Posttraumatic Stress Cures

Phobia Release Program

The curative methods that are described in the 5-Day Phobia Release Course are psychologically proven and are vouched for by many phobic patients, who no longer feel the fear. Each technique is something that you can perform them on your own. Each technique is easy, described in plain, ordinary English and requires no more than a couple of minutes to do. In all, the course contains 9 exercises, organized into 5 days for your convenience. You also receive some background information about Neuro-Linguistic Programming and references for further reading on Nlp if you are interested in learning more. Read more...

Phobia Release Program Overview

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Ptsd And Fast Phobia Relief Self-help Audio Program

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Ptsd And Fast Phobia Relief Selfhelp Audio Program Overview

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The Pediatric Pain Experience

Long-term adverse effects have been noted in children who experience greater severity of illness or invasive procedures. A prospective cohort study of 120 pediatric intensive care unit and medical-surgical ward patients revealed that 17.5 of all hospitalized patients expressed significant medical fears 6 weeks postdischarge, and 14 continued to demonstrate clinically significant fear at 6 months postdischarge. The younger the child was, the greater the likelihood of emotional trauma was, as demonstrated by the development of intrusive thoughts and avoidance behaviors (18). Children in the intensive care setting had limited recall of severe pain children on general wards who had undergone procedure-related pain expressed hesitation and dread of future painful events (18). Prompt and effective analgesic administration attenuates the occurrence of posttraumatic stress disorder in burn-related trauma (19).

Obtaining Background and Historical Information

Obtaining a psychosocial history is a delicate and sensitive process. For the most part, intake interviews are not designed to dig deeply into specific trauma experiences. On the other hand, opening up and sharing about traumas can be a therapeutic and emotionally ventilating experience (M. Greenberg, Wortman, & Stone, 1996 Pennebaker, 1995). Effective intake interviewers give clients an opportunity to disclose past traumatic events, but they do not require clients to do so.

Choosing the Structure and Content of Your Report

For many clients, this section is brief or nonexistent. For others, it is extensive, and you may need to reference other records you've reviewed regarding the client. For example, you might simply make a summary statement such as This client has been seen previously by a number of mental health providers for the treatment of posttraumatic stress disorder, substance abuse, and depression unless there is something in particular about the treatment that warrants specification (e.g., a particular form of treatment, such as dialectical behavior therapy was employed and associated with a positive or negative outcome). In this section, we also include information on any family history of psychiatric problems (although some report writers devote a separate section to this topic).

Evaluating Interpersonal Style

In the preceding example, the interviewer traced the client's interpersonal pattern to thoughts and feelings related to fear of rejection and responsibility. This type of exploration can provide useful information to psychotherapists of virtually any theoretical orientation. Behaviorists could consider it an evaluation of a client's behavioral repertoire. Cognitive therapists could use this approach to examine a client's underlying irrational beliefs. Psychoanalytic therapists might focus on what underlies the client's irrational fears, perhaps traumatic events that occurred early in the context of significant interpersonal relationships (e.g., dependency issues related to repressed memories of being rejected when a person asks directly to have his or her needs met). Narrative therapists might see this approach as helping clients re-script or retell their story in a new and different way. Solution-oriented therapists would likely help clients view their behavior patterns differently...

Chronic fatigue syndrome and stress

Another possible source of stress is a past history of traumatic events, which may have occurred long before the onset of CFS. Around 75 per cent of CFS patients report having been sexually or physically abused, or both, during childhood or adulthood compared to only 30 per cent of healthy controls (Schmaling and DiClementi 1995). Despite these dramatic figures, few patients seem to relate a past trauma to their CFS (Moss-Morris 1997 Ware 1993). It is also unclear at this stage if such events do indeed have an aetiological role to play. It is possible that victimisation lowers people's resistance to disease through alterations to the immune system. Alternatively, a traumatic history may make people more vulnerable to future stressors or ongoing distress, or both. This fact, coupled with a need to be seen as successful and achievement orientated, may result in the distress manifesting as somatic symptoms.

