotions are evaluated with a view to identifying an individuals’ negative thoughts.
Accordingly, it becomes necessary to develop interpretation alternatives, and facilitate in the adoption of new thinking ways for the patients (Cassels, 2009). Such a modality for treatment also entails a self-assessment of individual thoughts. Moreover, through cognitive restructuring, veterans could also be assisted to handle changes in perceptions as a result of having taken part in combat.
On the other hand, there is need to take into account exposure therapy following the preparation of patients to enable them confront their painful memories and the associated emotional trauma (Cassels, 2009). During this therapeutic session, the patient is normally encouraged to make verbal utterances more frequently regarding the traumatic experience.
The intention is to ensure that the patient gets frequent exposure to fear stimuli up until such a time when they shall have attained stable and reduced fear responses. Physicians charged with the responsibility of providing this particular treatment needs to have been properly trained and exposed as prior studies appear to suggest the likelihood of deterioration in the condition of a patient following an improper use of this therapy.
As a result of the observations that have been carried out on the psychologic and physiologic changes that are associated with PTSD, pharmacological agents have also been recognized as intervention agents in helping to manage the PTSD condition (Lineberry et al, 2006). It is important to view pharmacotherapy as the key modality for PTSD management.
A proper combination of psychotherapeutic and pharmacotherapy regimens is still regarded as the most ideal intervention strategy in facilitating in PTSD management. A number of medications have found use in the different treatment modalities for PTSD patients, with a number of these relying on clinical trials that have been well-designed, while others relies entirely on subjective evidence.
Up to now, paroxetine and setraline hydrochlorisde have been approved by the FDA in helping with treatment interventions of PTSD patients. Nevertheless, we also have other drugs in use, such as mood-stabilizing agents, antipsychotic agents, stabilizers, as well as the adrenergic-inhibiting agents (Cassels, 2009). These have also been found to aid in an effective treatment of the PTSD condition.
Treatment and associated complications in the during treatment of PTSD
In the treatment of PTSD, psychotherapy, medication, or a combination of the two methods finds use. PTSD patients have a higher likelihood of manifesting symptoms of the disorder even while undergoing rehabilitation counseling. For this reason, we need to take into account the issue of stress at either the educational setting or the place of work during program planning.
High cormobidity levels have been reported between on the one hand, alcoholism and on the other hand, anxiety disorders (Foa, Keane, & Friedman, 2008), including PTSD, not to mention the use of other substances.
This could represent one of the strategies that some of the patients with PTSD use in an attempt to reduce their anxiety symptoms. Furthermore, we also need to take into account the issue of the patients who gets addicted to certain prescription medication as well.
Barriers to society
Even as the understanding of the public regarding the issue of mental illness appear to have dramatically increased in recent years, however, stigma still remains a formidable social barrier for those individuals who have been diagnosed with a mental illness.
There is the tendency for members of the public to view individuals afflicted with a severe mental condition in an exceedingly negative manner in comparison with their counterparts who could be suffering from mental illnesses (Brodwin et al, 2009). For this reason, mental disorder patients are more likely to be negatively stereotyped as being erratic, unreliable, violent, and irrational, and hence the associated stereotype.
More often than not, people with mental disorders are usually considered as undesirable co-workers, friends, employees, and tenants. Negative stereotypes and stigma often linked to individuals with metal disorders have deep roots in the society (Brodwin et al, 2009).
Usually, people who commit a crime that borders on a heinous cat are usually labeled “sick” (that is, mentally ill). It is quite unfair to equate criminal behavior to a mental disorder, not to mention that the act itself is extremely unjust to those individuals who have been diagnosed with a psychiatric disorder, and this includes patients diagnosed with PTSD as well.
The mass media has emerged as yet another platform for the demeaning and misrepresentation of individuals with mental illnesses. In this case, the media is awash with images of individuals with mental disorders, often depicted in a negative manner. However, occasionally, the media presents positive portrayals of such individuals (Brodwin et al, 2009).
People with mental illnesses could also be depicted as being dangerous and violent by the media. A case in point here is the use of such labels as “psychos” or “psychotic killer” in movies, publications, and television shows.
