PTSD Symptoms and Their Function

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PTSD and Functionality of Symptoms
#PTSD #trauma #counselingskills

Purpose
~ By understanding the function of symptoms we can
~ Normalize the behavior
~ Identify alternate ways to meet that same need or address the issue
~ Re-Experiencing
~ Trying to replay it to figure out how to integrate into your schema (like fitting a puzzle piece)
~ Reminding the person of similar situations to “protect” them
~ Avoidance
~ The system is already over taxed. Avoiding upsetting stimuli by blocking out most stimuli, memories of the event.
~ Avoiding unnecessary use of energy by not getting “excited.”
~ Changes in Beliefs
~ Protects against future “surprises”
~ Tries to assimilate the experience into schema
~ Increased Arousal
~ Protects the individual

Re-Experiencing
~ You re-experience things every day
~ Access schema that guide your actions
~ When you go to work
~ When you encounter a particularly volatile client
~ When you approach a stop light
~ Re-Experiencing in PTSD
~ The context is often overgeneralized
~ The precipitating factors are often unknown
~ In many cases the resolution was not one of empowerment, resulting in trying to continually figure out how to not be disempowered


Hypocortisolism
~ Cortisol is the stress chemical
~ After extreme stress and/or under chronic stress the brain may reduce the responsiveness of the stress response system by reducing the cortisol
~ This is protective, it keeps the organism from using precious resources by getting “excited” about anything (including pleasure)
~ Due to fear conditioning, when a stressor is detected, the stress response is exaggerated.
Changes in Beliefs
~ Purpose: The need for order and meaning (Regaining control, Ability to predict)
~ Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world
~ “I am bad”
~ “No one can be trusted”
~ "The world is completely dangerous"
~ Persistent, distorted blame of self or others about the cause or consequences of the traumatic events


Changes in Beliefs

Beliefs Interventions
~ After a trauma people’s lives are changed forever.
~ It is often necessary to grieve the loss not only of tangible things like property, but also existential things like belief in a just world and the goodness of people.
~ Identifying the threats and associated thoughts the person had/is having
~ Addressing cognitive distortions using Cognitive Processing Therapy

CPT Challenging Questions

Increased Arousal
~ Irritable or aggressive behavior
~ Anger/threat reaction to continue to self-protect
~ Interventions:
~ Help the person identify and address triggers
~ Develop skills to address emotional and behavioral dysregulation (STOP Stop Think Observe Participate)
~ Reckless or self-destructive behavior
~ Stop the pain (I don’t care if I die, because…)
~ Distract (Numb through thrill)
~ Regain control (Lightening doesn’t strike twice)

Final Thoughts
~ Tormenting thoughts and feelings and attempts to stop or avoid those thoughts and feelings are central to PTSD
Summary
~ Increased Arousal
~ The traumatic threat was unpredictable, ergo future events are unpredictable.
~ Increased arousal keeps people alert to potential threats.
~ Using CPT Challenging Questions help the client examine his/her beliefs about the event and his/her current safety
~ Avoidance and numbing helps the person survive since nobody can be “alert” and agonizing for that long
~ Helping the person understand that during a traumatic event, certain chemicals in the body prevent effective memory formation. This is protective.
~ Numbing helps preserve precious energy.
~ Changes in beliefs
~ Keeps the person from being vulnerable again
~ Helps the person try to make sense of it.
~ Re-Experiencing
~ Like trying to fit a puzzle piece, the brain is trying to make sense of how this fits into current schema
~ The brain may have to develop new schema based on likely faulty memories from the trauma, so many stimuli are overgeneralized and cause “triggers” for anxiety to be everywhere.


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