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Practice self care, engage in activities that promote relaxationn and well-being, such as exercise, meditation, deep breathing exercise,, and hobbies that you enjoy such as soccer . taking care of your physical health can also have a positive impact on yur mental health

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By Diego: Not all wounds are superficial

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By Diego: Not all wounds are superficial

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It's important to recognize and adress these invisible wounds to ensure that veterans receive the support and care they need to heal and transition successfully back into civilian life. Many organizations are dedicated to providing mental health services, counseling, and support for veterans daling with these invisible wounds.

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Just because you suffer of PTSD it does not mean you'reare weak, in fact your are probably stronger than most.

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The word cult is defined as a system or group of people who practice excessive devotion to a figure, object, or belief system, typically following a charismatic leader. 

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PTSD can affect everything in a person's life from their behavior, mental state, actions or reactions. Identifying it is the first step to recovery!

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in some cases, medication may be prescribed to help manage PTSD symptoms. Consult a psycgiatrist or health care provider to discuss wether medication is an option for you.

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Learn about PTSD from Veterans who lived it 

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Learn about PTSD from Veterans who lived it 

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Get the facts about posttraumatic stress disorder (PTSD), learn about treatment options, and explore personal stories from Veterans, family members, and VA clinicians.

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Get the facts about posttraumatic stress disorder (PTSD), learn about treatment options, and explore personal stories from Veterans, family members, and VA clinicians.

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PTSD is a condition that can affect anyone involved in a traumatic experience. We are discovering those with PTSD (post-traumatic stress disorder) more and more as violence and death become more prevalent in America, from war to school shootings to car accidents. Car accidents or Motor Vehicle Collisions (MVC) happen roughly 35,000 times a day over the United States, and in those approximately 25-33% of those present with PTSD 30+ days post-accident. Symptoms include emotional pain, flashbacks, physical arousal, easy startling and somatic symptom pain. Patients who receive care immediately, including CBT (cognitive behavioral therapy) and supportive therapy were 50% more likely to be diagnosis free after five weeks. Chronic pain, developed from the accident or from the psychological pain, if treated, improved the likelihood of patients being diagnosis free if the physical symptoms were also addressed. Patients who experienced a MVC with a fatality were also at a higher risk of developing PTSD. Immediate, long-term care is the best option for ensuring a patient can recover from PTSD.

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Mental Health Anxiety GIF by All Better - Find & Share on GIPHY

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GIPHY is the platform that animates your world. Find the GIFs, Clips, and Stickers that make your conversations more positive, more expressive, and more you.

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By Diego: Clinical Conversation on PTSD Related to Military Combat

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By Diego: Clinical Conversation on PTSD Related to Military Combat

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by APA Practice Organization

February 14, 2008 - This "Clinical Conversation" was stimulated by the documented mental health needs of active duty military, National Guard, Reservists and veterans who served in Operation Iraqi Freedom and in Operation Enduring Freedom in Afghanistan.

Terence M. Keane, PhD, is Director of the Behavioral Science Division of the National Center for PTSD at VA Boston Healthcare System. He is also Professor and Vice Chairman of the Division of Psychiatry at Boston University School of Medicine and Professor of Psychology.

The author of more than 200 publications, Dr. Keane has also edited nine volumes on post-traumatic stress disorder (PTSD), while developing many of the most widely used measures of psychological trauma and PTSD. He is recognized internationally as one of the leading authorities on trauma and PTSD.

Randy Phelps, PhD, is Deputy Director of the American Psychological Association (APA) Practice Directorate and has worked for many years on veterans issues as an advocate of professional psychology. Dr. Phelps is serving as the Practice Directorate interim executive director until April 2008.

The online "Clinical Conversations" in this PracticeUpdate e-newsletter generally focus on clinical information and developments of interest to practicing psychologists. The psychologists featured in these conversations offer their own professional perspective on a particular topic.

This conversation is intended to stimulate feedback from APA members.
Dr. Phelps: Where do individuals who have returned from combat get treated for their mental health needs?

Dr. Keane: The Department of Veterans Affairs (VA) operates an integrated health care system dedicated to providing comprehensive health care and mental health care to military veterans. The VA health care system's mental health programs comprise a wide range of services including inpatient care, outpatient care, the Vet Center (psychological and social services in storefront settings), residential treatment programs, vocational rehabilitation programs, substance abuse treatment programs, sexual trauma treatment programs and homeless domiciliary programs, among other services. This care is provided to eligible men and women veterans.

