Post-traumatic stress disorder: Conceptualization, evaluation and treatment

The present work aims to offer a global and integrative vision of the current conception of the disorder due to post-traumatic stress, as well as diagnostic criteria and lines of intervention more broadly used.

We invite you to continue reading this PsicologíaOnline article if you want to know more about it. Post-traumatic stress disorder: Conceptualization, evaluation and treatment.

Index

1.  Work outline
2. Conceptualization
3. Evaluation
4. Symptoms of Post Traumatic Stress Disorder
5. Diagnostic criteria
6. Guidelines for diagnosis
7. Treatment for PTSD - Psychoeducational Approach and Cognitive-Behavioral Therapy
8. Treatment- Hypnosis, Psychodynamic Therapies, Drugs and Support Groups
9. Treatment- Family Therapies and Other Alternatives
10. Conclution

The text is divided into four sections:

• In the first place and as an introduction, the post traumatic stress disorder concept.
• Second, the diagnostic criteria most widely used today according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the International Classification of Diseases (ICD-10)
• Thirdly, the core items of the most frequent therapeutic modalities, including the cognitive-behavioral approach, group therapy, treatment psychopharmacology, clinical hypnosis, psychoeducational approaches, psychodynamic therapy, family therapy and therapies holistic / alternatives.
• Finally, a selection of therapeutic resources on the web, briefly commented, as well as a selection of relevant bibliography, both in Spanish and English, where the interested reader can expand the information offered in the present work.

Introduction

The world is well aware of the destructive power caused by natural disasters such as storms, hurricanes and earthquakes. Many others know in the same way the misery produced by terrorism, violence, war or crime. In the last 25 years, more than 150 million people annually have been directly affected by these types of disasters and traumatic events. The physical effects of a disaster are obvious. Hundreds or thousands of people lose their lives or are seriously injured. Survivors carry the consequences throughout their lives.

Pain and suffering are equally distributed.

The emotional effects - fear, anxiety, stress, anger, rage, resentment, emotional blockage - of disasters are also obvious. For many victims, these effects are mitigated and even disappear over time. However, for many others, the sequelae are long-term and sometimes reach the condition of chronic if they do not receive adequate treatment. So far, there is no effective recipe that can be universally applied to respond to disasters from a psychosocial point of view.

Probably part of the problem lies in the great variability that occurs in the origin of these traumatic events. Some, like hurricanes or earthquakes have a natural origin. Others, such as wars, violence or terrorism, are the product of human beings. Some, such as criminal acts with violence affect a small group of people. Others such as natural disasters affect communities, and even entire countries.

These circumstances only add complexity when it comes to approaching an effective intervention on POST-TRAUMATIC STRESS DISORDER, a term in multi-dimensional and complex itself, and that in recent years he is enjoying greater interest and recognition, being of special present at this time due to the events that occurred on September 11, 2001 in New York. The present work aims to offer a global vision of the concept, from a double perspective, both theoretical (conceptualization) and practical (evaluation and treatment). It also offers a selection of resources, both bibliographic and electronic, where the interested reader can expand the information offered in this document.

History of traumatic stress

Exposure to traumatic events and the resulting consequences is not a new phenomenon. Humans have been experiencing tragedies and disasters throughout history. Evidence of post-traumatic reactions dates from the 6th century BC and is based on the reactions of soldiers during combat (Holmes, 1985).

Responses to traumatic stress have been labeled in many different ways over the years. Some diagnostic terms used have included War Neurosis, Traumatic Neurosis, Post-Vietnam Syndrome, or Battle Fatigue (Meichenbaum, 1994)

The Diagnostic and Statistical Manual of Mental Disorders (DSM-III) first recognized post-traumatic stress disorder as a differentiated diagnostic entity in 1980.

It was categorized as an anxiety disorder due to the characteristic presence of persistent anxiety, hypervigilance and phobic avoidance behaviors. In 1994, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) was published and it includes, regarding the diagnostic criteria of the disorder, the latest advances and research carried out in the field.

