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Post Traumatic Stress Disorder: Systemic Psychotherapy


Posttraumatic stress disorder, or PTSD, is a holistic set of symptoms of mental activity disorders caused by a one-time or recurring strong external traumatic impact on the patient’s psyche (e.g., physical or sexual abuse, constant nervous stress associated with fear, humiliation, and empathy to the sufferings of other people). People with PTSD experience heightened anxiety caused by memories of traumatic events (Spoont, 2015).

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Such attacks often result when the patient encounters specific triggers or irritants, which are fragments of memories of the traumatic event (e.g., a crying baby, the creaking of brakes, and the smell of gasoline).

However, because PTSD can also be characterized by partial amnesia, the affected person may not remember the details of the traumatic situation. Due to the constant nervous strain and specific sleep disorders including nightmares and insomnia, patients can develop cardiovascular, endocrine, digestive, and other major organ system disorders. Clinical symptoms of PTSD usually appear after a certain latency period after the traumatic event. PTSD requires a complex attitude towards treatment, and the consequences of the illness can lead to both mental and physical deterioration.

Diagnostic Criteria and Statistics

The diagnosis of PTSD is based on several criteria (Spoont, 2015). First of all, the diagnosis requires the patient to have been exposed to a situation in which he or she experienced a death threat, serious injury, or sexual violence. The patient may have had direct or indirect exposure to these threatening situations, including traumatic family-related occurrences. Secondly, a PTSD diagnosis entails obsessive memories of stressful experiences, including vivid intrusive memories and nightmares focusing on the traumatic situation; signs of “flashback” syndrome; severe psychological reactions to reminders of the situation, which may include fear, anxiety, and helplessness; and symptoms of corresponding autonomic nervous system reactions such as increased heartbeat, palpitations, and a cold perspiration.

Thirdly, the diagnosis is based on the patient’s subconscious desire to forget or escape from the traumatic event, which may present itself in the form of avoiding talking about or reflecting on the situation. Similarly, the patient may express a general desire to avoid anything—including places, people, actions, smells, and sounds—that might somehow bring up a memory of the traumatic event. Fourthly, a person diagnosed with PTSD will present negative changes in cognition and mood-related to the traumatic event, as well as distorted cognitions about the situation or its consequences.

Fifthly, a PTSD diagnosis includes alterations in arousal and increased stress activity of the central nervous system related to the event: sleep disturbances, irritability, aggressive outbursts, decreased attention, general anxiety, hypervigilance, and an increased reaction to fear. Importantly, these pathological symptoms must persist for at least one month. The sixth indication of PTSD has decreased levels of social adaptation, which result in a lack of interest in activities that previously brought pleasure such as work, hobbies, and communication; decreased emotional contact with others up to complete exclusion; and the absence of long-term plans. Lastly, these symptoms and disturbances must not be linked to another medical or substance condition. To properly diagnose PTSD, all the above-mentioned criteria should be analyzed.

The assessed lifetime prevalence of PTSD among adult Americans is around eight percent, and women are twice as predisposed as men to experience PTSD (Coughlin, 2013). Almost 60 percent of men and 50 percent of women reported enduring one or several successive traumatic events, including witnessing other people be badly injured and being involved in natural disasters or other extreme situations (Coughlin, 2013). Almost half of the respondents had been exposed to life-threatening situations. More than half of them have recovered from PTSD; however, some of them have not fully recuperated and sometimes continue experiencing negative incidents in mental condition.

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Maladaptive Patterns

Distortions in cognitive abilities are frequently linked to PTSD. Maladaptive behavior patterns imply that a PTSD patient has feelings of guilt and shame (Spoont, 2015). The fact that he or she has been victimized provokes maladaptive cognitions and alters the individual’s assumptions about him or herself and the world. Thus, the affected person, especially if he or she is a child, tends to express anxious behavior and tries to avoid coping with the situation.