Typically, VA provides health care to those who were injured during their military service or who developed a disease/disorder during the time of their service. Additional eligibility is conferred on those whose annual income is below a certain level and who do not have alternative sources of health care available to them. Elderly veterans over the age of 65 can also receive care at VA.

Historically, VA provided care to approximately 20 percent of all veterans. Eighty percent of veterans received their health care elsewhere. Veterans from the current conflicts in Iraq and Afghanistan are accessing VA health care at a higher level. Approximately one-third of eligible veterans have been to a VA setting for some type of care. Generally, the problems driving this care are musculoskeletal complaints, dental needs and, naturally, mental health problems. Of course, combat-related PTSD is the most common psychological problem, but veterans also present with depression, substance abuse, chronic pain, traumatic brain injury (TBI) and other anxiety disorders.

The vast majority of veterans and their family members receive their mental health care from the private sector. For this reason, it's important for mental health practitioners of all types to assess for veteran status. Making this determination may provide important information for case formulation and treatment planning. Practitioners who feel the need for additional training in the assessment and treatment of military veterans (male and female) may find helpful information through APA and state, provincial and territorial psychological associations and through a wide range of Web training initiatives.

Dr. Phelps: How do various subgroups such as active duty military and National Guard/Reserve members access treatment?

Dr. Keane: Active duty military have their own health care system provided by the Department of Defense (DoD). For active duty military, mental health services can be provided by the DoD directly or through a mechanism known as One Source. Providers affiliated with One Source consist of psychologists and other mental health professionals who contract with the DoD to provide a limited number of assessment/therapy sessions to individuals and their families.

National Guard and Reservists are not ordinarily eligible for VA health care, nor are they typically eligible for DoD health care when they are inactive. However, an act of Congress created time-limited eligibility for these military members to utilize VA services. This legislative action has been a great source of mental health care for the returning Reservists and National Guard personnel.

The VA provides care largely to individual veterans themselves. Family members, and especially family members of those activated and serving in the war zones, are not deemed eligible for VA services. With a wide range of psychiatric and psychological services available in diverse settings, VA is a living example of the goals of the President's New Freedom Commission on Mental Health. It may well be the model system that the rest of the country could emulate.

Dr. Phelps: What is important for psychologists to know about the demographics of returning service members?

Dr. Keane: Several key demographic features of the current military force are important to appreciate. First, it is a decidedly diverse, multicultural military. More than 40 percent of active duty military personnel is a racial or ethnic minority. This figure represents greater diversity than in the U.S. population at large.

Second, women constitute more than 10 percent of the military serving in Afghanistan and Iraq, and they perform a wide range of professional roles and combat roles. This situation is different than Vietnam, for example, when women were disproportionately represented in nursing and administrative positions and served in the war zone in far lower percentages of the total military force.

Third, there is a bifurcated distribution of age among service members. Some members serving in their first enlistment might be in their late teens or early twenties. Others are Reservists and National Guard members who might be in their later thirties or forties. Accordingly, their backgrounds and issues are very different and reflect their age, vocational and family structures.

Dr. Phelps: How do family members - spouses, children, parents and other family members - factor into treatment for returning service members?

Dr. Keane: Veterans themselves are the ones deemed eligible for VA care. The VA's statutory authority to treat family members is limited.

Family members are treated to the extent to which they are directly involved in the veteran's care. For example, if a veteran develops depression or PTSD as a consequence of his or her service, the veteran's spouse could be actively involved in a marital treatment program for these conditions. If a veteran is injured by an improvised explosive device (IED) and his/her cognitive processes are compromised, the parents could be involved in a psycho-educational rehabilitative program in conjunction with the veteran. This treatment would be fully provided by VA to the veteran and their family members.

Dr. Phelps: How generalizable are skills in treating trauma to treating people exposed to combat? How likely is someone with a practice focused generally on trauma, such as helping victims of abuse, to be well skilled in meeting the needs of returning service personnel?

Dr. Keane: I'd like to think that the specific skills and conceptual models for understanding and treating one type of trauma are directly generalizable to another form of trauma exposure. This notion is fundamental to much of the work accomplished by our group at the National Center for PTSD over the past 30 years.

