Military Psychology

Gerhard Ohrband – ULIM University, Moldova

12th lecture

Trauma therapy

Course structure

1. Introduction: Historical Overview, main applications2. Environmental Stressors3. Leadership4. Team Effectiveness5. Individual and Group Behaviour6. Clinical Psychology7. Selection and Classification8. Training 9. Human Factor Engineering10. Psychotherapy and Counseling11. Terrorism12. Trauma Therapy13. Psychological Warfare14. Ethical Issues for a Psychologist in the Armed Forces15. Review: Preparation for the exams

Content

Post-traumatic stress disorder (PTSD) Trauma therapy In detail: Expressive writing (J. Pennebaker)

Post-traumatic stress disorder (PTSD) Relatively new anxiety disorder (first appearance in DSM-III in

1980) Anxiety that follows a traumatic event This event poses a threat to the individual’s life or lives of othersSymptoms: Re-experiencing of feelings related to the event (such as

intrusive memories, thoughts and images related to the event) Avoidant behaviour (such as denial and emotional numbing) Arousal (such as hypervigilance for trauma-related information) Also: sadness, guilt and anger (Shore et. al., 1989)

PTSD

Appears seldom alone but with other disorders or additional diagnoses (Bleich et al., 1997)

PTSD is a controversial inclusion in DSM-IV because its validity has been challenged

Some researchers point to the ease with which PTSD symptoms can be faked

Study: Burges and Mc Millan, 2001 Participants of a night class were asked to generate symptoms of

PTSD from a vignette The class also read a standard PTSD symptom checklist (or one

containing bogus items) and were asked to complete the measure as if they were suffering from PTSD

One percent of the sample self-generated PTSD symptoms that met DSM-IV criteria, despite 40 per cent claiming that they had witnessed a traumatic event

When given the symptom checklist, however, 94 % met the criteria for PTSD

Participants correctly identified around 38 % of the bogus items

Events and reference studiesEvent Reference studies

Rape Green, 1994

Road traffic accidents Stallard et al., 1998; Murray et. al., 2002

Bank robberies Kamphuis and Emmelkamp, 1998

War Fontana and Rosenheck, 1993

Natural or human-made disaster

Freedy et al., 1994

Prevalence

Prevalence rate is around 25-30 % in the general population

Rape is associated with the greatest prevalence

Onset of the disorder may be delayed by many years (Blank, 1993)

Study: Dunmoore et al., 1999 Determining the factors which are associated with the onset of PTSD

and those who help maintain it They analysed data from 96 victims of physical or sexual assault Some factors were common to both onset and maintenance whereas

others where specific to onsetFactors associated with both: appraising the event and the consequences of the event (dwelling on

the assault and its aftermath) Poor coping strategies (such as avoidance)Factors related to onset: Feeling detached during the assault Being unable to perceive positive responses from othersThese cognitive factors may prevent recovery by encouraging poor coping

strategy or by generating a sense of immediate threat

Other findings

Joseph et al., 1994: although crisis support was a good predictor of psychological well-being of survivors after the disaster, feelings of helplessness during the disaster, and bereavement, predicted the frequency of intrusive thoughts about the disaster

Joseph et al., 1997: negative attitude towards expressing emotion (for example, agreeing with statements such as, ‘I think getting emotional is a sign of weakness’) were associated with an increased number of PTSD symptoms

Study: Clohessy and Ehlers, 1999 Asked 56 ambulance drivers in the UK to describe the most

distressing aspects of their work and administered questionnaires which tapped their ability to cope with this distress and the degree to which the thoughts about the distress were intrusive

21 % of the sample met DSM-IV criteria for PTSDPredictors of the severity of the post-traumatic stress: Poor coping strategy Efforts to suppress intrusive thoughts Dwelling on previous distressing events

Post-traumatic stress disorder (PTSD) Horowitz’s model (1979, 1986): Trauma-related information is processed

because of a mechanism called completion tendency.