Even as a number of patients who have been diagnosed with a mental disorder could manifest violent reactions, nevertheless, the likelihood that they would be involved in acts of violence remains comparatively low.
Impact of stigma on PTSD patients on issues of employment and training
There are a number of ways through which stigma could impact on individuals with a mental disorder. From a personal context, an individual could be discouraged to the point of refusing to seek professional help for either employment purposes or for the condition that afflicts him or her. Stigma not only affects the self-esteem of the patients, but also that of their significant others and members of the family as well (Brodwin et al, 2009).
Ultimately, everyone involved ends up getting stress by the stigma. On the occupational and social arena, stigma affects social relations adversely, not to mention reducing the opportunities for housing and employment for the patients in question.
Within the public policy context, stigma acts to negatively impact on the willingness of the public to provide the necessary financial resources for treatment of individuals with mental health problems.
It is important to ensure that rehabilitation counselors remain extremely sensitive to the negative impacts of the stigma that is often associated with mental disorders clients. It therefore becomes necessary to undertake a realistic evaluation of the work setting in question in order to determine if at all it will be fit for the client.
Even though an agency or company could have in place an official policy that supports individuals that have been diagnosed with a mental illness, nevertheless, there is the likelihood that co-workers could view such employees with a certain amount of mistrust and fear (Brodwin et al, 2009). A number of the employees could also harbor a fear that employees with a mental disorder might turn violent or disruptive at the place of work.
On the other hand, we also have those employees who might be concerned that the individual with a mental disorder might “break down” should they accidentally utter the “wrong words” to them.
Although such concerns could be valid under certain circumstances, nevertheless, for the most part, they have been exceedingly generalized to take into account all people manifesting one form of mental disorder or another, and not just PTSD (Brodwin et al, 2009).
Occasional remarks or jokes and ostracism uttered by co-workers and insensitive colleagues (intentionally, or otherwise) have the potential to bring about a stressful and hostile working environment. As a result, individuals with a mental disorder might be discouraged from either seeking re-employment or remaining at the workplace altogether.
It is important for the rehabilitation counselors to ensure that they effectively collaborate with client advocacy groups and mental health specialist in order to promote a sensitive and accurate image of individuals with mental disorders. There is also the need for the individuals involved to address the issue at hand from a personal context when they are working hand in hand with clients.
An Interview with a PTSD patient
During the interview, the subject was very nervous and would not look me directly in the eye. They stated that they felt like they were a book lying open for everyone to see. They told me that PTSD had totally ruined their social and personal life. They are consistently looking over their shoulder, never knowing if something or someone is going to hurt them.
Many times, I had been told that a person with PTSD would often react angrily over the smallest issues. They also tend to become very irritable quickly if things look as if they are spiraling downward and the veteran feels as if they are losing control of the situation.
Difficulty in concentrating is another major setback with PTSD. They tend to start something with great hopes and expectations; however, they lose interest in the task rather quickly, so they have a lot of unfinished projects. This causes them to feel like they are worthless and cannot do anything right, which only worsens the problem. They lack sleep at night because the voices never seem to leave them alone.
Even with medication their sleeping patterns are very erratic. They do not like to socialize with people because they are afraid that either someone will start asking them about their disability or put them on the spot to answer a question, while the whole crowd awaits the answer.
My interviewee even stated that there have been several times that even the thought of going out their own front door onto the lawn brought them to a cold sweat. Many are the days when they would not even leave the house. The possibility of obtaining employment is very unnerving to them. They have told me that most of the veterans with PTSD are unemployable due to their disability.
Being around people, especially strangers, simply terrifies them. Taking orders, being on a time schedule is another problem because many times these people tend to need extra time to get the job accomplished.
Vocational Therapy and PTSD
Below are some useful suggestions that could be quite valuable in helping people with PTSD to not only relax, but also decrease the occurrences of symptoms as well.
Breathing techniques
The PTSD patient could be assisted to start the berating exercise while standing up, lying on their back, or even while sitting down on a chair. By way of having their hand placed on their stomach, the patient is then instructed to inhale, as the stomach rises. It is important however, to ensure that they begin with slow breathing via the nose, making sure that they hold their breath for about 5 seconds.
