PTSD (post-traumatic stress disorder) has been known by many names in the past, such as “shell shock” during the years of World War I and “combat fatigue” after World War II, but PTSD is not exclusive to combat veterans. PTSD is a disorder that can develop in people after experiencing many different types of shocking, scary, or dangerous events. Physical or sexual assaults, abuse, accidents, disasters, the sudden death of a family member, and other difficult events can lead to the development of PTSD. PTSD is now recognized as a disorder that can occur in anyone of any ethnicity, nationality or culture, and at any age, even children. It affects approximately 3.5 percent of U.S. adults every year. Although the treatment of PTSD has previously focused on psychotherapy and medication, emerging therapies such as Stellate Ganglion Blocks are showing positive results in many patients.
It is common to experience negative emotions after trauma, but most people are able to recover without intervention. Those who continue to experience problems after their traumatic experience may be diagnosed with PTSD. Symptoms usually begin early, within three months of the traumatic incident, but sometimes they begin years afterward. Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered PTSD. The course of the illness varies; some people recover within six months, while others have symptoms that last much longer. In some people, the condition becomes chronic.
Symptoms of PTSD fall into four categories, and these symptoms can vary in severity. To be diagnosed with PTSD, an adult must experience all of the following for at least one month:
- At least one re-experiencing symptom
- Re-experiencing: Intrusive thoughts such as repeated, involuntary memories; distressing dreams; or flashbacks of the traumatic event. Flashbacks may be so vivid that people feel they are reliving the traumatic experience or seeing it before their eyes.
- At least one avoidance symptom
- Avoidance: Avoiding reminders of the traumatic event may include avoiding people, places, activities, objects and situations that may trigger distressing memories. People may try to avoid remembering or thinking about the traumatic event. They may resist talking about what happened or how they feel about it.
- At least two arousal and reactivity symptoms
- Arousal and reactivity: Arousal and reactive symptoms may include being irritable and having angry outbursts; behaving recklessly or in a self-destructive way; being overly watchful of one’s surroundings in a suspecting way; being easily startled; or having problems concentrating or sleeping.
- At least two cognition and mood symptoms
- Cognition and mood: Inability to remember important aspects of the traumatic event, negative thoughts and feelings leading to ongoing and distorted beliefs about oneself or others (e.g., “I am bad,” “No one can be trusted”); distorted thoughts about the cause or consequences of the event leading to wrongly blaming self or other; ongoing fear, horror, anger, guilt or shame; much less interest in activities previously enjoyed; feeling detached or estranged from others; or being unable to experience positive emotions (a void of happiness or satisfaction).
Treatment
It is important to note that not everyone who experiences trauma develops PTSD, and not everyone who develops PTSD requires psychiatric treatment. For some people, the symptoms of PTSD subside or disappear over time. Others are able to get better with the help of their support system (family, friends or clergy). But many people with PTSD require professional treatment to recover from the psychological distress. That distress is not the individual’s fault, and PTSD is treatable. The earlier a person gets treatment, the better chance of recovery.
Psychiatrists and other mental health professionals use various effective, research-proven methods to help people recover from PTSD. Both talk therapy (psychotherapy) and medication provide effective evidence-based treatments for PTSD. There are also emerging treatments such as Stellate Ganglion Blocks that are showing positive results in many people.
Talk Therapy
One category of psychotherapy, cognitive behavior therapies (CBT), is very effective. Cognitive processing therapy, prolonged exposure therapy and stress inoculation therapy (described below) are among the types of CBT used to treat PTSD.
Cognitive Processing Therapy is an evidence-based, cognitive behavioral therapy designed specifically to treat PTSD and comorbid symptoms. It focuses on changing painful negative emotions (such as shame, guilt, etc.) and beliefs (such as “I have failed;” “the world is dangerous”) due to the trauma. Therapists help the person confront such distressing memories and emotions.
Prolonged Exposure Therapy uses repeated, detailed imagining of the trauma or progressive exposures to symptom “triggers” in a safe, controlled way to help a person face and gain control of fear and distress and learn to cope. For example, virtual reality programs have been used to help war veterans with PTSD re-experience the battlefield in a controlled, therapeutic way.
Trauma Focused Cognitive Behavioral Therapy is an evidence-based treatment model for children and adolescents that incorporates trauma-sensitive interventions with cognitive behavioral, family, and humanistic principles and techniques.
Eye Movement Desensitization and Reprocessing for PTSD is a trauma-focused psychotherapy which is administered over approximately 3 months. This therapy helps a person to reprocess the memory of the trauma so that it is experienced in a different way. After a thorough history is taken and a treatment plan developed, the therapist guides the patient through questions about the traumatic memory. Eye movements similar to those in REM sleep are recreated during a session by having the patient watch the therapist’s fingers go back and forth or by watching a light bar. After repeated sessions the memory tends to change and is experienced in a less negative manner.
Group therapy encourages survivors of similar traumatic events to share their experiences and reactions in a comfortable and non-judgmental setting. Group members help one another realize that many people would have responded the same way and felt the same emotions. Family therapy may also help because the behavior and distress of the person with PTSD can affect the entire family.
Medication
Medication can help to control the symptoms of PTSD. In addition, the symptom relief that medication provides allows many people to participate more effectively in psychotherapy.
Some antidepressants such as SSRIs and SNRIs (selective serotonin re-uptake inhibitors and serotonin-norepinephrine re-uptake inhibitors), are commonly used to treat the core symptoms of PTSD. They are used either alone or in combination with psychotherapy or other treatments.
Other medications may be used to lower anxiety and physical agitation, or treat the nightmares and sleep problems that trouble many people with PTSD.
Stellate Ganglion Blocks
Unlike a psychotherapy-based approach to overcoming PTSD, a stellate ganglion block is a minimally invasive, outpatient procedure used to treat a multitude of chronic pain syndromes in the face, head, neck, arm and chest. During this procedure, a small amount of pain-relieving medication (usually a combination of a local anesthetic and steroid) is injected into the part of the neck where the stellate ganglion lies. Because this bundle of nerves functions as a two-way conduit, connecting the parts of the brain that control the fight or flight response to the rest of the body, the goal of a stellate ganglion block is to “interrupt” or “block” the signals of the sympathetic nervous system from getting to the brain, in hopes of reducing or eliminating pain.
A sympathetic nerve block can be considered both a diagnostic and therapeutic procedure. If pain is substantially improved after the initial injection, then a diagnosis of sympathetic nerve pain can be established. Additional, “therapeutic” blocks may be repeated as the pain continues to sequentially diminish.
If you are suffering from PTSD that hasn’t responded well to other treatments, please reach out to The PainSmith. After a physical evaluation and medical history, Dr. Smith will be able to determine if your pain is related to the sympathetic nerves and if a stellate ganglion block can help. To book your appointment, please call (210) 963-7493 or Request an Appointment. We look forward to helping you Unlock a Life with Less Pain.