Post Traumatic Stress Disorder is a common type of anxiety disorder. This disorder occurs after an individual has experienced a traumatizing event that may lead to death or serious injury (Yehuda, 2002). Post-traumatic stress disorder (PTSD) may occur to any individual irrespective of age or gender. For instance, if a person witnessed or is part of terrible events such as domestic abuse, rape, war, assault, prison stay, terrorism, fire, and floods, he or she may undergo PTSD.
There was limited research undertaken on PSTD before the advent 1980s (Yehuda, 2002). In 1980, the American Psychiatric Association recognized this disorder officially. Currently, advancements are being made on the strategies that can be employed to counter this disorder (Yehuda, 2002). This paper will examine the definition, characteristics, and available forms of treatments for post-traumatic stress disorder (PTSD).
There are myriads of definitions of abnormal behavior. For in-depth understanding of the background of PTSD is, this paper will adopt a specific definition of abnormality that relates to the disorder itself. In this paper, abnormality has been explored in terms of personal distress.
In this case, abnormality has been viewed in terms of personal subjective feelings and distresses (Meyer, Chapman & Weaver, 2009). Therefore, an abnormal person from this point of view is an individual who feels anxious, miserable, and depressed. PTSD can therefore be termed as an abnormality since an individual affected by the condition exhibits at least one of the symptoms used in defining abnormality (Meyer, Chapman & Weaver, 2009). This form of abnormality takes away an individual’s character and his/her dignity.
The significant characteristics of PTSD is the consistent repeated visualization of an event once witnessed, avoiding situations that might lead to remembering the event and hyperarousal (Yehuda, 2002). These symptoms vary among different individuals with varied experiences.
In some people, these symptoms often emerge during the first three months from the day of trauma while in others; it might take a long period. Even though there are variations in the PTSD cases among different individuals, the characteristics of this disorder are the same in most cases since the features of the disorder may be typically categorized into three groups as expounded earlier (Yehuda, 2002).
Any form of a traumatizing event will usually affect the daily activities of the victim. In this case, the individual may experience repeated nightmares, flashbacks, upsetting memories, and sometimes a very strong reaction towards an event. The latter may act as a reminder of the traumatic event that the affected person went through (Yehuda, 2002).
The avoidance characteristics of a PTSD victim include the development of emotional behavioral characteristics, lack of hope for the future, tendencies of avoiding people and certain events, a feeling of being detached, inability to remember some aspects associated with the past trauma, general lack of interest in certain common activities, and displaying oneself in such a way that the moods are not openly displayed (Norris & Sloane, 2007).
During the arousal level in PTSD, the affected individual develops difficulties in concentrating, becomes extremely vigilant, begins to startle frequently, easily irritated, experiences lack of sleep, and also encounters the development of exaggerated responses to circumstances that may equally scare the person under post traumatic attack.
It is also possible for an individual to suffer from one, two, or all the three categories of this syndrome. The category of the syndrome will also determine the type of the PTSD the individual is suffering from. The clinical classification of this disorder is based on the symptoms witnessed on the victims who are affected by this disorder. The symptoms can be mild, moderate, or severe (Norris & Sloane, 2007).
An individual with mild symptoms of PTSD is in a position to manage the distress that result. As a result, such an affected person may experience mild effects in terms of the occupational and social functioning. Moderate symptoms of PTSD result into manageable anguish. The victim may still be in a position of staying safe or not committing suicide because of such distress.
There are limited cases of impaired functioning. On the other hand, severe cases of PSTD results into unmanageable distresses to the patient that may eventually lead to impaired occupational and social well being. Persons suffering from this kind of PTSD are at high risk of committing suicide as well as harming others.
Generally, this disorder is clinically classified as an anxiety disorder. There are two known types of this disorder namely the acute PTSD and the chronic PTSD (Norris & Sloane, 2007). Although these two classifications of the PTSD have the same symptoms, their health impacts are completely different.
If the disorder affects an individual for a period less than three months, then it is referred to as an acute PTSD. On the other hand, if the disorder affects an individual for more than three months, it is referred to as chronic PTSD. Therefore, an acute PTSD can be managed within three months and if the symptoms of the disorder persist for more than the given period, then it develops into the chronic PTSD.
Although men have recorded the most cases of exposure to traumatizing events, women often undergo several instances of PTSD (Mendelsohn & Sewell, 2004). These observations indicate that in a social setup, women are seen to be more emotional than men and hence vulnerable to such a disorder. In the past, this disorder was perceived by the society to be related to female characteristics.
Men who suffered from this disorder had extremely difficult time in trying to get out of it due to lack of support from the immediate community. When this disorder was clinically recognized and diagnosed, the wrong and misleading perception has significantly changed. It is currently recognized by many as a normal disorder thereby enhancing its treatability.
The social distance that existed in the past has been reduced greatly as many people accept individuals with such a condition (Mendelsohn & Sewell, 2004). Generally, the female gender suffering from this condition receives more support from the society than their male counterparts.
Women are also more welcoming and supportive to individuals with this condition than men (Mendelsohn & Sewell, 2004). The societal responses to an individual suffering from this condition has improved in recent times due to increased knowledge of the condition as well as elimination of mythical ideas of understanding the disorder.
Currently, there are quite a number of methods that can be employed in treating this disorder. This paper will examine two major ways that are currently in use for treating PTSD. Before documentation of this disorder as a clinical syndrome, victims used to have a difficult time to secure prompt treatment.
It was viewed from a mythical and supernatural point of view and patients were subjected to crude forms of treatments (Meyer, Chapman & Weaver, 2009). After the year 1980, PTSD was recognized and treatment measures put in place. The most common form of treatment is the cognitive behavioral therapy (CBT). It is a form of counseling that involves either cognitive processing therapy or prolonged exposure therapy (National Center for PTSD, 2007).
It is very effective method of treating PTSD involving therapeutic involvement to ensure an individual understands the trauma he/she is undergoing and hence effect changes to the reactions towards the trauma. The use of medications is also an effective way of treating PTSD. These medicines make an individual feel less worried or sad. These medications work with the brain chemicals by affecting how an individual feels (National Center for PTSD, 2007).
There are several researches being done on methods that can be employed in preventing PTSD. These methods are both therapeutic and medicinal. Therapists are used to help victims recovering from trauma to deal with the condition in the most efficient way. Medicines that can be used by affected individuals to prevent the onset of the PTSD are also available in most healthcare units (Norris & Sloane, 2007).
Most people are in a position of recovering from a traumatic event. However, some victims end up developing into full blow or chronic PTSD. This mental disorder may persist leading to failure in terms of the recovery process (Meyer, Chapman & Weaver, 2009). If the symptoms are handled at the initial development stages of the disorder, the possibility of being treated is also enhanced.
In any case, there is a correlation between PTSD and certain imbalanced brain functions. The treatment simply involves restoring normal brain functioning. In addition, there are variety of clinical and therapeutic methods that have been put in place for sake of preventing and curing the condition. The surrounding environment also affects the rate at which individuals are fully cured from this disorder.
References
Mendelsohn, M. & Sewell, K. W. (2004). Social Attitudes toward Traumatized Men and Women: A Vignette Study. Journal of Traumatic Stress, 17(2), 103-111.
Meyer, R., Chapman, L. K., & Weaver, C. M. (2009). Case studies in abnormal behavior. (8th Ed.). Boston: Pearson/Allyn & Bacon.
National Center for PTSD (2007.). Treatment of PTSD. Web.
Norris, F. & Sloane, L. B. (2007). The epidemiology of trauma and PTSD. In: Friedman MJ, Keane TM, Resick PA, eds. Handbook of PTSD: Science and practice. New York, NY: Guilford Press.
Yehuda, R. (2002). Post-Traumatic Stress Disorder. The New England Journal of Medicine 346, 108-114.
Though performing housework chores may appear simple, I find it a major stressing factor. This is, perhaps, because I have to juggle between the chores and my challenging studies, thus making me strain in balancing the activities within the time limited.
Health behavior and the stressors
My unhealthy behavior of avoiding physical exercises is strongly related to the stresses I experience. In particular, during examination period, I am not able to engage in any physical exercise despite being aware that physical activities are therapeutic and help lessen the stress.
I usually perceive physical exercises as a waste of time which could otherwise be used for studying. My thoughts are thus the etiology of the unhealthy behavior of avoiding exercises. Stressors mostly distract me from performing any duties, even predefined ones. When I feel distracted, I have developed a habit of chatting for hours over the phone. I know that chatting does not eliminate the stress, but it provides me with a means of escaping from the stressors, albeit for a little while.
Coping strategies and their effectiveness
Planning and emotional support are the main strategies for coping with the stress factors. In planning, I usually schedule all the tasks I intend to accomplish in writing. This compels me to adhere to the schedule and enables me to prioritize my tasks. Planning is an effective remedy since it gives me an opportunity to appropriately manage my time, hence dispelling the fears of time wastage.
