Lived through the horrific trauma of an earthquake, hurricane, massive floods or other natural disaster? Returning home after serving our country as a member of the armed forces in Afghanistan, Iraq or other fields of intense and unrelenting combat? Survived a devastating motor vehicle accident, fire, or an attempted burglary, assault, attempted homicide? Trying to put the pieces back together after a childhood of physical and/or sexual abuse, neglect, or abandonment? Struggling to make sense of life after years of domestic or partner abuse? You know who you are. You know that every day is both a gift and a curse, trying to mend a life shattered by trauma. Maybe you’ve healed in the physical sense, or at least made some headway in this area. But what about the non-stop nightmares, the sheer dread, or the terror — that just won’t leave? What about the desperation, the absolute agony of unremitting depression, the inability to feel anything at all? Of course you want to get over it. Getting over trauma in recovery is something that every person who’s suffering the residual effects is desperate to do. But getting over trauma is not as easy as it sounds. What many of you who find yourself in this situation, or love and care about someone who is, really want to know is: How do you do that? Here are some points to consider when constructing an approach on how to get your life back on track after trauma. You Are Not Alone The statistics are pretty grim, certainly enough to reassure anyone who’s gone through trauma and is now in recovery that they are not alone. There are literally millions of Americans, men, women, and children of all ages who fall into this category. The National Institutes of Health (NIH), reporting on a 2005 National Comorbidity-Replication Study, showed that 7.7 million Americans are affected by post-traumatic stress disorder (PTSD) in any given year. A recent epidemiological study by R.J. McNally (2012), abstract in PubMed.gov, on American military personnel deployed in Iraq and Afghanistan found that 4.3 percent developed PTSD. It was 7.6 percent among deployed combatants, versus 1.6 percent for deployed noncombatants. The U.S. Department of Veterans Affairs has developed a program to ensure that all veterans with PTSD receive evidence-based cognitive behavioral therapy (CBT). In addition, the Army has developed “Battlemind” postdeployment early interventions aimed at reducing the risk for PTSD. The numbers alone don’t even come close to the magnitude of the problem, however, since the untold suffering may continue unabated for many years-unless and until the issue is addressed. Only then can the true healing begin–the kind of healing that makes the imprinted psychological wounds start to fade away. You Can’t Heal on Your Own Another important consideration is that, despite how much you want to and believe that you are capable of doing so, you simply cannot heal on your own from the often crippling effects of trauma and post-traumatic stress syndrome. You may embark upon a self-learning program, researching all you can on the Internet, buying and borrowing books and pamphlets on how to overcome trauma in recovery – and this is indeed helpful in your recovery journey – but you more than likely will need some form of professional help to really put the residual effects of trauma behind you. This is not an indictment of your will or determination or desire to heal. It is simply a recognition of the fact that trauma is so much embedded in your subconscious that it can be extremely difficult for you alone to sort out the causes and, even if you know the causes, to stop your body’s debilitating responses to them. Fortunately, you don’t have to. Getting over trauma in recovery is possible. There are many effective forms of therapy that are in use today. Perhaps one of them, or a combination of different types of therapy, may work for you. Drugs and Alcohol Won’t Help It can be harrowing trying to cope with the effects of trauma and PTSD, especially if you’ve been focused on avoiding what’s really going on or are trying to deny that you’ve been affected. Many people try to blunt their feelings and numb themselves to the pain by resorting to alcohol and drug use. Some may begin using drugs or drinking just as a temporary coping mechanism, but this often turns out to be a daily activity. It may even become a full-blown substance abuse problem or addiction. It’s important to recognize that simply drinking to the point of unconsciousness or blacking out, or doing drugs that put you in an altered or euphoric state of mind will do nothing to resolve the effects of trauma or PTSD. They will still be there, most likely more frightening and disruptive than ever, once you sober up. So, any relief you may have felt will be only temporary. Drugs and alcohol only serve as crutches, and repeated use may render you addicted to them. So, while you may be extraordinarily tempted to take a break from the pain of recurring memories of the traumatic event, to fall into a deep sleep where you hope you don’t dream, or otherwise just want to escape your current awful feelings, realize first and foremost that drugs and alcohol won’t help. PTSD Years ago it was believed that PTSD was a psychological condition that affected only combat veterans who were so shocked by their experiences on the field of battle that they were unable to face what had happened or to get past it once returning to civilian life. Such soldiers often faced rejection and were stigmatized because of this. They were often considered weak and some were even discharged from military service. Mental health professionals and the general public doubted whether PTSD was even a true mental health disorder. It wasn’t until 1980 that PTSD was recognized as a disorder with specific symptoms that could be diagnosed with some reliability and it was added to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. PTSD was recognized as a psychological disorder that not only affected combat veterans, but also victims of natural disasters, terrorist attacks, assault, abuse, serious accidents, and even major emotional losses that occur suddenly. Symptoms can be grouped into three categories: re-experiencing (flashbacks, bad dreams and frightening thoughts), avoidance (staying away from people, places or things that are reminders of the event; feeling emotionally numb; feeling strong guilt, worry or depression; losing interest in previously enjoyable activities, and difficulty remembering the troubling event), and hyperarousal (easily startled, feeling tense or on edge, and difficulty sleeping and/or angry outbursts). Key to the development of effective treatment techniques for PTSD is studying how fear and other strong emotions are linked to the formation of memories and their retrieval. NIH-funded research in 2009 enabled scientists to use behavioral manipulation to selectively block learned fear memory with the result that patients remained free of that fear memory for at least one year. Fear extinction, or learning not to fear, involves disabling a type of cell in the amygdale, a brain structure with vital roles in