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Ways to Overcome Emotional and Psychological Trauma in a Day Today Life

Mini Review
Volume 17 Issue 1 - October 2018
DOI: 10.19080/CTBEB.2018.17.555955
Curr Trends Biomedical Eng & Biosci
Copyright © All rights are reserved by Susheelkumar V Ronad
Ways to Overcome Emotional and Psychological
Trauma in a Day Today Life
Susheelkumar V Ronad1*, Chetan S Patali2 and Suvarna C Patali3
1Department of Psychiatric Nursing, DIMHANS Dharwad , India
2Dhanush Institute of Nursing Sciences Bagalkot, India
3Dhanush Institute of Nursing Sciences Bagalkot, India
Submission: September 25, 2018; Published: October 30, 2018
*Corresponding author: Susheelkumar V Ronad, Department of Psychiatric Nursing DIMHANS Dharwad, India
Curr Trends Biomedical Eng & Biosci 17(1): CTBEB.MS.ID.555955 (2018) 001
Mini Review
Psychological trauma is a sort of harm to the mind that
happens because of an extremely troubling occasion. Injury is
regularly the after-effect of a staggering measure of pressure
that surpasses one’s capacity to adapt, or incorporate the
feelings required with that experience [1]. An awful accident
includes one’s understanding, or rehashing occasions of being
overpowered that can be encouraged in weeks, years, or even
a long time as the individual battles to adapt to the prompt
conditions, in the end prompting genuine, long haul negative
outcomes [2-5].
In the event that you’ve encountered to a great degree
distressing or exasperating occasion that is abandoned you
learning about vulnerable and sincerely of control, you may have
been damaged. Mental injury can abandon you battling with
irritating feelings, recollections, and tension that won’t leave. It
       
agony and feel safe once more. Be that as it may, with these self-
improvement methodologies and support, you can speed your
recuperation. Regardless of whether the injury happened years
back or yesterday, you can roll out mending improvements and
proceed onward with your life.
What is Emotional and Psychological Trauma?
Enthusiastic and mental injury is the after-effect of
phenomenally upsetting occasions that smash your suspicion
perilous world. Horrendous encounters frequently include a risk
to life or security; however, any circumstance that abandons you
feeling overpowered and disconnected can be awful, regardless
of whether it doesn’t include physical mischief [7]. It’s not the
target actualities that decide if an occasion is awful, yet your
abstract enthusiastic experience of the occasion. The more
scared and defenseless you feel, the more probable you are to
be damaged.
Enthusiastic and mental injury can be caused by:
i. One-time occasions, for example, mischance, damage,
or savage assault, particularly in the event that it was surprising
or occurred in adolescence.
ii. Ongoing, tenacious pressure, for example, living in a
or horrible accidents that happen more than once, for example,
tormenting, abusive behavior at home, or youth disregard.
iii. Commonly neglected causes, for example, medical
procedure (particularly in the initial 3 long stretches of life),
the sudden demise of somebody close, the separation of a
huge relationship, or a mortifying or profoundly frustrating
background, particularly on the off chance that somebody was
purposely barbarous.
   
weren’t straightforwardly associated with the occasion. Indeed,
while it’s exceptionally far-fetched any of us will ever be the
immediate casualties of a fear-based oppressor assault, plane
crash, or mass shooting, for instance, we’re all consistently
shelled by awful pictures via web-based networking media and
news wellsprings of those individuals who have been [8]. Review
these pictures again and again can overpower your sensory
system and make horrendous pressure.
Childhood Trauma and the Risk of Future Trauma
While horrendous mishaps can transpire, will probably
be damaged by an occasion in case you’re as of now under
an overwhelming pressure stack, have as of late endured a
progression of misfortunes [9-11], or have been damaged
     
