We hear a lot in the news lately about PTSD (Post-Traumatic Stress Disorder), or what is often simply called “trauma”. Unfortunately, much of what we hear is fraught with myths and misunderstandings. For instance, we often hear things that make us think that PTSD is a chronic condition for which there is no treatment; and that people with PTSD will be impaired for the rest of their lives. The good news is that there are indeed treatments that work for PTSD.
We also hear lots of inaccurate things about what works to treat PTSD. For instance, we might hear that certain psychiatric medications or marijuana help us to effectively overcome PTSD, when really they are only helping us to manage the symptoms.
What is PTSD?
PTSD is a specific term used to describe a series of symptoms that occur after a person or someone they love has been exposed, either first or second hand, to a life threatening situation or a situation involving potential or actual bodily harm. In order to be diagnosed with PTSD, an assessment by a psychologist or psychiatrist is required.
How does PTSD differ from “trauma”?
“Trauma” is a generic term used to refer to various things, including symptoms related to distressing or adverse events that may or may not have involved a threat to a person’s life. It is also commonly used to refer to the distressing or life threatening event itself. Clinicians who work with people with PTSD often refer to life threatening events as “Big ’T’ traumas” and to other events that aren’t life-threatening but still cause distressing symptoms as “Little ‘t’ traumas”.
What is Complex PTSD?
Some people experience multiple or prolonged traumatic events. Chronic trauma can lead to a more complex constellation of symptoms than is generally seen with PTSD. Although the DSM V (the diagnostic manual currently used by mental health clinicians in North America to diagnose mental health problems) doesn’t have an official classification for it, many clinicians and researchers have proposed that this should be identified as a distinct disorder. Child abuse and neglect, intimate partner violence, and torture are examples of traumatic events that can lead to Complex PTSD.
Are PTSD and Complex PTSD treatable?
YES!! The truth is that PTSD and CPTSD do NOT have to be chronic conditions, because there are treatments that have been shown through many research studies to be effective in overcoming PTSD, not just in managing the symptoms. Strangely enough, not much media attention has been given to these interventions that help people permanently overcome PTSD.
Even many family physicians and other health professionals are often not aware of the difference between treatments that permanently help us overcome PTSD versus treatments that just help us manage symptoms of PTSD. This is unfortunate, because focusing on managing the symptoms of PTSD can become an all-consuming task that can interfere with a satisfying and full life, when, all the while, effective treatment is within reach.
Well-researched and effective therapies that help people overcome PTSD include the following psychological interventions, which are recognized by the World Health Organization:
1. Trauma focused-CBT. There are three commonly recognized trauma-focused CBT approaches. They are:
Prolonged Exposure Therapy (PE) Prolonged Exposure Therapy involves the client engaging in imaginal exposure to the traumatic event through repeated in-session descriptions of the trauma by the client, which are recorded. Between session homework assignments involve listening to the recordings and in-vivo exposure in which clients are instructed to deliberately go to the anxiety-provoking environments.
Cognitive Processing Therapy (CPT) This therapy includes discussions of the trauma and techniques to directly address the negative beliefs associated with it.
Narrative Exposure Therapy (NET) This therapy uses a combination of cognitive therapy techniques and imaginal exposure.
2. Eye Movement Desensitization and Reprocessing (EMDR) EMDR began as a therapy specifically for the treatment of people with PTSD. It involves shorter exposures to the traumatic memory than CBT exposure therapies. At the same time, the client attends to bilateral dual attention stimuli such as eye movements, taps or tones. It also includes attention to physical sensations and cognitive reframing.
What about medication and other therapies for PTSD
Although psychiatric medications, cannabis, or animal companions may be used to manage the symptoms of PTSD, they are not cures. Sometimes they are necessary or important adjunctive treatments that help clients to manage their symptoms for a period of time until they begin to benefit from one of the proven psychological therapies listed above. However, our clinical experience has shown us that medications or cannabis may actually impede a person’s progress in one of the above therapies. It is important to work with your trauma therapist and medical professional to determine if and when to reduce or eliminate medications in order to fully benefit from trauma treatment.
What about treatment for Complex PTSD? Is it the same as treatment for PTSD?
This proposed disorder, known among clinicians and researchers as Complex PTSD or Disorder of Extreme Stress (DES), usually takes longer to treat than PTSD. Although the well-researched therapies described above may help to treat Complex PTSD, they require modifications. Examples of modifications include a longer period of preparation, and use of additional strategies. If you think you may be suffering from this, it is important to choose a trauma therapist with experience and additional training to treat it.
How do I choose a trauma therapist?
