POST TRAUMATIC STRESS

    The symptoms of post traumatic stress are often seen in combat soldiers and those responding to emergency situations such as police officers, emergency service workers and firemen. These effects are common among people who have experienced a traumatic event. The severity of the effects is based on a number of factors: the severity of the trauma, the length of duration, number of times the trauma occurred, the length of time repeated trauma was experienced, who did it, and how it happened.

What is Post Traumatic Stress?

   Post traumatic stress (PTS) occurs when a person experiences a traumatic event in which both of the following were present:

-The person experienced or witnessed or was confronted with an event or events that involved actual or threatened death or serious injury.

            -The person's response involved intense fear, helplessness, or terror.

Symptoms caused by Post traumatic stress

   The traumatic event is repeatedly re-experienced in any of the following ways:

-Returning and intrusive distressing memories of the event, including images, thoughts or perceptions;

            -Returning upsetting dreams of the event;

-Acting or feeling as if the traumatic event were recurring by reliving the experience through illusions, hallucinations, and flashback episodes, including those upon awakening or when intoxicated;

-Intense psychological distress or reactivity upon memories of the traumatic event.

   PTS causes persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma) as indicated by at least three of the following:

            -Efforts to avoid thoughts, feelings or conversations associated with the trauma;

-Efforts to avoid activities, places or people that trigger memories of this trauma;

            -Inability to recall an important aspect of the trauma;

            -Markedly diminished interest or participation in significant activities;

            -Feeling of detachment or estrangement from others;

            -Restricted range of affect (i.e., unable to have loving feelings);

-Sense of a foreshortened future (i.e., does not expect to have a career, marriage, children, or a normal life span).

   PTS causes persistent symptoms of increased arousal (not present before the trauma) as indicated by a least two of the following:

            -Difficulty falling or staying asleep

            -Irritability or outbursts of anger

            -Difficulty concentrating

            -Hyper-alertness

            -Exaggerated startle response

   The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning by:

-Reliving the event: through recurring nightmares or intrusive images that occur at any time.

-Avoiding reminders of the event including places, people, thoughts or other activities associated with the trauma.

-Being on guard or hyper-alert at all times, including feeling irritable or sudden anger, having difficulty sleeping or a lack of concentration, being overly alert or startled.

Physiological effects of Post traumatic stress:

-Shrinkage of brain tissue in the hippocampus region can bring on short term memory loss as well as distortion and fragmentation of memories.

-Decreased blood flow to the medial prefrontal cortex of the brain, which regulates emotional and fear responses, may result in the continuation of fear.

Psychiatric Symptoms:

            -Alcoholism

            -Drug abuse

            -Depression

            -Anxiety

            -Panic attacks

            -Isolation

            -Sleep disorders

            -Suicide

Effects of traumatic event:

            -Shatters world view

            -Unable to finalize events, dissociated during the event

            -Fearful of a future event similar in nature

            -Fearful they will not be able to respond

            -Stuck in the way they tell the story

            -Dwell in the negative

            -Loss of control

            -Shattered view of self, others or the world

   Perceptual Distortions in Combat from Deadly Force Encounters by Dr. Alexis Artwohol & Loren Christian based on a Survey of 141 officers.

            85% diminished sound

            16% intensified sound

            80% tunnel vision

            74% automatic pilot (scared speechless)

            74% heightened visual clarity

            65% slow motion time

            7% temporary paralysis

            51% memory loss for parts of the event

            47% memory loss for some of own actions

Post Combat Responses: BODY

            Trembling

            Nausea

            Thirsty

            Upset stomach

            Nightmares

            Sweating

            Hyperventilation

            Chills

            Dizziness

            Diarrhea

            Sleep disturbance

            Urge to urinate

            Jumpy, hyper

Post Combat Responses: EMOTIONS

            Preoccupied with the event

            Reliving it over and over in your mind

            Second guessing yourself and others

            Feeling like you did something wrong

            Guilt

            Doubting abilities

            Doubting willingness to do your job

            Angry

            Irritable

            Hypersensitive

            Anxious

            Feeling vulnerable

            Worried and/or scared

            Self-conscious

            Paranoid

            Afraid of being judged by others

            Glad to have survived, but feeling guilty if others were injured or killed

            Sad, despondent, crying

            Numb, robot-like, unnaturally calm

            Alone, isolated, alienated from others

            Heightened emotions including joy and sex drive

Post Combat Responses: THOUGHTS

            Dazed

            Confused

            Difficulty concentrating

            Memory impairment

Forms of PTS

            Single traumatic event

                        natural: tornado, flood, etc.