Youth injury can come about because of anything that disturbs a
tyke’s feeling of security, including:
i. An unstable or unsafe environment
Current Trends in Biomedical Engineering & Biosciences
How to cite this article: Susheelkumar V R, Chetan S P, Suvarna C P. Ways to Overcome Emotional and Psychological Trauma in a Day Today Life. Curr
Trends Biomedical Eng & Biosci. 2018; 17(1): 555955. DOI: 10.19080/CTBEB.2018.17.555955.
ii. Separation from a parent
iii. Serious illness
iv. Intrusive medical procedures
v. Sexual, physical, or verbal abuse
vi. Domestic violence
vii. Neglect
Encountering injury in youth can have a serious and
dependable impact. At the point when youth injury isn’t settled,
a feeling of dread and defenselessness continues into adulthood,
setting the phase for facilitate injury [12]. Be that as it may,
regardless of whether your injury happened numerous years
     
how to trust and associate with others once more, and recapture
your feeling of passionate adjust.
Symptoms of Psychological Trauma
We as a whole respond in various approaches to injury,
encountering an extensive variety of physical and passionate
responses [13]. There is no “right” or “wrong” approach to think,
feel, or react, so don’t pass judgment on your own responses or
those of other individuals. Your reactions are NORMAL responses
to ABNORMAL occasions.
Emotional & psychological symptoms
i. Shock, denial, or disbelief
 
iii. Anger, irritability, mood swings
iv. Anxiety and fear
v. Guilt, shame, self-blame
vi. Withdrawing from others
vii. Feeling sad or hopeless
viii. Feeling disconnected or numb
Physical symptoms
i. Insomnia or nightmares
ii. Fatigue
iii. Being startled easily
 
v. Racing heartbeat
vi. Edginess and agitation
vii. Aches and pains
viii. Muscle tension
Healing from Injury
Injury side effects regularly last from a couple of days
to a couple of months, bit by bit blurring as you process the
disrupting occasion [14]. Yet, notwithstanding when you’re
       
example, a commemoration of the occasion or something that
helps you to remember the injury. On the off chance that your
         
           
you can’t proceed onward from the occasion for a drawn out
timeframe, you might encounter Post-Traumatic Stress Disorder
(PTSD). While passionate injury is an ordinary reaction to an
irritating occasion, it progresses toward becoming PTSD when
your sensory system gets “stuck” [15] and you stay in mental
        
Regardless of whether a horrible accident includes passing,
you as a survivor must adapt to the misfortune, in any event
incidentally, of your feeling of wellbeing. The regular response
to this misfortune is sadness. Like individuals who have lost a
friend or family member, you have to experience a lamenting
procedure. The accompanying tips can enable you to adapt to
the feeling of despondency, mend from the injury, and proceed
Injury Recuperation tip 1: Get Moving
Injury upsets your body’s normal harmony, solidifying you
in a condition of hyper arousal and dread. And additionally
consuming off adrenaline and discharging endorphins, exercise
and development can really help repair your sensory system.
Endeavour to practice for 30 minutes or more on generally days.
Or on the other hand if it’s less demanding, three 10-minute
spurts of activity every day are similarly as great. Exercise
that is musical and draws in both your arms and legs, for
example, strolling, running, swimming, ball, or notwithstanding
       
