Abstract
Both chronic stress and an exposure to a traumatic experience can cause a myriad of issues, both mentally and physically. If the physical and emotional symptoms that accompany prolonged stress or posttraumatic stress disorder is not addressed, the effects can be lethal. Fortunately, research has helped us to understand the impact stress has on one’s mental and physical well-being, leading to developments within the field of psychology known as positive psychology. Through monitoring the mind-body connection, the effects of stress can be reduced greatly. The following paper will address the diagnostic criteria and background of PTSD, the biological changes that occur as a result of stress, and treatment options that incorporate positive psychology techniques.
Stress in an inevitable part of life, however, there are some instances in which the stress of a situation or event stays with an individual long after the threat has been removed. While some individuals are able to get on with their lives after a traumatic or stressful event, others are not so lucky. The development of posttraumatic stress disorder, or PTSD, is thought to be the mind’s way of coping with the experience or witnessing of a life-threatening event. Events that have been known to trigger the development of PTSD include military combat, terrorist attacks, natural disasters, car accidents, and sexual trauma, with the likelihood of PTSD increases with the intimacy of the situation (van der Kolk & Najavits, 2013).
The symptoms of PTSD were reported as far back as the 1500s, but it wasn’t until the first Diagnostic and Statistical Manual of Mental Disorders (DSM-I) was published in 1952 that the symptoms and characteristics of PTSD were formally introduced into the field of psychology (Andreasen, 2010). The first incarnation of PTSD was known as Gross Stress Reaction and swiftly disappeared from the diagnostic bible, until it resurfaced in the third edition of the DSM when the symptoms were becoming prevalent among Vietnam veterans (Andreasen, 2010). The DSM-IV-TR describes PTSD as having five distinct characteristics that must be present in order for a diagnosis of PTSD to be made and to rule out similar anxiety or mood disorders. According to the DSM-IV-TR:
- There must be a triggering traumatic event.
- The individual persistently re-experiences the traumatic event through either recurrent or intrusive recollections, flashbacks of the event, or recurrent nightmares. There can even be a physical reaction to events that are similar to the original traumatic event.
- The individual persistently avoids thoughts and activities that are associated with the traumatic event, or experiences a diminished interest in activities he or she once enjoyed.
- Physiological reactions are present, which is attributed to an increase in nervous system arousal, such as hypervigilance, heightened startle response, irritability, and difficulties in cognition or concentration.
- The disturbances are significant and impact the individual’s life in social, employment, or other arenas of one’s life. Additionally, the duration of the disturbances must be present for at least one month before a diagnosis of PTSD can be arrived upon (APA, 2000).
The newest version of the DSM (DSM-5) labels PTSD as an anxiety disorder which is triggered by an exposure to either an actual or perceived danger, such as death, injury, or sexual assault (APA, 2013). According to research into PTSD, “the most common precipitating event reported among persons with PTSD was the sudden, unexpected death of a loved one” (Gabbard, 2000, p. 252). The distress that is associated with the exposure to the traumatic event is severe in nature, and often disrupts an individual’s ability to work and engage in social interactions. The DSM-5 identifies PTSD as having four diagnostic clusters, which consist of re-experiencing the traumatic event, engaging in avoidance behaviors, the presence of negative cognitions and mood, and a heightened state of arousal which is characterized by aggression, sleep disturbances, hypervigilance, and reckless or self-destructive behavior (APA, 2013). The newest incarnation of the DSM focuses more on the behavioral aspect, which may be linked to neurobiological changes that occur in response to experiencing the trauma (U.S. Department of Veterans Affairs, 2014).
Biological Changes Associated with PTSD
According to research, mainly consisting of Vietnam veterans who had the symptoms of PTSD, those diagnosed with PTSD had markedly worse physical health, with the likelihood of developing infectious diseases, and diseases that affect the nervous system, muscular and skeletal systems (Schafer, 2000). Likewise, individuals who have a diagnosis or symptoms that are characteristically associated with PTSD have a 62 percent higher rate of developing circulatory diseases such as hypertension and strokes (Schafer, 2000). PTSD is also associated with an increase in inflammation-related medical conditions, which may be due to the body’s reaction to stress and the hormone known as cortisol, which is released when the hypothalamic-pituitary-adrenal (HPA) axis is activated due to stress, resulting in the fight or flight response (Gill, Saligan, Woods, & Page, 2009).