Types of traumatic events

Traumatic events are, in most cases, unexpected and uncontrollable and they hit the feeling of security and self-confidence of the individual causing intense reactions of vulnerability and fear towards the environment. Examples of this type of situation are the following:

• Accidents Natural disasters - hurricanes, earthquakes, floods, avalanches, volcanic eruptions-
• Unexpected deaths of relatives
• Assaults / crimes / rapes
• Childhood physical / sexual abuse
• Torture Kidnapping
• Combat experiences

Other forms of severe (but not extreme) stress can seriously affect the individual but are generally not the triggers. typical of post-traumatic stress disorder, such as loss of job, divorce, failure school... etc.

It is important to note, as recent research indicates, that despite the heterogeneity of the traumatic events, individuals who have directly or indirectly experienced these types of situations show a common psychopathological profile currently labeled as POST-TRAUMATIC STRESS DISORDER and other disorders are sometimes present associated such as depression, generalized anxiety disorder, panic attacks or substance abuse (Solomon, Gerrity, & Muff, 1992).

In the first place, some general principles of the clinical evaluation process of this type of disorders, highlighting the role of the interview within it and listing some of the most used.

Second, the symptoms most commonly related to POST-TRAUMATIC STRESS DISORDER are listed and briefly described. some of the pathologies associated with this disorder and that require in most cases an evaluation and / or treatments specific.

Finally, the diagnostic criteria most widely used today in clinical practice are presented, taking as reference the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the International Classification of Diseases (ICD-10).

General features

The professional who works with this type of patient must consider the multidimensional and necessarily complex nature of this type of disorder.

A global and multidimensional clinical interview it is a first-order evaluation strategy for the proper diagnosis of traumatic stress.

An adequate interview process allows the patient to relate their experience and her impressions of the event, having the opportunity to express themselves freely in a safe environment, empathetic and not critical.

Patients (and often their closest relatives) need to feel understood and supported as they try to find meaning in the recently lived experience.

The interview also facilitates an effective "working alliance", necessary for the normal development of the therapeutic process in stages. subsequent, as well as a unique opportunity to establish an adequate therapeutic relationship (rapport), essential for success therapeutic.

In addition, the interview allows to extract the details of the experience lived by the subject, to evaluate the past and present levels of functioning of the subject and determine the treatment modality as well as the most appropriate therapeutic objectives in each case concrete.

Between the structured interviews most used are:

• Clinician Administered PTSD scale (CAPS; Blake et al., 1990)
• Anxiety Disorders Interview Schedule-IV (ADIS-IV; DiNardo, Brown, & Barlow, 1994).

Other specific evaluation instruments used are:

• Subscale of the Minnesota Multiphasic Personality Inventory (MMPI; Keane, Malloy, & Fairbank, 1984; Schlenger & Kulka, 1987),
• The Penn Inventory for PTSD (Hammarberg, 1992).

It is common to find other associated disorders in this type of patient, such as panic, depression or anxiety disorders. generalized, so the evaluation of this type of disorders should be part of the evaluative process (Meichenbaum, 1994)

A global approach that implies the collection of information from different sources, using different methods and throughout various times is especially recommended and necessary in the diagnostic process of this type of disorder (Meichenbaum, 1994).

We could group the most common associated symptoms into three large blocks:

RE-EXPERIMENTATION OF THE TRAUMATIC EVENT

• Flashbacks. Feelings and sensations associated by the subject to the traumatic situation
• Nightmares. The event or other images associated with it recur frequently in dreams.
• Disproportionate physical and emotional reactions to events associated with the traumatic situation

ACTIVATION INCREASE

• Difficulties falling asleep
• Hypervigilance
• Concentration problems
• Irratibility / impulsiveness / aggressiveness

AVOIDANCE AND EMOTIONAL BLOCKING BEHAVIORS

• Intense avoidance / flight / rejection of the subject to situations, places, thoughts, sensations or conversations related to the traumatic event.
• Loss of interest
• Emotional block
• Social isolation

The three groups of symptoms mentioned are those that occur to a greater extent in the population affected by the post-traumatic stress disorder, however it is common to observe other problems associated with same.