than concentrating on your considerations or diverting yourself
while you work out, truly center around your body and how it
feels as you move. Notice the vibe of your feet hitting the ground,
for instance, or the mood of your breathing, or the sentiment of
twist on your skin. Shake climbing, boxing, weight preparing, or
considered, you have to center around your body developments
Tip 2: Don’t Seclude
Following an injury, you might need to pull back from others,
yet seclusion just exacerbates the situation. Associating with
others eye to eye will enable you to recuperate, so endeavor to
keep up your connections and abstain from investing excessively
energy alone. You don’t need to discuss the injury. Associating
with others doesn’t need to mean discussing the injury. Truth be
told, for a few people, that can simply compound the situation.
Solace originates from feeling drew in and acknowledged by
others [18]. Request bolsters. While you don’t need to discuss
Current Trends in Biomedical Engineering & Biosciences
How to cite this article: Susheelkumar V R, Chetan S P, Suvarna C P. Ways to Overcome Emotional and Psychological Trauma in a Day Today Life. Curr
Trends Biomedical Eng & Biosci. 2018; 17(1): 555955. DOI: 10.19080/CTBEB.2018.17.555955.
the injury itself, it is vital you have somebody to impart your
sentiments to up close and personal, somebody who will listen
in relative, companion, advocate, or priest. Take part in social
exercises, regardless of whether you don’t feel like it. Do “typical”
things with other individuals, things that have nothing to do with
the horrendous experience. Reconnect with old companions. In
the event that you’ve withdrawn from connections that were
once essential to you, try to reconnect. Join a care group for
injury survivors. Being with other people who are confronting
hearing how others adapt can help motivate you in your own
Volunteer. And in addition helping other people, volunteering
can be an incredible method to challenge the feeling of
powerlessness that frequently goes with injury. Help yourself to
remember your qualities and recover your feeling of intensity by
helping other people [19]. Make new companions. In the event
that you live alone or a long way from family and companions, it’s
vital to connect and make new companions. Take a class or join
a club to meet individuals with comparative interests, interface
work partners.
In the Event that Associating with Others is
Numerous individuals who have encountered injury feel
detached, pulled back and think that it’s hard to associate with
other individuals [20]. In the event that that portrays you, there
are a few things you can do before you next take a seat with a
Exercise or Move
Bounce all over, swing your arms and legs, or simply
thrash around. Your head will feel clearer and you’ll see it less
demanding to interface.
Vocal Conditioning
As peculiar as it sounds, vocal conditioning is an incredible
method to open up to social commitment. Sit straight and just
make “mmmm” sounds. Change the pitch and volume until the
point when you encounter a lovely vibration in your face.
Tip 3: Self-Direct your Sensory System
that you can change your excitement framework and quiet
yourself. Not exclusively will it help calm the uneasiness related
with injury, however it will likewise induce a more prominent
feeling of control.
Careful Relaxing
On the off chance that you are feeling perplexed, befuddled,
or disturb, a fast method to quiet yourself is through careful
Tactile Information
  
to feel quiet? Or on the other hand possibly petting a creature or
tuning in to music attempts to rapidly alleviate you? Everybody
reacts to tangible information a little in an unexpected way, so
explore different avenues regarding diverse snappy pressure
help strategies to discover what works best for you [21].
Staying Grounded
To feel in the present and more grounded, sit on a seat. Feel
your feet on the ground and your back against the seat. Check
out you and pick six questions that have red or blue in them.
Notice how your breathing gets further and quieter [22,23].
your emotions about the injury as they emerge and acknowledge
Tip 4: Take Care of your Wellbeing
It’s Actual
Having a solid body can expand your capacity to adapt to the
worry of injury.
Get a lot of Rest
After an awful ordeal, stress or dread may aggravate your
rest designs. Be that as it may, an absence of value sleep can
intensify your injury indications and make it harder to keep up
your passionate adjust [22]. Rest and get up in the meantime
every day and go for 7 to 9 long periods of rest every night.
Keep away from Liquor and Medications
       
and increment sentiments of despondency, uneasiness, and
Eat an all-around Adjusted Eating Regimen
Eating little, all around adjusted suppers for the duration of
the day will enable you to keep your vitality up and limit mind-
set swings. Evade sugary and browned nourishments and eat a
lot of omega-3 fats, for example, salmon, walnuts, soybeans, and
Diminish Pressure
Attempt unwinding systems, for example, contemplation,
yoga, or profound breathing activities. Timetable time for
exercises that bring you euphoria, for example, most loved
At the Point when to Look for Procient Treatment
for Injury
Recuperating from injury requires some serious energy, and
everybody mends at their own pace. In any case, if months have
passed and your side effects aren’t easing up, you may require
Current Trends in Biomedical Engineering & Biosciences
How to cite this article: Susheelkumar V R, Chetan S P, Suvarna C P. Ways to Overcome Emotional and Psychological Trauma in a Day Today Life. Curr
Trends Biomedical Eng & Biosci. 2018; 17(1): 555955. DOI: 10.19080/CTBEB.2018.17.555955.
Seek help for trauma if you’re:
i. Having trouble functioning at home or work.
ii. Suffering from severe fear, anxiety, or depression.
iii. Unable to form close, satisfying relationships.
iv. Experiencing terrifying memories, nightmares, or
v. Avoiding more and more things that remind you of the
vi. Emotionally numb and disconnected from others.
vii. Using alcohol or drugs to feel better.
Working through injury can be alarming, excruciating, and
conceivably re-damaging, so this recuperating work is best
        
