Examining Interventions for Post Traumatic Stress Disorder

Posttraumatic Stress Disorder (PTSD) is a complex anxiety condition that emerges following a deeply distressing event. Understanding its symptoms and interventions is crucial for effective treatment and support. A person must repeatedly relive the event in one of five defined ways, avoid stimuli related to the event in three of seven defined ways, and exhibit at least two symptoms of hyperarousal that were not present before the event. There are three interventions commonly used in the treatment of PTSD: critical incident stress debriefing, cognitive behavioral therapy, and eye movement desensitization and reprocessing. Effective management often includes these psychological approaches tailored to individual needs. The most effective pharmacotherapy intervention is the use of antidepressants with serotoninergic properties. Nurses treating patients with PTSD should be able to provide a calm environment and invoke a trusting relationship with their patient. Establishing this trust is essential for fostering a safe space for recovery.

Examining Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) manifests as a severe anxiety condition triggered by a traumatic experience. Its historical recognition provides context for modern treatment approaches. Swiss military physicians were among the first to identify and name the collection of symptoms characteristic of PTSD. In 1678, these physicians coined the term “Nostalgia” to describe the symptoms affecting their soldiers. This early identification laid the groundwork for understanding trauma-related disorders. The Swiss were not the only ones noticing this phenomenon; around the same time, the German, French, and Spanish observed similar symptoms. The German termed it “heimweh,” meaning homesickness. The French called it maladie du pays, and the Spanish estar roto, meaning to be broken (Bently, 2005). These varied cultural descriptions highlight the universal nature of trauma responses across different societies.

Originally termed “shell shock,” PTSD faced significant societal and medical skepticism. During the Civil War, the military struggled to manage the overwhelming number of PTSD cases. These individuals were often sent home on a train with their names and addresses pinned to their shirts or left to wander the countryside until they died of exposure or starvation. Such practices reflect the limited understanding and resources available at the time. The public soon became overwhelmed with the “disabled soldiers,” and as a result, the military opened its first hospital for the insane in 1863. However, this hospital was not maintained after the war (Bently, 2005). The lack of sustained care underscored the need for long-term mental health solutions. Although PTSD symptoms have affected people for thousands of years, it was not officially introduced into the DSM until 1980 (Ahmed, 2007). Brought to the attention of the psychiatric community by Vietnam War veterans, a definitive list of symptoms began to be developed (MacDonald, 2008). This formal recognition marked a pivotal shift toward structured diagnosis and treatment.

According to the DSM, a PTSD diagnosis requires that a person has experienced, witnessed, or been confronted with a traumatic event involving the death or harm of another person or themselves, resulting in intense fear, horror, or helplessness. After experiencing a traumatic event, the person must relive the experience through intrusive, distressing recollections, repeated distressing dreams, flashbacks, hallucinations, illusions, or internal or external cues that symbolize or resemble the event. These reliving experiences can significantly disrupt daily functioning. This results in physiological reactivity such as a rapid heartbeat and elevated blood pressure (Morrison, 2003). Such physical responses often compound the psychological distress, making intervention critical.

The individual must then exhibit three or more of the following avoidance behaviors: attempts to avoid thoughts, feelings, or conversations concerned with the event, attempts to avoid activities, people, or places that recall the event, inability to recall an important feature of the event, marked loss of interest or participation in activities important to the individual, detachment or isolation from others, restricted ability to love or feel strong emotions, or feelings that life will be brief or unfulfilled. They must also have at least two of the following symptoms of hyperarousal that were not present before the traumatic event: insomnia, irritability, poor concentration, hypervigilance, or increased startle response. These symptoms must persist for more than a month and impair work, social, or personal functioning. There are no cardinal symptoms of PTSD (Morrison, 2003). The complexity of these criteria highlights the multifaceted nature of the disorder. Having defined borders gave scientists boundaries with which to examine if there were any predisposed indicators of the disorder. This structured framework has guided subsequent research into risk factors and treatment efficacy.

The question remains: with so many people experiencing trauma, why do some recover while others develop PTSD? To answer this question, one must first examine PTSD from every angle. To begin with the sexes, it has been found that women are more likely than men to meet the criteria for PTSD and for lifetime PTSD. Women typically experience PTSD following rape or physical assault, while men often develop it after witnessing someone seriously injured or killed. These gender-specific triggers underscore the importance of tailored interventions. Since PTSD is dependent upon the experience of a traumatic event, there is no typical age of onset (Morrison, 2003). There also is no evidence to support that ethnicity plays a role in susceptibility for PTSD. However, one study found that PTSD symptoms have a heritable component. Another theory suggests that individuals who develop PTSD may have had pre-existing psychological vulnerabilities before the traumatic event. Early beliefs posited that severe trauma caused neuron damage or cell loss in the hippocampus, producing PTSD symptoms, but research has contradicted this theory. Studies have now found that PTSD sufferers have a smaller-than-average hippocampus. One theory is that this smaller hippocampus leads to difficulties in processing memories as past events, causing individuals to relive them as present. The critical component is that differences in cognitive and neurological functioning likely existed before the trauma, with PTSD triggered by the eventual traumatic experience (Tavris & Wade, 2008, p. 606). These findings emphasize the interplay between biology and environment in PTSD development.

