Hypnosis and PTSD Part 2

Part 2 – Understanding PTSD

Introduction

Part 1 of this three part series on Post Traumatic Stress Disorder (PTSD) looked at the history of how hypnosis has been used to treat trauma, specifically looking at the work of French psychologist Pierre Janet. The article briefly looked at how major wars contributed to our understanding of PTSD, until it was eventually acknowledged as a mental disorder in 1980.

In this article we will explore what PTSD is, as well as looking at some other stress disorders. It will also investigate how PTSD affects people.

Part 3 will explore the various ways in which PTSD is treated, with specific attention to hypnosis and the techniques that hypnotherapists can use in order to help their clients.

PTSD defined

As we have learned in Part 1, PTSD has in the past been known by many names. Initially, during the 18^th and 19^th centuries, it was labeled as hysteria.  During World War 1 it was known as shell shock, while during the Second World War it was called combat fatigue. It is important to note that PTSD is not just something that happens to soldiers who have experienced combat. It can happen to anyone. It is estimated that one in eleven people may be diagnosed with PTSD, while women are twice as likely to develop it than men. It may also affect people of certain racial ethnicities more than others.

Essentially PTSD is a psychiatric disorder that may occur after a person has experienced or witnessed a traumatic event. The kinds of events that may trigger PTSD are many, including wars, natural disasters, terrorist attacks, serious accidents, rape and sexual violence, being threatened with death, or even serious injury. It may be either a physical or a psychological experience that causes the trauma.

What separates PTSD from common stress is that the people who suffer from PTSD are haunted by very intense and disturbing thoughts and feelings related to their experience long after the traumatic event occurred. These may come in various forms, for instance vivid flashbacks and nightmares, or they may experience intense emotions such as sadness, fear or anger. It may even be that they become estranged from other people, experiencing a sense of detachment.

It is common for people who have PTSD to avoid certain situations or people that remind them of the traumatic event that they experienced. It may even be possible that they react strongly to something quite ordinary. Think of the ex-soldier who hears a car backfiring in the street, which could be enough to make him relive the trauma of an explosion on the battlefield.

Complex PTSD

While there is generally a good understanding of PTSD, Complex PTSD (CPTSD) is a fairly new classification. While PTSD is the result of a single incident, CPTSD is cumulative, underlying and most often interpersonally generated. It is therefore caused by more than one event and the effects increase with every successive trauma. It has the risk of being more prolonged and severe than PTSD.

The official definition of CPTSD will be incorporated into the World Health Organisation (WHO) International Classification of Diseases (ICD-11) on 1 January 2022 and reads as follows:

“Complex post-traumatic stress disorder (Complex PTSD) is a disorder that may develop following exposure to an event or series of events of an extreme and prolonged or repetitive nature that is experienced as extremely threatening or horrific and from which escape is difficult or impossible (e.g., torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse).”

CPTSD differs from PTSD in that it has a greater impact on the individual experiencing it. This can have the result that the person that experienced it has more severe and pervasive problems in affect regulation. Their beliefs about their selves being diminished, defeated or worthless may become more persistent and can be accompanied by feelings of deep and pervasive shame, guilt or failure related to the stressful events they experienced. Their difficulties sustaining relationships and feeling close to others may also persist for much longer. The sustained or repeated trauma causes more severe impacts on their different areas of functioning, which includes personal, family, social, educational, occupational and other important functioning, as well as having a more severe impact on their feelings.

Ultimately their sense of self is more impacted. Self-regulation, self-integrity, and attachment to security are compromised, which means that they not only experience threats to physical survival, but also to the development and survival of the self.

Related conditions

There are a number of other stress conditions that may be related to PTSD. The following could present themselves:

Acute Stress Disorder (ASD)– While the symptoms are similar to PTSD in reaction to a traumatic event, the symptoms may present within three days and one month after the event. About half of people who experience ASD will go on to develop PTSD. Roughly 13 – 21 % of car accident survivors develop ASD, while 20 – 50% of rape, assault and mass shooting survivors develop it.

