Most people are likely to experience a potentially traumatic event in their lifetime, and most individuals recover well, given time and adequate social support.1
For some individuals however, the experience of a traumatic event or chronic exposure to trauma can trigger symptoms of post-traumatic stress disorder (PTSD).
PTSD refers to a set of symptoms that can emerge following the experience of a traumatic event that involves exposure to actual or threatened death, serious injury, or sexual violence.
Exposure to such events can be through:
- directly experiencing the traumatic event
- witnessing, in person, the event happening to someone else
- learning that the event has happened to a close family member or close friend
- repeated or extreme exposure to the aftermath of trauma (e.g., first responders to emergency situations).
Symptoms are characterised by a sense of reliving of the traumatic event, avoidance of reminders of the traumatic event, feeling numb, having negative thoughts and mood, and feeling agitated or wound up.2
Without treatment, PTSD can become a chronic condition, and places the individual at greater risk of developing other mental health problems, such as depression or anxiety, or problems with alcohol or drug use.3 With sound psychological intervention however, the chances of recovery are good.4
Symptoms are characterised by:2,5
A sense of reliving the traumatic event
- experiencing unwanted and distressing thoughts or images, flashbacks, nightmares, or feeling as though the event is recurring.
Avoidance and numbing
- avoidance of people, places, thoughts and activities associated with the traumatic event
- feeling emotionally flat, losing interest in enjoyable activities, or feeling disconnected from friends and family.
Negative thoughts and mood
- persistent negative thoughts about self, others, and the world
- distorted views about the causes and consequences of the event.
- feeling irritable, angry, over-alert, or edgy
- experiencing difficulties concentrating
- experiencing difficulties getting to sleep or staying asleep.
A diagnosis of PTSD is made when these symptoms are present for more than one month and cause significant distress, or interfere with important areas of functioning, such as work, study, or family life.2
Whilst traumatic events are the trigger for PTSD, not everyone who experiences a traumatic event goes on to develop PTSD. Research looking at factors related to the causes of PTSD has revealed several explanations for how the disorder develops.2
The stress response, by nature, is physiological, and the core symptoms of PTSD such as agitation, a heightened startle response, and memory disturbances, have a basis in how the brain processes and responds to stress. Differences in the sympathetic nervous system, which controls stress hormones such as adrenalin, as well as brain circuitry related to anxiety responses, may differ between individuals with and without PTSD.6-8
In PTSD, previously neutral objects, places, people, sounds and smells can become associated with a traumatic event, and trigger the fear response even in the absence of danger. This association between benign stimuli and a fear response has been found to be the basis for many PTSD symptoms.9
Information processing and memory models
It has been suggested that high stress and arousal at the time of the trauma impacts on the way in which traumatic information is encoded in memory, which may underlie the physical symptoms of PTSD and the experience of ‘reliving’ the event.10-14
Other risk factors include:
- the type and severity of the trauma – sexual assault and abuse, military combat, and terrorist acts are linked to a higher rate of PTSD than motor vehicle accidents and natural disasters
- lack of social support
- subsequent life stress.3,15-17
Tips on coping with flashbacks
Flashbacks can be very distressing, but there are things you can do that might help. You could:
You can’t stop the waves but you can learn to surf; through my PTSD recovery journey I’ve learnt that emotions come and go in waves […] it’s best not to fight against them but ride with them.
Know your triggers
You might find that certain experiences, situations or people seem to trigger flashbacks or other symptoms. These might include specific reminders of past trauma, such as smells, sounds, words, places or particular types of books or films. Some people find things especially difficult on significant dates, such as the anniversary of a traumatic experience.
Confide in someone
Lots of people who experience PTSD find it hard to open up to others. This may be because you feel unable to talk about what has happened to you. However, you don’t need to be able to describe the trauma to tell someone how you are currently feeling.
It could help to talk to a friend or family member, or a professional such as a GP, or life psychologist.
Give yourself time
Everyone has their own unique response to trauma and it’s important to take things at your own pace. For example, it may not be helpful to talk about your experiences before you feel ready. Try to be patient with yourself and don’t judge yourself harshly for needing time and support to recover from PTSD.
Try peer support
Peer support brings together people who have had similar experiences, which some people find very helpful.
Find specialist support
You might find it useful to contact an organisation that specialises in advice and support for PTSD, such as Phoenix Australia | Centre for Posttraumatic Mental Health.