Among the most commonly associated DISORDERS are:

PANIC ATTACKS

Individuals who have experienced trauma are likely to experience panic attacks when exposed to situations related to the traumatic event.

These attacks include intense feelings of fear and anguish accompanied by symptoms such as rapid heartbeat, sweating, nausea, tremors... etc ...

DEPRESSION

Many people suffer subsequent depressive episodes, loss of interest, lowered self-esteem, and even in the most serious cases, recurrent suicidal ideations.

Recent studies show, for example, that approximately 50% of rape victims show recurrent thoughts of suicide.

ANGER AND AGGRESSIVENESS

These are common and to some extent logical reactions among trauma victims. However, when they reach disproportionate limits, it significantly interferes with the possibility of therapeutic success as well as in the daily functioning of the subject.

DRUGS ABUSE

The use of drugs such as alcohol is frequent to try to flee / hide the associated pain. Sometimes this escape strategy distances the subject from receiving adequate help and only prolongs the suffering situation.

EXTREME FEAR / AVOIDANCE BEHAVIORS

The flight / avoidance of everything related to the traumatic situation is a common sign in most cases, however, sometimes this intense fear and avoidance is generalizes to other situations, in principle not directly associated with the traumatic situation, which interferes in a very significant way with the daily functioning of the subject.

These and other symptoms, in most cases, decrease significantly during the treatment, however on occasions, and given its severity, may require additional interventions specific.

In clinical practice, the most widely used diagnostic criteria as a reference for the evaluation of post-traumatic stress disorder are those included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and in the International Classification of Diseases (ICD-10).

DIAGNOSTIC CRITERIA DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS DSM-IV

TO. The person has been exposed to a traumatic event in which 1 and 2 have existed:

• The person has experienced, witnessed or been explained one (or more) events characterized by deaths or threats to the physical integrity of him or others.
• The person has responded with intense fear, hopelessness, or horror. Note: In children these responses can be expressed in unstructured or agitated behaviors.

B. The traumatic event is persistently re-experienced through one (or more) of the following ways:

1. Recurring and intrusive memories of the event that cause discomfort and that include images, thoughts or perceptions. Note: In young children this can be expressed in repetitive games where characteristic themes or aspects of the trauma appear.
2. Recurrent dreams about the event, which cause discomfort. Note: In children there may be terrifying dreams of unrecognizable content.
3. The individual acts or has the sensation that the traumatic event is occurring (includes the sensation of reliving experience, illusions, hallucinations, and dissociative flashback episodes, including those that appear upon waking or get intoxicated). Note: Young children can re-enact the specific traumatic event.
4. Intense psychological distress when exposed to internal or external stimuli that symbolize or recall an aspect of the traumatic event.
5. Physiological responses to exposure to internal or external stimuli that symbolize or recall an aspect of the traumatic event.

C. Persistent avoidance of stimuli associated with trauma and blunting of the individual's general reactivity (absent before the trauma), as indicated by three (or more) of the following symptoms:

1. Efforts to avoid thoughts, feelings, or conversations about the traumatic event.
2. Efforts to avoid activities, places, or people that trigger memories of the trauma.
3. Inability to remember an important aspect of the trauma.
4. Sharp reduction in interest or participation in meaningful activities.
5. Feeling of detachment or alienation from others.
6. Restriction of affective life (p. g., inability to have feelings of love).
7. Sense of a bleak future (p. (e.g., you don't expect to get a job, get married, start a family, or ultimately lead a normal life).

D. Persistent symptoms of increased arousal (absent before trauma), as indicated by two (or more) of the following symptoms:

1. Difficulties falling or staying asleep.
2. Irritability or outbursts of anger.
3. Difficulty concentrating.
4. Hypervigilance.
5. Exaggerated startle responses.

AND. These alterations (symptoms of Criteria B, C and D) last more than 1 month.