Finding the correct advisor may take some time. It’s vital that the
specialist you pick has encounter treating injury. In any case, the
nature of the association with your advisor is similarly critical.
Pick an injury expert you feel good with. In the event that you
don’t feel protected, regarded, or comprehended, discover
another specialist.
Ask Yourself
i. Did you feel great talking about your issues with the
ii. Did you feel like the advisor comprehended what you
were discussing?
iii. Were your worries considered important or would
they say they were limited or rejected?
iv. Were you treated with empathy and regard?
         
Treatment for Injury
So as to recuperate from mental and passionate injury, you’ll
have to determine the unpalatable sentiments and recollections
you’ve since quite a while ago maintained a strategic distance
to manage compelling feelings, and reconstruct your capacity
range of treatment approaches in your treatment [23].
Physical encountering centres around substantial sensations,
as opposed to musings and recollections about the horrible
accident. By focusing on what’s going on in your body, you can
discharge repressed injury related vitality through shaking,
crying, and different types of physical discharge. Psychological
conduct treatment encourages you process and assess your
musings and sentiments about an injury. EMDR (Eye Movement
     
subjective social treatment with eye developments or different
       
awful recollections.
Helping a Friend or Family Member Manage Injury
At the point when a friend or family member has endured
injury, your help can be a critical factor in their recuperation.
Be patient and comprehension. Mending from injury requires
       