Emotional support is also another effective strategy in managing the stressors. Accompanied with my family members and friends, I do not develop the feelings of boredom and loneliness because I feel encouraged.
Health behavior and coping
By applying the strategies to cope with stress, I am able to allocate time for physical activities. The more I engage in exercises the more I feel relieved from the stressors. This is because the exercises reveal me from boredom and make me feel happy, thus giving me positive feelings. Exercises also provide me with the opportunity of applying the strategies to cope with my stress and enhancing my abilities of dealing with the stressors.
Self-efficacy
I managed to attain a score of about 78 in all the exercises. I anticipated improving self-efficacy as I put more efforts to improve my workout. My self-efficacy was nevertheless affected by two situations that made me score a zero. The two events happened when I had a lot of work at home, and my friends came to see me.
To increase self-efficacy, I utilized Bandura’s two strategies, which were the vicarious experience and physiological states. In vicarious experiences, I leaned on my mates who encouraged me to follow them as they were studying yet had time to engage in activities like gymnastics.
This helped me avoid becoming depressed. In physiological state strategy, I refined my thoughts to recognize that studies were not exhaustive, so I should have spared energy for other activities. This boosted my ability to handle stressors. Another important strategy that I employed was verbal persuasion when visitors were around. This made me more active and become appreciated with positive remarks. This encouraged me to work hard and boost my confidence.
Headspace Program
Headspace is a mental health program developed in response to the need to improve accessibility and effectiveness of healthcare to the youth suffering from cognitive and drug-dependent problems. The program targets at young people aged between 12 and 25 years. The initiative encourages the youth with cognitive disorders to seek professional help. The program also empowers the communities to be able to respond in time to the issues in focus.
This is done through provision of education and trainings. The healthcare concepts of this program are established on the realization that adolescents do not meet mental health needs that must be addressed in their development using the available local resources (McGorry et al. 68). The program works by creating friendly platforms where the suffering youth can seek for help.
Works Cited
McGorry, Patrick, Tanti Chris, Stokes Ryan, Hickie Ian, Carnell Kate, Littlefield Lyndel and Moran John. “Headspace: Australia’s National Youth Mental Health Foundation- Where young minds come first.” The Medical Journal of Australia 187.7 (2007): 68. Web.
This paper aims at identifying the impact of stress on one’s desire to eat sweets based on the relevant literature review. This issue is especially important in terms of the rapidly growing obesity rates among the population primarily caused by malnutrition. It is revealed that stress stimulates sweets eating due to several factors, including the calming effect, the addictive qualities, glucocorticoids (GC), energy homeostasis, and childhood reflex. Considering the literature review, the following recommendations are provided: change in eating habits towards healthy nutrition, mindful eating approach, and self-attunement increase.
Introduction
Nowadays, stress becomes an integral part of modern society caused by the rapidly increasing pace of life. Trying to make it all at once, people experience stress because of traffic jams, a nervous job, insufficient communication, and many other factors. On the one hand, some eat sweets and believe that it helps them reduce stressful emotions. On the other hand, the need for food takes second place for other people, and they tend to skip meals. Therefore, it is of great importance to investigate the impact of stress on a person’s desire to eat sweets.
Review and Discussion
There are plenty of people increasing the consumption of sweets during the period of stress and depression and having the drive to eat. There is an opinion that chocolate contains a hormone of happiness. Indeed, in the case of moderate consumption, it may help cope with stress to some extent. Yet, the problem is that many people are tempted to acquire the addictive qualities of such highly palatable food like sugar. It is known that uncontrolled sugar nutrition increases the risk of overweight and obesity.
Yau and Potenza (2013) point out that noticing that sweet food calms oneself (the body also remembers how good it was after eating a cake), a person resorts to this method repeatedly. It becomes an obsession soon: even in the event of the slightest stress, a person refers to sugar craving. In psychology, this is called positive fixation. The more a person does not realize his or her actions in a state of stress, the more they are inclined to reproduce these reactions in relation to sweets.
Nervous tension and stress require large reserves of energy, which people seek to replenish with chocolate, sweets, and other sugar-containing products. In this case, sweets begin to play the role of antidepressants (Yau & Potenza, 2013). Sweets stimulate the production of endorphins that play an especially significant role in providing mental equilibrium. They trigger the use of these neurotransmitters by the brain. Thus, in people who are painfully experiencing stress, the need for sweets may be rather pronounced. Finally, the craving for sweets during stress can be a conditioned reflex born in childhood and formed by parents, who used candies as a manipulative means.
However, after the blood sugar content decreases again, the need for this hormone becomes even stronger, and people tend to experience sugar craving. The subsequent malnutrition, when a lot of carbohydrates is received, makes the body to convert them to fats. At the same time, the glucose level decreases, and after dinner, one wants sweets if it was too substantial. The same applies to the rest of the meals.
Why do people want to eat more sweets during stress? Sinha and Jastreboff’s (2013) research reveals the connection between energy homeostasis and the neurobiology of stress. In particular, glucocorticoids (GC) steroid hormones produced by the adrenal cortex were observed during stress. Their blood level rises sharply under anxiety, trauma, or shock conditions, which are the mechanisms of adaptation of the body to stress.
For example, GC increases systemic arterial pressure, the myocardium’s sensitivity, and the walls of blood vessels: all this allows the body to deal with complex situations more successfully. The value of the mentioned research is that the connection between these hormones and taste buds has not been studied before. At the same time, this study explains only a person’s desire to handle stressful situations with sweets, while the latter does not affect mood improvement.
Recommendations and Conclusions
Considering that stress promotes poor food choices, it is important to provide recommendations on the potential ways to control eating habits and improve them. The understanding between stress and sweets consumption associations provides essential insights into the given nutrition issue. It is possible to recommend implementing a mindfulness-based intervention. According to the study conducted by Alberts, Thewissen, and Raes (2012), the participants showed improved eating behaviors compared to the control group. The authors note that the efficiency of the above method is based on the promotion of mindful awareness and change in automatic eating patterns and emotional regulation.
Mindful eating focuses on aligning a person’s internal issues with their reactions to stress and preventing sweets craving. Thus, self-regulation serves as the key factor that may help people cope with their desire to eat sugar-containing foods (Alberts et al., 2012). In its turn, mindfulness promotes one’s self-attunement concerning such physical sensations as hunger. For example, it is essential to learn to recognize personal hunger indicators, which may be expressed in stomach growling.
Consistent with the mentioned study, Katterman, Kleinman, Hood, Nackers, and Corsica (2014) consider that mindful eating reduces emotional eating behaviors. Based on the previous studies’ review, the authors claim that mindfulness meditation is likely to influence a person’s desire to consume sweets driven by stress. The practical recommendations are that it is better to replace the harmful amount of sweets with more useful mini-snacks such as cereals, rye bread, cracker, or spinach salad with pounded sunflower seeds.
The stimulants like tea and coffee are to be avoided. It is much more effective to deal with stress itself, and if it happened, a person should not find some relief in food. If one does not remove the irritant – the cause of stress – then no diet will help, and a person will gain excessive weight. In fact, because of the prolonged extreme work, the brain will always need nutritional support – glucose, which is given by carbohydrates and sweets. Therefore, the importance of mindful eating cannot be overestimated.
To conclude, stress increases one’s desire to eat sweets and leads to food craving. Several studies indicate that people tend to eat more sugar-containing products during and after stressful events. It is recommended to apply mindful eating to reduce the identified tendency based on one’s awareness of the problem and the subsequent self-attunement.
References
Alberts, H. J., Thewissen, R., & Raes, L. (2012). Dealing with problematic eating behaviour. The effects of a mindfulness-based intervention on eating behaviour, food cravings, dichotomous thinking and body image concern. Appetite, 58(3), 847-851.
Katterman, S. N., Kleinman, B. M., Hood, M. M., Nackers, L. M., & Corsica, J. A. (2014). Mindfulness meditation as an intervention for binge eating, emotional eating, and weight loss: A systematic review. Eating Behaviors, 15(2), 197-204.
Sinha, R., & Jastreboff, A. M. (2013). Stress as a common risk factor for obesity and addiction. Biological Psychiatry, 73(9), 827-835.
Yau, Y. H., & Potenza, M. N. (2013). Stress and eating behaviors. Minerva Endocrinologica, 38(3), 255-267.
In the article, “Early-Life Stress and Adult Inflammation,” the authors provide a literature synopsis of the relationship between early-life stress and inflammation in adulthood. They also discuss how factors that include neuroendocrine, epigenetic, psychological, and autonomic responses to childhood experiences put children at risk of inflammation in adulthood. The article’s conclusion provides recommendations that urge health care practitioners and other stakeholders to implement programs that aim to reduce the prevalence of stress among children. Modern psychology is primarily founded on the fundamental assumption that stressful experiences hurt individuals’ mental health. Studies conducted in the field of health psychology have shown that stress experienced during childhood affects physical well-being immensely (Fagundes and Way 277). For instance, it increases the risk of the development of conditions such as diabetes, cancer, cardiovascular disease, and type 2 diabetes. This claim has been augmented by research in the field of psychoneuroimmunology.
