Post Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PSTD) affects people who have experienced dangerous or shocking events. Almost everyone gets afraid after witnessing or experiencing a traumatic situation. It is as a result of a natural process that triggers flight or fight responses to protect one from danger. While most people do recover from such events, others battle with the problems for an extended period. Such individuals are often diagnosed with PSTD. Statistics show that over 7.7 million Americans have PTSD (Jaeger, Echiverri, Zoellner, Post, Feeny 2). The prevalence rate is 8 percent and much higher among the refugees. A significant percentage of the affected individuals are children as well as those in the military or their family members. Those suffering from the condition often feel frightened and stressed even during periods in which they are not in any danger. However, it is important to note that not every traumatized person will develop chronic or acute PTSD. At the same time, not everyone diagnosed with the condition had experienced a traumatic or dangerous situation.

More often than not, some experiences, such as the unexpected demise of a loved one can lead to PTSD. Some of the symptoms may manifest barely three months after exposure to a traumatic event while others may take years to occur. Doctors can diagnose PTSD when the symptoms persist for over a month and become intense to the extent that they interfere with work or relationships. Survivors of trauma can find challenges in maintaining relationships with their friends and family members (Jaeger et al. 3). Due to the negative impact on PTSD on the quality of life, several treatment interventions exist to help the victims recover and live a normal life. However, controversy exists about whether using behavioral interventions or challenging maladaptive thoughts alone has the most notable impact on the patients diagnosed with PSTD. Whether or not behavioral and cognitive treatment interventions are effective, it is imperative to consider both of them and recommend one. This paper argues the exposure therapy offers the best treatment for PTSD.

Cognitive and exposure therapy are the two commonly relied on interventions in addressing PSTD. Individuals diagnosed with PSTD often avoid situations that that remind them or they associate with the dangerous or traumatic situation that once experienced or witnessed (Najavits 3). For example, they may avoid sharing with a friend or a loved one about the event. For those involved in a previous road accident, they may avoid using public vehicles or walking in places with too much traffic for fear of experiencing another undesirable event. They may also refrain from engaging in conversations or watching movies that remind them about the traumatic events. Unfortunately, avoidance does not make things better. Instead, it fuels anxiety. It is not uncommon for PTSD people to blame themselves for failing to prevent the traumatic situation. These individuals need help to overcome their fears.

Exposure therapy provides an effective way of dealing with trauma and anxiety disorders, as well as PTSD. This technique borrows its approach from classical conditioning. The core objective of this intervention is to help the affected individuals address their anxiety feelings and panic. Despite its efficacy for treating chronic PTSD, it remains underutilized. The assumption for its underutilization is that traumatized patients often do not prefer this treatment option (Jaeger 5).

Contrary to the prevailing perceptions about exposure therapy, many clients consider it a viable treatment method. The treatment protocol involves psychoeducation which takes place during the initial sessions. It focuses on the symptoms of PTSD and how the patient experiences them. In vivo exposure entails confronting people, places, and things that remind the individual about the trauma event. Imaginal exposure involves revisiting the reminders of trauma and allowing the patient to engage his or her emotional aspects attached to the situations. For this to happen, the patient closes his or her eyes and participates with the thoughts and feelings associated with the trauma. The last stage is emotional processing. It involves the therapist discussing with the patient about the thoughts both during and after the traumatic situation. It ends avoidance behavior and in turn, helps the individual to confront things that make him or her fearful or anxious.

Moreover, it allows the victim to understand own thoughts and feelings and later learn that distress can end on its own. Exposure therapy helps in retraining the brain. Beyond merely being accustomed to the fear, the treatment intervention configures the brain to avoid sending fear signals, especially when everything is alright. However, for this treatment method to succeed, it is imperative that the individual fights events or situations that represent things they fear the most. For some people, traumatic events can be confronted wholesomely, but for others, they need to be introduced gradually from the least to the most traumatic situation. The technique is safe and proven, and when applied correctly, it can help people overcome phobia and anxiety.