Summary of the psychiatric findings

In summary, prospective studies suggest that psychological factors such as premorbid distress and a past history of psychiatric illness, particularly depression, play a significant role in the development of CFS. Other factors such as anxiety, somatisation, achievement orientated personality traits, neuroticism, a past history of traumatic events and perceived stress also appear to play a role in either the onset or maintenance of the condition. While these results do not negate the likelihood that organic factors are also involved in CFS, they certainly provide convincing evidence for the role of psychological factors in this illness. Despite this, the majority of CFS patients adamantly claim that their illness is largely physical in origin. As we saw in the previous chapter, they eagerly await results from organic investigations of their illnesses, and are easily swayed by the dramatic claims of preliminary work. In contrast, they ridicule any psychological findings from even...

Guide To Further Reading

Anderson IM, Nutt D J et al 2000 Evidence-based guidelines for treating depressive disorders with antidepressants a revision of the 1993 British Association for Psychopharmacology guidelines. Journal of Psychopharmacology 14 3-20 Ballenger J C et al 1998 Consensus statement on panic disorder from the International Consensus Group on Depression and Anxiety. Journal of Clinical Psychiatry 59 47-54 Ballenger J C et al 1998 Consensus statement on social anxiety disorder from the International Consensus Group on Depression and Anxiety. Journal of Clinical Psychiatry 59 54-60 Ballenger J C et al 2000 Consensus statement on posttraumatic stress disorder from the International Consensus Group on Depression and Anxiety. Journal of Clinical Psychiatry 61 60-66 Ballenger J C et al 2001 Consensus statement on generalized anxiety disorder. Journal of Clinical Psychiatry 62 53-58 Davies S J C et al 1999 Association of panic disorder and panic attacks with hypertension. American Journal of Medicine...

Proinflammatory Cytokines and the Acute Phase Response

Among the specific causes of CACS, there is evidence of a chronic, low-grade, tumour-induced activation of the host immune system that shares numerous characteristics with the acute-phase response found after major traumatic events and septic shock. The latter is characterised by an increased production of cytokines 27, 28 high levels of catecholamine, cortisol, and glucagon 27, 29-31 increased peripheral amino-acid mobilisation and hepatic amino acid uptake 27, 32 increased hepatic gluconeogenesis and acute-phase protein production 27, 33, 34 and enhanced mobilisation of free fatty acids and increased metabolism 35 . The acute-phase response is a systemic reaction to tissue injury, typically observed during inflammation, infection or trauma. It consists of the release of hepatocyte-derived plasma proteins, known as acute-phase reactants, which include C-reactive protein, fib-rinogen, complement factors B and C3, and of a reduced synthesis of albumin and transferrin. An acute-phase...

Specific Diagnostic Criteria

The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a Panic Attack (as in Panic Disorder), being embarrassed in public (as in Social Phobia), being contaminated (as in Obsessive-Compulsive Disorder), being away from home or close relatives (as in Separation Anxiety Disorder), gaining weight (as in Anorexia Nervosa), having multiple physical complaints (as in Somatization Disorder), or having a serious illness (as in Hypochondriasis), and the anxiety and worry do not occur exclusively during Posttraumatic Stress Disorder. Fourth, to label an individual as having generalized anxiety disorder, an interviewer needs considerable knowledge of other DSM diagnostic criteria. Eight other diagnoses that may need to be ruled out are listed in the generalized anxiety disorder criterion D. An interviewer needs to have working knowledge of diagnostic criteria associated with posttraumatic stress disorder,...

