What is post-traumatic stress disorder?
Post-traumatic stress disorder (PTSD) is an anxiety disorder which develops as a result of a life threatening or distressing event the impact of which may be experienced by the victim, perpetrator, witnesses or vicariously by another person who is subsequently told about the event.
Not everyone who has experienced such a traumatic event develops PTSD. Symptoms may develop immediately but may delayed for up to six months. The general advice is that if it is within six weeks of a traumatic event and the symptoms are improving then it is likely that they are part of a normal process of adjustment. If it is more than six weeks since the event and the symptoms are not receding then it is advisable to consult your GP.
PTSD may relate to a single event or in some cases to multiple events which include:
- severe repeated violence or abuse as an adult
- severe neglect as an adult or a child
What are the symptoms of PTSD?
- flashbacks i.e., vivid re-experiencing of the event in the form of recurrent, intrusive images and thoughts and/or recurrent distressing dreams;
- avoidance of reminders of the event and emotional numbness;
- memory impairment, poor concentration, exaggerated startle responses, hyper vigilance, sleep disturbance
- experiencing shame, guilt, anger
- feelings of panic and fear
- alcohol or drug abuse
- muscle aches and pains
- irregular heartbeat/palpitations
How many people suffer from PTSD?
About one in three people who experience a dangerous or life threatening event develop symptoms of PTSD. Studies have shown that 80-90% of individuals recover spontaneously.
PTSD was originally recognised in the First World War amongst soldiers who had experienced repeated bombardment and gas attacks and has always been associated with soldiers in combat situations. However, anyone who has experienced any of the following events may develop PTSD:
- serious accidents
- a violent personal assault
- natural disasters
- terrorist attacks
- being held hostage or prisoner of war
- being diagnosed with a life threatening illness
In 2011 a study identified that 2.8% of UK armed personnel in Afghanistan were probably suffering from PTSD. In 2007 a household study in the UK identified 2.6% of males and 3.3% of females suffered from PTSD.
What is the evidence that CBT is an effective treatment of PTSD?
The National Institute for Health and Care Excellence conducted a comprehensive review of current research into PTSD and relevant treatment approaches in Clinical Guideline 26 (CG26) in 2005. As a result CBT is recommended as an effective treatment for PTSD as well as Eye Movement Desensitisation and Reprocessing (EMDR).
CBT for trauma will normally involve psycho education to understand and normalise symptoms combined with some or all of the following: exposure, cognitive therapy and stress management
How many sessions does NICE recommend?
If treatment starts three months or more after a traumatic event NICE recommends 8-12 weekly sessions of CBT. If treatment has started early i.e. within one month of the event then less sessions are required and NICE recommend up to 5 sessions. The duration of sessions may need to be 90 minutes when the trauma is discussed in the session.
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