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Overview of the Post-Traumatic Stress Disorder (PTSD)
Post-Traumatic Stress Disorder (PTSD) is a complex state that is usually caused by the traumatic event or prolonged exposure to the extreme situations (APA, 2015). While people tend to react differently on traumatic events, the majority of them develop one or several symptoms that qualify for the diagnosis of PTSD. Specifically, the individuals with PTSD suffer from recurrent distressing memories about the traumatic event, repeating dreams and flashbacks involving the stressful situation, and prolonged psychological distress (APA, 2015).
Moreover, patients with this disorder tend to avoid the methods of mitigating their traumatic experience and manifest irritability, mood swings, disturbance, and negative emotions (APA, 2015). A failure to undergo necessary treatment can lead to adverse reactions, including the risk of suicide, especially when the traumatic event was experienced in the younger age (APA, 2015) or the exposure to stressful situation is continuous, like in first responders or military personnel involved in active duty (Garske, 2011; Chopko & Schwartz, 2009). Furthermore, individuals with PTSD tend to develop co-morbidity disorders, like anxiety-related impairments, bipolar, substance-use disorders, and the states associated with depression (APA, 2015). This fact makes the diagnosis quite complicated so as the treatment prescribed for the mitigation of symptoms.
Trends in Treatment of PTSD
While PTSD usually involves several co-morbid disorders, the main goal of the clinician is to consider all symptoms experienced by the patient and to develop a suitable approach, which will cover all aspect of individual’s state. Unfortunately, as it was admitted by experts, a lot of people experiencing PTSD do not seek help of professionals and usually turn to psychological assistance when the situation is out of control (Baschnagel, Coffey, & Rash, 2006). In such a case, the clinician may rely on more pervasive treatment. Overall, there are several options for the PTSD treatment that is usually divided into several types of psychotherapy and pharmacotherapy.
Each of these types includes several options that may be combined with each other or used as a single solution depending on the state of a patient. The forms of psychotherapy used for PTSD treatment include cognitive-behavioral therapy, eye movement desensitization and reprocessing (EMDR), and brief psychodynamic psychotherapy. Pharmacotherapy may be utilized by prescribing the selective serotonin reuptake inhibitors (SSRIs) that are usually referred to as antidepressants, anti-anxiety medications, mood stabilizers, anti-psychotics, and prazosin as mitigation of the sleep-related states (Kar, 2011; Asnis et al., 2012). Also, as the additional treatment, the clinician may propose group and/or family therapy that help to work with the close family members or seek to be supported by the people who underwent the same experience.
However, there are two methods of dealing with PTSD that are usually assigned for this purpose. In the majority of cases, cognitive-behavioral therapy with its several sub-types of treatment options and SSRI medications are considered to be the most effective ways of helping individuals with PTSD. As it was admitted earlier, people with this disorder can be on different stages of this problem, from mild to chronic states. Therefore, the solution of treatment can vary from patient to patient and also will depend on their personal characteristics as well as the character of traumatic event. For instance, if a patient with PTSD does not experience sleep deprivation, he/she will not be prescribed prazosin or any other drugs prescribed for this condition. Although the stressful events maybe of the same category, the patients may experience different symptoms depending on their resilience and ability to withstand difficulties.
A Comparison of Cognitive-Behavioral and SSRI Medications Treatment
Cognitive-Behavioral Therapy (CBT)
Cognitive-Behavioral Therapy (CBT) was initially designed for treatment of depression and related disorders but later on, the clinicians began to use this method for the treatment of other mental impairments, including PTSD. The concept of CBT refers to the use of forms of cognitive or behavioral therapy and the combination of both. The main idea behind CBT is the belief that the patients cannot maintain their behavior by rational thinking due to the certain factors emerged in the external environment (Lowinger & Rombom, 2012). CBT focuses on the specific problem experienced by the individuals and aims to employ certain actions in order to resolve the problem. Unlike the other types of psychotherapy, CBT professionals consider that conscious thought may help the patients to restore their psychological well-being all alone (Lowinger & Rombom, 2012). Overall, CBT believes that the ability of a person to think and perceive the reality rationally can help the patients with the malfunction in these abilities that can be delivered by CBT. This type of treatment is particularly flexible in the capability to address various psychological problems through the customization of the forms of the therapy.
