The current paper explores the issue of posttraumatic stress disorder (PTSD) that is considered to be one of the vital problems both in contemporary medicine and the world society. The goal of the paper is to identify the phenomenon of PTSD, explore the nature and causes of trauma in general, and regard certain features of PTSD in individuals who acquired the disorder because of traumas during wartime. This research focuses on the spirituality as an effective way to cope with severe stress. The paper discusses major spiritual and professional approaches to the treatment of PTSD-patients. The research work examines a great range of sources, including articles in the medical journals, books and the Internet sources to explain current approaches to the issue of posttraumatic stress disorder.
Posttraumatic Stress Disorder (PTSD)
During the last decades, the posttraumatic stress disorder was truly considered one of the burning problems in both the contemporary medicine and society. Health experts have been searching the most constructive ways to help people facing severe traumas to recover emotionally from PTSD. In fact, researchers state that every individual has many chances to develop PTSD. To illustrate, about 8% of the US population are likely to suffer from PTSD in their lifetime. According to statistics, the number of children and teenagers, who has suffered from the disorder at least once, exceeds 40%. Approximately 15% of girls and 6% of boys have PTSD. High-school students with the disorder comprise 3%-6%. Moreover, 30%-60% of children that survived in catastrophes and 100% of children who have seen a parent killed acquire PTSD. This statistics includes combat veterans and rape victims, comprising up to 30% (“Posttraumatic Stress Disorder”, n.d.). The above-mentioned facts prove the actuality of the problem.
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The Nature and Causes of a Trauma in General
Regarding the issue of key features of PTSD and certain peculiarities of its treatment, major notions of the paper should be defined. These are the concepts of ‘trauma’ and ‘posttraumatic stress disorder’.
In psychology, trauma can be referred to as “an emotional response to a terrible event like an accident, rape or natural disaster” (“Trauma”, n.d.).
In fact, shock and denial can be normally observed during the first period after the traumatic event. To illustrate, sexual assault, severe injuring, and threat of death can be reasons of trauma. In fact, women have a greater possibility of acquiring traumas than men or children who suffer more than adults do from psychological traumas. Moreover, children under ten years old represent the most vulnerable part of the society. Military veterans are considered to belong to the greatest risk group facing trauma, and PTSD as its negative consequence.
Posttraumatic stress disorder (PTSD) may be described as “well recognized psychiatric disorder that can occur following a major traumatic event” (Bisson & Andrew, 2007, p. 2).
Howard & Crandall (2011) consider PTSD to be a standard reaction to severe stress (p.4). Howard and Crandall highlight that PTSD is typically accompanied with “panic disorder, agoraphobia, obsessive-compulsive disorder, social anxiety disorder, phobias, depression, sleep disorders, and substance abuse” (Howard & Crandall, 2011, p. 16).
According to the National Co-morbidity Survey, approximately 8% of 5,877 American adults experienced PTSD during certain period of their lives (Bisson and Andrew, 2007, p. 2). In cases when an individual suffers from a prolonged, extreme or repetitive trauma, his or her brain may be physically injured. The neuron pathways in the amygdale become deprived of their capacity to recuperate. Moreover, the risk of permanent brain damage grows in a direct ratio to the time the trauma lasts (Howard & Crandall, 2011, p. 1).
According to numerous studies, PTSD patients suffer from rising detrimental feedback inhibition of cortisol secretion disturbing hypothalamic-pituitary-adrenocortical system. Moreover, an increased amount of a steroid hormone, dehydroepiandrosterone (DHEA) or its sulphated metabolite DHEAS may be found in peripheral blood of PTSD patients (Corales, 2005, p. 29).
Thus, PTSD can be referred to as “an anxiety disorder that people get after seeing or living through a dangerous event” (“Post-traumatic stress disorder”, n.d.). Numerous powerful theories regard the individual’s emotions as organized, biologically based responses to internal and external factors according to the individual’s basic human needs, aims or troubles (Boden et al., 2013, p. 297). Negative emotions often play a detrimental role leading to PTSD.