Research studies conducted in the fields of biological and behavioral sciences have validated the argument that early-life stress impacts physical well-being negatively. In that regard, certain conditions that develop in adulthood can be attributed to stressful situations that are experienced during childhood. Inflammation is a normal mechanism elicited by the immune system to eliminate foreign invaders such as bacteria and viruses (Fagundes and Way 278). However, it affects optimal body functioning if it persists. High levels of inflammation are common occurrences in conditions such as osteoporosis, certain cancers, Alzheimer’s disease, and rheumatoid arthritis, and they are also predictors of mortality, life quality, and morbidity in adults. Psychologists have studied both chronic and severe life stressors in children to determine how they affect the proper functioning of the immune system. Examples of conditions linked to chronic inflammation include periodontal disease, osteoporosis, fatigue, rheumatoid arthritis, frailty, disability, cardiovascular disease, and type 2 diabetes.
Previous studies conducted on early stress and inflammation have focused on socioeconomic status and parental maltreatment as the major sources of stress. Children from low socioeconomic backgrounds, experience numerous conditions that expose them to chronic risk. Moreover, they are subjected to a high risk of malnutrition, poor health practices, unhealthy diets, and substance abuse. According to the article, approximately 30-50 percent of adults report that they experienced some type of mistreatment during childhood, including sexual, physical, and emotional abuse as well as emotional and physical neglect (Fagundes and Way 279). Children raised in stressful environments exhibit higher levels of inflammatory cytokine production in comparison to children raised in low-stress environments. The prevalence of inflammation markers starts in childhood and progresses into adulthood. The article provides the results of several studies that found out that childhood adversity exposes children to inflammatory activity. The risk of developing certain chronic conditions in adulthood is higher among individuals who grew up in stressful environments and unsupportive families.
Psychological pathways that potentiate inflammation function by upregulating the transcription of nuclear factor kappa-light-chain-enhancer of activated B cells. Critical factors in the development of inflammatory activity include the frequency of stressful events and the intensity of reactivity to adversity. Studies have shown that adults who experienced childhood abuse exhibit high reactivity to stress in their daily lives compared to those who did not experience abuse. Moreover, they are more likely to report frequent psychological stress. Experiments conducted in the laboratory showed high levels of plasma IL-6 in response to simulated stressful situations by individuals who experienced traumatic events in childhood (Fagundes and Way 282). The levels were low in individuals who did not experience traumatic events in childhood. Experiments conducted among depressed participants showed high levels of IL-6 plasma in reaction to stress.
Scientists have established a relationship between autonomic activity and childhood abuse. The fight or flight response elicited by stressful situations is accentuated by responses to adversity. The response suppresses parasympathetic activity and increases inflammation. In that regard, increased sympathetic activity and decreased parasympathetic activity due to maltreatment exposes children to the risk of inflammation in adulthood. Children with a background of abuse exhibit lower heart-rate variability than children who were not abused. Childhood abuse also alters the body’s immune response to cortisol. Another cause of inflammation in adulthood is epigenetic change, which involves the structural modification of DNA. Methylation is an example of an epigenetic change that involves the addition of a chemical group to DNA (Fagundes and Way 285). More research needs to be conducted because few studies on epigenetic change have been done. Future studies should focus on the identification of periods during development that epigenetic changes occur and the role played by inflammatory molecules in DNA modification processes such as methylation.
In conclusion, the authors recommended basic research for the identification of the most responsive periods and biological pathways for the efficacious implementation of interventions. Implementing interventions that help children who experience maltreatment is critical to enhancing their mental and physical health. Anti-inflammatory medications should be administered to adults who experienced abuse during childhood. Effective psychological remedies include cognitive behavioral therapy and relaxation exercises. Researchers should study the role of inflammatory biomarkers in aiding the implementation of the aforementioned interventions.
Work Cited
Fagundes, Christopher P, and Baldwin Way. “Early –Life Stress and Adult Inflammation.” Current Directions in Psychological Science, vol. 23, no. 4, 2014, pp. 277-283.
Marylyn is a 17-year-old African American girl. She lives with her mother, grandmother, and 11-year-old twin sisters. Three weeks ago, she was attacked by a group of young men while returning home after her theater class. They were bullying and beating her. They were going to take the girl into their car and could probably rape her, but a man who was passing by called the police and made them go. At present, the girl has recovered physically, and the bruises have almost disappeared. However, her mental condition is unsatisfactory. She has been depressed since the day of the accident. She experiences nightmares in which the sex offenders did what they intended to do. The girl gave up her theatre class and did not leave the house alone. In fact, she stays in most of the days. She threw away skirts, bright tops, and dresses. She believes that she should become less noticeable and blames herself for everything that happened to her. At the same time, she suffers from a lack of self-realization because she had an active life before the accident. She wants to come back to college and the theatre class, but the symptoms she observes do not let her do so.
During the treatment of the patient, the Target Memory (T-ICES) is the day the girl was attacked. The Image that appears most often is one of the offenders trying to make her get into the car. The Cognitions in her mind are that even the neighborhood can be dangerous, and it is better to stay at home. The Emotions she experiences are fear, mistrust, and loneliness. The Sensations she remembers are danger and panic.
The unmet needs include the lack of psychological stability, deficiency of self-confidence, and the lack of feeling of safety. However, her strengths, which include the ability to concentrate, creativity, and strong motivation, will be helpful in the interventions that are aimed at meeting the needs of the patient.
In her treatment, it is necessary to eliminate the feeling of guilt for the accident. Moreover, it is important to cope with the nightmares because they do not let her sleep normally and make the situation even more complicated. Finally, the symptoms of depression should be removed to let the girl return to her usual active life.
Treatment Plan
At present, the primary goals of the girl are to be able to leave the house without fears and to sleep without nightmares. Thus, the treatment plan is concentrated on minimizing the existing symptoms of posttraumatic stress disorder and eliminating nightmares, thus providing normal sleep.
Big Behaviors
Nightmares and bad sleep
The unmet need for psychological stability results in the interruption of sleep because of trauma.
The TF-CBT Intervention applicable for the patient is the development of a self-relaxation technique that will allow the young girl to calm down when she becomes hypervigilant.
Strength: the major strength of Marylyn is her ability to concentrate on her actions, even being stressed. It can be helpful in developing the self-relaxation technique.
Self-accusation
The unmet need for this symptom is the lack of self-confidence.
The TF-CBT Intervention that can be used to manage this condition is the compare and contrast writing. The young girl should note down the reasons for blaming herself and the reasons for the actions of the offenders.
Strength: her main strength useful for this intervention is the creativity that allows her to imagine the forces that were driving her offenders.
Depression (staying in for days)
The unmet need is the feeling of the lack of safety.
The TF-CBT Intervention would be the development of strategies for self-protection. Probably, an appointment to a self-defense class can be useful.
Strength: her main strength is strong motivation to overcome her depression and return to her usual active life.
Stress at the workplace is mostly positive because it stimulates resourcefulness and efficiency. It prompts individuals to reach their zenith of productivity. Naturally, humans are supposed to experience a stressful situation, contain it with a higher tension and then resume their relaxed state. Stress and the associated anxiety stimulate the release of chemicals that gives the victim in question strength and energy that can be very helpful if one is facing physical danger. However, the energy and strength resulting from stress can be detrimental if the stress is a reaction to an emotional danger because the extra strength produced is not utilized.
United Nations International Labor Organizations defines stress as a global epidemic. Stress has both physical and economic effects that can be very detrimental to an organization’s productivity. Workplace stress and its related expenses cost U.S. investors about $200 billion annually in absenteeism, staff turnover, reduced productivity and rising compensation costs (Ferguson & Gerspach, 1985). Holmes-Rahe Life Events scale indicates that stressful incidents at the workplace include: firings, change in responsibilities, fluctuations in finances, conflicts with superiors, and change in working conditions.
Fire Administration’s Stress Management Implementation Strategy in the United States
The fire administration acknowledges that stress is one the major work hazards firefighters are exposed to in their line of duty (Ferguson & Gerspach, 1985). Fire service individuals perform their duties in a pressured environment and thus the organizations recognize the importance of educating employees on how to deal with stress. According to the United States Fire Fighters Administration, stress management entails knowledge on what stress is, its effects on our lives, and mechanisms that enhance effective control.
The Fire Department Occupational Safety and Health Program (1987) framework covers concerns that emphasize on both physical and emotional well being of the firefighter. The stress management program is tailored to impart knowledge as well as meeting individual needs at both group and individual level. The program is all inclusive, catering for the entire firefighters staff. In addition, the main program is carried within a short period of time to ensure that it does not affect the organizational schedules. The program to be implemented should comfortably fit into the organizational schedule. The recommended channel for stress management is through promotion of healthy delivery channels. Individuals are allowed to participate in the program at their own liberty.
