Newsletter 5, effective tools for alleviating effects of trauma
December 2013

Effective therapies for Post Traumatic Stress Disorder

 

I have a contract with ACC to treat claimants living in Hawkes Bay with mental injury as a result of physical injury or sexual abuse. Very often the most disabling mental injury related to these events is Post Traumatic Stress Disorder (PTSD) which involves unpleasant memories or dreams related to the event, avoiding situations or activities related to the event, and physical stress responses to reminders of the event. Panic disorder can also result, along with significant restriction of activities of daily living. I have found the interventions below and others not described here, used in individualised treatment plans, can provide effective relief and often return to normal functioning. It is more difficult to effect improvement for Complex PTSD where other disorders, especially insecure attachment or psychosis, are comorbid with PTSD. This can require long term supportive counselling. I have worked with people diagnosed with PTSD for Pain Management Services in Palmerston North and Napier, and I am also associated with The Back Institute (TBI) recently established in Hastings and Napier.

 

Desensitisation

One of the well known attributes of people who are badly affected by PTSD and anxiety conditions in general is that they have vivid imaginations and can initiate a phobic response in an instant. The solution lies in the use of this visualisation talent to alleviate the anxiety.

 

Imaginal Desensitisation - Traditionally psychologists have used rehearsal of feared situations to reduce their emotional content. Neurolinguistic Programming techniques have demonstrated that reviewing distressing scenes twice removed, for instance watching yourself watching the event on a TV, allows emotional distance from the event. Watching the event in fast forward and fast rewind mode, further normalises it, and perhaps introducing an amusing element also helps to neutralise it. Variations of these elements can give surprisingly rapid relief and restore normal functioning for those suffering uncomplicated and often complex PTSD.

 

In vivo Desensitisation - For people who have experienced terrifying and life threatening events such that have resulted in severe phobic reactions to people or places, undergoing graded exposure to the feared situations can be very useful along with home practice and other interventions described here.

 

Emotional Freedom Technique (EFT) - When a traumatic memory is reviewed and the person is distracted simultaneously, the emotional content can be neutralised. Eye Movement Desensitisation and NLP anchoring work in this way. EFT is a self help technique that can help people who are unable to visualise well. This technique involves tapping meridian/acupuncture points on the head and body whilst stating the problem in various ways. It nearly always provides measurable reduction in the emotional charge of the event.

 

Hypnosis - I have a diploma in hypnosis from the NZ Hypnosis Society for registered health professionals. For those who are hypnotisable, I use indirect suggestion to alleviate the emotional impact of past events.

 

Relaxation/mindfulness

In my practice relaxation is central to all psychological interventions. The following interventions can help improve the affects of head injury as well as alleviating hyper-vigilance associated with PTSD. Learning to let go of issues, physical tension, emotional states is the basis for improved physical and psychological status. This begins by learning to breathe properly. Next, learning to relax the muscles and the mind using effective relaxation techniques will provide the person who is willing to practice, a learned relaxation response that will help with sleep, pacing self in daily life, and ease interpersonal relations. Occasionally excessive pain is a barrier to relaxation. Brief meditation can be useful for these people and for those who like to be active.

 

Breathing techniques - Diaphragmatic breathing is taught and the client is expected to practice this until it becomes second nature. A breathing meditation is taught to help with sleep onset. The use of heart rate variability biofeedback described below teaches regulation of the speed and depth of breathing. Using breathing to reduce anxiety levels is very effective. Many anxious clients report that breathing techniques helped them a great deal.

 

Relaxation - I use a modified 20 minute autogenic relaxation script in preference to progressive muscle relaxation as I find that it provides complete mental relaxation as well as physical relaxation and works for all clients. I provide clients with a CD and they are asked to listen to it daily for at least a month. If people comply they experience enhanced sleep patterns and a more relaxed approach to life.

 

Biofeedback - Biofeedback takes recordings of vital signs such as hand temperature and displays them on a computer screen for the client to learn to regulate them. I have an American qualification in Biofeedback and have completed the Biofeedback Certification Institute of America certification course. Of the many modalities, I use skin conductance to measure emotional reactivity, heart rate variability (synchronising the breath with the heart rate so that the heart rate change graph resembles a sine wave which is known to be good for heart health and reduce anxiety), hand temperature training to induce a relaxed state. Technically minded people tend to like these ways to learn to relax. It can be a revelation for people to find how their thoughts impact on their bodies and this enhances the effectiveness of cognitive-behavioural approaches that address cognitive distortions. It is useful for head injury to learn to reduce skin conductivity responses.

 

Meditation/mindfulness - All of the above techniques overlap with mindfulness. Mindfulness has a good research basis. Again clients need to complete home practice and people's ability to quiet the mind varies. I use a four pronged mindfulness technique that ensures rapid attainment of mind and body relaxation and is ideal for busy people such as working mothers who can schedule 5 minutes breaks in their day.