Systemic Inflammation

There is evidence that a chronic, low-grade, tumour-induced activation of the host immune system that shares numerous characteristics with the 'acute-phase response' found after major traumatic events and septic shock is involved in CAC. Septic shock is a situation characterised by an increased production of cytokines 29,30 , high levels of catecholamines, cortisol and glucagon 29, 31-33 , increased peripheral amino acid mobilisation and hepatic amino acid uptake 29,34 , increased hepatic gluconeogenesis and acute-phase protein production 29,35,36 , enhanced mobilisation of free fatty acids 37 and increased metabolism 38 . The acute-phase response is a systemic reaction to tissue injury, typically observed during inflammation, infection or trauma, characterised by the release of a series of hepatocyte-derived plasma proteins known as acute-phase reactants, including C-reac-tive protein, fibrinogen, complement factors B and C3, and by reduced synthesis of albumin and trans-ferrin. An...

Client Personal History

At least a minimal social or developmental history information is necessary for accurate diagnosis. Take the assessment of clinical depression as an example. Currently, DSM-IV-TR lists numerous disorders that have depressive symptoms as one of their primary features, including (a) dysthymic disorder, (b) major depression, (c) adjustment disorder with mixed anxiety and depression, (d) adjustment disorder with depressed mood, (e) bipolar I disorder, (f) bipolar II disorder, and (g) cyclothymic disorder. Additionally, there are a number of disorders outside the general mood disorder category that include depressive-like symptoms or that are commonly comorbid with one of the previously listed depressive disorders. These include, but are not limited to (a) posttraumatic stress disorder, (b) generalized anxiety disorder, (c) anorexia nervosa, (d) bulimia nervosa, and (e) conduct disorder. As you may have already concluded from this rather formidable list, the question is not necessarily...

Interviewing Trauma Survivors

Many clients come to therapy because they are struggling with an experience of trauma. When individuals are exposed to traumatic events, such as natural disasters, school or workplace shootings, sexual assault, or war-related violence, they often experience immediate and longer term emotional and psychological symptoms. In this section, we briefly review issues associated with interviewing trauma survivors. In 1980, when posttraumatic stress disorder was first included in the DSM, trauma was defined as an event outside the range of usual human experience (p. 236). As Judith Herman (1992) wrote in her powerful book, Trauma and Recovery, Sadly this definition has proved to be inaccurate (p. 33). The sad part of this inaccuracy is the fact that many individuals, particularly women, experience sexual abuse, rape, and or physical battering as a part of their usual human experience (Herman, 1992). Additionally, soldiers, police officers, and emergency personnel experience trauma as a part...

Sex Differences In Personality Traits Coping And Stressrelated Psychiatric Disorders

Women have higher rates of civilian violence and sexual abuse. Rates of violent victimization and PTSD are higher in women. Note. PTSD, posttraumatic stress disorder HPA, hypothalamic-pituitary-adrenal. There also appear to be some sex differences in physiological and behavioral coping with traumatic and chronic adverse life events. For example, women are more likely than men to develop posttraumatic stress disorder (PTSD) following traumatic events (Weiss, Longhurst, & Mazure, 1999 Widom, 1999). Furthermore, experiences of early trauma, such as physical and childhood sexual abuse, have been found to confer a greater susceptibility to developing psychiatric illness and illicit drug abuse on women than on men (MacMillan et al., 2001). The well-known association between adverse life events and increased risk of major depression is significantly higher in women than in men (Maciejewski, Prigerson, & Mazure, 2001). Early life trauma is associated with an increased HPA reactivity to...

HOME and Socio Emotional Development

Studies show that scores on HOME reflect many factors in addition to parental social status (Bradley & Caldwell, 1978), including parental personality (Allen, Affleck, McQueeney, & McGrade, 1982 Bergerson, 1989 Fein et al., 1993 Pederson et al., 1988 Reis, Barbera-Stein, & Bennett, 1986), parental substance abuse (Fried, O'Connell, & Watkinson, 1992 Noll et al., 1989 Ragozin et al., 1978), parental IQ (Longstreth et al., 1981 Plomin & Bergeman, 1991), family structure (Bradley et al., 1982, 1984), parental knowledge about child development and attitudes toward child rearing (Reis et al., 1986), social support (Bradley et al., 1987, 1989 Wandersman & Unger, 1983), psychosocial climate of the home (Bradley et al., 1987 Gottfried & Gottfried, 1984 Nihira, Mink, & Meyers, 1981 Wandersman & Unger, 1983), presence of traumatic events (Bradley et al., 1987), and a variety of other community and cultural factors. Ragozin, Landesman-Dwyer, & Streissguth (1980)...