In general, PTSD may cause clues of three major types: re-experiencing, avoidance, and hyperarousal symptoms. Re-experiencing symptoms may include flashbacks, when the individuals are looped and constantly relive their traumas. These negative cues often cause such drawbacks as a racing heart and sweating. The individuals have serious problems with the sleep. Moreover, they often suffer from negative thoughts. PTSD is often followed by the avoidence clues that are characterised by a strong desire of the individual to avoid certain places, events, and things reminding their trauma. Hyperarousal syptoms include habitual angry outbursts and severe stress (“Post-traumatic stress disorder”, n.d., 1-3).
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Howard & Crandall (2011) distinguish six critiria for identifying the exact cause of PTSD. First criterion include cases when the individual faces the thing including real or endangered death or severe injury. The individual reacts to this event with a strong fear, helplessness or panic. The second criterion involves situations when the individual is not endangered. Nevertheless, the patient perceives the reality through dreams and impressions. Under the circumstances, the individual acts as if he or she is really suffering from authentic trauma. The third case concerns situations when the individual desperately attempts to avoid everything related to the trauma. Despite neglecting the trauma, he or she responds to certain stimuli in an intensive way. The fourth criterion includes the cases when the individual has problems with sleeping and concentrating. The patient may be extremely careful to notice any signs of danger or trouble. The fifth criterion comprises cases of long duration when the stressful event lasts longer than one month. The last criterion embraces the cases of a considerable long-term distress caused by the trauma (Howard & Crandall, 2011, p. 4).
The Nature and the Causes of Traumas within the Military Veterans Risk Group
Researchers studied Iraq and Afghanistan war veterans suffering from PTSD, identifying risk factors for suicidal behavior. The outcome of the examination was the following: individuals who had had military experiences demonstrated possible suicidal rate four times greater, than non-PTSD veterans did. Military veterans, who had two or more morbid disorders, were under the risk of suicidal ideation approximately 6 times greater, than veterans with PTSD were (Jacupcak et al., 2009, p. 303).
Analyzing the problem, researches conducted numerous experiments. For example, a total of 272 military veterans were examined to identify features of psychopathology. Approximately 13% of respondents demonstrated contemplating suicide in 14 days before the survey. The outcome was the following: suicide contemplators demonstrated features of PTSD. Moreover, they suffered from bad mood and alcohol problems (Pietrzak et al., 2010, p. 102).
There has also been conducted another experiment. A total of 93 former soldiers who took part in war actions were involved in the rehabilitation program during the period between 2008 and 2010. All the individuals had a diagnosis of PTSD. The larger part of the participants was veterans of military actions in Iraq, Afghanistan, Vietnam, and the Persian Gulf. Four major criteria of the experiment included four issues. The first criterion included impending danger to injure themselves or other individuals. The second criterion comprised active withdrawal or incapacity to refuse alcohol and drugs during the period of treatment. The third issue embraced medical or psychiatric environment demonstrating that the patient was unsuitable for residential level of care. The last criterion included legal issues demanding absence from medical care or court-ordered to the above-mentioned program. The outcome of the research demonstrated that “PTST symptom severity is positively associated with use of expressive suppression, and inversely associated with use of cognitive reappraisal” (Boden et al., 2013, p. 308).
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Treatment of PTSD-patients
Researchers state that posttraumatic stress disorder is hard to cure. Moreover, many health experts hesitate while identifying the problem (Howard & Crandall, 2011, p. 4).
Meichenbaum (n.d.) suggests interesting ideas concerning spiritual approach to the issue of PTSD.
Meichenbaum (n.d.) gives a definition of the concept “spirituality” as “an attempt to seek meaning, purpose and a direction of lifein relation to a higher power, universal spirit of God” (p. 5).
The researcher reminds that the American nation is extremely religious and faith-baithed. To illustrate, the prevailing majority (approximately 90%) of US citizens have a sincere belief in God. In fact, about 60% correlate themselves with local religious groups, while another 40% go to church once a week and and more often. Moreover, approximately 30% od adult population in the USA pray every day, and, what is more important, 80% pray in case of difficult circumstances. These facts prove the idea that spirituality plays a significant role in this case. Therefore, it should be taken into account.
There is no denial of the fact that religion helps people overcome problems and protect themselves against stress. One fact should be mentioned. Facing serious traumas caused by the terrorist attacks of September 11, 2001, approximately 90% of US citizens reported that prayers halped them to cope with the stress (Meichenbaum, n.d., p. 6).