It could also be helpful to find an organisation with expertise and support in the particular type of trauma you have experienced, such:
- Adults Surviving Child Abuse (ASCA) for adult survivors of child abuse
- Department of Veterans’ Affairs (DVA) for military veterans
- Defence Force Community Organisation (DCO) for members of the defence force and their families
- Lawlink for victims of crime
- Police Post Trauma Support Group (PPTSG) for first responders
- Veterans and Veterans Families Counselling Service (VVCS) for serving members of the Defence Force
- www.1800respect.org.au for sufferers of sexual assault and domestic family violence
Look after your physical health
Coping with PTSD can be exhausting. You might feel like you can’t find the energy to take care of yourself, but looking after your physical health can make a difference to how you feel emotionally. For example, it can help to:
- Think about your diet. Eating regularly and keeping your blood sugar stable can help you cope when things feel difficult.
- Try to exercise. Exercise can be really helpful for your mental wellbeing.
- Spend time outside. The outside world might feel overwhelming, but spending time in green space can boost your wellbeing.
- Avoid drugs and alcohol. While you might want to use drugs or alcohol to cope with difficult feelings, memories or physical pain, they can make you feel worse in the long run. They can also make other problems worse, such as difficulty sleeping.
There are a range of psychological treatments for adults with PTSD. The two types of treatment that are most effective are called trauma-focused cognitive behaviour therapy (TF-CBT) and eye movement desensitisation and reprocessing (EMDR).4
Trauma-focused Cognitive Behaviour Therapy (TF-CBT)
In Trauma-focused Cognitive Behaviour Therapy (TF-CBT) the psychologist helps the person to confront memories and reminders of the trauma, change the way they think and feel about the traumatic experience, and find more helpful ways of coping, through exposure therapy and cognitive therapy techniques.
In imaginal exposure therapy the person is supported to gradually confront their memories of the trauma, whilst within in vivo exposure therapy the person is supported to gradually confront safe situational reminders of the trauma that are otherwise avoided. Repeated imaginal and in vivo exposure, has been found to be highly effective.18,19
EMDR is based on the idea that overwhelming emotions during a traumatic event interfere with normal information processing, resulting in flashbacks, nightmares, and other distressing symptoms.
In EMDR, the person is asked to focus on particular images, thoughts, and bodily sensations related to the traumatic event while moving their eyes back and forth across their field of vision, tracking the movement of the therapist’s finger. It is proposed that the dual attention helps the individual to process the trauma and integrate the memory with existing memory networks.20
Social and behavioural interventions
Social support after a trauma has been found to be the best predictor of recovery.21 As such, treatment for PTSD is likely to involve building or strengthening the person’s social support network.
Some lifestyle changes might also be helpful, such as reducing or eliminating the use of alcohol or drugs which can increase certain PTSD symptoms and slow recovery.22-24
Relaxation exercises can help reduce feelings of agitation and being on edge while maintaining a balanced diet and engaging in routine exercise supports general emotional and physical wellbeing which can also aid recovery 25,26,27-29
- Kessler, R. C., Sonnega, A., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the national comorbidity survey.Archives of General Psychiatry, 52, 1048-1060.
- American Psychiatric Association. (2013).Diagnostic and Statistical Manual of Mental Disorders(5th ed.). Washington DC: Author.
- Creamer, M., Burgess, P., & McFarlane, A. C. (2001). Post-traumatic stress disorder: Findings from the Australian National Survey of Mental Health and Well-being.Psychological Medicine, 31(7), 1237-1247.
- Australian Centre for Posttraumatic Mental Health. (2013).Australian Guidelines for the Treatment of Acute Stress Disorder and Posttraumatic Stress Disorder.Melbourne, Victoria: ACPMH.
- World Health Organization. (2008).ICD-10: International Statistical Classification of Diseases and Related Health Problems (10th Rev.). New York, NY: Author.
- Pole, N. (2007). The psychophysiology of posttraumatic stress disorder: A meta-analysis.Psychological Bulletin, 133(5), 725-746. doi: 10.1037/0033-2909.133.5.725
- Karl, A., Schaefer, M., Malta, L. S., Dörfel, D., Rohleder, N., & Werner, A. (2006). A meta-analysis of structural brain abnormalities in PTSD.Neuroscience & Biobehavioral Reviews, 30(7), 1004-1031. doi:http://dx.doi.org/10.1016/j.neubiorev.2006.03.004
- Vasterling, J., & Brewin, C. (2005).The Neuropsychology of PTSD: Biological, Cognitive and Clinical Pperspectives. New York: Guilford Press.
- Keane, T. M., Zimering, R. T., & Caddell, J. M. (1985). A behavioral formulation of posttraumatic stress disorder in Vietnam veterans.Behavior Therapist, 8(1), 9-12.
- Janoff-Bulman, R. (1985). Criminal vs. non-criminal victimization: Victims’ reactions.Victimology: An International Journal, 10(1-4), 498-511.
- Horowitz, M. J. (1976).Stress response syndromes.Oxford, England: Jason Aronson.
- Foa, E. B., & Rothbaum, B. O. (1998).Treating the trauma of rape: Cognitive-behavioral therapy for PTSD.New York: Guilford Press.