Studies have also explored the neurological aspects of PTSD. It has been found that neuropeptide Y, an amino acid released with noradrenaline upon activation of the sympathetic nervous system, may play a role. Low levels of neuropeptide Y have been observed in veterans with chronic PTSD. This biological marker offers insights into potential treatment targets. Other studies have found that individuals who can restrain corticotrophin-releasing hormone (CRH) have an easier time recovering from a traumatic experience. Researchers have also linked increased levels of CRH in the cerebral spinal fluid to PTSD (Ahmed, 2007). These neurological findings enhance our understanding of the physiological underpinnings of the disorder. Now that the biology of the disorder has been examined, how is PTSD treated? Effective treatment requires addressing both the psychological and physiological components of the condition.

Many interventions have been tested in the treatment of PTSD, with varying degrees of success. The most popular intervention, though not the most successful, is Critical Incident Stress Debriefing (CISD). CISD involves a one- to three-hour “debriefing” immediately post-trauma, where victims disclose their thoughts and emotions about the traumatic experience, and the group leader warns them about possible trauma symptoms. Research, however, has found that this method is not only ineffective but can have long-term adverse effects. CISD has been shown to worsen outcomes for some victims compared to those who receive no such treatment (Tavris, 2008, p. 659). This evidence underscores the need for careful evaluation of intervention efficacy.

Another intervention, cognitive behavioral therapy (CBT), has proven highly effective. “Trauma-focused cognitive behavioral therapy is the most effective psychological treatment for PTSD” (MacDonald, 2008). CBT requires individuals to challenge self-damaging thoughts and beliefs about the event and develop a more reasonable outlook on their recovery. This approach empowers individuals to regain control over their memories. It also fosters resilience by reframing negative thought patterns (MacDonald, 2008). The success of CBT highlights the importance of addressing cognitive distortions in trauma recovery.

The last intervention to be discussed is eye movement desensitization and reprocessing (EMDR). This treatment is specifically designed for PTSD and is recommended within the first month following a traumatic event, particularly for those with severe symptoms. During EMDR, patients make rhythmic eye movements that stimulate the brain’s information processing system. These movements help patients process flashbacks and better understand the traumatic event (MacDonald, 2008). EMDR’s targeted approach makes it a valuable tool for early intervention. Although psychological interventions are primary, pharmacotherapy also plays a role in treating PTSD.

Pharmacotherapy should not be the first line of defense but can aid in managing PTSD symptoms. Medication therapy is used to alleviate symptoms rather than cure the disorder. For treating core PTSD symptoms, antidepressants with serotoninergic properties, such as paroxetine (Paxil) and sertraline (Zoloft), have been effective when given at higher doses for five to eight weeks (Sutherland & Davidson, 1994). These medications target serotonin reuptake, stabilizing mood and reducing anxiety. Paroxetine inhibits central nervous system (CNS) neuron uptake of serotonin but not norepinephrine or dopamine, with a recommended dose of 20 mg per day, up to a maximum of 60 mg (Skidmore-Roth, 2010, p. 836). Sertraline inhibits serotonin reuptake in the CNS with no effect on dopamine or norepinephrine, recommended at 25 to 50 mg per day, with increases to a maximum of 200 mg per day over intervals greater than one week (Skidmore-Roth, 2010, p. 981). For hyperarousal symptoms unresponsive to antidepressants, buspirone or benzodiazepines may be indicated (Sutherland, 1994). These medications provide additional options for managing severe symptoms.

Buspirone (Buspar) is an anti-anxiety sedative that inhibits serotonin action, recommended at 5 mg divided into three daily doses, with a maximum of 60 mg per day. Benzodiazepines reduce anxiety by stimulating the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) in the limbic system. Common benzodiazepines include alprazolam, chlordiazepoxide, clorazepate, diazepam, lorazepam, and oxazepam (Skidmore-Roth, 2010, p. 69). These medications offer relief for acute anxiety but require careful monitoring due to potential dependency. Phenelzine (Nardil), a monoamine oxidase inhibitor, is effective for depressive symptoms and autonomic arousal, blocking the metabolic destruction of epinephrine, norepinephrine, dopamine, and serotonin (Clayton, Stock, Harroun, 2010, p. 258). Other drug therapy options, such as lithium, carbamazepine, and beta-blocking drugs, help manage poor impulse control (Sutherland, 1994). These pharmacological options complement psychological interventions for comprehensive care.