In exposure therapy, a therapist works closely with a client to identify the best approach to address the trauma (Najavits 2). Therapists are barred from forcing their clients into treatments that they are not comfortable. Instead, they provide their patients with a variety of techniques and ensure that the clients are satisfied with the method they use. However, it is worth noting that exposing an individual diagnosed with PSTD without allowing him or her to learn coping techniques, such as imagery exercises and relaxation can make the individual re-traumatized. Therefore, for this method to be effective, it is imperative that the therapist should carry it out in the context of a psychotherapeutic relationship. The healthcare professional should be knowledgeable and experienced about the different coping mechanisms.

Exposure therapy is highly effective in reducing various symptoms of PTSD. Its efficacy is optimal when it is done in a repeatedly and graduated over an extended period. The method is recommended by the Department of Veteran Affairs and DOD based on clinical evidence as a first-line treatment option for patients diagnosed with PTSD. It allows patients to develop a sense of control and self-competence over adverse effect. In turn, these the individuals gradually reduce their avoidance behavior. Other authors echo the same by indicating that exposure therapy is the first-line treatment for PSTD involving all traumas. The intervention treats not only the condition, but also the comorbid aspects, including depression, guilt, and anger. Multiple studies have confirmed the efficacy of exposure therapy. Walker’s study examined the benefits of ET as compared to sertraline in the treatment of social phobia (2). The authors found out the patients who were treated with exposure therapy alone reported a significant improvement while those who received a combination of sertraline and exposure therapy tended to deteriorate upon the cessation of medication. The researchers also found out that individuals who were treated using exposure therapy alone reported higher social phobia scores. Another study examined the preferences for the treatment of PTSD among 160 college students. The authors compared several intervention options, including sertraline, psychotherapies, and prolonged exposure (Becker, Darius, and Schaumberg, 2861). The participants were given a comprehensive treatment rationale for the treatments to ensure that the respondents gave an informed response. The authors observed that over half of the participants preferred exposure therapy as they found it more credible than the others. Cognitive treatment came in second place with a preference of 22 percent (Becker et al. 2862). For those who were diagnosed with PTSD, they cited exposure therapy as the most preferred treatment option. These studies provide convincing evidence that many people prefer psychotherapy interventions for trauma problems. The slight differences in the preferences could be attributed to individual beliefs as well as the level of understanding of empirical evidence. Nonetheless, these findings confirm that exposure therapy is an effective treatment of PTSD.

On the other hand, cognitive therapy involves collaboration between a client and a therapist where distorted thoughts are identified, monitored and analyzed. This treatment plan builds on the idea that individuals with PTSD show symptom after interpreting the trauma rather than being exposed to the traumatic event or situation. The implication is that the patients need to realize their distorted cognitions and should be helped to replace them with less distressing and more realistic thoughts. Typically, cognitive therapy lasts for about 12 to 16 sessions. When the victims undergo these sessions, they eventually realign their cognition with reality. CT uses several methods, including challenging and monitoring video feedback, and behavioral experiments. Regardless of the specific technique used, the approach of CT remains the same. It involves identifying unhelpful cognition, examining them collaboratively, testing the validity and giving an opportunity for the client to make conclusions from own experience and lastly revise original perception. The underlying principle behind CT is that human thoughts influence their feelings and actions. People who have phobias or are anxious tend to panic or resort to avoidance of situations that raise their anxiety levels. The core idea of CT is that for people to change their actions and behavior, they must first change the way they think (Najavits10). Thus, for individuals who fear traumatic or dangerous situations, they must first change their thoughts so that they do not associate the events with danger or trauma. However, the structured nature of cognitive therapy makes it unsuitable for individuals diagnosed with learning difficulties or advanced mental health needs. Another limitation of this treatment is that it focuses on the capacity of people to change and does not address the problems in families or systems that affect people’s health and wellbeing. It can also be challenging for people to attend all the sessions because they are time-consuming and involving.