F. These alterations cause significant clinical discomfort or social, occupational deterioration or other important areas of the individual's activity.

DIAGNOSTIC CRITERIA INTERNATIONAL CLASSIFICATION OF DISEASES ICD-10

Disorder arising as delayed or delayed response to a stressful event or situation (short-lived or long-lasting) of an exceptionally threatening or catastrophic nature, which would themselves cause widespread unrest almost everywhere in the world (for example, catastrophic natural or man-made, fighting, serious accidents, witnessing someone's violent death, being a victim of torture, terrorism, rape or other crime).

Certain personality traits (for example, compulsive or asthenic) or history of neurotic disease, if present, they can be predisposing factors and to lower the threshold for the appearance of the syndrome or to aggravate its course, but these factors are neither necessary nor sufficient to explain the appearance of the same.

The typical characteristics of post-traumatic stress disorder are:

Repeated episodes of re-experiencing the trauma in the form of flashbacks or dreams that take place against a persistent background of a feeling of "numbness" and emotional dullness, of detachment from others, of lack of responsiveness to the environment, of anhedonia and avoidance of activities and situations evocative of trauma.

Situations that recall or suggest trauma are often feared, and even avoided. On rare occasions there may be dramatic and sharp outbursts of fear, panic or aggression, triggered by stimuli that evoke a sudden memory, an actualization of the trauma or the original reaction to it or both to the time.

Usually there is a vegetative hyperactivity state with hypervigilance, an increased startle reaction and insomnia. Symptoms are accompanied by anxiety and depression, and suicidal ideations are not uncommon. Excessive use of psychotropic substances or alcohol can be an aggravating factor.

Onset follows trauma with a latency period that varies in duration from a few weeks to months (but rarely exceeds six months).

The course is fluctuating, but recovery can be expected in most cases. In a small proportion of patients, the disorder can have a chronic course and evolution towards a persistent transformation of the personality for many years.

This disorder should not be diagnosed unless it is not totally clear that has appeared within six months after a traumatic event of exceptional intensity.

A "probable" diagnosis might still be possible if the time between the fact and the onset of symptoms is greater than six months, provided that the manifestations clinical symptoms are typical and no other alternative diagnosis is plausible (for example, anxiety disorder, obsessive-compulsive disorder or episode depressant).

Besides the trauma, evocations or representations of the event must be present in the form of waking memories or images or repeated daydreams.

Clear emotional detachment, with affective blunting, and avoidance of stimuli that could rekindle the memory of the trauma are also usually present, but not essential for the diagnosis. Vegetative symptoms, mood disorders, and abnormal behavior also contribute to the diagnosis, but are not critically important to the diagnosis.

Many techniques and strategies, often of conflicting theoretical approaches, have been used and continue to be used in the therapeutic approach of POST-TRAUMATIC STRESS DISORDER. In my opinion, no strategy, considered in isolation, can be labeled superior to the rest in terms of its effectiveness for all types of patients or under all types of circumstances.

It seems clear that the choice of one technique over another will largely depend on the theoretical and practical training of the mental health professional.

In any case, and recognizing the multidimensionality and complexity of the disorder,It seems advisable in most cases to opt for an eclectic approach, adaptable to the circumstances of the patient as far as possible.

Here is a brief review of some of the most commonly used treatment modalities today.

PSYCHOEDUCATIONAL APPROACH

The psychoeducational approach involves providing the patient / family with basic information about their illness, characteristic symptoms and various coping strategies.

This first category of treatments includes sharing basic information with the subject, through books, articles and other documents of interest. that allows the patient to acquire essential notions of concepts related to the disorder such as knowledge of psychophysiology, introduction to concept of stress response, basic legal knowledge related to the problem (such as in cases of rape / crime )...etc...

At the family level it includes teaching coping strategies and solution skills of problems to facilitate the relationship with the person affected by the disorder.

This psychoeducational approach, at the family level, seems considerably reduce feelings of stress, confusion and anxiety that usually occur within the family structure and that can deconstruct it, helping significantly in the recovery of the patient.