Exploring a beneficial impact of religion on individuals’ mental health, Meichenbaum (n.d.) identifies major features of spiritual and religious activities. He argues that the above-mentioned phenomena return to a normal state individuals’ reactions, develops emotional utterance, carries a sense of control, and enhances social connectedness. Meichenbaum points that “participation in a faith community can help a victim find ways to create blessings from his/her tragedy” (Meichenbaum, n.d., p. 8). Finally, religion and spirituality enhance group connection and support a sense of communition (Meichenbaum, n.d., p.9).
Meichenbaum distinguishes a great variety of spirituality related activities. They comprise involving in spiritually-based actions, feeling strengthened, calling upon forgiveness, performing spiritual acivities and searching consolation in religion (Meichenbaum, n.d., p. 17).
Meichenbaum (n.d.) focuses on the beneficial integration of spirituality and psychotherapy.
Traditionally, the major cure for the individuals with PTSD includes psychotherapy, medical care, or their combination.
Psychotherapy may be individual or carried out in a group. Psychotherapy treatment lasts from 6 to 12 weeks. Although, the terms may differ, the state of certain individual’s health and each person’s needs should be taken into account. Experts state that relatives and friends may make beneficial impact on the patient, supporting him (“Post-traumatic stress disorder”, n.d., 1-3).
Cognitive behavioral therapy comprises three major components: exposure therapy, cognitive restructuring, and stress inoculation training. Exposure therapy exposes patients to the trauma they have gone through. This psychological mental technique includes mental imagination, writing, and return to the places where the trauma has happened. The above-mentioned methods improve the individual’s mental health and teach him or her to control feelings (“Post-traumatic stress disorder”, n.d., 1-3).
Cognitive reconstruction helps people receive a positive outcome from depressive memories. Experts help patients to remember the traumatic event differently, getting rid of feelings of fault, guilt or shame (“Post-traumatic stress disorder”, n.d., 1-3).
Murphrey (2011) notes that the treatment of PTSD-patients must address individuals’ spirituality. “Early attacment injuries have been shown to affect an individual’s decision to seek proximity not only to actual attachment figures, but perceived attachment figures (e.g., ‘God’)” (Murphrey, 2011, p. 4). The researcher argues that the capability to assign to perceived attachment figures may be crucial when negative initial attachment experiences happen, being an attachment to an observed spiritual figure performing a compensatory attachment function. A spiritual part such as mindfullness therapy can promote patients’ recovery through transcening the sorrow and existential crises occurring with trauma. This shift promotes self-regulatory skills and the demotion of detrimental emotions of the past (Murphrey, 2011, p. 4).
Murphrey (2011) makes an accent on three-phase oriented integrative model as means of the successful treatment for PTSD. The above-mentioned model comprises of relational, interoceptive and skill-building types in the treatment of the disorder. The first phase includes engagement, safety and stabilization. The scentist draws attention to the fact that PTSD-patients typically start the treatment having safety concerns like suicidality and suicidal ideation. Therefore, these negative emotions must be reduced immediately. According to Murphrey (2011), the second phase is recollection of traumatic memories. The third phase of treatment is creating a life in the present time. During this period, the therapist tries to assist his or her patient in searching the wise balance in life. This phase is the most intensive of all the three periods of PTSD-treatment.
Murphrey (2011) notes that modern treatment models can belong to two groups:
The first model, Cognitive-Behavioral Therapy makes an accent on cognitive retraining by means of remembering traumatic episodes or by specifically addressing PTSD manifistations.
Interpersonal Self-Regulation and Affect Regulation Therapy
The second model of the treatment, Interpersonal Self-Regulation and Affect Regulation Therapy makes an accent on “use of memories to inform current decision-making rather than attempting to modify beliefs about past occurrences” (Murphrey, 2011, p. 20). Nevertheless, the researcher states that the contemporary evidence based on the PTSD treatment may be improved.
Health experts habitually proscribe psychological treatments for PTSD during the course that lasts from once or twice a week to several months.