Firefighters are exposed to powerful stressors like environmental hazards that include: noise, harmful gasses, organizational policies, and psychological stressors like trauma and death. According to Ellsworth and Baer (1981), stress management involves the application of therapeutic and common sense techniques with an aim of alleviating unnecessary pressure. The fire administration recommends techniques like decompression, relaxation at given intervals, mediation, yoga, self-pacing, and muscle relaxation. Additional mechanisms include: class control classes, vacations, creative use of leisure time, having social relationships and hobbies that are not related to the work environment.
The disastrous work performed by firefighters requires that they should receive marriage, family and peer counseling to help them make informed decisions. In addition to deal with stress at work, firefighters are given privileges to rotate assignments and personnel to help in dealing with fatigue, decrease workload, and monotony (Ellsworth & Baer, 1981). Firefighters are required to have physical exercise to maintain physical fitness and reduce the probability of development of risks of heart attack.
Components of the Stress Management Program
According to Hildebrand (1980), the program implementation and evaluation committee coordinates fire professional fighters’ entry into the program. It acts like a link the management, medics, and employees. It also manages the program through initiating in-house publicity and team motivation. It also prepares the logistics, organizes for training facilities, keeps the staff training records and carries out needs assessment. After the implementation of the program, the committee modifies it to ensure that it is customized to accommodate the entire department needs. The committee is made up of representatives from all departments in the fire administration organization.
The core program is based on psycho physiologic stress theory. The objectives of stress management program include gaining knowledge and receiving feedback to assess the participant’s stress levels and appropriate coping mechanisms. Program evaluation aims at estimating the extent to which objectives of the program can be achieved (Hildebrand, 1980).
A supplemental module entails devising of new stress management strategies by the fire department. The approved modules should be interactive flexible and should be brief enough to be presented within two hours (Hildebrand, 1980). In addition, satellite modules cover topics like relaxation skills, drug education, methods of stress, prevention, helping others cope with stress, death, family, use of leisure time, counseling, life associated stress, and time management.
The Program Evaluation and Sustenance
Organizational needs assessment enables the committee to identify needs and help in the prioritization of programs. In the process of data collection, the committee should ensure that the confidentiality of the interviewed workers is maintained. The refresher gives the workers an opportunity to revisit the organization’s core program. The annual follow up provides an opportunity for evaluation of the program.
To evaluate the degree of understanding of the participants, the facilitators use a five-point rating scale that is placed at the appendix. The requirement of the program is that the rating scale should be filled in by all participants before a training program and after the conclusion of the training.
The effectiveness of the training aids used in the core programs is evaluated through rating scales feedback given by the participants. In addition, evaluation of the level of individual knowledge acquisition is assessed through the use of rating scales paced at the appendix. The self-evaluation rating scale should be completed at the end of the training program. The organization’s administration recommends that the instructor should review the participant’s responses immediately after the training program (Hildebrand, 1980). This is to ensure that the participants receive immediate feedback and help in the process of reinforcing the day’s lesson.
In the evaluation process, instructors are advised to assign and record scores aggregately. After the study of the evaluation results, the instructor is able to identify the points that require more emphasis, different training materials and program changes for clarity and efficiency in learning. Re-administration of the self-test can be done at intervals to assess the rate of retention among the firefighters.
Recommended Stress Management Ideas
Avoid the use of pills and tranquilizers to control stress and fatigue. This is because it involves the purchase of pills which may turn out to be expensive if the body develops resistance and one requires a higher dosage for effectiveness. Avoid the use of sleeping pills, tranquilizers, and other drugs to control stress. Instead of repressing the stressing situation, one can choose to talk it out with a colleague and as a result easing the pressure off his or her chest (Ellsworth & Baer, 1981).
Define your personal principles to avoid intrusions on personal space. Being principled at work place enables an individual to be responsible, respect others and create harmonious relationships. Individual responsibility at workplace enhances productivity because everyone is obligated to perform their duties. In addition, harmonious relationships at the workplace foster teamwork, makes work enjoyable, and motivates workers thus improving productivity.
Create time for personal reflection. Personal reflection enables an individual to review his or her goal and the extent to which they have been achieved. As an individual, do not let stressful situations have the best of you. In a workplace setting, as individual should change the strategies that are not working than shoving away the problem (Ellsworth & Baer, 1981). Adopting new solutions to solve problems as they arise is economical to the business. Ingoring the problem to can make it advance thus bringing about complications which can disrupt smooth running of the business
Review your responsibilities and obligations in the workplace. Assess if they are sufficient to make you realize your goals, if not discard them and adapt new practical ones. Change of strategy approaches at work calls for venture into new experiences, to help forget the previous awful experiences and learn new ideas and acquire different approaches to problems.
Comparison of the Fire Administration’s Strategy to Siegrist Model
The effort -reward model was advanced by Johannes Siegrists. According to Siegrist (1996), stressful experiences result from the individual’s uncertainty of the continuity of important occupational roles. Other factors include: occupational change, demotion, status inconsistency, and workload. The model incorporates psychological aspects like vigor (positive) and immersion (frustration and negative feelings).
The model hypothesis is similar to the main considerations of the United States firefighters program. The firefighters stress management strategy focuses on competence, control of job uncertainties, and sense of achievement. In addition, the firefighters want to ensure that they are not drained by their work in terms of health. Stress is perceived as one of the main obstacles to the achievement of individual competence, management of personal resources, maintenance of good health, and job satisfaction.
According to Siegrist (1996), the need for control of vigor and immersion are used to define individuals in this model. However, it is not clear to what extent they are affected by an individual’s level of control at work. A study in the United States indicated that an individual’s decision making ability positively affected intellectual flexibility, understanding and creation of personal space. Another study from Sweden indicates that workers in passive jobs for more than six years showed disinterest in leisure activities and participation in politics and the vice versa is true for workers in more active jobs.
On the other hand, in situations whereby the firefighters have to deal with death victims, the scenario is traumatizing and reminds them of their own deaths. These individuals have feelings of failure if they are not able to save lives. On the contrary, they are proud when they save lives. The program aims at reducing the stress levels for the firefighters despite the outcome of their rescue missions. Peer counseling is provided to help them get over anger and anxiety related to positive and negative experiences.
The Siegrist model does not take into account the psychological effects of working conditions like motivation mechanisms for the employees, coping patterns for the traumatized individuals, and learning activities. On the contrary, the firefighters’ stress management program acknowledges the potential effects of the firefighter’s harsh working environment and their nature of work. The program recommends peer counseling, psychological assessment, motivation, and appreciation of individuals’ efforts at work.
Conclusion
In conclusion, stress is the body’s mechanism of dealing with pressure. It can either be positive or negative depending on individual level of management and ability to assume normal functioning. In a work context, stress makes individuals reach their optimum point in productivity. Stress at the workplace is mostly positive because it stimulates resourcefulness and efficiency. It prompts individuals to reach their zenith of productivity.
Naturally, humans are supposed to experience a stressful situation, contain it with a higher tension and then resume their relaxed state. Stress is perceived as one of the main obstacles to the achievement of individual competence, management of personal resources, maintenance of good health, and job satisfaction. Various models have been developed to explain the causes and effects of stress. The Siergist model perceives stress to be resulting from positive and negative aspects revolving around an individual’s ability to control various aspects at the workplace. Firefighters are exposed to stress situations by their nature of work.
The stress management program is meant to enable them to separate their works from their other aspects of life and to enable them to make informed decisions. It also enhances physical and psychological fitness through exercise, professional counseling, exploring new fields, and interpersonal growth through creation of new relationships.
References
Ellsworth, D. W. & Baer, R. J. (1981). Psychological services for firefighters. Fire Chief Magazine, 1, 52-53.
Ferguson, J. K. & Gerspach, J. E. (1985). Stress factors in the fire service: are we having fun yet? American Fire Journal, 2(1), 9-10.
Hildebrand, J. F. (1980). Assessing the psychological needs of firefighters, The International Fire Chief, 15(2), 18-21.
Siegrist, J. (1996). Adverse health effects of high effort/low reward conditions. Journal Occupational Health Psychology, 1, 27-41.
Any form of stress in the workplace can make it impossible for employees to complete their roles diligently. Individuals and leaders should pursue evidence-based initiatives to deal with such hurdles. This paper gives a detailed personal reflection of the common causes of workplace stress and the most appropriate measures to mitigate them.
Common Causes and Performance
There are leading contributors of personal stress that employees should take into consideration. The first one is prolonged or heavy workload. Such attributes will discourage individuals and make it impossible for them to focus on their duties. The second one is that of job insecurity. A person whose employment contract is uncertain might become disoriented and unwilling to pursue his or her personal dreams (Bhui, Dinos, Galant-Miecznikowska, de Jongh, & Stansfeld, 2016).
This means that the worker will perform negatively in the targeted organization. The issue of role conflict will result in personal stress and make it impossible for the affected individual to complete his or her roles efficiently. Trauma, abuse, and discrimination will trigger depression among workers and increase cases of absenteeism and disunity. Such aspects will affect the contributions of different workers.
