PTSD – Tips on Patient Treatment

After you go through a trauma (a dangerous/shocking event that you experience or witness), you can develop PTSD.  (PTSD is an abbreviation for posttraumatic stress disorder.)  PTSD is defined as “a serious potentially debilitating condition that can occur in people who have experienced or witnessed a natural disaster, serious accident, terrorist incident, sudden death of a loved one, war, violent personal assault such as rape, or other life-threatening events.”

Experiencing trauma is common.  About 60% of males and 50% of females will experience at one trauma in their lives.  In general, men are more likely to be exposed to accidents, physical assault, combat, disaster, or witness death/injury while women are more likely to experience sexual assault and child sexual abuse.

Most people who experience trauma can recover from it, but those with PTSD will continue to be depressed or anxious for months or years after the event.  Developing PTSD is not a sign of weakness.  Those diagnosed with PTSD are assumed to be veterans, but other populations are affected, too.

But how common is PTSD?

  • 74–92%  female victims of domestic violence develop PTSD
  • 7-8% of the US population will experience PTSD during their lifetime
  • ~ 8 million adults per year have PTSD (this is a fraction of people who have experienced trauma)

PTSD is usually diagnosed due to the following groups of symptoms being present:

1. Reliving: flashbacks, intrusive imagery, nightmares, anxiety, etc.
2. Avoidance:  avoiding people, places, or thoughts, emotional numbing, lack of interest, hopelessness, etc.
3. Arousal: difficulty concentrating, irritability, outbursts of anger, insomnia, hyper-vigilance, etc.

PTSD can have additional symptoms such as: 

Panic attacks: feeling an intense fear, usually with shortness of breath, dizziness, sweating, nausea, and racing heart.  Patients might describe that it feels like they are dying.

Physical symptoms: chronic pain, headaches, stomach pain, diarrhea, chest tightness/burning, muscle cramps, or low back pain.

Feelings of mistrust: thinking that the world is a dangerous place and that others cannot be trusted.

Problems in daily living: issue functioning at their job, school, or in social situations.

Substance abuse: using drugs or alcohol to cope with the emotional pain.

Relationship problems: having problems with intimacy; they may report feeling distant from their family and friends.

Depression: persistent sad, anxious or empty mood; loss of interest in once-enjoyed activities; feelings of guilt/shame; hopelessness about the future, etc.

Suicidal thoughts: thoughts about taking one’s own life.

If you or someone you know is thinking about suicidechat online at http://www.suicidepreventionlifeline.org/ or call 1-800-273-TALK (8255).

When treating patients with PTSD, a clinician should remember that the patient’s comfort level is vital to adherence.  It’s important to identify what events may increase their symptoms as well as what seems to cause/lead to panic attacks.  The triggers of these heightened responses vary per person.  A victim of domestic violence may experience panic when touched while a witness of a car accident could be triggered by a car backfiring.

To help a patient with PTSD, learning grounding techniques can be helpful.  Grounding techniques are used to help an individual calm themselves during a flashback, panic attack, etc; they help an individual realize that they are in a safe environment and that the trauma is over. By knowing an overview of these techniques, healthcare providers can provide appropriate support.  Usually, focusing on the five senses is effective to help manage these unwanted feelings.

Examples of Grounding Techniques

Focus on Your 5 Senses: close your eyes and focus on slowing down your breathing.  At the same time, think about your environment.  Name an item in the following categories: something you can hear, something you feel, something you smell, something you have seen, and something you can taste.  Slowing down and focusing on your current environment can help relieve symptoms. 

Use 5,4,3,2,1:  Think about 5 things you can see, 4 things you can hear, 3 things you can touch (and touch them), 2 things  you can smell or like the smell of, and 1 slow, deep breath.  (This a variant of the method above)

Open your eyes and put a light on if it’s dark.

Look around the room notice your environment.  Focus on the colors, the people, the shapes of things, etc.

Listen to and focus on the sounds around you: the traffic, voices, washing machine, music, etc.

Notice your body – focus on how your clothes feel on your skin, the movement in your hair as your head turns, the chair/floor beneath you: how does that feel in your feet, your legs, your body.  Pinch yourself – that feeling is from now and you were re-experiencing something from the past. 

Move Around – stretch, stamp your feet, jump up and down, dance, run on the spot, rub your arms and legs, open and close your fists, etc.  Remind yourself where you are in this moment.

Compare Environments – think about what is happening right now and how different it is from the traumatic event.  Describe your environment in great detail: what is going on?

Diaphragmatic Breathing – put your hand on your stomach above your navel; focus on pushing your hand up when you breathe in and down as you breathe out.  Breathe in for 5 seconds, hold for 5 seconds (this can be skipped if needed), and exhale for 5 seconds.

Mental Games – count backwards in 7s from 100, name 10 red things, one animal for each letter in the alphabet, etc.

Grounding Objects – sometimes people carry an small object with them that has personal meaning.  Feeling it can provide comfort.   

What Do You Do After A Flashback/Negative Event?

Feeling intense anxiety, flashbacks, and panic attacks can make your patient physically tired. If they are rapidly breathing, they might feel light headed or dizzy.  Be aware that the patient might feel faint. Make sure that your patient has a surface to hold onto or a chair to sit down in. Do not push the patient afterwards and allow the patient to fully calm down.  Take into consideration that the patient alone knows how they are feeling.  Providing a soothing and quiet environment is ideal.  

As a healthcare student recovering from PTSD, this is the knowledge I believe all healthcare professionals should have.  Overall, taking time to know your patient allows you to provide higher quality patient care.

As always, feel free to comment below or message me with any questions.

My next post will come out Friday, November 10th.  It will be a more light-hearted topic. 

 

Here are some resources and references that I’ve found helpful.

Post-Traumatic Stress Disorder

Grounding Techniques to Cope with Flashbacks and Distress

Biologic Correlates to the Development of Post-traumatic Stress Disorder in Female Victims of Intimate Partner Violence: Implications for Practice

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Much of what I have learned about physical therapy and online health/wellness, I have learned from Greg Todd, the founder of Physical Therapy Builder.  He is a fantastic physical therapist whose mission is to help physical therapy students and physical therapists provide patient focused care without becoming overwhelmed.  Greg Todd is also known as a “social media guru,” and I have a lot of thank him for.  I highly suggest his courses, especially Smart Success PT.  In May, I attended Smart Success PT Live, a business, marketing, and branding course by some of the top PT entrepreneurs in the field.

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