Yet, specific contextual factors are important to consider if one is to succeed in navigating the transition from working with one group of trauma-exposed people to another group. In the instance of combat trauma, it is critical to understand general military contextual variables and the specific details associated with the war itself, and to have an appreciation of the stressors and pressures under which the individual served. Even understanding the political climate in Afghanistan or Iraq during the time of service may communicate to your patient important things about your competence. Learning about the contextual factors associated with a particular type of trauma exposure would, in my view, be far easier and quicker to master than the acquisition of new therapy skills.

The principles for treating trauma survivors are far better understood today than 30 years ago when we first started to treat combatants. Importantly, the models and techniques that guide psychological assessment and psychological treatment of PTSD now possess reliability and validity data that transcend the various types of trauma to which people are exposed. These same principles appear to be effective across racial, ethnic and cultural boundaries. These facts are enormously encouraging to me.

Dr. Phelps: What is important for practitioners to know about the combat-related experience that today's returning soldiers may bring to treatment that's different from other trauma-related life experiences?

Dr. Keane: Fundamentally, trauma is about exposure to life-and-death situations. Trauma may also be secondary to exposure to events that challenge one's personal integrity or may inculcate shame or humiliation. For combatants, their experience in a war zone may transcend all of these experiences and exposure to these experiences often happens multiple times over the period of service.

Combat is not exposure to a uniform, single traumatic event. Rather, it often involves multiple types of life-and-death experiences associated with strong and wide-ranging emotional reactions in the context of a malevolent living environment that is estranged from the usual forms of family and social support. As a result, it's vital to conduct a comprehensive assessment of exposures both in the war zone and prior to service in the war zone.

My experience is that veterans can be extraordinarily open in describing the devastation of war but may be reluctant to express details of events in which they might have had an active role. Patience is needed to understand the precise role of the individual in certain war events, their immediate reactions to those events and the long-term impact of this participation. Combatants are often actively and passively involved in acts of violence; understanding the boundary conditions of war is pivotal in making progress in the psychological treatment of war veterans regardless of their rank at the time of service.

Dr. Phelps: What specific treatments show the greatest promise for successful treatment of combat-related PTSD?

Dr. Keane: The general principles that guide treatment of PTSD are derived from several different models of care. First, the development of a strong therapeutic alliance is pivotal for all future work. It may determine the extent to which particular patients might even share with you the details of their military experiences. Conflict about one's participation in combat is a function of what one does in the war zone and what happens to that person in the war zone. The complex emotions that emerge can be fear, anxiety, dread, horror, shame, guilt and disgust - the strongest and most aversive of human emotions.

Treatment of these emotional responses initially involves a quieting of the strong emotions often employing relaxation or meditational strategies, accompanied by psycho-educational efforts to inform the patient of the psychological, physiological and interpersonal consequences of trauma exposure. Reframing the experiences using cognitive restructuring models that focus upon realistic appraisals of the situation and the circumstances found in a war zone by combatants also is an important component of psychological care. Finally, emotional processing of the details associated with difficult combat events is also demonstrably effective in helping patients to overcome their reactions. Emotional processing can take many forms, including prolonged exposure therapy, systematic desensitization, eye movement desensitization and reprocessing (EMDR) and other approaches that focus directly upon the emotional reactions precipitated by the traumatic events per se.

Dr. Phelps: Of course psychologists are trained to pay attention to countertransference. But are there potential blind spots for certain practitioners, such as those unfamiliar with military service or opposed to war, that they should be mindful of in working with returning service members?

Dr. Keane: Yes, I think so. The therapeutic alliance can be a challenge in any setting and with any type of patient, but there are some key features that will determine whether veteran patients will return for continuing care. Listening attentively to the description of service, while asking informed questions about location, duties and training, can communicate to the veteran an understanding of their experience in important ways.

Most people who join the military do so for the honor and defense of their country. Their belief system is such that they respect those who join the military and they consider the work of the military among the most worthwhile things possible. Challenging this belief or even demonstrating a political position on the value and merits of a particular war may inadvertently damage the therapeutic alliance in ways that aren't remediable.

For many war veterans, even those in their eighties today, the work they did for their country in the military was among the most rewarding life experiences they've had. Supporting this belief is important to moving to the next stage of treatment.