recuperation and recall that everybody’s reaction to injury is
extraordinary. Try not to judge your cherished one’s response
against your own particular reaction or anybody else’s. Offer
functional help to enable your cherished one to get over into
a typical schedule. That may mean help with gathering staple
goods or housework, for instance, or basically being accessible
to talk or tune in.
Try not to weight your adored one into talking yet be
accessible on the off chance that they need to talk. Some injury
survivors think that its hard to discuss what happened. Try not
to compel your adored one to open up yet let them know you
are there to tune in on the off chance that they need to talk, or
accessible to simply hang out in the event that they don’t. Help
your adored one to mingle and unwind. Urge them to take part
in physical exercise, search out companions, and seek after side
interests and different exercises that bring them delight. Take
a wellness class together or set a general get-together with
companions. Try not to think about the injury manifestations
literally. Your cherished one may end up furious, fractious,
pulled back, or sincerely inaccessible. Keep in mind this is a
consequence of the injury and might not have anything to do
with you or your relationship.
Helping Children Cope with Trauma
To enable a youngster to recoup from injury, it’s vital to
impart transparently. Tell them that it’s typical to feel frightened
or irritate. Your youngster may likewise seek you for signs on
how they should react to injury so give them a chance to see you
managing side effects emphatically.
How Kids Respond to Passionate and Mental Injury
Some basic responses to injury and approaches to enable
your youngster to manage them:
i. Regression. Numerous kids need to come back to a
before arranging when they felt more secure. More youthful
kids may wet the bed or need a jug; more established
youngsters may fear being distant from everyone else. It’s
essential to comprehend, tolerant and consoling if your
youngster reacts along these lines.
ii. Thinking the occasion is their blame. Youngsters more
youthful than 8 tend to feel that if something turns out
badly, it must be their blame. Make certain your youngster
comprehends that he or she didn’t cause the occasion.
iii. Sleep issue. A few kids experience issues tumbling to
rest; others wake every now and again or have disturbing
Current Trends in Biomedical Engineering & Biosciences
How to cite this article: Susheelkumar V R, Chetan S P, Suvarna C P. Ways to Overcome Emotional and Psychological Trauma in a Day Today Life. Curr
Trends Biomedical Eng & Biosci. 2018; 17(1): 555955. DOI: 10.19080/CTBEB.2018.17.555955.
dreams. Give your kid a squishy toy, delicate cover, or
spotlight to take to bed. Take a stab at getting to know one
another at night, doing calm exercises or perusing. Be quiet.
It might take a while before your kid can stay asleep from
sundown to sunset once more.
iv. Feeling powerless. Being dynamic in a battle to keep
an occasion from happening once more, written work thank
you letters to individuals who have aided and looking after
others can bring a feeling of expectation and control to
everybody in the family.
1. American Psychiatric Association (2004) Practice Guideline for the
Treatment of Patients with Acute Stress Disorder and Post-Traumatic
Stress Disorder American Psychiatric Association, 2004.
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In the wake of the terrorist attacks at the World Trade Center, more than 9,000 counselors went to New York City to offer aid to rescue workers, families, and direct victims of the violence of September 11, 2001. These mental health professionals assumed that many New Yorkers were at high risk for developing posttraumatic stress disorder (PTSD), and they hoped that their interventions would mitigate psychological distress and prevent the emergence of this syndrome. Typically developing in response to horrific, life-threatening events, such as combat, rape, and earthquakes, PTSD is characterized by reexperiencing symptoms (e.g., intrusive recollections of the trauma, nightmares), emotional numbing and avoidance of reminders of the trauma, and hyperarousal (e.g., exaggerated startle, difficulty sleeping). People vary widely in their vulnerability for developing PTSD in the wake of trauma. For example, higher cognitive ability and strong social support buffer people against PTSD, whereas a family or personal history of emotional disorder heightens risk, as does negative appraisal of one's stress reactions (e.g., as a sign of personal weakness) and dissociation during the trauma (e.g., feeling unreal or experiencing time slowing down). However, the vast majority of trauma survivors recover from initial posttrauma reactions without professional help. Accordingly, the efficacy of interventions designed to mitigate acute distress and prevent long-term psychopathology, such as PTSD, needs to be evaluated against the effects of natural recovery. The need for controlled evaluations of early interventions has only recently been widely acknowledged. Psychological debriefing—the most widely used method—has undergone increasing empirical scrutiny, and the results have been disappointing. Although the majority of debriefed survivors describe the experience as helpful, there is no convincing evidence that debriefing reduces the incidence of PTSD, and some controlled studies suggest that it may impede natural recovery from trauma. Most studies show that individuals who receive debriefing fare no better than those who do not receive debriefing. Methodological limitations have complicated interpretation of the data, and an intense controversy has