Nurses play a critical role in supporting patients with PTSD. They must be knowledgeable about the disorder and aware of available resources. Building a trusting relationship with the patient through good communication and empathy is essential. Therapeutic or healing touch can promote this trust, creating a safe environment for recovery. Nurses should also be vigilant for signs of drug or alcohol abuse, as patients may use these to cope with PTSD symptoms. Assessing for ongoing signs of PTSD, such as avoidant behavior and dissociation, is crucial for effective care (Ackley & Ladwig, 2008, p. 145). This holistic approach ensures that patients receive both emotional and practical support.

In managing ongoing PTSD symptoms, nurses should encourage patients to discuss their feelings surrounding the traumatic event. Promoting positive thinking when examining the effects of the trauma can help reduce symptom severity. Encouraging patients to focus on their strengths rather than weaknesses fosters resilience. As PTSD symptoms can become overwhelming, nurses must be alert for signs of self-harm, such as poor self-concept, excessive grief, and hopelessness (Ackley, 2008, p. 623). Early identification of these signs can prevent further deterioration of the patient’s mental health.

Nurses should also address sleep difficulties, as nightmares related to the traumatic event are common. Suggesting relaxation techniques before bedtime can promote better sleep. If present at night, nurses can use a back massage to relax the patient. In treatment centers, nurses should keep the unit quiet by silencing alarms and speaking in hushed tones. For patients at home, nurses can recommend calming music to encourage restful sleep (Ackley, 2008, p. 757). These strategies enhance patient comfort and support recovery.

Posttraumatic stress disorder is a debilitating anxiety condition that can disrupt a person’s life for an extended period. Seeking help promptly is critical, as the disorder can have serious adverse effects on health and well-being. Psychotherapy interventions, particularly cognitive behavioral therapy (CBT), are the most effective for managing PTSD (MacDonald, 2008). Pharmacotherapy, especially antidepressants with serotoninergic properties, is often used in combination with psychotherapy to control symptoms (Sutherland, 1994). Nurses play a vital role in building trusting relationships with patients, which is foundational to effective care. Through these interventions, patients can achieve a life free of PTSD symptoms. Comprehensive care integrates psychological, pharmacological, and nursing support for optimal outcomes.

Emerging Research and Future Directions

Recent studies have expanded our understanding of PTSD interventions, emphasizing the need for personalized and integrative approaches. Advances in neuroimaging have revealed how brain structures like the amygdala and prefrontal cortex interact in PTSD, offering new avenues for targeted therapies (Lanius et al., 2019). These findings suggest that combining neurofeedback with traditional interventions like CBT may enhance treatment outcomes. Additionally, research into virtual reality exposure therapy (VRET) has shown promise in helping patients process traumatic memories in a controlled environment (Difede et al., 2022). Such innovations highlight the evolving landscape of PTSD treatment. As research progresses, integrating these novel approaches with established interventions could further improve recovery rates and quality of life for those affected by PTSD.

References

Ackley, B. J., & Ladwig, G. B. (2008). Nursing diagnosis handbook: An evidence-based guide to planning care. Mosby Elsevier.

Ahmed, A. (2007). PTSD, the traumatic principle, and lawsuits. Psychiatric Times, 24(5).

Bently, S. (2005). A short history of PTSD: From Thermopylae to Hue. Soldier’s Heart, 3(2).

Clayton, B. D., Stock, Y. N., & Harroun, R. D. (2010). Basic pharmacology for nurses. Mosby Elsevier.

Difede, J., Rothbaum, B. O., & Rizzo, A. A. (2022). Virtual reality exposure therapy for PTSD: Current evidence and future directions. Current Psychiatry Reports, 24(7), 365-374.

Lanius, R. A., Rabellino, D., & Boyd, J. E. (2019). Neuroimaging of PTSD: Advances and challenges. Journal of Traumatic Stress, 32(1), 1-10.

MacDonald, C. (2008). Treatment issues in PTSD. Journal of Psychosocial Nursing, 46(2).

Morrison, J. (2003). DSM-IV made easy: The clinician’s guide to diagnosis. Guilford Press.

Skidmore-Roth, L. (2010). Mosby’s nursing drug reference. Mosby Elsevier.

Sutherland, S. M., & Davidson, J. R. T. (1994). Pharmacotherapy for post-traumatic stress disorder. Psychiatric Clinics of North America, 17(2), 409-423.

Tavris, C., & Wade, C. (2008). Psychology. Pearson Prentice Hall.