Dr. Phelps: What is the Department of Veterans Affairs doing to help psychologists - both VA psychologists and non-VA psychologists - become better informed? What's the role for non-DoD and non-VA psychologists in helping with PTSD treatment?

Dr. Keane: The National Center for PTSD has an award-winning website that is a national resource on the topic of PTSD broadly, but with a special emphasis on combat-related PTSD. The PILOTS (Published International Literature on Traumatic Stress) literature search engine, one of the most widely used facets of our website, contains both published and unpublished works on the topic of trauma - including chapters in books from across the world. PILOTS can be accessed directly from our website.

At the moment there are two fantastic initiatives within VA to bring effective treatments to all corners of the VA mental health system. Several treatments appear to help veterans and others to overcome symptoms of PTSD: Exposure Therapy, Cognitive Therapy, Anxiety Management (for example, Stress Inoculation, Stress Management) Treatments, EMDR, combinations of the above treatments and psychopharmacological treatment using serotonin-acting medications. These treatments are identified and described in the most recent edition (in press; Guilford Press) of the International Society for Traumatic Stress Studies (ISTSS) Best Practice Guidelines for PTSD. My colleagues in Boston, Patricia Resick, PhD, and Candice Monson, PhD, are involved in a national VA-based dissemination of Cognitive Processing Therapy, a treatment developed by Patti some 20 years ago. Joe Ruzek, PhD, also from the National Center for PTSD, is engaged in a dissemination project for Exposure Therapy and works closely with Edna Foa, PhD, and her colleagues at the University of Pennsylvania. These projects are the first efforts to bring evidence-based psychotherapy to the clinicians working in VA.

Secondly, Brian Marx, PhD, Paula Schnurr, PhD, Matthew Friedman, MD, PhD, and I are involved in a project that will disseminate evidence-based approaches to the assessment of PTSD nationwide. We've developed a Best Practice Guideline for the assessment of PTSD. Following a recommendation from the Institute of Medicine, the VA will disseminate these best practices nationwide to bring uniformity to the process of evaluating veterans seeking compensation for psychological war injuries.

Dr. Phelps: What widely accessible resources, especially online resources, are helpful for psychologists who want to become better informed about spotting signs and symptoms of PTSD and treating individuals who have returned from recent combat for PTSD?

Dr. Keane: Surely, the National Center for PTSD's Web site is a wonderful resource, but there are others. The APA has resources for evaluating and treating psychological trauma, as does the International Society for Traumatic Stress Studies and the the Anxiety Disorders Association of America. The American Psychiatric Association also has much information on the assessment and treatment of PTSD.

For texts on the topic, following are recent publications from Guilford Press:

Friedman, M.J., Keane, T.M., & Resick, P.A. (2007) Handbook of PTSD: Science and Practice.

Wilson, J. P. & Keane, T.M. (2004) Assessing Trauma and PTSD. (2nd Edition).

Contact APA Services

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Clinical Conversation on PTSD Related to Military Combat

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This discussion concerns the documented mental health needs of active duty military, National Guard, Reservists and veterans who served in Iraq and Afghanistan.

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It is important to seek help, do ot try to cope with PTSD on your own. With the right support and treatment, it is possible to manage PTSD symptoms and work towards healing and recovery

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By Diego: Dr. Frank McGeorge discusses the symptoms of PTSD

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By Diego: Dr. Frank McGeorge discusses the symptoms of PTSD

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Doctor discusses PTSD, its effects on war veterans

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A mother talks about how her car accident still gives her PTSD

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PTSD: Mother talks about distress driving after car crash

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Study on Treatments and Outcomes for Car Accident PTSD patients

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Study on Treatments and Outcomes for Car Accident PTSD patients

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Prof Psychol Res Pr. Author manuscript; available in PMC 2008 May 28.

Published in final edited form as:

Abstract

Individuals who experience a serious motor vehicle accident (MVA) are at increased risk for psychological problems, particularly Posttraumatic Stress Disorder (PTSD). In this article, we review the literature on PTSD among MVA survivors, with particular attention to available instruments to screen for and assess symptomatology of the disorder. Approaches to the treatment of PTSD in this population are reviewed, separated into interventions designed to prevent PTSD in unselected samples, treatment targeting individuals with Acute Stress Disorder that are designed to prevent subsequent development of PTSD, and therapy for individuals with chronic PTSD. Treatment process issues are discussed, in an effort to integrate empirical findings with clinical observations. The empirical literature suggests several approaches to treatment that have good potential outcomes, although continued work is needed to identify factors that predict treatment response, as well as augment individual-based treatment formats.