Stress Management Methods
Although there are powerful strategies for managing stress in the workplace, there are specific ones that I am yet to implement in my unit. Firstly, the use of relaxation techniques can reduce levels of burnout and ensure that I am capable of coping effectively. This approach can empower me to deal with stress and eventually achieve my objectives. Secondly, the use of healthy responses is a powerful method that can deliver meaningful outcomes. Some of the practices include engaging in exercises, reading inspirational books, and interacting with individuals from diverse backgrounds (Bhui et al., 2016). The last powerful method for tackling stress is that of therapy. Troubled workers can identify competent psychologists to support them until they record meaningful outcomes.
Enhancing Creativity Practices
There are specific creativity development strategies that I can enhance to support my stress management strategies. The first one is the idea of relaxation whereby I can create adequate time to engage in exercises and meditation. I can also listen to music and read inspirational books. Such a creative process will ensure that the level of stress reduces significantly (Quick & Henderson, 2016). The second approach is that of sleep. A stressed person can embrace this method to avoid the negative aspects of depression. Employees should avoid any form of self-blame, adjust his or her expectations, and embrace the power of humor.
Personal Thoughts
Workplace-related stress makes it hard for employees to pursue the outlined organizational goals. The outlined contributors affect people’s commitment, morale, and responsiveness, thereby disorienting performance. The described mitigation strategies are simple, cost effective, and capable of delivering positive results. For example, relaxation and therapy techniques guide workers to overcome the burden of stress and pursue their roles.
Getting adequate sleep is an effective strategy for minimizing fatigue (Denhardt, Denhardt, & Aristigueta, 2016). People can also involve colleagues and develop appropriate work-life balances. Exercises, reading, and the application of healthy responses will help individuals to tackle work-related stress (Quick & Henderson, 2016). They can also seek social support from friends and organizational leaders. People should go further to have proper time plans for all duties to minimize burnout.
Conclusion
The above discussion has identified stress as a major problem many employees face. With the use of the proposed interventions, every person will formulate new expectations, promote an effective work-life balance, and join groups that can maximize inspiration. The individual will become reenergized and capable of achieving the outlined goals.
References
Bhui, K., Dinos, S., Galant-Miecznikowska, M., de Jongh, B., & Stansfeld, B. (2016). Perceptions of work stress causes and effective interventions in employees working in public, private and non-governmental organisations: A qualitative study. BJPsych Bulletin, 40(6), 318–325. Web.
Denhardt, R. B., Denhardt, J. V., & Aristigueta, M. P. (2016). Managing human behavior in public and nonprofit organizations (4th ed.). Thousand Oaks, CA: Sage.
Quick, J. C., & Henderson, D. F. (2016). Occupational stress: Preventing suffering, enhancing wellbeing. International Journal of Environmental Research and Public Health, 13(5), 459-469. Web.
PTSD is a psychological condition that is known to occur as a result of a certain traumatic experience, such as partner violence, kidnapping and hostage situation, physical abuse, neglect in childhood, and concentration camp imprisonment, among others (NIMH, n.d.). The condition is known to produce numerous socioemotional, cognitive, and physical issues. In combination, these issues are known to have a detrimental effect on the individual’s development (Weston, 2014). The following paper identifies developmental issues characteristic for adults with PTSD and describes an intervention expected to address them.
Developmental Issues
The most common socioemotional behavior associated with the condition is avoidance – the tendency of an individual to deliberately or subconsciously avoid experiences related to trauma. On the most basic level, this behavior can affect decisions regarding visits to certain places or events. In more complex cases, certain types of emotions, feelings, and thoughts can fall within the avoidance range (Boden et al., 2013). The latter constitutes a major lifespan issue due to its potential for disruption of daily routines. For instance, a victim of a particularly traumatizing traffic accident may start avoiding cars and other means of transportation, which, in some scenarios, can introduce social challenges.
Another widespread developmental issue is related to disproportional reactivity and arousal. Adults with PTSD are known to experience sleep problems and are more likely to engage in angry behaviors, such as emotional outbursts (Pineles et al., 2013). In addition, individuals with PTSD are more likely to be startled and perceive excessive tension. Unlike the avoidance-related issues, increased arousal and reactivity is rarely tied to specific environmental situations. Instead, it is characterized by prolonged exposure and, over time, accumulates into a feeling of anger and stress, described by the sufferers as “being on edge” (Pineles et al., 2013). As a result, it may become more difficult for an individual to concentrate on relatively simple tasks such as eating or sleeping.
The third area of developmental issues impacts the cognitive domain. Adults with PTSD experience difficulties remembering details of a traumatic event, which is commonly considered a psychological defensive mechanism intended to shield them from excessive stress. However, this issue also creates a range of social and emotional aspect of the client’s life. Specifically, a client may feel guilty and blame oneself either for the initial traumatic event or subsequent adverse outcomes associated with it (Alabama State Department of Education, 2017). On a broader scale, these feelings may facilitate dissatisfaction with the surrounding reality. Finally, the loss of satisfaction with enjoyable activities can be observed.
At this point, it is important to mention that the occurrence of these issues within a short time does not necessarily constitute a PTSD-related developmental issue. In many cases, people experience the same effects within few weeks after the traumatic event with no long-term consequences, in which case lifespan issues do not manifest afterwards. However, once the duration of the symptoms exceeds one month, they become noticeable on a social and psychological level. Specifically, the loss of interest coupled with negative thoughts about oneself impairs individual’s functioning ability and contribute to the sense of detachment from family and friends. In the long run, these factors increase the likelihood of substance abuse and depression and, by extension, lead to a significant decline in health due to constant stress.
It is also necessary to address the impaired functioning ability mentioned in the previous section. According to the current understanding of neurobiological behavior, visuospatial skills, attention, working memory, and social cognition are closely related to cognitive capacity of the individual. Thus, according to the psychodynamic learning theory, the loss or noticeable decline of any of these functions leads to significant developmental deficiencies. In other words, PTSD-impacted populations are at an increased risk of developmental impairment.
Intervention Description
As can be seen from the information above, PTSD-related issues can become detrimental to the individual’s development. Thus, it is necessary to facilitate an intervention that would address the main adverse effects of the condition. The proposed intervention is a family-oriented event. This choice can be attributed to the positive role of the family in the emotional and cognitive function of a sufferer. Simply put, psychological and emotional support offered by friends and relatives is known to improve coping ability and mitigate adverse effects associated with the condition (Boden et al., 2013). In order to achieve the described effect, it is necessary to ensure sufficient understanding of the impacted individual’s needs by their peers. The proposed intervention is to be in the form of a workshop for families of adults with PTSD. The duration of the program is four weeks, with one hour-sessions on a weekly basis. Such timing would ensure adequate coverage of essential information necessary for an understanding of the condition. At the same time, it would provide the participants with an opportunity to test the learned techniques, assess and discuss the results with an instructor, and introduce necessary adjustments.
The intervention will cover strategies and techniques of managing interpersonal difficulties, such as addressing the avoidance of certain routines disruptive for behavior. Next, the information on the enhancement of communication skills will be included in the program’s plan. For a client, this component will provide valuable insights for improving social interactions. At the same time, the client’s family members will be able to avoid a number of potentially risky scenarios common for PTSD-impacted populations (CACREP, 2016). From the strategic perspective, this approach would guarantee the reduction of family-based conflicts and, by extension, would mitigate the perceived dissatisfaction with life characteristic for the impacted individuals.
It is equally necessary to cover common erroneous beliefs and misconceptions associated with the disorder. For instance, it will be necessary to explain to the family the causes of impaired affective involvement observed among individuals with PTSD. In many instances, family members attribute the effect to emotional numbing whereas in reality, disengagement with reality and depersonalizing effect of PTSD are responsible for it (Pineles et al., 2013). Establishing sufficient understanding of the condition enables trust and improves emotional attachment within the family, which has an overall positive effect on the client’s well-being.
Finally, it is important to capitalize on the development of condition-specific communication skills. First, such an approach will contribute to the understanding of the PTSD-related effects and symptoms, thus eliminating confusion and frustration (CACREP, 2016). In addition, it will allow family members to identify and address emerging issues in a timely manner or refer the client to a professional. On a broader scale, they will also contribute to the restoration of social functions and emotional intimacy.
The primary outcome expected to occur as a result of the described intervention is the reduction of negative exchanges between the affected individuals and their families. By extension, the reduced hostility, criticism, and emotional detachment will add to the perceived social and emotional comfort, reducing the likelihood of conflicts and establishing positive developmental conditions.
Individual, Group, and Family Interventions
According to the data available in the academic literature, two types of interventions can be suggested for individuals within the VA dealing with PTSD. The first category includes generic components aimed at treatment of disrupted relationships and mitigating mental health-related issues. The most recognized type of a generic intervention is behavioral therapy (e.g. traditional couple-oriented therapy). The objective of such a therapy is to promote problem-solving skills and increase the proportion of positive family-related experiences. The second common component is the promotion of openness and expression of unusual feelings. According to the attachment theory perspective, this component is expected to strengthen interpersonal communications. Generic interventions can be oriented towards individuals, couples, families, and groups of PTSD sufferers.
