Post-traumatic stress disorder treatment

Trauma means injury. In medical terminology, it refers to an injury that may occur as a result of a fall or other accident. In psychological terminology, trauma is exposure to a threatening event that involves a real risk to the physical or mental integrity of a person, or of people close to them.

Peter Levine likens life to a river that flows between two banks. A traumatic event that occurs in life is like a large stone in the path of the river, which creates waves and eddies in its waters. As long as the river banks are able to contain the created eddy, time and distance may pass but the river will flow again between its banks. But when the stone is large or thrown quickly, the river banks are unable to contain it, and they break, says Peter Levine. In other words, when the trauma comes and we are too vulnerable, too weak, too young, helpless, or do not have sufficient social support in the early stages after the trauma, we may develop post-traumatic stress disorder.

Post-traumatic stress disorder, הלעמט in Hebrew, is a disorder that occurs following exposure to a traumatic event. A stress response after a traumatic event is normal, and only if it persists for more than a month is it considered a disorder.

Post-traumatic stress disorder has several characteristics. There is a component of hyperarousal, alertness, and anxiety. There is a component of flashbacks, which are reenactments of the event. There is a component of avoidance of situations, places, and objects that remind you of the trauma. There may also be a component of freezing and dissociation. All of these cause significant psychological distress, and significant impairment in the victim's functioning and mental well-being.

Trauma is embedded in the body because it affects the nervous system, changing the way we experience the world: how we relate to visual, auditory, sensory stimuli, to stimuli that come from within the body such as heart rate, breathing, and thoughts, and what interpretation we give to the social contexts we find ourselves in. Therefore, any treatment for psychological trauma must simultaneously treat the mind and the body.

Stephen Forges talks of a model called Polyvagal theory.

The autonomic nervous system is divided into two systems: the sympathetic system, which stimulates us to action, and the parasympathetic system, which relaxes us.

In a relaxed state, when a person is in a social situation and is not threatened, the anterior (ventral) vagus system, which is responsible for innervating the muscles of the face and ears, is active, allowing us to correctly identify social interactions and actively participate in them. In the relaxed social state, the parasympathetic system dominates.

When a person is in situation he deems less safe, and he recognizes a threat to himself or to people close to him, his nervous arousal is higher, the sympathetic system is activated, the heart rate increases, and more blood is pumped to hands and feet in preparation for fight or flight, so as to prepare the person to deal with the perceived threat. In this case, the sympathetic system is dominant.

When a person is in a situation that is perceived as a threat to their life, and the body's assessment is that the threat is too great for the person to cope with, the vagus comes into action again, but this time the dorsal vagus. This part of the vagus, which is also present in reptiles, inhibits the fight-or-flight response, leading to stagnation and paralysis.

It is important to emphasize here that the choice of course of action is not made consciously. Our body perceives cues of safety or threat from the environment, and responds to them very quickly and unconsciously. The goal of this process, which Stephen Forges calls neuroception, is to preserve our lives, and rational thought is too slow to do this in time. The body that chose to fight, or chose to freeze, did so as a result of cumulative learning throughout life, and did so because that is the best way it knows to preserve us.

How does all this relate to post-traumatic stress disorder?

When a person suffers from post-traumatic stress disorder, their neurosensory system works abnormally. It recognizes danger where there is none, and it misses the detection of dangers that actually exist in reality. In essence, we had a course of action that worked and protected us in the past, and got us out of a situation where we were in mortal danger, and today we act in a similar way to the way we had acted then, and do not recognize that the current conditions are not the same as in the past.

So what do we do to ameliorate the situation?

We will always start by building trust and a good working therapeutic relationship. Nothing can be fixed as long as we do not trust each other. Part of working on the therapeutic relationship will also include identifying resources and strengthening them. What helps you and gives you strength? What are your strengths? Who are the people who are important to you, who love you and fill you with love. What places make you feel safe and at peace?

If trauma is caused by a human act (or the absence of a human), then its healing can only occur in the loving and accepting presence of a human.

Part of our work in therapy will be to help the neurosensory system operate more reliably. To identity dangerous situations in a truer and reliable way. To avoid re-traumatization situations that occur due to poor identification of danger, and not to avoid social situations that are not dangerous.

Another part will be to understand what the arousal window is and how we work with it and within it. The arousal window represents the range in which we are able to process the experiences we are going through, and respond to them, without being overwhelmed (over-arousal) or disconnected (paralysis and freezing). We will make sure to work within the arousal window, and try to expand it, using the resources we have learned to recognize together.

Another part of the work will be to identify your preferred way of coping, and to offer alternatives to other ways of coping. Not because your preferred way is wrong, but to enable you to have more options to choose from. For example, to help you get out of a freeze, if that is your usual way, and to show assertiveness. Another example, to help you get out of a fight or flight situation, when they are not justified, and perhaps to try to choose social interaction. We do this by using breathing techniques, and self-touch techniques, which can be learned in the treatment room, and can be applied in life outside the clinic.

The most important part will be to hand over the reins to you, so that everything happens at a pace and in a way that is right for you. If trauma is caused by helplessness, its healing can only occur from a state of control and choice.

Waiting for you.