Failure to Provide a Sample of Blood

Probably the most common defense for failure to provide a sample of blood is that of needle phobia. If this is alleged, a full medical history should be obtained and enquiry made of whether the person has had blood tests before, whether ears or other parts of the body have been pierced, or whether there have been foreign travel immunizations or any other medical or dental procedure undertaken in which an injection may have been administered. Specific inquiry about the phobia should be made. British appellate judges (53) have stated that no fear short of phobia recognized by medical science to be as strong and as inhibiting as, for instance, claustrophobia can be allowed to excuse failure to provide a specimen for a laboratory test, and in most if not all cases where the fear of providing it is claimed to be invincible, the claim will have to be supported by medical evidence. Stark and Brener (54) stress the importance of having a standardized approach for assessing needle phobia using...

The Mediational Role of Maternal Functioning

As compared to school-age children, the maternal role may be more salient during the preschool years because of fewer competing socialization influences, e.g. teachers and peers therefore we focused on the role of maternal functioning as a crucial mediator in the linkage between exposure to community violence and child problems (Linares, Heeren, Bronfman, Zuckerman, Augustyn, & Tronick, 2001). There is substantial evidence from the developmental and family relations literature that mothers' own histories of interpersonal victimization (e.g., community or intra-family violence) are associated with global, and stress-specific symptoms of psychological distress. For example, victimized women (mothers) suffer from poor physical health (Koss, Woodruff, & Koss, 1990), increased distress, and show a higher risk for PTSD symptoms, as compared with nonvictimized women (Breslau, Glenn, Davis, Andreski, & Peterson, 1991 North, Smith, & Spitz-Nagel, 1994 Zlotnick, Warshaw, Shea, &...

TABLE 163 Anxiety Disorders

Agoraphobia Specific Phobia Posttraumatic Stress Disorder A specific phobia is a marked, persistent, and excessive or unreasonable fear that is cued by the presence or anticipation of a specific object or situation, such as dogs, injections, or flying. The person recognizes the fear as excessive or unreasonable, but exposure to the cue provokes immediate anxiety. Avoidance or fear impairs the person's normal routine, occupational or academic functioning, or social activities or relationships.

Contributions To Neuronal Atrophy And Cell Death

In young and middle-aged humans caused brain atrophy, and the atrophy was reversed in several patients when steroids were no longer used 144 . As mentioned, patients with high Cortisol levels due to Cushing's syndrome have small hippocampal volumes 134 but hippocampal volumes increase after treatment to reduce Cortisol levels 135 . Smaller hippocampal volumes have been reported in patients with stress-related psychiatric disorders including PTSD 145 , borderline personality disorder with abuse 146 , and depression 147 , and dissociative identity disorder 148 . Caution must be used, however, when correlating psychiatric disease with alterations in brain volumes, as it is possible that volumetric differences precede the disease. Such a finding was recently demonstrated for smaller hippocampal volumes in patients with PTSD 54 . Researchers identified monozygotic twin pairs, one of whom had combat exposure (combat exposed) during military experience and the other without combat experience...