The second category includes condition-specific therapies. These interventions are based mostly on the cognitive-behavioral framework (CACREP, 2016). In contrast to generic approaches, these interventions are aimed at the reduction of social dysfunctions and emotional distress. Such an intervention usually delivers psycho-education on PTSD-related effects, communication-enhancing techniques, and address avoidance behaviors. Tightly scheduled training exercises are necessary to create sustainable effects of avoidance reduction and positive family experience promotion.
Conclusion
As can be seen, some of the symptoms associated with PTSD in adults produce a range of developmental issues. In most cases, the effect of these symptoms is both prolonged and cumulative, leading to significant long-term effects when left unaddressed. Therefore, it is necessary to develop an intervention that would mitigate the identified issues. The suggested intervention is expected to improve emotional and social functions of adults with PTSD and facilitate support from family members and friends. In addition to direct therapeutic effect, it will improve understanding and, by extension, establish trusted and emotionally-satisfying social environment.
References
Alabama State Department of Education. (2017). Chapter 290-3-3: Educator preparation. Web.
Boden, M. T., Westermann, S., McRae, K., Kuo, J., Alvarez, J., Kulkarni, M. R.,… Bonn-Miller, M. O. (2013). Emotion regulation and posttraumatic stress disorder: A prospective investigation. Journal of Social and Clinical Psychology, 32(3), 296-314.
Pineles, S. L., Suvak, M. K., Liverant, G. I., Gregor, K., Wisco, B. E., Pitman, R. K., & Orr, S. P. (2013). Psychophysiologic reactivity, subjective distress, and their associations with PTSD diagnosis. Journal of Abnormal Psychology, 122(3), 635-644.
Weston, C. S. (2014). Posttraumatic stress disorder: A theoretical model of the hyperarousal subtype. Frontiers in Psychiatry, 5, 37-57.
Post-traumatic stress disorder (PTSD) is a mental disease characterized by distress, disturbing feelings and thoughts regarding the event that caused it, and avoiding syndrome. The identified symptoms are largely associated with such transmitters as serotonin (5-HT), cortisol (COR), norepinephrine (NE), and dopamine (DA). As stated in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5), during PTSD, 5-HT levels decrease, which is related to amplified aggressiveness and impulsivity (Wilson, Ebenezer, McLaughlin, & Francis, 2014).
The low levels of 5-HT also make it difficult to regulate excitation, leading to irritability and hypersensitivity, thus causing the excessively emotional response to neutral stimuli. Under chronic stress, the body adapts by increasing negative feedback, which causes an increase in the number of glucocorticoid receptors in the hippocampus, a decrease in the background level of glucocorticoids, and reduction in glucocorticoid synthesis in response to repeated stress stimuli.
The more there are receptors, the more the opportunity to enhance feedback, making ground-glass nodules more sensitive, and allowing one to recover from stress faster. The study by Bandelow et al. (2017) showed that the development of PTSD is associated with the dysregulation of the hypothalamic-pituitary-adrenal axis and the impaired sympathoadrenal medullary system as part of immunity.
In patients with PTSD, low cortisol and high levels of dehydroepiandrosterone (DHEA), necrotic tumor factor (TNF-α), and interleukin-6 (IL-6) were found compared with the healthy control group (Bandelow et al., 2017). With these changes, the authors explain the inflammatory changes accompanying the development of PTSD. As for DA, it is responsible for the reward system of the brain and may be expressed in dopaminergic hyperactivity, when a patient with DTSD becomes unusually energetic, which is rapidly replaced by inertness.
The evidence demonstrates that stress hormones change the structure of the limbic system that involves the hippocampus, one of the most plastic and unstable areas of the brain (Wilson, 2014). In the hippocampus, impulses arrive through ramifications between the dentate gyrus and CA3-pyramidal neurons from the olfactory cortex to the dentate gyrus. Wilson et al. (2014) state that the dentate gyrus is essential in ensuring the memorization of sequences of events, although long-term data storage occurs in other areas of the brain.
Since the CA3 section of the dentate gyrus is balanced and vulnerable, there is adaptive structural plasticity during which new neurons continue to appear throughout life, and pyramidal cells, in response to chronic stress or hibernation, undergo reversible dendritic remodeling. In their study, Depue et al. (2014) suggest that a reduced amygdala is another anatomic change related to PTSD.
At the same time, PTSD causes an increase in physiological parameters, while prolonged stress exposure can lead to pathology. The allostatic overload that exceeds the adaptation threshold leads to atrophy and remodeling of the hippocampal and prefrontal cortex neurons, which are involved in the mechanisms of memory, attention, and executive functions, as well as hypertrophy of neurons almond-shaped nucleus associated with the processes of fear, anxiety, and aggression (Wilson, 2014).
It is especially critical that the stressful experiences of a child, apparently, can occur during the period of active development of the brain. In this period, myelination of its different departments is completed, and neural connections are established, both horizontal (between sections of the cortex) and vertical (between the cortex and subcortical structures), and has a negative effect on the course of these processes. This can lay the foundation for the subsequent development of personality and various affective disorders.
Summarizing behavioral, neuroanatomic, and neurotransmitter changes of PTSD, one may note that the lack of neurotransmitter in neurons of the cortico-basal ganglia-thalamocortical loop, where normally serotonin activity is necessary for inhibiting anxiety, is associated with persistent phobias, anxiety, avoidant behavior, pathological shyness, et cetera (Bandelow et al., 2017). Similarly, an increased level of norepinephrine in the amygdala is associated with the development of nightmarish dreams, obsessive memories, overexcitement, and panic attacks.
In addition, excessive amounts of this neurotransmitter are associated with autonomic disorders such as tachycardia, tremor, hyperventilation, excessive sweating, and so on. The lack of norepinephrine is associated with persistent phobias, nervousness, tension, anxious expectation, and avoiding behavior (Bandelow et al., 2017). Thus, the mentioned neurotransmitters promote processes that ensure the development of anxiety in neurons of cortico-basal ganglia-thalamocortical loops. Based on the mentioned findings, it is possible to suggest that there is a connection between various symptoms of PTSD.
The symptoms that occur as a result of the impaired activity of serotonin and noradrenaline systems are unevenly presented in various diagnostic categories. In other words, the manifestations of anxiety associated with a surplus of norepinephrine are the most characteristic of post-traumatic stress disorder.
Hypothetically, it can be assumed that a decrease in the activity of the GABAergic system is a common and primary pathogenetic mechanism that determines the manifestation of any anxiety disorder, while a specific clinical target depends on the features of metabolic disorders of serotonin and norepinephrine. Most likely, serotonin and norepinephrine neurons try to combat an activity deficit, for example, in the cortico-basal ganglia-thalamocortical loops, thus contributing to better recovery.
References
Bandelow, B., Baldwin, D., Abelli, M., Bolea-Alamanac, B., Bourin, M., Chamberlain, S. R.,… Grünblatt, E. (2017). Biological markers for anxiety disorders, OCD and PTSD: A consensus statement. Part II: Neurochemistry, neurophysiology and neurocognition. The World Journal of Biological Psychiatry, 18(3), 162-214.
Depue, B. E., Olson-Madden, J. H., Smolker, H. R., Rajamani, M., Brenner, L. A., & Banich, M. T. (2014). Reduced amygdala volume is associated with deficits in inhibitory control: A voxel-and surface-based morphometric analysis of comorbid PTSD/mild TBI. BioMed Research International, 2014, 1-11.
Wilson, C. B., Ebenezer, P. J., McLaughlin, L. D., & Francis, J. (2014). Predator exposure/psychosocial stress animal model of post-traumatic stress disorder modulates neurotransmitters in the rat hippocampus and prefrontal cortex. PLoS One, 9(2), 1-7.
The DSM-IV-TR defines a PTSD patient as an individual who has either witnessed or experienced a significant event(s) or trauma, serious injury, either to oneself or others, or one who has been faced with threatening near- death experience. The anxiety reaction of an individual with PTSD to trauma is different from the normal anxiety reaction that has the tendency to dissipate (Brodwin et al, 2009), as time goes by.
In the case of PTSD, the patient still continues to experience intrusive, recurrent, and distressing recounts of the actual event in the form of nightmares or flashbacks. The presence of any cues within the immediate environment of such an individual, and which could resemble or symbolize an element of the actual traumatic experience has the potential to arouse in them profound psychological distress.
For clients in need of rehabilitation counseling, Post Traumatic Stress Disorder still remains a leading anxiety disorder that they are more likely to experience. In recent years, PTSD has gained a lot of attention as a result of the high number of the Vietnamese War Veterans who have manifested the symptoms of the condition.
Further attention to the disorder has been called following the recent combats in both Iraq and Afghanistan. The New England Journal of Medicine carried the report of a study that showed the prevalence of PTSD to be 9. 3% (Kolb, 1986, p. 642). For Marines and soldiers deployed to Iraq, and who had encountered between one and two combats.