developed regarding how best to help people in the immediate wake of trauma. Recent published recommendations suggest that individuals providing crisis intervention in the immediate aftermath of the event should carefully assess trauma survivors' needs and offer support as necessary, without forcing survivors to disclose their personal thoughts and feelings about the event. Providing information about the trauma and its consequences is also important. However, research evaluating the efficacy of such “psychological first aid” is needed. Some researchers have developed early interventions to treat individuals who are already showing marked stress symptoms, and have tested methods of identifying those at risk for chronic PTSD. The single most important indicator of subsequent risk for chronic PTSD appears to be the severity or number of posttrauma symptoms from about 1 to 2 weeks after the event onward (provided that the event is over and that there is no ongoing threat). Cognitive-behavioral treatments differ from crisis intervention (e.g., debriefing) in that they are delivered weeks or months after the trauma, and therefore constitute a form of psychotherapy, not immediate emotional first aid. Several controlled trials suggest that certain cognitive-behavioral therapy methods may reduce the incidence of PTSD among people exposed to traumatic events. These methods are more effective than either supportive counseling or no intervention. In this monograph, we review risk factors for PTSD, research on psychological debriefing, recent recommendations for crisis intervention and the identification of individuals at risk of chronic PTSD, and research on early interventions based on cognitive-behavioral therapy. We close by placing the controversy regarding early aid for trauma survivors in its social, political, and economic context.
There are notable challenges in translating empirically supported psychosocial treatments (ESTs) into general routine clinical practice. However, there may be additional unique dissemination and implementation obstacles for ESTs for trauma-related disorders. For example, despite considerable evidence from randomized clinical trials that attests to the efficacy of exposure therapy for posttraumatic stress disorder, front-line clinicians in real-world settings rarely use this treatment. Perceived and actual barriers that interfere with adoption include clinician misconceptions about what exposure entails and complex cases to which ESTs may not be readily applicable. Specific suggestions for bridging the science-into-service gap in trauma ESTs (in general) and in exposure therapy (in particular) are proposed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Background: Psychological interventions are widely used in the treatment of post-traumatic stress disorder (PTSD). Objectives: To perform a systematic review of randomised controlled trials of all psychological treatments except eye movement desensitisation and reprocessing following the guidelines of the Cochrane Collaboration. Search strategy: Systematic searches of computerised databases, hand search of the Journal of Traumatic Stress, searches of reference lists, known websites and discussion fora, and personal communication with key workers. Selection criteria: Types of studies - Any randomised controlled trial of a psychological treatment. Types of participants - Adults suffering from traumatic stress symptoms for three months or more. Types of interventions - Trauma-focused cognitive behavioural therapy/exposure therapy (TFCBT); stress management (SM); other therapies (supportive therapy, non-directive counselling, psychodynamic therapy and hypnotherapy); group cognitive behavioural therapy (group CBT). Types of outcomes - Severity of clinician rated traumatic stress symptoms. Secondary measures included self-reported traumatic stress symptoms, depressive symptoms, anxiety symptoms, adverse effects and dropouts. Data collection and analysis: Data was entered using the Review Management software. Quality assessments were performed. The data were analysed for summary effects using the RevMan 4.2 programme. Main results: Twenty-nine studies were included in the review. With regards to reduction of clinician assessed PTSD symptoms TFCBT did significantly better than waitlist/usual care (standardised mean difference (SMD) = -1.36; 95% CI, -1.88 to -0.84; 13 studies; n = 609). There was no significant difference between TFCBT and SM (SMD = -0.27; 95% CI, -0.71 to 0.16; 6 studies; n = 239). TFCBT did significantly better than other therapies (SMD = -0.81; 95% CI, -1.19 to -0.42; 3 studies; n = 120). Stress management did significantly better than waitlist/usual care (SMD = -1.14; 95% CI, -1.62 to -0.67; 3 studies; n = 86) and than other therapies (SMD = -1.22; 95% CI, -2.09 to -0.35; 1 study; n = 25). There was no significant difference between other therapies and waitlist/usual care control (SMD = -0.43; 95% CI, -0.90 to 0.04; 2 studies; n = 72). Group TFCBT was significantly better than waitlist/usual care (SMD = -0.72; 95% CI, -1.14 to -0.31). Authors' conclusions: There was evidence that individual TFCBT, stress management and group TFCBT are effective in the treatment of PTSD. Other non-trauma focused psychological treatments did not reduce PTSD symptoms as significantly. There was some evidence that individual TFCBT is superior to stress management in the treatment of PTSD at between 2 and 5 months following treatment, and also that TFCBT was also more effective than other therapies. There was insufficient evidence to determine whether psychological treatment is harmful. There was some evidence of greater drop-out in active treatment groups.