In any case, it seems important to me to highlight the need for a collaborative approach, where both patient and therapist share relevant information, in one direction and the other, thus facilitating the process therapeutic.

COGNITIVE-BEHAVIORAL THERAPY

Emerged from the Second World War, originally under the concept of BEHAVIOR MODIFICATION OR BEHAVIOR THERAPY, was based in its first origins on techniques of a basically behavioral nature, based on the works of Paulov and Skinner.

Later with the incorporation of the works of authors such as Bandura and more recently Ellis, Beck, Meichenbaum or Cautela, the BEHAVIOR MODIFICATION has been "assimilating" to its repertoire of intervention techniques the strategies and procedures of cognitive psychology, based on modification of distorted thought patterns and training in problem solving skills, anxiety management or inoculation of stress.

Both because of the number of effective intervention strategies available and because of the multi-dimensional nature of the disorder, the cognitive-behavioral approach seems especially suitable in the psychotherapeutic approach of this type of disorders.

The potentially useful intervention techniques are presented schematically below, from a cognitive-behavioral perspective:

• RELAXATION / CONTROL TECHNIQUES EMOTIONAL ACTIVATION

  • Jacobson's progressive relaxation
  • Autogenic training
  • The meditation
  • Breathing techniques
  • Biofeedback techniques
  • Imagination / visualization techniques
  • Self-hypnosis techniques
  • Sophrology

• SYSTEMATIC DESENSITIZATION

• EXPOSURE AND FLOOD TECHNIQUES

• OPERATING TECHNIQUES

  • Basic operant procedures
    • Positive reinforcement
    • Negative reinforcement
    • Positive Punishment
    • Negative Punishment
    • Extinction
  • Operating techniques to develop and maintain behaviors
    • Molding
    • Fading
    • Chaining
  • Techniques to reduce and eliminate behaviors
    • Differential reinforcement
    • Response cost
    • Time out
    • Satiation
    • Overcorrection
  • Contingency Organization Systems
    • Token Economy
    • Contingency contracts

• COVERT CONDITIONING TECHNIQUES

• SELF-CONTROL TECHNIQUES

  • Environmental Planning Techniques
    • Stimulus control
    • Contingency contracts
    • Training employment alternative answers
  • Behavioral programming techniques
    • Self reinforcement
    • Self-punishment
  • Techniques to facilitate behavior change
    • Self-observation
    • Self-registration
    • Therapeutic tasks between sessions

• AVERSIVE TECHNIQUES

• MODELING TECHNIQUES

• COGNITIVE RESTRUCTURING TECHNIQUES

  • Ellis Rational Emotive Therapy
  • Beck's Cognitive Therapy
  • Meichenbaum Self-Instruction Training
  • Systematic rational restructuring of Goldfried and Goldfried

• ENGAGEMENT SKILLS TECHNIQUES

  • Meichenbaum Stress Inoculation
  • Suinn and Richardson's anxiety management training
  • Goldfried's self-control desensitization
  • Stealth Covert Modeling

• TROUBLESHOOTING TECHNIQUES

  • D'Zurilla and Goldfried's Problem Solving Therapy
  • Spivack and Shure Interpersonal Problem Solving Tech

CLINICAL HYPNOSIS

Leaving aside possible misgivings that among certain sectors of the scientific community raises the concept of hypnosis (increased by the public image of her), the truth is that hypnotic strategies, applied by a professional with the appropriate qualifications and in in conjunction with other intervention techniques, they have shown a relevant therapeutic potential in the treatment of stress disorder post-traumatic. In the initial phase of the intervention, hypnosis can be especially effective in stabilizing the patient, providing you with emotional self-control strategies and stress management / activation control, helping you through learning simple self-hypnosis techniques to generalize the skills acquired in consultation to your life everyday.

In the hypnotic state it is an especially suitable time to provide hypnotic and posthypnotic suggestions that increase your self-esteem and your sense of security / control, facilitate the coping with the most painful memories and combat common symptoms associated with PTSD such as insomnia, aggressiveness / anger, excessive emotional activation or anxiety generalized.