In addition, for these marines and soldiers who had encountered between there and five combats, the prevalence of PTSD was 12.7 %. Above five combats, the prevalence of PTSD was 19.3% (Lande, Marin & Ruzek, 2004).
These statistics appear to somewhat match those released by a study undertaken on the marines and soldiers deployed to Afghanistan whereby the prevalence rates of 8.2 %, 8.3%, and 18.9% (Reeves, 2007, p. 183) , in that order, were recorded for the different categories of firefight experience.
Other forms of PTSD
Besides the veterans, individuals seeking for refugees’ status in the United States have also been seen to present with PTSD symptoms (Brodwin et al, 2009).
For instance, a majority of the Americans of Southeast Asian descent were seen to have developed this disorder following their traumatic encounter with war and socio-political unrest back home, not to mention their traumatic experiences as refugees, on their way to the United States.
Other than war experiences, individuals that have been afflicted with major violent crimes, serious and life threatening experiences, and personal trauma, are also more likely to experience PTSD as well.
Further, PTSD may also come about due to upheavals of a large scale, normally affecting an entire region or community, including such natural disasters as hurricanes, earthquakes, and floods. In addition, such distressing events as acts of terrorism and riots could; also trigger the PTSD condition.
There is a wide variation in terms of the prevalence of PTSD. In this case, projections range between 2 and 15 % (Brodwin et al, 2009), owing to the variations in exposure to trauma from one community to another.
Etiology
Learning theories on the causes of PTSD argue that the main symptoms attributed to this condition can be attributed to the patient’s classical conditioning to fear. On the basis of this model, there is the likelihood of a patient suffering from PTSD experiencing enhanced fear or anxiety following a car accident that remains quite traumatic, or at a time when they are travelling in a car (Schoenfeld, Marmar, & Neylan, 2004).
Should the patient resolve to avoid traveling in motor vehicles, this only act to reinforce the fear that such a patient may have for cars, in a negative way. Accordingly, in the absence of a car, the anxiety also fades. Explored from a biological context, patients who have already been diagnosed with PTSD have been seen to experience lasting changes in their brain chemistry.
There is the tendency for PTSD patients to manifest increased psychological reactions towards both physical stress and physiological reactions as well. When we are faced with a traumatic event, such an emergency, this in effect acts to activate the sympathetic nervous system (Schoenfeld, Marmar, & Neylan, 2004).
As a result, epinephrine and norepinepherine, the two catecholamine neurotransmitters, are released by the “locus coeruleus” region in the brain. A majority of the studies indicates that those patients who have been diagnosed with PTSD could also manifest characteristics of catecholamine abnormalities.
In this case such studies reveals when the cortisol/norepinephrine ration tends to be high, this serves as a valuable sign of PTSD (for example David et al, 2004). Completely mindful of individual exposure to traumatic experiences, there are important PTSD predictors that we need to address. They include early separation from one’s parents, family history, being female, parental history, child abuse, or divorce.
Medical management/intervention
Social and psychologic interventions could still be the first choice form of treatment for a majority of the patients who have diagnosed with PTSD. At times, such interventions have proved quite valuable in comparison with medications. The interventions ought to constitute a vital element of the treatment regimen of the patients.
The first step while starting any form of treatment often entails a cultivation of a relationship built on trust between on the one hand, the healthcare provider and on the other hand, the patient (Brodwin et al, 2009).
However, this may not be an easy thing to do for patients who have already gone through a traumatic experience. There is the need for physicians to make use of a patient-center context while evaluating the current patients’ concerns.
Psycho- educational interventions
Patient education is important in order to eradicate any form of misconception that the patients may have about PTSD, and enhance the levels of understanding of the patients, along with an improvement on their ability to recognize symptoms associated with of the disorder (Brodwin et al, 2009). Moreover, educating the patient on the condition that is affecting them acts to reduce shame and fear that they could be faced with.
Psycho-educational interventions are not only useful in empowering the patients, but they are also a source of valuable information on the possible symptoms of the disorder and their causes. In addition, patients also get to learn what the treatment regimens for the condition entails, and the ensuing recovery program (Brodwin et al, 2009).
During the psycho-education session, counselors are normally encouraged to dwell more on stress as a potential cause of a majority of the symptoms manifested by patients with PTSD. Accordingly, healthcare providers are called upon to assist patients with PTSD in interpretation of the reactions that they encounter, possibly as a result of elevated level of stress, and not due to personal weaknesses.
Coaching the patients in other mechanism of coping could also provide them with practical skills that would allow them to adequately handle the strong emotional problems they could be faced with (Brodwin et al, 2009).
We have quite a number of coping skills that could be introduced to patients with PTSD. This form of training is valuable to patients as it enables them to reclaim the control they once had over their emotions, along with the associated symptoms.
Due to the convoluted involvement of families in the lives of patients with trauma, the patients as well as the rest of the family could also benefit enormously from family counseling session (Brodwin et al, 2009). Furthermore, the presence of members of the family to patients with PTSD during therapy is vital. This is because they might provide useful information on the medical history of the patients.
Such relevant history includes previous involvement of the patient in drug abuse, social relations, and sleep habits, among others. In this case, it is important to note that patients may either be unwilling ro lacking the capacity to report such issues.
Through cognitive restructuring, it is intended that patients with PTSD shall be guided on how best to evaluate their condition, and the most suitable remedial actions that they ought to take regarding erroneous beliefs that are usually linked to the issue of trauma. Normally, this happens when the existing relationship between their though processes and emotions are evaluated with a view to identifying an individuals’ negative thoughts.
Accordingly, it becomes necessary to develop interpretation alternatives, and facilitate in the adoption of new thinking ways for the patients (Cassels, 2009). Such a modality for treatment also entails a self-assessment of individual thoughts. Moreover, through cognitive restructuring, veterans could also be assisted to handle changes in perceptions as a result of having taken part in combat.
On the other hand, there is need to take into account exposure therapy following the preparation of patients to enable them confront their painful memories and the associated emotional trauma (Cassels, 2009). During this therapeutic session, the patient is normally encouraged to make verbal utterances more frequently regarding the traumatic experience.
The intention is to ensure that the patient gets frequent exposure to fear stimuli up until such a time when they shall have attained stable and reduced fear responses. Physicians charged with the responsibility of providing this particular treatment needs to have been properly trained and exposed as prior studies appear to suggest the likelihood of deterioration in the condition of a patient following an improper use of this therapy.
As a result of the observations that have been carried out on the psychologic and physiologic changes that are associated with PTSD, pharmacological agents have also been recognized as intervention agents in helping to manage the PTSD condition (Lineberry et al, 2006). It is important to view pharmacotherapy as the key modality for PTSD management.
A proper combination of psychotherapeutic and pharmacotherapy regimens is still regarded as the most ideal intervention strategy in facilitating in PTSD management. A number of medications have found use in the different treatment modalities for PTSD patients, with a number of these relying on clinical trials that have been well-designed, while others relies entirely on subjective evidence.
Up to now, paroxetine and setraline hydrochlorisde have been approved by the FDA in helping with treatment interventions of PTSD patients. Nevertheless, we also have other drugs in use, such as mood-stabilizing agents, antipsychotic agents, stabilizers, as well as the adrenergic-inhibiting agents (Cassels, 2009). These have also been found to aid in an effective treatment of the PTSD condition.
Treatment and associated complications in the during treatment of PTSD
In the treatment of PTSD, psychotherapy, medication, or a combination of the two methods finds use. PTSD patients have a higher likelihood of manifesting symptoms of the disorder even while undergoing rehabilitation counseling. For this reason, we need to take into account the issue of stress at either the educational setting or the place of work during program planning.
High cormobidity levels have been reported between on the one hand, alcoholism and on the other hand, anxiety disorders (Foa, Keane, & Friedman, 2008), including PTSD, not to mention the use of other substances.
This could represent one of the strategies that some of the patients with PTSD use in an attempt to reduce their anxiety symptoms. Furthermore, we also need to take into account the issue of the patients who gets addicted to certain prescription medication as well.
Barriers to society
Even as the understanding of the public regarding the issue of mental illness appear to have dramatically increased in recent years, however, stigma still remains a formidable social barrier for those individuals who have been diagnosed with a mental illness.
There is the tendency for members of the public to view individuals afflicted with a severe mental condition in an exceedingly negative manner in comparison with their counterparts who could be suffering from mental illnesses (Brodwin et al, 2009). For this reason, mental disorder patients are more likely to be negatively stereotyped as being erratic, unreliable, violent, and irrational, and hence the associated stereotype.
More often than not, people with mental disorders are usually considered as undesirable co-workers, friends, employees, and tenants. Negative stereotypes and stigma often linked to individuals with metal disorders have deep roots in the society (Brodwin et al, 2009).