Unanswered questions from controlled studies of posttraumatic stress disorder concern the value of cognitive restructuring alone without prolonged exposure therapy and whether its combination with prolonged exposure is enhancing. In a controlled study, 87 patients with posttraumatic stress disorder of at least 6 months' duration were randomly assigned to have 10 sessions of 1 of 4 treatments: prolonged exposure (imaginal and live) alone; cognitive restructuring alone; combined prolonged exposure and cognitive restructuring; or relaxation without prolonged exposure or cognitive restructuring. Integrity of audiotaped treatment sessions was satisfactory when rated by an assessor unaware of the treatment assignment. Seventy-seven patients completed treatment. The pattern of results was similar regardless of rater, statistical method, measure, occasion, and therapist. Exposure and cognitive restructuring, singly or combined, improved posttraumatic stress disorder markedly on a broad front. Gains continued to 6-month follow-up and were significantly greater than the moderate improvement from relaxation. Both prolonged exposure and cognitive restructuring were each therapeutic on their own, were not mutually enhancing when combined, and were each superior to relaxation.
The majority of persons exposed to a disaster do well and have only mild, transitory symptoms. However, some individuals develop psychiatric illness postdisaster. Such illnesses include those that are secondary to physical injury and sickenss as well as specific trauma-related psychiatric disorders such as acute stress disorder. The extent of the psychiatric morbidity and mortality that develops in individuals in the community depends on the type of disaster, the degree of injury sustained, the amount of life threat, and the duration of community disruption. In this paper we examine the posttraumatic responses of direct concern to psychiatrists working in a community exposed to a disaster. We review the epidemiology of posttraumatic responses, the interface of psychiatry and traumatic stress, the psychiatric disorders associated with trauma, and psychiatric consultation to the disaster community. Overall, psychiatric intervention after a disaster is based on the principles of preventive medicine and includes community consultation and outreach programs with the goals of identifying high-risk groups, promoting community recovery, and minimizing social disruption.
Sleep disturbances in traumatized patients are complex behavioral events. In many cases, the subjective reports are out of proportion to the frequency and severity of objective sleep-laboratory findings, and patients are generally unaware of the true nature of their sleep disturbances. In contradistinction to the hypothesis that patients with PTSD must sleep lightly, which is derived from the diagnostic criterion of hyperarousal, patients with PTSD appear to have deeper sleep and lower rates of dream recall than normal persons, even after planned awakenings from REM sleep. Sleep disturbances in traumatized patients should be treated as an independent clinical entity, and both behavioral and pharmacologic therapies can be beneficial.
Preclinical considerations suggest that treatment with a beta-adrenergic blocker following an acute psychologically traumatic event may reduce subsequent posttraumatic stress disorder (PTSD) symptoms. This pilot study addressed this hypothesis. Patients were randomized to begin, within 6 hours of the event, a 10-day course of double-blind propranolol (n = 18) versus placebo (n = 23) 40 mg four times daily. The mean (SD) 1-month Clinician-Administered PTSD Scale (CAPS) score of 11 propranolol completers was 27.6 (15.7), with one outlier 5.2 SDs above the others' mean, and of 20 placebo completers, 35.5 (21.5), t = 1.1, df = 29, p =.15. Two propranolol patients' scores fell above, and nine below, the placebo group's median, p =.03 (sign test). Zero of eight propranolol, but six of 14 placebo, patients were physiologic responders during script-driven imagery of the traumatic event when tested 3 months afterward, p =.04 (all p values one-tailed). These pilot results suggest that acute, posttrauma propranolol may have a preventive effect on subsequent PTSD.
Psychological interventions after traumatic events have only recently been evaluated in randomized, controlled trials. Recent systematic reviews concluded that single sessions of individual psychological debriefing are not effective in reducing distress or subsequent posttraumatic stress disorder (PTSD) symptoms. The present article reviews trials of early cognitive behavior therapy (CBT) after trauma. Cognitive behavioral therapy was more effective than supportive counseling in preventing chronicity of PTSD symptoms; however, in most available studies it remained unclear whether supportive counseling facilitated or retarded recovery, compared with no intervention. A brief CBT program given in the first month of trauma was not superior to repeated assessment; however, a course of CBT of up to 16 sessions given at 1-4 months after trauma was superior to self-help, repeated assessment, and no intervention. Possible reasons for the difference in efficacy between CBT and debriefing or self-help are discussed. These include the way of working through traumatic memories and the impact of the interventions on patients' interpretations of their PTSD symptoms. Possible ways of identifying people who are in need of specialist psychological intervention after trauma and who are unlikely to recover on their own are discussed. Some ideas for alternative ways of offering help to trauma survivors are presented, and methodologic suggestions for future research are given.