            Prolonged repeated trauma

                        natural

hostage-taking, political prisoner, POW, victimization, i.e., child sexual abuse

            Vicarious

                        exposure to “near miss” traumatic experiences

Estimated levels or risk for developing Post traumatic stress

            -Rape 49%

            -Severe beating or physical assault 31.9%

            -Other sexual assault 23.7%

            -Shooting or stabbing 15.4%

            -Sudden, unexpected death of a family member or friend 14.3%

            -Child’s life-threatening illness 10.4%

            -Witness to a killing or serious injury 7.3%

            -Natural disaster 3.8%

Precursors prior to a trauma which place an individual at higher risk for PTS

            Adverse life events prior to the trauma

            Depression

            Developmental and family instability

            Early substance abuse

            History of prior psychiatric help

            Absence of social supports

            Age

            Gender: boys more susceptible to stressors, such as divorce, than girls

Skills Acquisition to Relieve Stress:

-Learning breathing exercises, to relax during stressful situations and afterward

            -Desensitization: training under situations which are realistic

            -Reframe thoughts so that they accurately represent the situation

CAUSES OF STRESS

     The cause of stress can be summed up in one word “change.” The bigger the change the more stress there is. Change with the death of a loved one, divorce, legal problems, injury or illness, marriage, work or living situation, finances, family, habits, assaults, and responsibilities all cause stress.

Stress Assessment

     Identify where stress is coming from. You can reduce stress by identifying its source and by accepting the fact that there is nothing you can do about it when it is out of your control. If it is in your control, you can make changes to relieve the stress.

     Figure out what your role is. If a rainy day is stressing you out, ask what your role is in that rainy day. Because the weather is out of your control, accept the rain as the way it is rather than getting angry over it. You do have control of the activities you do on a rainy day. Your role is to make the best of a rainy day, not to change the weather. Accept what you cannot change and make the most of what you can change. Identify what is your responsibility and what is someone else’s. Too often, we worry about what is someone else’s responsibility or what is God’s responsibility. By leaving other’s responsibilities to them instead of taking it upon ourselves, we reduce our stress. Reducing the number of responsibilities or changing types of responsibilities may reduce stress. Focus on what is your responsibility, not what is out of your control, and know the difference.

     Know and acknowledge your limitations. God made everyone with strengths and weaknesses. God does not expect you to do more than your best. If you are doing what God wants you to do right now, God will take care of everything else (Matt. 6:34). Deuteronomy 10:12, 13 gives what God required of His people.

     Make sure you are in the center of God’s will right now. Are you where you are supposed to be and doing what God wants you to be doing right now? If yes, then trust that God will take care of everything else.

Stress reduction

Cast your cares on God (I Pet. 5:7)

Pray (Phil 4:6-7)

Think of peaceful things (Phil. 4:8, 9)

Read your Bible (Ps. 119:49, 50)

Take a break and think

Evaluate its importance - if it is not important, do not worry about it

Breathing exercises - take slow deep breaths, hold it for a few seconds, then exhale slowly

Muscle relaxation, warm baths, massage

Exercise for at least 20 minutes or more three times weekly

Stretching exercises

Sex

Laughter

Ask for help

Assertiveness

Nap, good night sleep, rest

Getting out of a rut

Singing

Hobby

Soft music

Count your blessings instead of your difficulties

Crying

Eating nutritious meals

Vacation

How to Handle Memories   

     Avoid books and movies that are scary and deal with violence and other issues that trigger memories of the traumatic event. Judge what you expose yourself to by Philippians 4:8, 9.

     If memories occur, turn them into positive things. Thank God the trauma is over. Use it to remind yourself to pray for your safety. Thank God that He will bring justice. Look forward to seeing how God will work it out to good according to Romans 8:28. Think about the benefits of suffering. Ask God to make you a better person from it. Thank God that He can make you righteous through Christ’s sacrifice. Prayer helps ease memories. Learn to replace bad thoughts with good thoughts. Renew your mind according to Romans 12:2. You can renew your mind by filling it with Scripture. Remember, “if any man be in Christ, he is a new creature: old things are passed away; behold, all things are become new”(2 Cor. 5:17).