Excessive inflammation has been associated with suppressed immune functioning, arthritis, type II diabetes, and cardiovascular disease (Gill, Saligan, Woods, & Page, 2009). However, by treating the symptoms associated with PTSD, the negative health effects have been shown to diminish, suggesting that mental health counseling and psychological interventions may effective in alleviating both the emotional and physical symptoms of PTSD (Gill, Saligan, Woods, & Page, 2009). While there are some individual and genetic differences that may predispose individuals to developing either PTSD or cardiovascular disease, learning effective coping skills and techniques appears to instrumental in reducing both the severity and duration of the physical and emotional responses to a chronic state of elevated stress.
Nearly every aspect of an individual’s life can be impacted by the physical and neurological effects associated with PTSD. Research indicates that the brain in individuals with chronic stress and PTSD shows changes in the amygdala, prefrontal cortex, and hippocampus that are not present in individuals who are not under prolonged distress (U.S. Department of Veteran Affairs, 2014). The changes in neural and brain activity may be linked directly to the presence of chronic stress or the unhealthy and ineffective coping strategies an individual employs during times of distress. PTSD is often comorbid with alcohol or substance abuse disorders, which could further complicate treatment choices.
Treatment Options
Within the field of psychology and mental health counseling, there are a variety of traditional therapies that have shown to be quite promising; from cognitive behavioral to rapid eye movement therapy, the options are plentiful. Some of the approaches involve addressing the stress response, which, in theory, would assist in diminishing the symptoms experienced. Research suggests that recovery from PTSD is more likely to occur if there is sufficient emotional support, especially from individuals who have experienced a similar event as the individual with the PTSD symptoms (Morris & Maisto, 2001). Social and emotional support is thought to work as a buffer between stress and the effect it has on the body, including blood pressure and stress hormones, thus acting as an immunity boost that also improves the emotional status of the individual (Schafer, 2000).
One branch within psychology may be useful when working to decrease the severity and duration of PTSD symptoms; positive psychology, or the study of happiness, suggests that a positive outlook and optimism can build resilience. Optimism, specifically dispositional optimism, shows a positive impact on the severity of PTSD symptoms among active duty soldiers deployed to war zones (Thomas, Britt, Odle-Dusseau, & Bliese, 2011). Similar to the premise behind cognitive behavioral therapy, positive psychology posits a link between mood and cognition. Positive affect appears to influence a variety of aspects which may decrease the symptoms associated with PTSD and other stress or anxiety-related disorders. Research suggests that memory is greatly influenced by affect; specifically that positive affect during the time of memory retrieval and memory organization results in a decrease of distress, even if the memory is of a stressful or negative nature (Baron & Baron, 1991). Engaging in positive emotions has been shown to also reduce the evaluation of distress (Sarafino & Smith, 2012), providing a useful tool when working with individuals who have been diagnosed or are experiencing symptoms associated with PTSD.
An examination of 35 studies into the role of positive well-being has on mortality revealed that among individuals who possessed a positive outlook, mortality was reduced when compared to individuals who did not report high levels of positive affect (Chida & Steptoe, 2008). Maintaining a positive outlook, reporting feelings of joy, happiness, and optimism may lead to a decrease in death among individuals with immune deficiencies such as those that have been witnessed among individuals who are either under prolonged levels of stress or those who have been diagnosed with PTSD.
Conclusion
The field of positive psychology appears to be of great benefit to those who are experiencing symptoms associated with PTSD and other stress or anxiety-related disorders. By changing the thought process, incorporating a more positive outlook, fostering optimism and resilience, the potentially lethal effects that accompany prolonged exposure to stress can be mitigated. Learning healthy coping skills and surrounding oneself with sufficient social and emotional support can also assist in reducing the impact stress has on both the mind and body. By paying attention to the mind-body connection, a diagnosis of PTSD does not have to equate with a life full of hopelessness and despair, but can rather be a life of happiness, fulfillment, and purpose.
References
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