In the experiment, PTSD patients were allotted an intensive cognitive therapy during one week. They received standard weekly cognitive therapy during 12 weeks. They also received weekly emotion-focused supportive treatment during 12 weeks, and waiting list condition was carried out during 14 weeks. According to the primary results, changes in PTSD clues were observed by means of self-determining assessor evaluation. The secondary results demonstrated alterations in disability, anxiety, and lifestyle. Approximately 70% of the intensive cognitive therapy group, 80% of the standard group, 40% of the supportive therapy group, and about 10% of the waiting list group improved their mental health. Therefore, cognitive treatment prescribed intensively during the period of a week demonstrated approximately the same results as cognitive treatment prescribed for the period exceeding three months. The researchers argue that “intensive cognitive therapy for PTSD is a feasible and promising alternative to traditional weekly treatment” (Ehlers et al., 2014, p. 294).
The US Food and Drug Administration has accepted two types of medications as suitable for curing adult patients with PTSD. They are sertraline and paroxetine. These medicines belong to the group of antidepressants for coping with depressive feelings (Smith & Segal, n.d.). These medications may have certain negative effects, such as headache and nausea. In fact, the above-mentioned side effects lessen in several days (Smith & Sagal, n.d.).
To sum up, the problem of posttraumatic stress disorder, its origin, consequences and successful treatment has been the subject of brisk discussions for several decades. Health experts have been searching the most constructive ways to help people facing serious traumas recover emotionally from PTSD. Regarding the issue of key features of PTSD and certain peculiarities of its treatment, major notions of the paper should be defined. They are the concepts of ‘trauma, ‘posttraumatic stress disorder’, and ‘spirituality’. In psychology, trauma can be referred to as an emotional response to a terrible event like an accident, rape or natural disaster.
Post-traumatic stress disorder (PTSD) may be described as a well-recognized psychiatric disorder that can occur following a major traumatic event.
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“Spirituality”can be defined as an attempt to seek meaning, purpose and a direction of life in relation to a higher power that is the universal spirit of God.
Researchers distinguish several risk groups among the individuals facing traumas. Women, children under the age of ten, war veterans and individuals facing sexual assault, serious injury and threat of death belong to the risk groups.
Among the above-mentioned types of risk groups, war veterans stand apart. It is the most vulnerable type of potential PTSD-patients nowadays. This fact can be explained numerous war activities in the world. Therefore, military veterans have drawn special attention. Researchers studied Iraq and Afghanistan war veterans suffering from PTSD, identifying risk factors for suicidal behavior. The outcome of the examination was the following: individuals who had had military experiences demonstrated possible suicidal rate four times greater, than non-PTSD veterans did. Analyzing the problem, researchers have conducted numerous experiments. The outcome was the following: suicide contemplators demonstrated features of PTSD. Moreover, they suffered from bad mood and alcohol related problems. As for special features, PTSD may cause clues of three major types: re-experiencing, avoidance, and hyperarousal symptoms. As for treatment, researchers state that posttraumatic stress disorder is difficult to treat. Nevertheless, there are several successful tools to overcome the disease.
Traditionally, the major cure for the individuals with PTSD includes psychotherapy, medical care or their combination. Meichenbaum (n.d.) focuses on the beneficial integration of spirituality and psychotherapy. Religion helps people overcome problems and protect themselves from stress. Psychotherapy may be individual or carried out in a group.
Howard & Crandall (2011) distinguish six critiria for identifying the exact cause of PTSD. First criterion includes cases when the individual faces certain traumatic event including real or endangered death or severe injury. The second criterion involves situations when the individual is not endangered. The third case concerns situations when the individual desperately attempts to avoid all the things related to the trauma. The fourth criterion includes the cases when the individual has problems with sleeping and concentrating. The fifth criterion comprises of cases of long duration when the stressful event lasts longer than one month.
Cognitive behavioral therapy comprises of three major components: exposure therapy, cognitive restructuring, and stress inoculation training.
Murphrey (2011) makes an accent on three-phase oriented integrative model as the means of successful treatment of PTSD. The above-mentioned model comprises of relational, interoceptive, and skill-building types during the treatment of the disorder. The first phase includes engagement, safety, and stabilization. The second phase is recollection of traumatic memories. The third phase of the treatment is creating a life in the present time. During this period, the therapist tries to assist his patient in searching the wise balance in life.
To sum up, PTSD is a serious disorder concerning each individual in the world. Nevertheless, this burning problem needs to be solved. In the spheres of psychotherapy, medical care or their combination, spirituality is drawing the attention of the global society.