East increased emotional self-control of the patient through hypnosis as a stress management strategy will allow the patient to benefit from other subsequent intervention strategies.

In a second phase, various techniques can be used for the integration and resolution of traumatic memories. In this context, the patient can learn to modulate the cognitive and emotional distance towards the traumatic event and associated memories.

On the other hand, hypnosis can serve as a strategy to access painful and traumatic memories that may be influencing the present state of the subject and of those who, on occasions, are not aware or have been repressed.

Imaginative, projective, and cognitive restructuring techniques can be especially helpful in this process.

Finally, the therapeutic objectives would be directed to the achievement of a functional integration and adaptation of traumatic experiences in the patient's life and the acquisition of new techniques of coping.

Strategies such as covert tests or the empowerment of one's own self-concept would go in this direction. Clinical hypnosis, in my opinion, constitutes a potentially effective therapeutic strategy, easily compatible with other intervention techniques and should not be excluded a priori due to ignorance, prejudices or lack of specialized training.

PSYCHODYNAMIC THERAPIES

The dynamic school, which emphasizes the importance of the client's thoughts, feelings and past history, as well such as the need to discover our own interior to change the personality, has arisen from the psychoanalytic theory of Freud.

Although today there are relatively few supporters of classical analysis, the Freudian philosophy it continues to be shared, to a greater or lesser extent, by a whole series of therapeutic schools encompassed under the concept of psychodynamic therapies.

Psychodynamic therapies focus on emotional conflicts caused by the traumatic event, particularly those related to early experiences.

Through the expression of the various emotions and thoughts associated with the event, in an empathetic and safe environment, the patient acquires a greater sense of confidence and self-esteem, develops effective ways of thinking and coping with the traumatic experience and the intense associated emotions that emerge during the process therapeutic.

The goal is to increase awareness ("insight") of intrapersonal conflicts and their resolution. The patient is guided towards the development of a reinforced self-esteem, greater self-control and a new vision of the personal integrity and self-confidence of her.

The more traditional psychoanalysis involves several weekly sessions, lasting between 45 and 50 minutes, for periods of between 2 and 7 years. It is precisely this long duration that has caused, in the light of the original formulation, various variations of the original method, of more limited duration, have arisen.

Brief psychodynamic psychotherapy, for example, comprises one to two sessions per week for an average of 12 to 20 sessions.

Ultimately, the psychodynamic therapist claims a far reaching change. It seeks to restructure the basic personality by changing the way a person views life and reacts to it, helping people to develop an adequate view of themselves and become aware of the powerful psychological forces buried deep in their unconscious.

GROUP THERAPIES / SELF-HELP-SOCIAL SUPPORT GROUPS

Group therapy is an effective therapeutic option to the extent that allows the patient to share their memories traumatic events in an environment of security, cohesion and empathy provided by other patients and the therapist himself.

Share your own experience and deal directly with anger, anxiety, and guilt often associated with traumatic memories, it allows many patients to deal effectively with their memories, their emotions and adapt them to their daily life.

Despite the fact that there are a great variety of group approaches to the treatment of trauma in general, group therapy aims to achieve the following therapeutic objectives:

• Stabilize reactions, both physically and mentally, in the face of the traumatic experience.
• Explore, share and deal with emotions and perceptions.
• Learn effective coping and stress management strategies.

As for self-help / support groups for patients and families with mental illness, fortunately they are becoming progressively more common.

Even if they are not directed by mental health professionals, their value therapeutic is undoubted insofar as they provide the members of the same with emotional support considerable. Sharing experiences, successes, failures, information and resources are some of the possibilities offered by these groups.