Keywords: Trauma, Road traffic accidents, Cognitive Behavior Therapy, Supportive Psychotherapy, Acute Stress Disorder

As Cathy sat at the traffic light thinking about the errands she was running, she could hear her two year-old singing in the backseat. Suddenly, a violent blow from behind launched her car forward approximately 15 feet. Immediately, she felt a sharp pain in her neck. With her ears ringing from the noise of the collision, she at once thought, "my baby is dead". Whipping her head around despite the intense pain, she saw her baby wide-eyed and surprised, but completely uninjured as he sat buckled in his car seat. For months following the collision she asked herself, "It was just a wreck- like people have every day ... Why am I having bad dreams about it, a hard time driving, and I can't seem to relax anymore". If you have a patient in your office who sounds like this, you are not alone. Millions of motor vehicle accidents (MVAs) occur each year, many with serious consequences ( U.S. Department of Transportation, 2004), For example, in 2004 just under 6.2 million traffic accidents were reported to police departments in the United States resulting in approximately 2.8 million injuries. Despite the large number of MVAs and injuries that result from these accidents, only recently have the psychological consequences of MVAs been fully recognized (see Blanchard & Hickling, 2004). In this article, we will review the available knowledge about emotional after-effects of serious collisions, with particular emphasis on the assessment and treatment of PTSD.

Psychological consequences of a serious motor vehicle accident

PTSD

One serious psychological consequence often associated with serious MVAs is posttraumatic stress disorder (PTSD). PTSD is an anxiety disorder that often follows a traumatic event involving actual or threatened death, serious injury, or threat to the physical integrity of oneself or others ( American Psychiatric Association, 2000). For many individuals, the symptoms of PTSD following a serious MVA may include psychologically re-experiencing the trauma (e.g., intrusive thoughts about the accident, distressing dreams about the accident), persistent avoidance of thoughts or situations associated with the accident (e.g., reluctance or refusal to drive, actively avoiding thoughts about the MVA), numbing of emotional responsiveness (e.g., greatly reduced or absence of emotions, feeling detached from others), and increased physical arousal (e.g., exaggerated startle, irritability, disturbed sleep).

Reported rates of MVA-related PTSD can vary across studies depending on methodologies employed in the various studies. However, from the approximately two dozen studies assessing samples consisting largely of MVA survivors (often recruited from emergency room admissions or hospital wards) and using well validated structured interviews, the presence of PTSD at least 30 days post-MVA is approximately 25-33% (e.g., Bryant, Harvey, Guthrie, & Moulds, 2000; Harvey & Bryant, 1998; Ursano et al., 1999). Although these samples may be seeking medical attention, the presenting problem in these studies typically is not psychological in nature so they would not be classified as psychological treatment seekers. As might be expected, the rates of PTSD found in assessment or psychological treatment-seeking samples of MVA survivors tends to be higher (e.g., Blanchard & Hickling, 2004). In looking at the general population, Norris (1992) conducted a large survey of four Southern cities ( n = 1,000; response rate 71%) and found the lifetime prevalence rate of PTSD to be 7.4% and that MVAs were among the leading cause of PTSD in her sample. These data, along with a lower rate of MVA-related PTSD found in a survey of relatively young Americans ( Breslau et al., 1991), leads to a conservative estimate that MVA-related PTSD may affect 2.5 to 7 million people in the United States, reflecting a significant public health problem ( Blanchard & Hickling, 2004).