Before hiring a licensed therapist, ask them if they have achieved a level of formal certification in one of the evidenced-based therapies for PTSD: Prolonged Exposure Therapy (PE); Cognitive Processing Therapy (CPT); Narrative Exposure Therapy (NET) or Eye Movement Desensitization and Reprocessing (EMDR).
If they do, you can ask them how many clients with PTSD or traumas similar to your own that they have treated.
It is recommended that you do a bit of research on the different evidenced-based therapies to choose the one that feels like the best fit for you. The approaches differ, and one therapy may be more amenable to you and your needs than another.
Finally, and very importantly, make sure you feel comfortable with the person you choose to work with. Do you feel safe with them? Do you feel that they understand you? Do you feel confident in their skill? Getting recommendations from family and friends who have worked with a particular therapist can be a good place to start.
Lots of people might say they are “trauma-informed” therapists. The term “trauma-informed” means that a professional considers the impact of trauma on a person, and tailors their interventions to ensure that they are not harmful to people who have experienced trauma. There is no recognized training program to ensure that a person is “trauma-informed”, so this is not a claim that can be validated. “Trauma-informed” does not mean a therapist is trained in any of the validated interventions for ameliorating trauma listed above.
Why do the therapists at LHA focus on EMDR as their treatment of choice for trauma and PTSD?
At LHA, our preferred method of treating PTSD is EMDR, although we do have clinicians who are also trained in one or more of the CBT approaches. The reason for this preference for EMDR is informed by both our clinical experience and the research. In our experience, EMDR is a gentler approach to treating PTSD than the other evidenced based alternatives, while being just as effective and more efficient. The research supports our observations. Although there are comparable outcomes from EMDR and the CBT-based therapies, EMDR requires less homework to be effective. Furthermore, EMDR results in less drop-outs from therapy than the CBT-based exposure therapies, presumably because of its gentler approach.
What can I expect in my EMDR therapy sessions?
Standard EMDR involves different phases. Initially, your EMDR therapist will focus on getting to know you and your history before you collaboratively determine a treatment plan. After this thorough assessment, your EMDR therapist will assist you with skill development to help you to manage the symptoms of PTSD, in order to decrease your day-to-day distress, while also preparing you for the trauma reprocessing phase of treatment. During the trauma reprocessing phase, your therapist will help you to address your trauma memories one by one, in a structured way. You will not be required to do a great deal of homework, and although sometimes it may be painful, a skilled EMDR therapist will work to ensure that the treatment does not push you outside your window of tolerance. During this phase, clients begin to report a significant decrease in their symptoms. After working through past traumas, your therapist will work with you to eliminate any remaining distress related to present day triggers. In the final phase of treatment, your therapist will work with you to get comfortable with any imagined future stressors related to your traumas.
Sometimes the EMDR phases and protocols need to be adapted to suit different situations. For instance, when people experience concurrent alcohol or drug abuse issues, have experienced many traumatic events in their lives, have suffered childhood traumas, or have dissociative disorders, they may require some adaptations to these standard protocols.
EMDR can be used to treat the symptoms of many other problems (for instance, mood or anxiety disorders; eating disorders; psychotic disorders etc.) that have been exacerbated by or had their genesis in adverse life events.
Can EMDR help me with the adverse experiences I’ve had that don’t meet criteria for PTSD but still bother me?
Yes! You don’t have to have a diagnosis of PTSD to have been impacted in many ways by difficult life events, or to benefit from EMDR. For instance, if a person has experienced the loss of a relationship, and continues to find it difficult to trust someone new, they may be experiencing a type of trauma, even though it isn’t PTSD. The negative residual effects of such experiences can be effectively treated with EMDR.
Where can I find out more about EMDR?
To find out more about EMDR, including to find an EMDR therapist near you, you can check out the EMDR Canada website: emdrcanada.org,
or the EMDR International Association (EMDRIA) website: emdria.site-ym.com.
In addition to being the private practice that offers HRM the largest team of trained EMDR clinicians, and among them clinicians with a high degree of additional specialized training to assist people with Complex PTSD, we also periodically offer a Trauma Stabilization Group. This group assists clients with strategies and skills to manage their symptoms effectively, and is a cost effective way to prepare for one-on-one trauma therapy. For more information about any upcoming trauma groups, please contact our intake worker at firstname.lastname@example.org.
Lesley Hartman and Associates Inc. also runs Newcomer-specific Trauma Groups in conjunction with the Newcomer Wellness Program at ISANS. These groups are offered with interpretation for different language speakers, and are geared to the unique experiences of newcomers to Canada. For more information about these groups, you may contact the ISANS Newcomer Wellness counsellor. A link to their email is located on their website: www.isans.ca/get-settled/community-wellness-services/. Or you can speak with your settlement worker at ISANS.