Then, the patient is required to exhale slowly, via the mouth. This procedure requires to be repeated for an additional 5 minutes. However, patients are often instructed to stop the process as soon as they feel uncomfortable, and should only resume once their breathing has returned to normal (Brodwin et al, 2009).
Enhanced muscle relaxation
Once again, this exercise often starts with the patient either sitting on a chair, or lying down on the floor. For better relaxation, one is often instructed to ensure that they close their eyes. However, in the event that a patient feels a bit uncomfortable by closing their eyes, they are often advised to open them.
To start the breathing process, the patients needs to ensure that they either lie or sit down with legs and arms in neutral position. To accomplish this technique, there is the need to methodically and slowly release and tighten one’s voluntary muscle groups. This in effect acts to counter the states of relaxation and tension (Cara & MacRae, 2005).
One is also advised to ensure that his/her muscles remains as hard as they can get for a period of 5 seconds, being careful not to hurt oneself. Thereafter, patients are often requested that they relax for an additional 5 seconds.
They should then start by lifting their toes off the ground, making sure that their heels still remains firmly on the ground. A session of tightening and relaxation of muscles should then follow. In this case, one should begin by tightening and relaxing their abdominal muscles, after which the arms and hands should then follow.
A pulling back of one’s shoulder is aimed at ensuring that the upper back and arms are tightened, followed by a relaxation session. Thereafter, the patient should be encouraged to shrug off their shoulders, in the same way as someone would say, I do not know. Then, another relaxation session should follow.
Thereafter the neck muscles ought to be tightened by way of lowering one’s head, followed by a forward extension of one’s back of the head, and finally, a relaxation session follows. After that, the patient needs to ensure that their facial muscles are tightened.
This can be achieved by having the patient open their mouth wide enough, after which they are to ensure that their eyebrows are raised, followed by a tight shutting on one’s eyes. Then, the patient needs to ensure that they have relaxed as much as they can. To end each of these exercises, there is need to ensure that the breathing techniques that one had started with are used.
Expressive activities
Emotional expression is yet another relaxation technique that is also aimed at clearing of one’s mind. Some useful alternatives here include diary or journal writing, playing an instrument, listening to music, creating crafts or art, watching one’s favorite movie, or drawing.
Lifestyle changes
Elimination of drugs that have not been medically prescribed, a reduction in the intake of caffeine, regular exercising, observing a balanced diet, weight management, ensuring that one gets sufficient sleep, reducing one’s blood pressure, increased participation in leisure activities, and proper time management are all elements capable of having a positive impact in as far as the ability of an individual to deal with anxiety is concerned (Cara & MacRae, 2005).
At times, laughing helps one to remain healthy and happy, and reduces worry.
Conclusion
As a mental disorder, PTSD has lately been seen to impact on an increasingly higher number of war veterans, following their completion of combat(s). In this case, such victims are more likely to experience flashbacks and nightmares of the actual episodes that they were exposed to during combat.
However, PTSD could also come about after an individual has been exposed to significant events of trauma, besides combat, due to a serious injury (such as those sustained following a car accident), or after being faced with a near death experience.
Most of the hypotheses on the causation of PTSD argue that the key symptoms of PTSD are due to classical conditioning to fear, on the part of the patient. Accordingly, being exposed to an environment similar to that which led to the traumatic experience only serves to reinforce their fear. Socio-psychological intervention still remains the first choice treatment for PTSD patients.
However, it is important to ensure that the interventions employed constitute a vital element of the patient’s treatment regimen. On the other hand, psycho-educational interventions involve empowering and coaching the patient on how best to deal with the condition.
Owing to societal barriers, people with PTSD are often considered as undesirable co-workers, friends, employees, and tenants. Owing to the stigma attached to them, such individuals could even refuse to seek professional help for employment purposes, or even treatment.
For this reason, rehabilitation counselors should remain extremely sensitive to the negative impacts on the stigma associated with mental disorders clients.
Moreover, rehabilitation counselors also need to collaborate more effectively with client advocacy groups and mental health specialist in order to promote a sensitive and accurate image of individuals with PTSD. Vocational therapy such as enhanced muscle relaxation exercises, breathing techniques, expressive activities and lifestyle changes are all vital in helping patients with PTSD to better manage their condition.
Reference List
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