(p. 118) For Families and Loved Ones: What Is PTSD and How Is It Treated?
Your loved one is about to begin a treatment program for individuals diagnosed with both post-traumatic stress disorder (PTSD) and a substance use disorder (SUD). As you are a family member or the significant other of someone who is experiencing PTSD, we would like to give you some information about the disorder so that you may help your loved one’s recovery. We also realize that when something bad happens to someone you care about, you suffer too. Included in these handouts is information on how you can take care of yourself, so that you will be most able to help your loved one through this process. Therapy can be challenging at times, and you are in a prime position to help serve as a coach or cheerleader for your loved one.
PTSD and its Symptoms
PTSD refers to a set of symptoms that can occur after experiencing a traumatic event. The main symptoms of PTSD include:
■ Re-experiencing the event. This can take the form of unwanted memories, dreams, nightmares, or flashbacks. It also involves becoming upset when reminded of the traumatic event.
■ Avoiding reminders of the trauma. This can include avoiding thoughts, feelings, places, people, situations, or events that are reminders of the traumatic event. It can also include problems such as loss of interest in activities that used to be enjoyed, not feeling close to others, and having difficulty experiencing emotions (i.e., feeling numb inside).
■ Increased anxiety. This can cause sleep problems, difficulty concentrating, irritability, anger, feeling on edge, feeling as if danger is all around, and becoming easily startled.
Unfortunately, traumatic events are common. Events that can cause traumatic stress vary and include things such as house fires, combat exposure, physical and sexual assault, serious car accidents, or natural disasters (e.g., hurricanes, earthquakes). A person does not necessarily need to experience an event directly to have symptoms of PTSD. Witnessing an accident, a shooting, the death of another soldier, or domestic violence can cause feelings of fear, horror, and helplessness and can lead to PTSD as well.
It is helpful for significant others and loved ones to remember that most people who experience a major trauma will have symptoms of PTSD immediately afterward. Some people will feel much (p. 119) better within a few months after the event; others recover more slowly, and some do not recover well enough without seeking the help of a professional. When problems last longer than a month, or when they interfere significantly with everyday life, treatment for PTSD may be helpful.
Treatment for PTSD
The best therapy available for helping people recover from PTSD is a cognitive behavioral therapy (CBT) program that is called prolonged exposure (PE). PE focuses on reducing the fear and other emotion related to the trauma and getting back into activities that people have given up due to fear or loss of interest after the trauma. There are two main parts of this type of treatment.
The first part is called in vivo exposure during which your loved one systematically confronts safe situations in “real life” that are avoided because they remind him or her of the event and therefore cause significant distress or anxiety. The second part is called imaginal exposure, followed by processing. In this activity, your loved one will revisit the memory of the traumatic event in the therapy session and then will discuss his experience during the revisiting with his therapist.
As we said earlier, many people who have experienced a trauma try to avoid thoughts and feelings associated with that event. They also avoid situations, places, and activities that remind them of the trauma. However, while avoiding these things can make your loved one feel more comfortable in the short run, it actually makes the problem worse in the long run and serves to maintain the PTSD, because it stops him or her from overcoming these PTSD symptoms. The in vivo and imaginal exposures and the processing work by helping your loved one approach and confront her own fears in a safe and systematic way. The goal of this treatment is not for your loved one to forget about what happened, but rather for him to be able to remember the trauma without it causing so much distress and interfering with his, and your, life.
When individuals with PTSD confront the distressing memories and situations in an orderly way under safe circumstances, several things happen. First, going over the memory helps them to make sense of what happened. Sometimes this is necessary before a person can really move on. Second, they learn that thinking about what happened and feeling upset or anxious are not dangerous. They can handle the distressing feelings, and these feelings do diminish in time. The anxiety does not last forever, and your loved one does not need to use substances to help get rid of the anxiety or distressing feelings. In fact, alcohol and drug use only make the symptoms worse in the long run and prevents recovery from PTSD. Third, by realizing that thinking about something is not harmful, they become less distressed by other situations that remind them of the trauma. This means that they become less restricted in their life, and less likely to avoid certain places, situations, thoughts, and so on. Finally, they learn that the more they think, talk about, and experience memories or situations that were avoided, their fear and distress gradually decrease. In other words, they again become comfortable in these situations. Thinking and talking about (p. 120) the memories of a traumatic event will allow your loved one to remember the trauma with less distress, and he or she will learn that the memories are not dangerous. Remembering the painful memories in a safe space with a therapist also allows him or her to gain control over the memories, and these memories become less likely to pop up when she or he doesn’t want them to. All of these help individuals with PTSD to feel better about themselves and more in control of their lives.
After a trauma, people’s beliefs about themselves and about the world may change. They may see situations as dangerous, whereas before the trauma the situations would not have bothered them at all. Their attitude may become more negative than it used to be, or their self-image may get worse. These are all considered trauma-related changes in thinking. How people think about themselves, the world, and other people affects how they feel. That is why it is useful to pay attention to how the traumatic experience has changed your loved one’s thoughts and beliefs. As your loved one goes through the therapy program, we will discuss these changes. We will explore these changes in thinking and will help your loved one to regain the more realistic beliefs that he or she had before the trauma.
Confronting memories through in vivo and imaginal exposures may seem difficult at first, and some significant others may worry that it will be too difficult for their loved one. While you may find that this treatment is challenging for you and your loved one, it should help him or her to feel better about him- or herself and about what happened.