In general, the main aim of the clinician who applies is to make the patients understand the reasons why they feel negative emotions and to change them with the positive thoughts that will help them to feel joy in their life. While the entire idea sounds quite easy, in the reality the patients with PTSD will need a series of sessions in order to gain results. For example, war veterans may regret difficult decisions they made during their service; the goal of treatment in this case is to make the patients realize that it was not their fault and the decision was taken in regard to the specific situation. CBT Treatment of PTSD patients may be performed by implementing different types of CBT treatment. In the case of PTSD it is customary to use the forms of CBT, like exposure therapy, stress-inoculation training, and cognitive therapy (Lowinger & Rombom, 2012). In some cases, the clinicians use the combination of several forms of CBT for the better effect. Each of these types uses the similar approach to the patients with certain differences in methods of mitigating the symptoms.
For instance, exposure therapy, which is believed to be one of the most effective forms of CBT, targets fear and the way patients react on their most stressful memories (Rauch, Eftekhari, & Ruzek, 2012). The main aim of the exposure therapy is to analyze the most adverse emotions experienced by the client and to acknowledge them. In the beginning of this treatment, the clinicians usually use the method of decentralization that usually starts from the evaluation of less stressful thoughts in order to cope with the most difficult memories (Rauch, Eftekhari, & Ruzek, 2012). Also, the therapists use the method of “flooding” that helps the patients to remember all negative experience at once in order to cope with it altogether (Rauch, Eftekhari, & Ruzek, 2012). Although these methods are quite aggressive, the implementation of relaxing exercises and special breathing techniques may help to cope with the pressure.
Cognitive therapy is similar to exposure treatment, as it aims to make the individuals realize the nature of their negative feelings and to actualize them. With the help of a clinician, the patients learn how to replace the negative thoughts with the positive ones and to identify the world with the joyful experiences. Cognitive therapy targets different emotions, like regret, guilt, or anger, to eliminate them from the association with a specific situation and to accept the fact of their existence (Ellis, 1999). One of the forms of cognitive therapy is cognitive processing treatment that is often used for treatment of first responders and war veterans, because it allows immediate treatment of individuals exposed to prolonged stressful situations (Halligan et al., 2003). This type of treatment allows the patients to identify so-called “stuck points”, in other words, emotions and thoughts that prevent them from overcoming the difficult period. The clinician uses open-ended questions to challenge these “stuck points” that finally will enable the patients to realize the problem and overcome the barriers hindering them from moving on (halligan et al., 2003).
Stress inoculation training (SIT) is the form of CBT that is mostly effective at the beginning stage of PTSD. The main aim here is to replace negative and adverse emotions of the patients with the positive ones before the individuals become depressed or anxious (Lee et al., 2002). If such symptoms already emerged, SIT will not be as effective. SIT sees the reason of adverse emotions in the ability of humans to exaggerate their impact or the effect of an event on a specific situation. Therefore, through stages of actualization, skill acquisition, and application, the patients with PTSD are learning to increase their emotional intelligence and improve the evaluation of their emotions (Lee et al., 2002). It is possible to see that the approach to the PTSD in all CBT treatments is similar; the main distinction is the collection of methods of influence on patients and the stage of disorder experienced by the person.
Serotonin Reuptake Inhibitors (SSRIs) Medication Therapy
SSRI medications are prescribed when individuals with PTSD experience the symptoms of depression, anxiety, and sleep deprivation related to this disorder. These type of pharmacotherapy is proposed to be implemented all stages of the disease. The main objective here is to eliminate the symptoms that preventing the patients with PTSD to recover. Overall, this type of therapy has the same goal as CBT despite the fact that its methods are cardinally different. The main drugs prescribed for patients with PTSD are fluoxetine, paroxetine and sertraline, which are approved by the U.S. Food and Drug Administration (FDA) (Davidson, 2006). Several trials testing the efficacy of each of these mediations revealed the effectiveness of each of them comparing to placebo (Davidson, 2006). Overall, the use of these SSRI medications revealed that they help the patients to improve resilience and anger management in the individuals with PTSD (Asnis et al., 2004). Therefore, it was decided to use them as the first-line treatment of PTSD in patients with moderate to severe symptoms. At the same time, it was also recognized that the positive effect of the medications may be observed only in six to nine months after the treatment.