Unlike the cognitive behavioral therapy that requires a formal cognitive intervention, exposure therapy allows open-ended discussions. However, the extent of the client’s benefit varies from one individual to another. Some of the patients may respond well to exposure therapy while others to cognitive therapy or both. Moreover, exposure therapy can be challenging for young children particularly when their caregivers do not motivate them to change their behavior. As a result, embracing behavioral management strategies can help support the treatment. Besides, relying on positive reinforcement strategies alone might be inadequate to make children participate in exposures (Najavits12). It may manifest especially when the caregivers concentrate on anxious or negative behaviors. When treating children, caregivers should be skilled in shifting their focus from unwanted behaviors to desired ones. Combining contingency management in the exposure therapy protocol can enable children to progress well.

 The value of exposure therapy in treating PTSD cannot be overemphasized. It helps the victims overcome their fears through habituation. When individuals are exposed continuously to traumatic events, their reactions to such situations eventually decrease over time. The technique can also help individuals through extinction. It can effectively weaken one’s association with stressful or feared events, outcomes, or situations. It can also improve one’s self-efficacy. It can assist the clients to recognize their capabilities in confronting their fears as well as managing their anxiety feelings effectively. It allows individuals to realize that they should desist from focusing on their concerns. It can also help individuals through emotional processing. When exposed to traumatic events, the victims learn to develop realistic beliefs and eventually learn to become comfortable with their fears.

However, concerns about exposure therapy exist especially during imaginal exposure. The patients may get a negative experience, and in turn, they may desist from seeking therapy. Some of them may experience heightened distress than what they felt before the treatment. Therefore, they may refrain from seeking help in the future. Even though these concerns exist, it is worth noting that they have not been proven empirically. None of the studies has ever shown that exposure therapy makes patients drop out of the treatment or makes their condition worse. The lack of proper training among the therapists perhaps explains its underutilization. Some of the health practitioners fear using the treatment option because they do not know whether the clients will tolerate it (Olatunji, Deacon and Abramowitz 175). Based on these unfounded fears, both therapists and clients.

In conclusion, exposure therapy provides an effective treatment for PTSD. Although controversy still exists on the best intervention for addressing the condition, this paper argues that exposure therapy allows the victim to overcome fears or traumatic situations that are the critical drives of PTSD. Across several studies that have examined the efficacy of this treatment option, patients have consistently ranked exposure therapy as their most preferred intervention. It allows the patient to understand their thoughts and feelings and learn to control them when exposed to an environment that reminds them of the dangerous event. It ends the avoidance tendencies by helping the affected individuals to confront their fears and concerns gradually from the least to the most troublesome. Unlike other treatment interventions, such as cognitive therapy, exposure therapy does not require any formal process. Patients engage with the therapist through open discussions where they can identify their thoughts and feelings and learn ways of overcoming them. However, the efficacy of this method is depended on the therapist as he or she must be skilled and experienced to avoid causing more fear to the patient. Over and above, there is a need to increase the utilization of exposure therapy. Efforts should be directed at addressing the factors that contribute to the underutilization of the treatment option despite its proven efficacy in treating PTSD.

Works Cited

Becker Carolyn, Darius Ellen, and Schaumberg, Katherine. “An Analog Study of Patient

Preferences for Exposure Versus Alternative Treatments for Posttraumatic Stress Disorder.” Behaviour Research and Therapy vol. 45, no. 1, (2007 ) 2861–28.

Jaeger Jeff, Echiverri Aileen, Zoellner Lori, Post Loren, Feeny, Norah. “Factors Associated

with Choice of Exposure Therapy for PTSD.” International Journal Consul Therapy

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Najavits Lisa, M. “The Problem of Dropout from Gold Standard PTSD Therapies.”

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Olatunji Bunmi, Deacon Brett, and Abramowitz, Jonathan. “The Cruelest Cure? Ethical

Issues in the Implementation of Exposure-Based Treatments.” Cognitive and Behavioral Practice vol. 16 , no. 2 (2009): 172-180.

Walker, John. “The benefits of Exposure Therapy Alone may Last Longer than Sertraline

alone or Sertraline Plus Exposure Therapy in Social Phobia.” BMJ Journals vol. 1, no. 2 (2003).