Adjustment Disorder (AD) – When a person experiences emotional or behavioural symptoms that are out of proportion to the type of event that occurred, it can be labeled AD. Symptoms may include feelings of sadness or hopelessness, withdrawal from other people, palpitations, tremors or headaches, or acting defiantly or by exhibiting impulsive behaviours. Symptoms of AD may begin within three months of the stress-causing event and won’t last longer than about six months after that event.

Disinhibited Social Engagement Disorder (DSED) – This disorder occurs in children who have experienced severe social neglect or deprivation before the age of two years. It is caused when children are not provided with the basic emotional needs for support, stimulation or affection. It can also be caused when they experience regular changes in caregivers, such as when they are frequently sent from foster care to foster care, preventing them from forming stable attachments. While rare, children who suffer from DSED may exhibit problems relating to adults and their peers. They may also experience cognitive and language development delays.

Reactive Attachment Disorder (RAD) – Children who experienced severe social neglect or deprivation during the first year of their life may develop RAD. The causes and symptoms are much the same as for DSED and it is considered a rare disorder.

Signs and symptoms of PTSD

Most of us experience trauma in some form or another during our lifetimes and the effects of that trauma may not last very long. However, if symptoms last more than a month and are severe enough to start interfering with daily life, relationships, work, and being able to function normally, a diagnosis of PTSD might become more likely.

Such as with any illness, the symptoms may vary. Some people may recover within six months, while others take much longer to recover. For some it becomes a chronic and debilitating condition. It will take a doctor, psychiatrist or psychologist to make a formal diagnosis.

In order for the stress condition to be considered PTSD, all of the following symptoms must be present for at least a month:

• At least one re-experiencing symptom such as:
  
  • Flashbacks (reliving the trauma again and again, which will include physical symptoms such as sweating or increased heart rate);
  • Nightmares;
  • Frightening thoughts.

• At least one avoidance symptom such as:
  
  • Staying away from things that remind of the trauma, such as events, places or objects;
  • Avoiding thoughts or feelings that can be related back to the original traumatic event.

• At least two arousal or reactivity symptoms such as:
  
  • Being easily scared or startled;
  • Feeling tense or on edge;
  • Difficulty sleeping;
  • Angry outbursts.

• At least two cognitive or mood symptoms such as:
  
  • Trouble remembering key features of the traumatic event;
  • Negative feeling about the self and the world;
  • Distorted feelings such as guilt or blame;
  • Losing interest in activities that used to be enjoyable.

While it is natural to experience some of these feelings after a traumatic event, it becomes problematic when the symptoms persist for more than a month. It is then that it starts to affect the person’s ability to function. It may often lead to depression, substance abuse or to some of the other anxiety disorders.

Older children and teenagers may have some of the same symptoms outlined above, but may also react differently.  Some children might become disruptive, disrespectful or exhibit destructive behaviours. Other symptoms may include:

• Bedwetting;
• Forgetting or being unable to talk;
• Acting out the trauma during playtime;
• Becoming very clingy.

What causes PTSD?

While being directly exposed to a traumatic event may cause PTSD, it can also happen indirectly. Examples include hearing about the violent death of a family member or friend, or the police detective who has had to deal with many cases of child abuse.

There is research that investigated how a woman had an unexpected stillborn delivery by emergency caesarean section under anesthesia and who subsequently developed PTSD. When going for another caesarian section some years later, she started experiencing flashbacks and severe anxiety. How a hypnosis technique helped solve this issue will be highlighted in the next article.

Pandemics are a well-known cause of PTSD. This includes healthcare workers who have close contact with patients who are infected by potentially deadly viruses. These healthcare workers may be witnessing the suffering and deaths of patients and even the lack of lifesaving supplies, causing them trauma that could have lasting effects on heir mental health.

Current research into Covid-19 related PTSD points out that not only healthcare workers are affected by it. It encompasses those who have themselves suffered from serious illness and potential death because of the virus. Family members who are witnessing this kind of suffering and death of their loved ones may be susceptible to PTSD as well. Teachers, first responders, journalists, medical examiners, and others are also at risk.