Usually, people who commit a crime that borders on a heinous cat are usually labeled “sick” (that is, mentally ill). It is quite unfair to equate criminal behavior to a mental disorder, not to mention that the act itself is extremely unjust to those individuals who have been diagnosed with a psychiatric disorder, and this includes patients diagnosed with PTSD as well.
The mass media has emerged as yet another platform for the demeaning and misrepresentation of individuals with mental illnesses. In this case, the media is awash with images of individuals with mental disorders, often depicted in a negative manner. However, occasionally, the media presents positive portrayals of such individuals (Brodwin et al, 2009).
People with mental illnesses could also be depicted as being dangerous and violent by the media. A case in point here is the use of such labels as “psychos” or “psychotic killer” in movies, publications, and television shows.
Even as a number of patients who have been diagnosed with a mental disorder could manifest violent reactions, nevertheless, the likelihood that they would be involved in acts of violence remains comparatively low.
Impact of stigma on PTSD patients on issues of employment and training
There are a number of ways through which stigma could impact on individuals with a mental disorder. From a personal context, an individual could be discouraged to the point of refusing to seek professional help for either employment purposes or for the condition that afflicts him or her. Stigma not only affects the self-esteem of the patients, but also that of their significant others and members of the family as well (Brodwin et al, 2009).
Ultimately, everyone involved ends up getting stress by the stigma. On the occupational and social arena, stigma affects social relations adversely, not to mention reducing the opportunities for housing and employment for the patients in question.
Within the public policy context, stigma acts to negatively impact on the willingness of the public to provide the necessary financial resources for treatment of individuals with mental health problems.
It is important to ensure that rehabilitation counselors remain extremely sensitive to the negative impacts of the stigma that is often associated with mental disorders clients. It therefore becomes necessary to undertake a realistic evaluation of the work setting in question in order to determine if at all it will be fit for the client.
Even though an agency or company could have in place an official policy that supports individuals that have been diagnosed with a mental illness, nevertheless, there is the likelihood that co-workers could view such employees with a certain amount of mistrust and fear (Brodwin et al, 2009). A number of the employees could also harbor a fear that employees with a mental disorder might turn violent or disruptive at the place of work.
On the other hand, we also have those employees who might be concerned that the individual with a mental disorder might “break down” should they accidentally utter the “wrong words” to them.
Although such concerns could be valid under certain circumstances, nevertheless, for the most part, they have been exceedingly generalized to take into account all people manifesting one form of mental disorder or another, and not just PTSD (Brodwin et al, 2009).
Occasional remarks or jokes and ostracism uttered by co-workers and insensitive colleagues (intentionally, or otherwise) have the potential to bring about a stressful and hostile working environment. As a result, individuals with a mental disorder might be discouraged from either seeking re-employment or remaining at the workplace altogether.
It is important for the rehabilitation counselors to ensure that they effectively collaborate with client advocacy groups and mental health specialist in order to promote a sensitive and accurate image of individuals with mental disorders. There is also the need for the individuals involved to address the issue at hand from a personal context when they are working hand in hand with clients.
An Interview with a PTSD patient
During the interview, the subject was very nervous and would not look me directly in the eye. They stated that they felt like they were a book lying open for everyone to see. They told me that PTSD had totally ruined their social and personal life. They are consistently looking over their shoulder, never knowing if something or someone is going to hurt them.
Many times, I had been told that a person with PTSD would often react angrily over the smallest issues. They also tend to become very irritable quickly if things look as if they are spiraling downward and the veteran feels as if they are losing control of the situation.
Difficulty in concentrating is another major setback with PTSD. They tend to start something with great hopes and expectations; however, they lose interest in the task rather quickly, so they have a lot of unfinished projects. This causes them to feel like they are worthless and cannot do anything right, which only worsens the problem. They lack sleep at night because the voices never seem to leave them alone.
Even with medication their sleeping patterns are very erratic. They do not like to socialize with people because they are afraid that either someone will start asking them about their disability or put them on the spot to answer a question, while the whole crowd awaits the answer.
My interviewee even stated that there have been several times that even the thought of going out their own front door onto the lawn brought them to a cold sweat. Many are the days when they would not even leave the house. The possibility of obtaining employment is very unnerving to them. They have told me that most of the veterans with PTSD are unemployable due to their disability.
Being around people, especially strangers, simply terrifies them. Taking orders, being on a time schedule is another problem because many times these people tend to need extra time to get the job accomplished.
Vocational Therapy and PTSD
Below are some useful suggestions that could be quite valuable in helping people with PTSD to not only relax, but also decrease the occurrences of symptoms as well.
Breathing techniques
The PTSD patient could be assisted to start the berating exercise while standing up, lying on their back, or even while sitting down on a chair. By way of having their hand placed on their stomach, the patient is then instructed to inhale, as the stomach rises. It is important however, to ensure that they begin with slow breathing via the nose, making sure that they hold their breath for about 5 seconds.
Then, the patient is required to exhale slowly, via the mouth. This procedure requires to be repeated for an additional 5 minutes. However, patients are often instructed to stop the process as soon as they feel uncomfortable, and should only resume once their breathing has returned to normal (Brodwin et al, 2009).
Enhanced muscle relaxation
Once again, this exercise often starts with the patient either sitting on a chair, or lying down on the floor. For better relaxation, one is often instructed to ensure that they close their eyes. However, in the event that a patient feels a bit uncomfortable by closing their eyes, they are often advised to open them.
To start the breathing process, the patients needs to ensure that they either lie or sit down with legs and arms in neutral position. To accomplish this technique, there is the need to methodically and slowly release and tighten one’s voluntary muscle groups. This in effect acts to counter the states of relaxation and tension (Cara & MacRae, 2005).
One is also advised to ensure that his/her muscles remains as hard as they can get for a period of 5 seconds, being careful not to hurt oneself. Thereafter, patients are often requested that they relax for an additional 5 seconds.
They should then start by lifting their toes off the ground, making sure that their heels still remains firmly on the ground. A session of tightening and relaxation of muscles should then follow. In this case, one should begin by tightening and relaxing their abdominal muscles, after which the arms and hands should then follow.
A pulling back of one’s shoulder is aimed at ensuring that the upper back and arms are tightened, followed by a relaxation session. Thereafter, the patient should be encouraged to shrug off their shoulders, in the same way as someone would say, I do not know. Then, another relaxation session should follow.
Thereafter the neck muscles ought to be tightened by way of lowering one’s head, followed by a forward extension of one’s back of the head, and finally, a relaxation session follows. After that, the patient needs to ensure that their facial muscles are tightened.
This can be achieved by having the patient open their mouth wide enough, after which they are to ensure that their eyebrows are raised, followed by a tight shutting on one’s eyes. Then, the patient needs to ensure that they have relaxed as much as they can. To end each of these exercises, there is need to ensure that the breathing techniques that one had started with are used.
Expressive activities
Emotional expression is yet another relaxation technique that is also aimed at clearing of one’s mind. Some useful alternatives here include diary or journal writing, playing an instrument, listening to music, creating crafts or art, watching one’s favorite movie, or drawing.
Lifestyle changes
Elimination of drugs that have not been medically prescribed, a reduction in the intake of caffeine, regular exercising, observing a balanced diet, weight management, ensuring that one gets sufficient sleep, reducing one’s blood pressure, increased participation in leisure activities, and proper time management are all elements capable of having a positive impact in as far as the ability of an individual to deal with anxiety is concerned (Cara & MacRae, 2005).
At times, laughing helps one to remain healthy and happy, and reduces worry.
Conclusion
As a mental disorder, PTSD has lately been seen to impact on an increasingly higher number of war veterans, following their completion of combat(s). In this case, such victims are more likely to experience flashbacks and nightmares of the actual episodes that they were exposed to during combat.
However, PTSD could also come about after an individual has been exposed to significant events of trauma, besides combat, due to a serious injury (such as those sustained following a car accident), or after being faced with a near death experience.
Most of the hypotheses on the causation of PTSD argue that the key symptoms of PTSD are due to classical conditioning to fear, on the part of the patient. Accordingly, being exposed to an environment similar to that which led to the traumatic experience only serves to reinforce their fear. Socio-psychological intervention still remains the first choice treatment for PTSD patients.
However, it is important to ensure that the interventions employed constitute a vital element of the patient’s treatment regimen. On the other hand, psycho-educational interventions involve empowering and coaching the patient on how best to deal with the condition.
Owing to societal barriers, people with PTSD are often considered as undesirable co-workers, friends, employees, and tenants. Owing to the stigma attached to them, such individuals could even refuse to seek professional help for employment purposes, or even treatment.
For this reason, rehabilitation counselors should remain extremely sensitive to the negative impacts on the stigma associated with mental disorders clients.
Moreover, rehabilitation counselors also need to collaborate more effectively with client advocacy groups and mental health specialist in order to promote a sensitive and accurate image of individuals with PTSD. Vocational therapy such as enhanced muscle relaxation exercises, breathing techniques, expressive activities and lifestyle changes are all vital in helping patients with PTSD to better manage their condition.
Reference List
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