The fact of joining also allows a greater effectiveness in the fight to eradicate stigma that still remain in society towards people with psychological problems

PHARMACOTHERAPY

Probably the following quote from Dr. Friedman taken from a recent article on the psychopharmacological approach to The treatment of post-traumatic stress disorder pretty much sums up some of the challenges that need to be faced in this moment:

"There are many challenges in writing an article on post-traumatic stress disorder (PTSD) pharmacotherapy. The most obvious problem is that the published literature on clinical trials is too sparse and inconsistent for anyone to make trustworthy recommendations. Second, what we currently understand about the psychobiology of PTSD is so complicated that It is difficult to predict which classes of drugs they may hope to improve and which group of symptom. Third, selecting the best drug implies taking into account the clinical reality that the patient with PTSD usually exhibits with a comorbid diagnostic spectrum (e.g. depression, anxiety, anxiety disorders, and agent dependence or abuse chemicals). Despite these many considerations, psychiatrists must immerse themselves in the sea of ​​current uncertainties and make the smartest decisions they can about which drugs or which drugs to prescribe to their patients with PTSD. "

Current drug therapy can reduce anxiety, depression and insomnia often associated with PTSD itself, and in some cases can help relieve stress and emotional blockage associated with memories of the traumatic experience.

Various types of antidepressant drugs They have been shown to be effective in some clinical trials and other types of substances have shown promising results.

Now, up to this point, no particular drug has emerged as the definitive and sufficient treatment. on its own to effectively treat the broad spectrum of symptoms associated with stress disorder post-traumatic.

Pharmacological treatment of post-traumatic stress indicates that different medications can affect the many symptoms present in PTSD.

• For example, Clonidine has been shown to reduce symptoms of hyperarousal.
• Propranolol, Clonazepam, and Alprazolam appear to regulate anxiety and panic attacks.
• Fluoxetine can reduce avoidance behaviors and depression can be treated through tricyclic antidepressants and SSRIs. (Vargas & Davidson, 1993).

As Dr. Friedman himself concludes:

"However, patients need treatment today. They can't wait for the entire investigation to be complete.

Long story short, what I recommend is starting with an anti-adrenergic agent. If symptoms persist, as they usually do, after optimal evaluation, the next drug to be prescribed is an SSRI. If insomnia and / or agitation develop in patients, as is often the case, the next choice is to add trazadone at bedtime. If there are still significant clinical symptoms, after an 8-10 week trial of SSRI at its optimal dose, it is time to restart. "

It is important to note that the pharmacotherapy alone as the sole intervention strategy is rarely sufficient to cause a complete remission of the problems associated with post-traumatic stress disorder. (Vargas & Davidson, 1993).

Although medication, by itself, does not seem likely to be the only tool, it does appear as clearly useful for relief symptomatic of the disorder, so as to enable the patient to benefit from other subsequent intervention strategies, such as psychotherapy.

FAMILY THERAPY

Family therapy is similar to group therapy insofar as its fundamental focus of interest is the interaction between people, however it differs in some important aspects.

First of all, a group does not have a common past, history or future. On the other hand, the family does have them and it is in good measure the determining factor of success in therapy. Second, the role of the family therapist, in most cases, is more directive.

The group therapist tends to act more as a process facilitator and group facilitator.

But perhaps the most important difference is that the ultimate goal of the family therapist is to strengthen the group itself, as well as its partners. individual members, whereas the goal of group therapy is for the group itself to dissolve itself when its individual members have resolved their conflicts.

Generally this type of therapy is used as a necessary complement to other therapeutic strategies more directly associated with the symptomatology of post-traumatic stress disorder, not being considered as a sufficient strategy, by itself, for an effective treatment of the disorder.

Therapeutic strategies encompass a variety of goals, from the most ambitious to intervene on the family as a whole, from a systemic and global perspective, up to the most centered on offer strategies, information and specific guidelines for action to the members of the patient's family to support them during the therapeutic process, enhancing communication between families and reducing possible sources of tension.

ALTERNATIVE / HOLISTIC / NATURAL THERAPIES

Under this concept, by broad and global definition, and which arouses not a few misgivings among some sectors, a whole set of methods, techniques, philosophies and procedures are hidden with more or less scientific support and that can be used, alone or in conjunction with other strategies, for the treatment of problems associated with stress disorder post-traumatic.