Exposure And Preschool Development

Mirroring the broad psychological consequences on the development of school-aged children exposed to acts of community violence, mothers of preschoolers report child distress-related problems in various functioning domains including internalizing behavior problems (i.e., anxiety and depression), externalizing behavior problems (i.e., aggression), and trauma-specific PTSD symptoms. In the Shahinfar et al., study (2000) of Head Start preschoolers exposed to interpersonal violence, CBCL internalizing (mean 5.3 vs. 3.5) and externalizing (mean 13.2 vs. 9.6) behavior symptoms were more likely in children who witnessed violence than in those who did not. These results are difficult to interpret, however, once again because of the lack of distinction between types of violence exposure (i.e., community violence and family violence). Finally, the Aisenberg study (2001) of a small sample of 31 Latina mothers and their children found that children exposed to acts of community violence obtained...

Historical Context

Ogists proliferated and terms such as post-traumatic stress disorder (PTSD) were coined. PTSD, formerly referred to as battle fatigue or shell shock, is not new, but the term continues to be applied to returning soldiers with ongoing problems such as loss of concentration, sleep disturbances, nightmares, flashbacks, intrusive thoughts, and emotional stress. This spotlight on identifying prospective mental disorders brought about the National Institute for Mental Health in 1949, advocating more study on the origins of mental illness, its diagnosis, and its treatment. For the first time in the place of hospitalization the new drug chlorpromazine was used to relieve anxiety and control delusions. Thorazine, the prescription straitjacket, was used to treat and ameliorate depressive or compulsive disorders. With the widespread use of these drugs and others, the psychopharmaceut-ical revolution in mental health care began. Ironically, as the 1950s rolled in, the counterculture movement...

Clinical Approach Partner Abuse

Victims of abuse can present with varied symptoms and signs suggestive of the problem. Direct physical findings can include obvious traumatic injuries, such as contusions, fractures, black eyes, concussions and internal bleeding. Genital, anal, or pharyngeal trauma, sexually transmitted diseases (STDs). and unintended pregnancy may be signs of sexual assault. Depression, anxiety, posttraumatic stress disorder, and suicide attempts can also result from abusive relationships.

Speech and Thought

Clients can talk about an unlimited array of subjects during an interview. However, several specific content areas should be noted and explored in a mental status exam. These include delusions, obsessions, suicidal or homicidal thoughts or plans, specific phobias, and preoccupation with any emotion, particularly guilt (see Chapter 9 for ideas regarding inquiries about suicidal ideation). Although it is important in most mental status exams to ask a routine question regarding suicidal thoughts or impulses, we delay our discussion of suicide assessment until Chapter 9. The remainder of this section focuses on evaluating for delusions and obsessions.

Biological Evidence

In humans, early life traumatic events are associated with hyperresponsiveness to stress in adulthood and predisposition to the development of comorbidity with anxiety disorders and IBS (36,115). There is also evidence that alterations in brain neurotransmitters, including

Physical Findings

Anxiety disorders is a classification of mood disorders that are common in the population such as panic disorder, obsessive-compulsive disorder (OCD), generalized anxiety disorder, posttraumatic stress disorder (PTSD). and phobia. Patients with generalized anxiety disorder have excessive and difficult-to-control worry and anxiety that causes physical symptoms, including restlessness. irritability, sleep disturbance, and difficulty concentrating. Panic disorder is characterized by recurrent panic attacks, which are defined as periods of intense fear of abrupt onset. OCD manifests as either obsessions (recurrent, intrusive, and inappropriate thoughts) or compulsions (repetitive behaviors) that are unreasonable, excessive, and cause much distress to the patient. PTSD is a response to a severe traumatic event in which the patient suffers fear, helplessness, or horror. A phobia is an irrational fear that causes a conscious avoidance of a situation, subject, or activity. Patients with...

Perioperative Pain

Aggressive pain management with opioids has been shown to attenuate the development of posttraumatic stress disorder (19). However, analgesic requirements may change after the first 24 hours of burn care because of decreased protein levels and increased bioavailability of free drugs. Because of the shifts in drug availability and physiological instability, administration of opioids requires close observation and frequent pain assessment (77). The treatment plan should address background pain and provide additional dosing for the intense, brief pain associated with procedures. A comprehensive long-term plan for possible chronic pain should be developed before discharge from the hospital.

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