memory, learning and emotion. Virtual reality exposure therapy (VRE) may be an effective alternative to traditional exposure therapy. Such therapy, conducted in a doctor’s office, allows the patient with PTSD to receive immersive therapy that involves a multisensory experience of sight, sound, smell and touch. VRE is showing results as an efficient and effective therapy for some sufferers of PTSD. Certain medications may help individuals affected by PTSD to reduce fear, stress and to help them manage problems with sleeping. Medications may also help enhance the effects of talk therapy in PTSD patients. Researchers today are working on prevention methods, exploring the optimum time to begin exposure therapy after trauma to prevent the development of PTSD. Related to this research is study to find predictive markers, including genes and hormone levels, for the disorder. Resiliency research focuses on studying how some people are able to recover from traumatic experiences or avoid adverse reactions entirely. This may lead to the ability to predict who will most likely develop PTSD, and then to targeting the most effective treatments for those individuals. As for treating victims of mass trauma, affecting individuals in situations such as a natural disaster, terrorist attack, school shooting rampage and other mass events, researchers are testing approaches to make cognitive and behavioral therapy techniques available on a widespread scale. Use of the Internet, self-help therapy and talk therapy over the telephone are some of the creative ways being studied. There are also a number of clinical trials underway or recruiting for the treatment of PTSD. These are posted in ClinicalTrials.gov and include links to learn more about the specific trials, purpose, target audience, length, and description. Some recent examples include:
- CBT for people with additional serious mental illnesses
- Mild traumatic brain injury and PTSD
- Effectiveness of Propranolol for treating people with PTSD
- Comparing behavioral therapies for treating adolescents with PTSD related to sexual abuse
- Examining the effectiveness of an early psychological intervention to prevent PTSD
- Prazosin for treating noncombat PTSD
- Effectiveness of Virtual Reality Exposure (VRE) and D-Cycloserine to treat Iraq war veterans with PTSD
- The effect of NK1R antagonism on alcohol craving and PTSD symptoms in alcohol dependent patients with PTSD
- Structural and functional neuroimaging studies of combat veterans
Overcoming Trauma in Children A form of cognitive behavioral therapy (CBT) for children is trauma-focused CBT, or TF-CBT. A number of mental health facilities make use of this approach to jointly help parents, children and adolescents who are experiencing significant emotional and behavioral difficulties related to trauma. Children may experience symptoms similar to those of adults trying to overcome trauma, but some symptoms are specific to children. These include bedwetting, forgetting how or being unable to talk, acting out the traumatic event during play, and being unusually clingy with one or both parents or another adult. With older teens, symptoms may mirror those of adults, but may also include developing disruptive, destructive, or disrespectful behaviors, feelings of guilt over not being able to prevent injury or death, and harboring feelings of revenge. TF-CBT has been proven effective in addressing children with PTSD, anxiety, depression, sexualized behaviors, shame and mistrust, and externalizing behaviors. The parents, meanwhile, learn how they can increase positive effects for their children by reducing their own depression and emotional distress levels about their child’s abuse, and by learning positive parenting practices and how to better support their child’s healing process. TF-CBT is a relatively short-term treatment that typically lasts 12 to 16 sessions, although it can also be provided for longer periods, depending on the needs of the child and the family. In a similar manner, children with more complex difficulties may benefit from the incorporation of TF-CBT with a larger treatment program. It can take place in a number of different mental health settings, delivered by clinical social workers, psychiatrists, psychologists, and professional or clinical counselors. The Child Welfare Information Gateway , part of the U.S. Department of Health and Human Services (HHS), has more information on research and examples of how TF-CBT works and what to expect during treatment. The National Child Traumatic Stress Network (NCTSN) provides a PDF document on TF-CBT that may also prove helpful to parents and caregivers desiring to learn more about this type of therapy. How to Begin the Healing Process from Trauma Recognizing that you are not alone, and that you cannot completely heal yourself after suffering trauma or PTSD, there are some immediate things that you can do to begin the healing process.
- Recognize that healing is going to take some time, that it will not be an immediate fix or happen overnight.
- Talk with your doctor about some different options to help you get better.
- Begin some modest and realistic activities to help reduce your levels of stress and tension, such as a daily exercise regimen (you may need to consult with and get your doctor’s okay first).
- Structure some realistic goals that you can reasonably achieve.
- Learn how to set priorities. Not everything has to be done today. Breaking up large and complex task into smaller and more manageable ones will help you do what you can do easier and with less frustration.
- Spend time with others that you enjoy, and talk with those you trust, telling them about anything you’ve noticed that seems to trigger your symptoms.
- Expect gradual improvement of your symptoms over time, with treatment.
- Figure out comforting situations, places and people and make use of these coping techniques.
Where to Find Help Where can you go to find help? You can begin by asking your doctor. Other resources include mental health specialists, including psychiatrists and psychologists, mental health counselors and social workers; family services, social agents, members of the clergy; mental health programs at universities or medical schools; private clinics and treatment facilities specializing in treating trauma and PTSD; state hospital outpatient clinics; hospital psychiatry departments and outpatient clinics; health maintenance organizations (HMOs); community mental health centers; peer support groups; employee assistance programs, and medical and/or psychiatric societies in your community. In Crisis, Feeling Lost? If you are in crisis, feel like you’re going to harm yourself or are thinking about committing suicide, call 911 immediately or get to the nearest hospital emergency room. If you feel you’re not able to do this yourself, ask a friend or a family member to assist you without delay. You can also get crisis help by calling the 24-hour hotline at the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255). If you are a veteran in crisis, call this same hotline and press 1 at the prompt. You can also chat online at the Veterans Crisis Line .