- Brewin, C. R., Dalgleish, T., & Joseph, S. (1996). A dual representation theory of posttraumatic stress disorder.Psychological Review, 103(4), 670-686.
- Ehlers, A., & Clark, D. (2000). A cognitive model of posttraumatic stress disorder.Behaviour Research and Therapy, 38(4), 319-345.
- Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults.Journal of Consulting and Clinical Psychology, 68(5), 748-766.
- O’Toole, B. I., Marshall, R. P., Grayson, D. A., Schureck, R. J., Dobson, M., Ffrench, M., . . . Vennard, J. (1996). The Australian Vietnam veterans health study: III. Psychological health of Australian Vietnam veterans and its relationship to combat.International Journal of Epidemiology, 25(2), 331-339.
- Lee, A., Isaac, M., & Janca, A. (2002). Post-traumatic stress disorder and terrorism.Current Opinion in Psychiatry, 15(6), 633-637.
- Hembree, E. A., Rauch, S. A. M., & Foa, E. B. (2003). Beyond the manual: The insider’s guide to Prolonged Exposure therapy for PTSD.Cognitive and Behavioral Practice, 10(1), 22-30. doi:http://dx.doi.org/10.1016/S1077-7229(03)80005-6
- Powers, M. B., Halpern, J. M., Ferenschak, M. P., Gillihan, S. J., & Foa, E. B. (2010). A meta-analytic review of prolonged exposure for posttraumatic stress disorder.Clinical Psychology Review, 30(6), 635-641. doi:http://dx.doi.org/10.1016/j.cpr.2010.04.007
- Shapiro, F. (1989). Efficacy of the Eye Movement Desensitization procedure in the treatment of traumatic memories.Journal of Traumatic Stress, 2(2), 199-223. doi: 10.1002/jts.2490020207
- Schnurr, P. P., Lunney, C. A., & Sengupta, A. (2004). Risk factors for the development versus maintenance of posttraumatic stress disorder.Journal of Traumatic Stress, 17(2), 85-95.
- Back, S. E., Sonne, S. C., Killeen, T., Dansky, B. S., & Brady, K. T. (2003). Comparative profiles of women with PTSD and comorbid cocaine or alcohol dependence.The American Journal of Drug and Alcohol Abuse, 29(1), 169-189.
- Read, J. P., Brown, P. J., & Kahler, C. W. (2004). Substance use and posttraumatic stress disorders: Symptom interplay and effects on outcome.Addictive Behaviors, 29, 1665-1672.
- Perconte, S. T., & Griger, M. L. (1991). Comparison of successful, unsuccessful, and relapsed Vietnam veterans treated for posttraumatic stress disorder.Journal of Nervous and Mental Disease, 179(9), 558-562.
- Taylor, S., Thordarson, D. S., Maxfield, L., Fedoroff, I. C., Lovell, K., & Ogrodniczuk, J. (2003). Comparative efficacy, speed, and adverse effects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training.Journal of Consulting and Clinical Psychology, 71(2), 330-338.
- Vaughan, K., Armstrong, M. S., Gold, R., O’Connor, N., Jenneke, W., & Tarrier, N. (1994). A trial of eye movement desensitization compared to image habituation training and applied muscle relaxation in post-traumatic stress disorder.Journal of Behavior Therapy and Experimental Psychiatry, 25(4), 283-291. doi: 10.1016/0005-7916(94)90036-1
- Lang, A. J., Rodgers, C. S., Laffaye, C., Satz, L. E., Dresselhaus, T. R., & Stein, M. B. (2003). Sexual trauma, posttraumatic stress disorder, and health behavior.Behavioral Medicine, 28(4), 150-158. doi: 10.1080/08964280309596053
- Rutter, L. A., Weatherill, R. P., Krill, S. C., Orazem, R., & Taft, C. T. (2011). Posttraumatic stress disorder symptoms, depressive symptoms, exercise, and health in college students.Psychological Trauma: Theory, Research, Practice, and Policy. doi: 10.1037/a0021996
- Zen, A. L., Whooley, M. A., Zhao, S., & Cohen, B. E. (2012). Post-traumatic stress disorder is associated with poor health behaviors: Findings from the Heart and Soul Study.Health Psychology, 31(2), 194-201. doi: 10.1037/a0025989
If the distress associated with a traumatic event has been affecting a person’s work, school, or home life for more than two weeks, psychological assistance should be considered.
- Life Psychologists are highly trained and qualified professionals, skilled in providing effective interventions for a range of mental health concerns, including PTSD.
- A Life Psychologist can help you to identify and address factors that might be contributing to your distress and the most effective ways to address PTSD using techniques based on best available research.
- Life Psychologists usually see clients individually, but can also include family members to support treatment where appropriate.
A medical check-up with a GP might also be helpful to see if there is an underlying health issue.