Completion tendency: need for new information to be integrated into existing patterns of thought and memory

Power and Dalgleish (1997)

Stunned reaction to the traumatic event Experience of information overload as the individual realises the

enormity of the trauma as it ‘sinks in’. Such information cannot be accommodated by existing mental

schemata Defence mechanism such as denial and numbing are a means of

coping with this lack of accommodation Completion tendency, however, insists on keeping the memory

of the event alive through flashbacks and nightmares Anxiety results from the vacillation between these two processes:

defence mechanisms and completion tendency

Questions

Why do only some individuals develop PTSD?

Why is PTSD delayed in some individuals?

A bio-psycho-social model of psychological disorders

Biological factors

Psychological factorsSocial Factors

Increased vulnerability

Non-adaptive behaviour

Chronic psychological disorder

Stressful life-events

reinforcement

Treatment

Debriefing (Deahl et al., 1994): effective Drug treatments (O’Brien and Nutt, 1998): mixed

success Exposure (Foa and Meadows, 1997): effective Other techniques: Expressive writing (James

Pennebaker) For an overview: Shalev et al., 1996; Foa and

Meadows, 1997

What therapies treat PTSD symptoms by integrating cognitive, emotional and

sensory/motor experience? Noted trauma authority and author Bessel van der Kolk has

written, "... re-living trauma often occurs in the form of physical sensations that precipitate emotions of terror and helplessness. Learning how to manage and release these physical sensations from trauma-based emotions is an essential aspect of the effective treatment of PTSD.”

There are now a number of schools of what has come to be known a somatic psychotherapy which utilize cognitive, emotional and sensory/motor experience to treat PTSD. These include:

What therapies treat PTSD symptoms by integrating cognitive, emotional and

sensory/motor experience? Noted trauma authority and author Bessel van der Kolk

has written, "... re-living trauma often occurs in the form of physical sensations that precipitate emotions of terror and helplessness. Learning how to manage and release these physical sensations from trauma-based emotions is an essential aspect of the effective treatment of PTSD.”

There are now a number of schools of what has come to be known a somatic psychotherapy which utilize cognitive, emotional and sensory/motor experience to treat PTSD. These include:

EMDR therapy

combines a somatic therapeutic approach with eye movements or other forms of rhythmical stimulation, such as hand taps or sounds that stimulate and integrate the left and right hemispheres of the brain. See Helpguide's EMDR Therapy: A Guide to Making An Informed Choice for more information and practitioner listings.

Somatic experiencing

is a therapy developed by Peter Levine that incorporates observations of how animals treat themselves following traumatic events and focuses on restoring normality to the stress response. According to Levine, the symptoms of trauma result from highly activated incomplete biological response to threat. Wild animals have the ability to “shake off” this excess energy. By enabling humans to do the same, trauma can be healed. See Helpguide's Panic, Biology, and Reason: Giving the Body Its Due in the references & resources below for more information and practitioner listings.

Literature

Clohessy, S. and Ehlers, A. (1999). PTSD symptoms, response to intrusive memories and coping in ambulance workers. Brithish Journal of Clinical Psychology, 38, 251-266.

Foa, E.B. and Meadows, E.A. (1997). Psychosocial treatments for post-traumatic stress disorder: A critical review. Annual Review of Psychology, 48, 449-480.

Horowitz, M.J. (1986). Stress Response Syndromes (2nd edition). Northvale, NJ: Jason Aronson

Janoff-Bulman, R. (1992). Shattered assumptions: Towards a new psychology of trauma. New York: Free Press.

Sarason, I. and Sarason, B. (1993). Abnormal Psychology: The problem of maladaptive behavior (7th edition). Englewood Cliffs, NJ: Prentice Hall.

Shalev, A.Y., Bonne, O. and Eth, S. (1996). Treatment of the post-traumatic stress disorder. Psychosomatic Medicine, 58, 165-182.