Comorbidity

In addition to PTSD, a number of other psychological problems often are present after a MVA. Mood disturbances are particularly common, with one report indicating that 53% of patients with PTSD have concurrent mood disorders ( Blanchard et al., 1995). In a sample of MVA survivors seeking an assessment and treatment for trauma-related symptoms at the University at Buffalo ( n = 237), 25% of the overall sample reported symptoms consistent with a major depressive episode. However, of those meeting criteria for PTSD (n = 103), 41% reported symptoms consistent with a major depressive episode. These data are somewhat consistent with a larger epidemiological study (National Comorbidity Survey, NCS) examining psychiatric comorbidity among individuals with PTSD in which approximately 48% of those with PTSD also experienced a major depressive episode ( Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). However, the rates of co-occurrence of PTSD and depression in the Buffalo sample may be higher than rates reported in the NCS because the NCS assessed lifetime comorbidity while the Buffalo MVA sample represents current comorbidity. Additional anxiety disorders also can be present, with rates ranging from 7% to 31%, depending on gender and the specific disorder in question ( Kessler et al., 1995). In addition, the presence of PTSD increases an individual's risk of meeting criteria for a substance use disorder. For example, Helzer et al. (1987) reported that men and women with PTSD were 5 and 1.4 times more likely, respectively, to have a substance use disorder compared with the general population. In contrast, rates of a current drug or alcohol abuse disorder (0% and 1.6%, respectively) among MVA survivors with PTSD are relatively low and did not differ between MVA survivors with PTSD, MVA survivors without PTSD, and non-MVA controls ( Blanchard et al., 1995). So while MVA survivors with PTSD appear to present for treatment with high rates of depression, substance use disorders may be somewhat lower in this PTSD population compared to other PTSD populations. Further research is needed to test this hypothesis.

Chronic pain

Among the issues that are associated with MVA-related PTSD, the presence of chronic pain may be the single most defining characteristic. For example, in a psychometric study assessing PTSD in 229 MVA survivors, Coffey, Gudmundsdottir, Beck, Palyo, & Miller (2006) found that 69% of the sample reported chronic pain that could be attributed to their MVA. For an individual to be described as having MVA-related chronic pain, it was required that pain symptoms be attributed to injuries sustained during their MVA and that the pain symptoms had not responded to standard medical treatment after one month. In addition, the reported pain caused significant lifestyle limitations, impairment, or significant distress, determined on the basis of behavioral restriction (e.g., unable to work), continued utilization of health care for pain relief, or consistent use of pain medication. In a study of a MVA survivors presenting with chronic headache and other pain, Hickling and Blanchard (1992) found a 50% prevalence rate for PTSD. In another study of MVA survivors by this research group ( Blanchard et al., 1995), physical injury was associated with the development of PTSD (and subsyndromal PTSD). Finally, in a sample of litigating MVA survivors with chronic pain and posttraumatic stress symptoms, Duckworth and Iezzi (2005) found that high posttraumatic stress symptoms were related to physical impairment, psychological distress, and maladaptive pain coping strategies. In sum, it is clear that pain often co-occurs in assessment and treatment seeking MVA survivors. The role that chronic pain may play in treatment will be discussed below.

MVAs, symptom presentation, and litigation

Litigation is a ubiquitous feature of working with MVA survivors. Clinical lore suggests that litigation markedly affects symptom presentation among MVA survivors. Specifically, many believe that litigation is the driving force behind complaints of PTSD symptoms in MVA survivors and once litigation is concluded (e.g., a favorable ruling is won by the litigant), symptom presentation will improve. As cogently reviewed in Blanchard and Hickling (2004), there is little evidence that litigation affects symptoms among assessment or treatment seeking MVA survivors. Although a number of researchers have investigated the effects of litigation on symptom presentation and an individual's willingness/ability to return to work, Mayou and colleagues have produced the largest body of work to date (e.g., Mayou, 1995, 2002; Mayou, B. Bryant, & Duthie, 1993). Following a group of 171 MVA accident survivors seen at an emergency room in England, Mayou and colleagues, at three-year follow-up, found no differences in symptom presentation between the 96 individuals who were involved in MVA-related litigation and the 75 who had not filed claims ( Mayou, 1995; Mayou et al., 1993). At 6 year follow-up, 81 of the 96 individuals pursuing litigation were located and re-assessed ( B. Bryant, Mayou, & Lloyd-Bostock, 1997). Sixty-nine of the 81 cases had been settled but there were no dramatic improvements in physical complaints, mental state, or social functioning among those with settled cases compared to those whose cases were still active. These data have been largely replicated in an Australian sample ( n = 106) of MVA survivors who were hospitalized because of their injuries ( R. A. Bryant & Harvey, 2003). Although it is always possible that an individual involved in an MVA may be less than genuine when describing psychological or physical symptoms attributed to the MVA, at this point, the available data does not support that contention that there is widespread deceit among assessment or treatment seeking MVA survivors.