At the same time, SSRIs are the medications that require close supervision of the clinician and acute attention to side effects and the possibility to develop addiction to these medications. Each of these medications has a long list of side effects that may overlap the positive effect of treatment, like vomiting, nausea, anxiety, sweating, allergic reactions, loss of appetite, and even suicidal thoughts (Walter, 2012). There are also the cases of withdrawal when the course of treatment has finished (Walter, 2012). While SSRIs are not addictive in the conventional sense of this meaning, the person might sense the need to take them due to the somatic and psychological symptoms experienced after the treatment is over (Asnis et al., 2004). With the medications there is always a case of overdosing that may lead to fatal outcomes; on the other hand, it was reported that some patients do not feel the effect of the SSRIs at all (Etten & Taylor, 1998). In general, the pharmacotherapy can produce more immediate results than the other types of treatment by targeting the physiological and psychological symptoms, yet this treatment does not take into account the reasons why PTSD was developed. However, SSRIs help the patients to eliminate severe symptoms that prevent them from succeeding in the CBT interventions.
Comparison of CBT and SSRIs
There are both pros and cons of both treatments that stem from the methods they use and the stage of the disorder the patients are experiencing. There is a possibility to use each of the options as well as the combination of both in order to decrease the time for treatment. CBT is proficient in dealing with the core of the traumatic event by conceptualizing it and re-thinking its impact and the role of patient in it. This type of treatment helps the patients to become more self-aware and improves their emotional intelligence. Also, the advantage of CBT is the ability to make patients more rational and realistic regarding the traumatic event as well as their personal role in it. At the same time, CBT will not suit patients who are not ready to accept the treatment and those who experience adverse symptoms that cannot be mitigated by the conversational approach. Also, this treatment may be particularly expensive for the patients due to the period necessary for the treatment to work out and the prices for the therapy in general.
SSRIs medications propose effective way for eliminating or mitigating the symptoms of anxiety, depression, anger, and other related symptoms in shorter terms by affecting the organism of human from inside. Medications are a cheaper way to deal with PTSD, especially when there is no time for undergoing treatment; one of the examples is military personnel on the line of duty. Also, SSRIs are time-consuming comparing to CBT and helps to overcome the symptoms of depression without the need to undergo the conversational treatment (Baschnagel, Coffey, & Rash, 2006). It will suit the patients who have severe symptoms and cannot deal with the psychological pressure of the entire situation. At the same time, medications can trigger a wide variety of side effects that will devalue their possible positive effect, which will deteriorate the patients’ state. Also, the drugs may cause withdrawal and psychological addiction as the only way to fight with the symptoms. In addition, the prescription of SSRIs in the patients in mild stage of the disease may decrease the effectiveness of the CBT.
In general, a major advantage of CBT comparing to SSRIs is its ability to deal with the root of the problem and to resolve this problem once and for all. SSRIs do not have such effect. The medications address only the symptoms of the disorder and help the patients to minimize them. If the individuals with PTSD have their own resources and resilience to understand the problem on their own, management of such symptoms as anxiety can be helpful. Also, the medications will be more helpful to produce immediate effect, even though some people may feel the results only in 6-9 months. It is possible to imply that each of these treatments uses its own methods for combating PTSD. Both of them are proved to be effective in terms of decreasing symptoms and overcoming stress. At the same time, when prescribing each of these methods, it is crucial to take into account the symptoms, patients’ state, and flaws of each method in order to gain success.
It is customary for the clinicians to use the combination of SSRIs and one or several types of CBT for better results. For instance, it was determined that CBT sessions in combination with SSRIs are more effective than each of the therapies on their own (Marshall et al., 2003). Therefore, it is possible to recommend using both treatments in the cases of severe and moderate stage of PTSD for obtaining better results. Medications in the combination of CBT can help the patients to conceptualize the treatment, battle the symptoms that prevent them from overcoming the stressful situation, and to become effective in daily routine.
Conclusion and Recommendations
After the analysis of options for PTSD treatment, it is possible to imply that each of the treatments can help the patients in its own way. At the same time, it is important to consider the initial state of the patient and his/her ability to deal with the problem. If the situation is too severe, the patients have to take SSRIs medications for maintaining their normal psychological state. In the cases when the individuals are ready to realize their problems and admit the need to re-visit the stressful event, CBT may be the best solution. At the same time, even those who cannot initially undergo CBT will have to be exposed to it afterwards due to the need to address the core of the problem. PTSD cannot be overcome by the patient alone, because the majority of people do not have a practical knowledge about the mechanisms of their behavior and psychological state. In this case, the analysis revealed that while each of the treatments is effective, medications have too many aftereffects and have limited methods of effect for being able to resolve the problem on their own.
References
American Psychological Association (APA). (2015). Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Washington, DC: New School Library.
Asnis, G. M., Kohn, S. M., Henderson, M. & Brown, N. L. (2004). SSRIs versus Non-SSRIs in Post-traumatic Stress Disorder. Drugs, 64(4), 383-404.
Baschnagel, J. S., Coffey, S. F., & Rash, C. J. (2006). The Treatment of Co-Occurring PTSD and Substance Use Disorders Using Trauma-Focused Exposure Therapy. The International Journal of Behavioral Consultation and Therapy, 2(4), 498-514.
Chopko, B. A., & Schwartz, R. C. (2009). The Relation between Mindfulness and Posttraumatic Growth: A Study of First Responders to Trauma-Inducing Incidents. Journal of Mental Health Counseling, 31(4), 363-378.
Davidson, J. R. T. (2006). Pharmacological Treatment of Acute and Chronic Stress Following Trauma. Journal of Clinical Psychiatry, 67(2), 34-39.
Ellis, E. M. (1999). Treating the Trauma of Rape: Cognitive Behavioral Therapy for PTSD. American Journal of Psychotherapy, 53(1), 126-136.
Etten, M. L. & Taylor, S. 1998. Comparative Efficacy of Treatments for Post-traumatic Stress Disorder: A Meta-Analysis. Clinical Psychology and Psychotherapy, 5, 126-144.
Garske, G. G. (2011). Military-Related PTSD: A Focus on the Symptomatology and Treatment Approaches. The Journal of Rehabilitation, 77(4), 31-44.
Halligan, S. L., Michael, T., Clark, D. M. & Ehlers, A. (2003). Posttraumatic Stress Disorder Following Assault: The Role of Cognitive Processing, Trauma Memory, and Appraisals. Journal of Consulting and Clinical Psychology, 71(3), 419-431.
Kar, N. (2011). Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: A review. Neuropsychiatric Disease and Treatment, 7, 167-181.
Lee, C., Gavriel, H., Drummond, P., Richards, J. & Greenwald, R. (2002). Treatment of PTSD: Stress Inoculation Training with Prolonged Exposure Compared to EMDR. Journal of Clinical Psychology, 58(9), 1071-1089.
Lowinger, R. J., & Rombom, H. (2012). The Effectiveness of Cognitive Behavioral Therapy for PTSD in New York City Transit Workers: A Preliminary Evaluation. North American Journal of Psychology, 14(3), 5-14.
Marshall, R. D., Carcamo, J. H., Blanco, C., & Liebowitz, M. (2003). Trauma-Focused Psychotheraphy after a Trial of Medication for Chronic PTSD: Pilot Observations. American Journal of Psychotherapy, 57(3), 1-31.
Rauch, S. A., Eftekhari, A., & Ruzek, J. I. (2012). Review of Exposure Therapy: A Gold Standard for PTSD Treatment. Journal of Rehabilitation Research & Development, 49(5), 679-688.
Walter, A. 2012. Pharmacotherapy for Post-traumatic Stress Disorder In Combat Veterans: Focus on Antidepressants and Atypical Antipsychotic Agents. Pharmacy & Therapeutics, 37(1), 32-38.