In severe cases, the patient can experience episodes of visual and auditory hallucinations, such as seeing dead people, hearing voices, or experiencing flashbacks; these intense symptoms may cause inappropriate actions such as impulsive movements, aggression, or suicide attempts. Nervous overexertion, prolonged insomnia, and alcohol or drug abuse most often trigger hallucinations in patients with PTSD, although they can also occur for no apparent reason.

Treatment and Interventions

PTSD intervention strategies are usually preventive, and they include both psychological and pharmacological approaches. Depending on the case, the specialist should decide on the intensity and prevalence of each intervention (Coughlin, 2013). Psychological interventions include “psychological debriefing interventions, psychological first aid, trauma-focused cognitive behavioral therapy, cognitive restructuring or processing therapy, coping skills therapy, eye movement desensitization and reprocessing and other” (Forneris, et al., 2013, p. 35).

Nowadays, cognitive behavioral therapy is considered to be one of the most effective types of counseling. Apart from that, eye movement desensitization and reprocessing are believed to be effective in most cases (Forneris, et al., 2013). Cognitive therapy implies that patients will be able to understand the nature of the traumatic event and its impact on their health and wellbeing. The eye movement desensitization and reprocessing strategy entail discussions and specific eye and hand movements to ensure relaxation and distraction from negative emotions.

To move beyond the trauma, patients should take part in group therapy with other people who have experienced similar stresses to share their experiences and discuss them together. This approach facilitates faster socialization of patients. Moreover, family therapy helps patients rebuild relationships with their family members and involves relatives for faster stress reduction (Coulter, 2013). These counseling measures help prevent the onset of PTSD by educating victims about conventional reactions to traumatic events and stimulating them to overcome the negative implications through sharing their emotional responses.

Moving Beyond Trauma

In terms of the treatment of PTSD, drug therapy is integrated with therapeutic intervention and is never used as an independent treatment (Coulter, 2013). Drug therapy is carried out under the supervision of a medical professional and is combined with therapeutic activities. In less severe cases with nervous overstrain symptoms, the practitioner may prescribe sedatives. However, sedatives are often insufficient for the relief of severe symptoms of PTSD. In severe cases, patients have prescribed antidepressants from the selective serotonin reuptake inhibitors (SSRIs) group (Forneris, et al., 2013). In some cases of PTSD, benzodiazepines may be prescribed if the patient has no psychotic symptoms.


Other crucial aspects of the treatment of PTSD are ethical and cross-cultural considerations. It is important to understand the cultural implications of trauma among different groups and the levels of their exposure to them (R. J. Ferreira, Buttell, & S. B. Ferreira, 2015). Race-related stressors and any type of prejudice should be taken into consideration when developing a treatment for PTSD. Facilitating patient-centered care, as well as a secure and respectful environment, is the basis for successful PTSD recovery.

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Coughlin, S. S. (2013) Post-traumatic stress disorder and chronic health conditions. Washington, D. C.: American Public Health Association.

Coulter, S. (2013). Systemic psychotherapy as an intervention for post-traumatic stress responses: An introduction, theoretical rationale and overview of developments in an emerging field of interest. Journal of Family Therapy, 35(4), 381–406.

Ferreira, R. J., Buttell, F., & Ferreira, S. B. (2015). Ethical considerations for conducting disaster research with vulnerable populations. Journal of Social Work Values and Ethics, 12(1), 29-40.

Forneris, C. A., Gartlehner, G., Brownley, K. A., Gaynes, B. N., Sonis, J., Coker-Schwimmer, E., Jonas, D. E., Greenblatt, A., Wilkins, T. M., Woodell, C. L., & Lohr, K.N. (2013). Interventions to prevent post-traumatic stress disorder: A systematic review. American Journal of Preventive Medicine, 44(6), 635.

Spoont, M. (2015). Posttraumatic stress disorder (PTSD). JAMA, 314(5):532.

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