Researchers are even seeing that issues such as social isolation, becoming unemployed and having economic distress and working from home while having to take care of children or other family members are having an adverse effect of people’s mental health and in some cases leading to PTSD.

Risk factors for developing PTSD

It must be noted that any person can develop PTSD at any age. Not everyone who experiences trauma will however develop PTSD. Women are more likely to develop this disorder than men, while those who experienced sexual trauma while growing up are much more likely to develop it after experiencing a trauma during adulthood.

Medical events and procedures are often underappreciated in their ability to cause PTSD. For instance, up to 15% of people who experience a myocardial infarction or acute coronary syndrome may develop PTSD. Up to 20% of patients who have undergone major thoracic surgeries such as cardiac bypass graft (CABG) and open abdominal aortic aneurysm (AAA) repair may end up developing PTSD.

Currently medical events particularly related to Covid-19 may induce PTSD. These may include prolonged treatment in intensive care units (ICU) for sepsis, and more specifically for intubation. Some 35% of ICU survivors will develop PTSD.

Consequences of PTSD

If left untreated, PTSD can last for many decades and will get worse over time. It will cause major distress and disrupt social and work functioning. It will have detrimental effects on relationships with other people and the ability to keep a steady job and function effectively at work.

On a physiological level PTSD will affect and profoundly change the functioning of the autonomic nervous system. More specifically, it will dramatically change how the sympathetic nervous system operates.  This is the system that controls the so-called ‘fight or flight’ reactions. It will also result in a reduction in the parasympathetic nervous system functions, which control the ‘rest and digest’ system.

The brain will exaggerate activity in certain neural networks that are associated with the processing of detecting threats and negative emotional responses. It may result in a decrease in the functioning of the networks that control executive control, problem solving and the control of emotions. It may also have a detrimental effect on brain circuitry that control the reward system.

Preventing PTSD

While most people do not develop PTSD after experiencing a traumatic event, others do. It is important to get help and support as soon as possible after a stressful life event has occurred, so as to stop it from becoming worse and possibly developing into full-blown PTSD. Family and friends may be the first ones to offer comfort and support. Brief therapy with professionals may also be useful. Some people turn to faith-based organisations for help. Alcohol and drugs are never th solution; so one should rather seek out people who can help you through such stressful times.

In Part 3 of this series, we will focus on some of the treatments available to people who may be suffering from PTSD. Special attention will be given to hypnotherapy, highlighting some of the more successful methods that can be applied during a hypnosis session, including a revolutionary new method that was developed in Israel and which is said to produce very good results.

Bibliography

Kazelman, C. & Stavrapoulos, P. (2010). Practice Guidelines for Clinical Treatment of Complex Trauma.  Blue Knot Foundation. https://aztrauma.org/wp-content/uploads/2020/11/BlueKnot_Practice_Guidelines_2019.pdf

Slater, P.M. (2015). Post-traumatic stress disorder managed successfully with hypnosis and the rewind technique: two cases in obstetric patients. International Journal of Obstetric Anesthesia. DOI: https://doi.org/10.1016/j.ijoa.2015.03.003

Tucker, P. (2021). Post-COVID Stress Disorder: Another Emerging Consequence of the Global Pandemic. Psychiatric Times, Vol 38, Issue 1. https://www.psychiatrictimes.com/view/post-covid-stress-disorder-emerging-consequence-global-pandemic

Xiao, S., Luo, D. & Xiao, Y. (2020). Survivors of COVID-19 are at high risk of posttraumatic stress disorder. Glob health res policy 5, 29. https://doi.org/10.1186/s41256-020-00155-2

American Psychiatric Association. What is Posttraumatic Stress Disorder? https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

Mayo Clinic. Post-traumatic Stress Disorder (PTSD). https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967

Michigan Medicine Department of Psychiatry. Post Traumatic Stress Disorder during Covid-19. https://medicine.umich.edu/dept/psychiatry/michigan-psychiatry-resources-covid-19/specific-mental-health-conditions/posttraumatic-stress-disorder-during-covid-19

National Institute of Mental Health. Post Traumatic Stress Disorder. https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml