Post Traumatic Stress Disorder — Individualized Approaches to Treatment
PTSD, also known as post-traumatic stress disorder, is a psychological condition that an individual can go through after experiencing a traumatic event. These traumatic events are not only experienced by war veterans, but also civilians who might have survived a natural disaster was the victim of a hate crime, a victim of domestic violence or abuse, victims of emotional abuse, or even individuals who have been in a horrendous car accident. The underlying reason can vary from person to person and that is what makes treatment of post-traumatic stress disorder so individualized. There is not a one size fits all protocol. In an article titled Post Traumatic Stress Disorder PTSD, written by Emedicine Health, they state that the statistics show that up to 3.5% of Americans may have post-traumatic stress disorder. Although that seems low, PTSD is actually relatively common. (Emedicine Health, 2017)
So what are the symptoms of post-traumatic stress disorder? The U.S. Department of Veteran Affairs breaks down the symptoms of PTSD into four categories. The first is re-living the event. This type of symptom can include nightmares about the traumatic event and even flashbacks of the event happening. Re-living the event can also be triggered by specific smells and sounds that were experienced during the event. The memory recall can also happen if there is a news segment or article that is similar to what the individual experienced themselves. This is what is known as triggers. The second category is avoiding situations that remind you of the event. In this category, individuals may avoid certain situations, people, or areas that remind them of the traumatic event. Examples of this would be avoiding crowded areas, driving, flying, movies or television shows about certain topics, as well as purposely keeping busy to avoid these situations. The third category of symptoms is negative changes in beliefs and feelings. Individuals experiencing PTSD may avoid talking about the traumatic event or they forget certain details about it. These symptoms can also include changing the way that they feel towards people and feeling like they cannot trust anybody. The fourth category is hyperarousal. This category of symptoms includes insomnia, struggling to concentrate, being startled by loud noises, and wanting to have your back against a wall in public spaces. (U.S. Department of Veteran Affairs, n.d.) Besides behavioral, emotional, and psychological symptoms, there are also physical symptoms that individuals may experience such as chronic pain, headaches, diarrhea, stomach pain, a tightness or burning sensation in the chest, muscle cramps, and lower back pain. Individuals may also struggle with daily life activities such as going to work on time, going to school, participating socially with their peers, and also struggle with daily hygiene and other priorities. Some people also may turn to use drugs or alcohol to help them cope with all of these symptoms that they are experiencing, which can possibly lead to other complications later on such as addiction. Psychiatric disorders can also develop from post-traumatic stress disorder such as depression and thoughts of suicide. (Emedicine Health, 2017)
So what exactly happens to the brain to cause all of these symptoms to arise? Psych Central has an incredibly informative article written titled The Science Behind PTSD Symptoms: How Trauma Changes the Brain. In this article, the writers explain that when a person experiences a traumatic event in their life, the body shifts over into reactive mode. You may also know this as the fight or flight mode. The sympathetic nervous system increases the output of stress hormones. Normally, when the event or threat is over, the body will naturally re-adjust and go into what they term “restorative mode” where the stress hormone output is reduced and the brain shifts back to normal functioning. Unfortunately, for people who develop PTSD, the body is not wanting to shift back to normal functioning and can get stuck in this hyper-reactive state of fight mode. Multiple chemical and biological changes are actually taking place due to dysregulation in the brain. This is exacerbated by an overstimulated amygdala, underactive hippocampus, and ineffective variability where the sympathetic nervous system remains in an over-reactive state. (Psych Central, 2015)
The treatments that are available to help individuals with post-traumatic stress disorder are quite varied and there are a lot of options available. The National Institute of Mental Health states that the main treatments and therapies for PTSD include medications and psychotherapy. The most commonly used pharmaceutical medications include antidepressants such as Zoloft, Paxil, Prozac, and Effexor. Other treatments can include anxiolytics to help sedate the nervous system, psychotherapy, exposure therapy, cognitive restructuring therapy, and eye movement desensitization and reprocessing, also commonly referred to as EMDR. (U.S. Department of Veteran Affairs, n.d.)
Other than allopathic treatments and therapies, there are also holistic therapies which use complementary and alternative medicine protocols. These options are mentioned on the U.S. Department of Veteran Affairs website, but, they do not go into detail about them because they feel that they are not backed by enough science to prove effective in the treatment of post-traumatic stress disorder. Although, they do state that most VA mental health programs offer CAM approaches to treatment and that the VA does support the efforts in studying the benefits of CAM treatments for PTSD. The complementary and alternative medicine therapies mentioned that are also considered conventional include cognitive behavioral therapies such as relaxation and mindfulness which could help during exposure-based treatments. Mindfulness and relaxation are also integrated into other types of therapies such as Acceptance and Commitment Therapy, Dialectical Behavioral Therapy, and Mindfulness-Based Cognitive Therapy. Other types of therapies can include Brief Eclectic Therapy, Narrative Exposure Therapy, and Written Narrative Exposure. Other holistic modalities mentioned include acupuncture, meditation, relaxation, yoga, energy therapy, and emotional freedom techniques. (U.S. Department of Veteran Affairs, n.d.) Using relaxation techniques has been researched and shown that it generally alters the sympathetic activity by decreasing oxygen consumption, slowing down the respiration rate, decreasing the heart rate, and lowering the individuals' blood pressure. By relaxing, the individual is also reducing their arousal state. (Freeman, 2009, p. 142)
Lifestyle changes, whether permanent or temporary, can also be beneficial in helping ease the symptoms of post-traumatic stress disorder. Some changes that could be implemented are to set priorities for each day. Being overwhelmed can be a trigger. Prioritize what you need to do each day and work your way through the list. Be organized when it comes to your daily tasks, this can help to alleviate the stress and anxiety of the unknown and feeling like you don’t have control in your life. If possible, delegate what you can to other people to help alleviate the stress load. Learning to accept help from others is very important. (Murray, 2012, p. 210) Another lifestyle change to implement is to make sure that you are getting enough physical exercise each day. This is beneficial to anybody, but a study done in 2015 showed that Kundalini Yoga changed the symptomology of PTSD sufferers in a positive way by improving quality of sleep, and lowering stress and anxiety levels. The study states that one of the essential components to recovering from trauma is to regulate emotions. The researchers found that practices which encourage mindfulness actually increase the tolerance and acceptance of emotions which in turn regulates them and normalizes the perceptions of stress. (National Institute of Mental Health, 2015) Another area of focus that I have personally found overlooked in the allopathic treatment of post-traumatic stress disorder is the importance of nutrition. Phyllis A. Balch, CNC, author of Prescription for Nutritional Healing, has a great overview of nutrients that are vital for individuals with stress disorders. Inositol is an essential nutrient that can help with depression and panic attacks. Taurine (in a sublingual form) is an essential amino acid that provides protection for the brain and heart. All of the B vitamins are crucial for the proper functioning and health of the nervous system, vitamin B5 is also an anti-stress vitamin that is required by the thymus gland. Vitamin C is supportive of the adrenal glands because when individuals are under a lot of stress it can deplete the adrenal gland hormones which are the anti-stress hormones. Gamma-amino-butyric acid (GABA) is a natural tranquilizer which supports healthy brain function. Other important nutrients include glutathione, calcium, magnesium, coenzyme Q10, and melatonin. (Balch, 2010, p. 738) In the book Staying Healthy with Nutrition, written by Elson M. Haas, M.D., there is a section titled “Anti-Stress”. I find the information in this book very useful in understanding why nutrition is very important for anybody under stress or suffering from stress disorders. Haas states that nutrients become depleted when we are stressed out and these include antioxidant vitamins A, vitamin E, vitamin C, the B vitamins, and the minerals of zinc, selenium, calcium, magnesium, iron, potassium, sulfur, and molybdenum. The depletion of these nutrients is contributed to the increase in the body’s metabolism when stressed. Each of these nutrients has an important job in helping our body during times of stress such as regulating our heartbeat, supporting physiological activities, aiding relaxation, supporting brain function, and so on. (Haas, 1996, p. 740–742) Not only does stress deplete nutrients in the body, but prescription medications can also. An example would be with paroxetine (Paxil). In the book A-Z Guide to Drug-Herb-Vitamin Interactions, Paxil is noted as a pharmaceutical drug that can deplete the body of sodium. Scheduled lab work during the time that a patient is taking pharmaceuticals could help to identify and correct deficiencies that could be caused by the medications or even if there was a deficiency prior to starting the medication. (Healthnotes & Gaby, 2006, p. 209)
“SSRI drugs, including paroxetine, have been reported to cause sodium depletion. The risk for SSRI-induced sodium depletion appears to be increased during the first few weeks of treatment in women, the elderly, and patients also using diuretics. Doctors prescribing SSRI drugs, including paroxetine, should monitor their patients for signs of sodium depletion.”
