‘Shell shock’ was a common diagnosis for soldiers in the first world war, and sadly many of those suffering from it, who refused to return to ‘the front’, were shot for cowardice. A lot of what was described as ‘shell shock’ then was probably post traumatic stress disorder, or PTSD, which has most recently come to public awareness as an anxiety-based psychological problem faced by military personnel involved in the recent conflicts in the middle east. However as a psychological issue PTSD is not confined to the military. There are traumas in civilian life as well which result in such anxiety, such as observing a serious road accident, being involved in a natural disaster, suffering a violent or sexual assault, or even being held hostage.
What is PTSD?
PTSD only became internationally recognised as a condition in the 1980’s when it was included in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). A person suffering from PTSD will always have been involved in a distressing event. When they remember the event they can become overwhelmed with a replication of the feelings that they had when the event happened. This is because (although not thoroughly understood), the memory and feelings are stored deep within their memory. A single stimulus such as smell, sound sight thought or even remark may reawaken this deep-seated memory and make the person as distressed psychologically, and sometimes physically, as they were when the event happened.
In many cases, as the person distances her or himself from the event, they will naturally avoid such stimuli in order to avoid those feelings. Unfortunately we do not have control of all the stimuli around us and sufferers from PTSD can be caught unaware by any one of a host of sensory experience, and become very distressed with all the memories flooding back in an instant. Such distress may have a range of outcomes from uncontrollable tears to anger and rage at those around them. At its worst, untreated PTSD has led to family relationship breakdown, drug misuse, alcoholism and in the worst cases, suicide and murder.
What are the symptoms of PTSD?
PTSD can be a severe condition that seriously affects a people’s daily lives. Sufferers may vividly re-experience their trauma in the form of flash-backs of memory and often in nightmares. Some of these re-experiences even being physically exhibited as sweating and trembling, or exceptionally physical pain. Common symptoms are often of guilt or shame when remembering the event. The sufferer questioning whether they could have prevented it or if they were responsible for it.
Frequently, sufferers will avoid thinking about the event, or going near places or things associated with it. They may become fixated/driven on work or a hobby to push the memories from their conscious mind. Perversely they may also lose total interest in anything they have been involved with, aiming to remove all stimuli and thus the risk of the distress returning.
Many sufferers have a lack of concentration and can feel physically drained after an intellectual or physical task. Some sufferers feel ‘on edge’ all the time, this is referred to as hyperarousal. They cannot relax and often suffer with depression and phobias.
Often sufferers will try to numb themselves to the feelings they derive from their distress. Sometimes sufferers will use prescription or illicit drugs, although most frequently, because of its accessibility, they will use alcohol.
What is EMDR and how can it help with PTSD?
There are a range of treatments and therapies for PTSD recommended by the UK National Institute for Health and Care Excellence (NICE). These fall into three categories:
- Watchful waiting – where the clinician will observe for any deterioration in the sufferers’ mood or behaviour. Like many depressive illnesses, the PTSD suffer may recover without any medical or psychological intervention. However, if they are regularly subjected to the stimuli that induce the feelings of distress, their support may need to be escalated.
- Medication, normally using anti-depressants. However because these are often numbing the feelings, they may have to be delivered over a long term with subsequent health and social implications.
- Psychological treatments/therapies. There are two principal treatments but they can be combined and used in conjunction with medication:
- Trauma-focused cognitive behavioural therapy (CBT), which is a talking therapy exploring the source of the feelings and helping the suffer to recognise and deal with them, and
- Eye Movement Desensitisation and Reprocessing (EMDR)
EMDR is a psychological treatment developed in the US in the 1980’s. It is a very powerful therapy which has been likened to the rapid eye movement (REM) sleep that people gain when they are deeply asleep. The client, in a safe and controlled environment, is given alternating left and right stimulation to the brain using lights, in conjunction with a series of sounds. The belief is that the stimulus produced by the combination of the lights and sounds ‘releases’ the memories that have been deeply stored in the brain into the conscious levels allowing them to potentially dissipate, like the daily memories that are dealt with in REM sleep i.e. our dreams.
There is significant evidence that EMDR considerably reduces the distress felt by people when they encounter the stimuli that used to cause them problems after the period of treatment. The period of treatment however cannot be determined at the outset. Because the traumas are often so intense, and frequently they are historic, whether by months, or often years, it may be that the suffer will need first an intensive period of EMDR, and then a regular ‘top up’ for a significant period of time. As the real case below suggests (The name has been changed) , it can be a very effective treatment :
June was 43, and a pillar of her local church community who had been brought up to respect the police, when she was arrested and kept overnight in a cell in a case of mistaken identity. June found herself put into a police van, taken to her local station with a cell, bodily searched, asked to give up her jewellery including her watch and wedding ring. She protested but was taken to a cell and kept overnight and released the following morning without charge. During the night she was kept awake a man in the next cell crying like a baby, begging for his medication -and the shouts of the (female ) custody sergeant replying in horrible terms, insulting him.
When released, June felt OK and glad to be free. A few days later however, she began to suffer flashbacks. The aggression of the police, the van, the red door without a handle on the inside, jumbled all together as flashes, controlled her thinking. Then it got worse. Each time the door-bell rang, she began hiding in cupboards, and running away to hide fearing the police had returned to arrest her again. She stopped driving and she couldn’t go to town because she had to pass the police station and worst of all she began to be more and more tearful. Eventually, she was diagnosed with PTSD.
A friend recommended and EMDR practitioner. At her first session after consultation, she was asked to sit in front of a black box with a double row of LED lights across the middle. She was then asked to hold soft weights, one in each hand which had shaking sensors left and right which matched the flashing movement of the lights as they too moved across the black screen. She thought about each trauma in turn while focussing on the lights. As she remembered each indignity and fear, the lights seem to make the immediacy of the events fade and in an experience that she described as like folding a piece of origami paper, each memory changed and lost its power to hurt her.
While everyone is different, June only needed four sessions to feel in control of her life again and so far, two years later, she has maintained emotional health.
Independent academic reviews of the treatment in comparison with other similar treatments, shows that EMDR is at least as effective as the best and much better than most.. The British institute for clinical excellence (NICE – UK) has recommended its use for the treatment of PTSD. It is relatively cheap, brief and effective.
It is important to add that whilst EMDR is highly effective, it is not a cure. The trauma remains, but if EMDR has been effective the person with the traumatic experience can manage the feelings and distress it generates and get on with their life.
- Lee, Christopher et al: Treatment of PTSD: Stress inoculation training with prolonged exposure compared to EMDR in Journal of Clinical Psychology Volume 58, Issue 9, pages 1071–1089, September 2002