Here is a brief definition of some of the most common:

• Acupuncture. Millennial therapeutic method, and an integral part of traditional Chinese medicine, based on the use of needles to prevent and treat diseases, stimulating the "energy channels" of the body.
• Aromatherapy.Wide system of massages through natural oils adapted to specific purposes. The essential oils used are aromatic distillates extracted from medicinal plants that concentrate their main virtues.
• Physical exerciseThe use of physical activity to keep fit, release tension, and improve mood.
• -EMDR (Eye Movement Desensitization and Reprocessing).It is a relatively new psychotherapeutic approach, developed by the American psychologist FRANCINE SHAPIRO, which combines elements of exposure therapy, therapy cognitive-behavioral and certain patterns of eye movement and sounds that generate an alteration of the focus of attention, which would facilitate, in theory, the access and processing of the traumatic memories.
• Herbal therapy.Use of plants and plant extracts for the treatment of specific disorders based on their medicinal and / or nutritional properties.
• HomeopathyTerm derived from two Greek words HOMEO (similar) and PATHOS (suffering) .Uses remedies prepared from substances that occur in nature to treat the whole person, stimulating the body's tendency to heal itself by itself. It uses very specific doses of substances that in massive doses produce effects similar to those produced by the disease to be treated.
• MassageManual technique aimed primarily at releasing tension in the muscles.
• Holistic medicine. The objective is to treat the person in the "globality" of it. It starts from the premise that mind, body and spirit are intimately united and must be treated "jointly". Various alternative / natural treatment strategies are used such as meditation, yoga, prayers, certain dietary combinations, vitamins, minerals, herbs and other dietary / natural supplements avoiding traditional approaches based on drug use.
• Naturopathy.Emphasizes "natural healing" and employs natural treatments such as specific diets, massages, hydrotherapy, exercises and counseling.
• Neuro-Linguistic ProgrammingPsychotherapeutic model, developed in the 1970s from the works of RICHARD BANDLER AND JOHN GRINDER and based on the study of the structure of subjective experience. He has developed numerous specific procedures for dealing with trauma based on imaginative / covert techniques.
• Reflexology.A type of massage, focused on "unlocking" the 7,200 nerve endings concentrated in the feet, with the aim of stimulating the feet themselves. healing processes of the body, and reaching a "balanced state". Used for the treatment of specific conditions and general feelings of discomfort.
• Bach flower remediesThey are prepared with wild herb flowers, shrubs and trees. They are often used to "modify" the individual's mood and state of mind, as fear, apprehension, and worry are known to interfere with the body's healing processes.
• Shiatsu.A massage-based approach aimed at correcting the body's "energy flow" through a body contact treatment. In Japanese, "shiatsu" means "finger pressure", a pressure that replaces acupuncture needles in stimulating energy channels
• Tai Chi. Traditional Chinese system based on a gentle physical movement, which allows the individual to channel his energy, his strength and his power in a more positive way.
• Nutritional (dietary) treatment.It focuses on improving mood through good dietary habits and specific supplementation of certain nutrients (vitamins, minerals, natural substances... etc ...)
• YogaAncient system of body postures, breath control and meditation practices that promote general well-being and inner balance.

Post-traumatic stress has been claimed to represent "one of the most severe and disabling forms of human stress known"(Everly, 1995, p. 7)

Fortunately, traumatic stress and its consequences continue to gain recognition and recent research is abundant in this field, although more research work must be done to achieve the desired effectiveness results. The detection and recognition of stress associated with traumatic situations is the first step for the individual on his way to full recovery and social integration.

The treatment through professionals with the due qualification and experience is constituted as the crucial factor, together with the own attitude and predisposition of the patient, to help the victims to face the tragedy and continue with their life in a satisfactory.

This article is merely informative, in Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.

If you want to read more articles similar to Post-traumatic stress disorder: Conceptualization, evaluation and treatment, we recommend that you enter our category of Clinical psychology.

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