In addition to nutrients, herbs have also been used to help support individuals with stress disorders. These herbs include ashwagandha, bilberry, ginkgo biloba, milk thistle, catnip, German chamomile, dong quai, holy basil, hops, kava kava, passionflower, St. John’s wort, Siberian ginseng, skullcap, valerian, and wild oats. Many of these herbs are considered nervines and support the nervous system. All herbs should be discussed with an herbalist and your primary medical doctor prior to using them as part of your treatment. (Balch, 2010, p. 739–740) Another complementary modality that can be beneficial in synergy with other therapies is the use of aromatherapy. The use of essential oils in the practice of aromatherapy can help support the body’s systems. The nervous system would be the main focus in the instances of post-traumatic stress disorder. For symptoms of anxiety, supportive essential oils include lemon balm, bergamot, frankincense, juniper, hemlock spruce, and ylang-ylang. For depression; allspice, lemon balm, Canadian balsam, French basil, grapefruit, helichrysum, clary sage, true lavender, sandalwood, and hemlock spruce. For insomnia; lemon balm, German or Roman chamomile, hops, true lavender, sandalwood, valerian, vetiver, and ylang-ylang. For nervous tension and/or stress; allspice, lemon balm, Canadian balsam, copaiba balsam, bergamot, cardamom, cedarwood (Atlas, Texas, Virginiana), German or Roman chamomile, elemi, frankincense, juniper, sweet marjoram, peppermint, spearmint, sweet orange, patchouli, rosemary, clary sage, hemlock spruce, and vetiver. (Lawless & Roche, 2002, p. 204) As with the use of herbs, it is vital that you speak with a certified or registered aromatherapist so they can check for any contraindications between the essential oils and any medications that you may be taking or health conditions you may have.
Post-traumatic stress disorder (PTSD) can often be a complicated disorder to diagnose for medical professionals, and the available treatments vary so much in terms of choosing an allopathic, complementary alternative, or a combination of both. From my experience with PTSD personally, I found that a combination of both helped me get to where I am today. Allopathic medicine helped me initially get to a point where I could learn to actually identify and manage my stressors and triggers, and complementary alternative medicine helped me work through them so that I could get back to living how I wanted to live. Each person is unique in how they respond to treatments, so the treatments and support should be tailored that way for each individual.
References
Balch, P. A. (2010). Prescription for nutritional healing, fifth edition — a practical a-to-z re (5th ed.). New York, NY: Penguin Group.
Emedicine Health. (2017, September 11). Post-traumatic Stress Disorder (PTSD) Symptoms, Tests & Treatments. Retrieved from https://www.emedicinehealth.com/post-traumatic_stress_disorder_ptsd/article_em.htm
Freeman, L. W. (2009). Mosby’s complementary & alternative medicine: A research-based approach (3rd ed.). St. Louis, MO: Mosby.
Haas, E. M. (1996). Staying healthy with nutrition: The complete guide to diet and nutritional medicine. Berkeley, CA: Celestial Arts.
Healthnotes, & Gaby, A. (2006). A-Z guide to drug-herb-vitamin interactions: Improve your health and avoid side effects when using common medications and natural supplements together (2nd ed.). New York, NY: Three Rivers Press.
Lawless, J., & Roche, S. (2002). The encyclopedia of essential oils: The complete guide to the use of aromatic oils in aromatherapy, herbalism, health & well-being (2nd ed.). Hammersmith, U.K.: Thorsons.
Murray, M. T. (2012). The encyclopedia of natural medicine third edition (3rd ed.). New York, NY: Atria Books.
National Institute of Mental Health. (2015, August 20). A Yoga Intervention for Posttraumatic Stress: A Preliminary Randomized Control Trial. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4558444/
National Institute of Mental Health. (2016, February). NIMH » Post-Traumatic Stress Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml#part_145375
Psych Central. (2015, September 11). The Science Behind PTSD Symptoms: How Trauma Changes The Brain. Retrieved from https://psychcentral.com/blog/the-science-behind-ptsd-symptoms-how-trauma-changes-the-brain/
Sheppard-Hanger, S. (2008). The Aromatic Mind Book Natural Aromatherapy with Essential Oils for Mental Health Professionals. Tampa, FL: Atlantic Institute of Aromatherapy.
U.S. Department of Veteran Affairs. (n.d.). Complementary and Alternative Medicine (CAM) for PTSD — PTSD: National Center for PTSD. Retrieved from https://www.ptsd.va.gov/professional/treatment/overview/complementary_alternative_for_ptsd.asp
U.S. Department of Veteran Affairs. (n.d.). Medications for PTSD — PTSD: National Center for PTSD. Retrieved from https://www.ptsd.va.gov/public/treatment/therapy-med/medications-for-ptsd.asp
U.S. Department of Veteran Affairs. (n.d.). Symptoms of PTSD — PTSD: National Center for PTSD. Retrieved from https://www.ptsd.va.gov/public/PTSD-overview/basics/symptoms_of_ptsd.asp
