Inside the world of post-traumatic stress disorder

Jeff, a 42-year-old attorney, married for 12 years and father of three, has always considered himself a very emotionally balanced individual. About six months ago, Jeff drove home from work late in the evening and a dog cut across the highway right in front of his car. He swerved to avoid hitting the animal but lost control of his car and drove off the road, rolling over before slamming into an embankment. His airbags inflated, which probably saved his life, but one bag covered his face and he felt like he was suffocating. An ambulance came and took him to a nearby hospital. He was X-rayed and examined and, fortunately, did not suffer from any serious injuries. As the days went by, Jeff found it hard to fall asleep. Each night, his mind would race with repeated visualizations of his car rolling over and the airbag suffocating him, which made him feel panicky. His feelings vacillated between severe anxiety and complete numbness. He was afraid to drive to work, and relied on his wife to take him. Both his wife and his law partners were very concerned about the way Jeff was behaving and feeling. His wife insisted that he get professional help after he became very short-tempered with her and the kids, something that was not characteristic of him. During our first session, it was quite clear that Jeff was suffering from the psychological aftereffects of the car accident. Psychologists call this post-traumatic stress disorder, also called PTSD. PTSD is a mental health condition triggered by a terrifying event that overwhelms the individual's normal coping devices. Examples of traumatic events include violent crime, personal assault, rape, natural or unnatural disasters, military combat and acts of terrorism. Jeff had many of the classic symptoms of PTSD described in the literature. (1) Re-experiencing symptoms: Jeff kept on re-experiencing his car accident in bad dreams and flashbacks, which made his heart feel like it was racing and his breathing became very heavy. It did not take much to trigger him into panic. Even getting into his wife's car made him feel very worried and scared that he would be in another accident. (2) Avoidance behavior: Jeff avoided driving his car and was even reluctant to let his wife drive him to work. He told me that he had trouble remembering the details of the accident itself and he felt emotionally numb, both strong indicators of his wish to avoid the memories of his car accident. He also found himself losing interest in many things that he normally found pleasurable, like his weekly tennis game, which he canceled. (3) Hyper-arousal symptoms: Jeff stated that he was easily startled and more on edge then he had ever felt. This type of startle response happened when his wife would drive him to work. If she came too close to the car in front of her, he would have an outburst of anger. This too was classic in PTSD individuals who tend to show hypervigilance and are on the lookout for dangers that are reminders of the original traumatic event. He started to scream at his wife over small things that she was doing while driving. He had no awareness that this behavior was related to PTSD. He also suffered from difficulties falling asleep, another symptom of hyper-arousal. Not all cases of trauma produce PTSD. Experts note that in many cases trauma symptoms disappear gradually over a short period of time. Only when these symptoms stay around for longer than a month and continue to cause havoc in a person's life is a diagnosis of PTSD made. How is PTSD treated? The literature is full of treatment methods for helping suffers of PTSD. My preference is to use cognitive-behavioral supportive therapy. In the first stage of treatment, I helped Jeff to recognize and understand the symptoms of PTSD so that he could understand that what he was experiencing was a normal reaction to a very abnormal event. He was helped to face his trauma by talking about it, expressing his fears, and identifying and recognizing that his physical and psychological symptoms were part of the aftermath of his trauma experience. A central part of cognitive-behavioral therapy includes looking at one's thoughts and beliefs, such as, “How could I have been so stupid as to drive my car off the road?” or “I will never be able to drive again.” Correcting these maladaptive thoughts with more positive and realistic thoughts is part of the healing process. In addition, I taught Jeff several relaxation and imagery exercises to counteract the overstimulation he felt from the trauma, and lower his hyperarousal responses. Perhaps most important, therapy provided him with a non-judgmental, safe place where he could feel free to express his pain and fear. He learned a clear lesson from his treatment: If you have PTSD symptoms, don't be self-critical, but instead realize that help is available. In Jeff's case, the therapy put him back on track with his life, and even back in the driver's seat. ■ The writer is a marital, child and adult psychotherapist, with offices in Jerusalem and Ra'anana; he also provides online videoconferencing psychotherapy. drmikegropper@ gmail.com

Inside the world of post-traumatic stress disorder

A terrifying event can overwhelm an individual’s normal coping devices; healing takes turning negative ideas into positive thoughts.

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Inside the world of post-traumatic stress disorder

A terrifying event can overwhelm an individual’s normal coping devices; healing takes turning negative ideas into positive thoughts.

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