Assessment of MVA-Related PTSD

PTSD screening and treatment outcome measures

Given the high prevalence of MVA-related PTSD described above, it is prudent to screen clients who report a serious MVA for PTSD. Shrout and colleagues have recommended a two-step approach to identifying PTSD ( Shrout, Skodol, & Dohrenwend, 1986). In the first step, individuals are administered self-report measures relevant for a particular disorder. If a predetermined cutoff score is exceeded, a more extensive and time-consuming diagnostic evaluation can be conducted. By administering a self-report measure first to identify cases that are most likely to require additional assessment and possibly treatment, clinicians can efficiently allocate services where they are potentially most needed. In the case of MVA survivors, easy to administer self-report screening tools may help to identify individuals in both psychological and medical settings who are suffering serious psychological sequelae of an MVA and increase referrals to effective MVA-PTSD treatment (e.g., Blanchard & Hickling, 2004; Taylor & Koch, 1995).

Although, there are a number of psychometrically sound measures of PTSD symptoms, three measures may be particularly useful in screening clients for MVA-related PTSD; one because of its excellent psychometric properties and widespread use and two others because they are psychometrically sound and have established screening scores specific for MVA-related PTSD. These three measures also can be used to index change during the course of treatment, as they have been shown to be sensitive to change in this population.

One of the most widely used PTSD screening measures is the PTSD Checklist (PCL; Weathers, Litz, Huska, & Keane, 1994). The items of the PCL correspond to the 17 symptoms of PTSD in DSM-IV ( APA, 2000). Respondents rate each item in terms of how much the symptom has bothered them in the past month using a 1 ( not at all) to 5 ( extremely) scale. Internal consistency coefficient of the PCL total score has been reported to be 0.94 ( Blanchard, Jones-Alexander, Buckley, & Forneris, 1996; Ruggiero, Del Ben, Scotti, & Rabalais, 2003) and two-week test-retest reliability correlation coefficient has been reported to be 0.68 ( Ruggiero et al., 2003). When the PCL is used as a screening tool, perhaps the most commonly reported scoring strategy is to simply sum the scores of the 17 items into a total score. Individuals whose total score fall at or above the cutoff score, likely will meet diagnostic criteria for PTSD and should be assessed with a diagnostic interview. Various cutoff scores for the PCL have been identified in the literature but the two most commonly reported are 50 and 44. Weathers et al. (1994), using a sample of combat veterans, identified a total score of 50 as an appropriate cutoff score for screening purposes. In contrast, Blanchard and colleagues evaluating a small sample of MVA and sexual assault survivors (n=40; 92% female) recommend a cut off score of 44 ( Blanchard et al., 1996). Blanchard and Hickling (2004) hypothesize that the difference in recommended cutoff score in these two studies may be due to the sharp gender difference in the two samples (and the chronicity of PTSD in the Vietnam veteran sample used by Weathers et al.). The PCL is available from the National Center for PTSD at http://www.ncptsd.va.gov/index.html.

In addition to the PCL, two other self-report PTSD symptom scales, the Impact of Event Scale (IES; Horowitz, Wilner, & Alvarez, 1979) and the PTSD Symptom Scale-Self Report (PSS-SR; Foa, Riggs, Dancu, & Rothbaum, 1993), have been used as screening tools with MVA survivors. The PSS-SR contains 17 items, reflecting the DSM-IV symptoms of PTSD, which are rated on a 4-point Likert scale, ranging from not at all to 5 or more times/week - almost always. The highest possible score on the PSS-SR is 51. Foa et al. (1993) evaluated the psychometric properties of the PSS-SR with 46 female rape victims and 72 female non-sexual assault victims, noting that the scale showed high internal consistency (α = .91), good one-month test-retest reliability ( r = .74), and adequate convergent validity (.52 to .81) ( Foa et al., 1993). The IES contains 15 items that are distributed across two subscales, which assess intrusion (7 items) and avoidance (8 items). The frequency of each item is rated on a 4-point scale: 0 ( not at all), 1 ( rarely), 3 ( sometimes), or 5 ( often). The highest possible total score on the IES is 75. The IES has been shown to have high internal consistency with alpha coefficients of .78 for the intrusion subscale and .82 for the avoidance subscale in a sample of 66 outpatients ( Horowitz et al., 1979). Split-half reliability of the total scale was .86 and the one-week test-retest reliability was .89 for the intrusion subscale and .79 for the avoidance subscale ( Horowitz et al., 1979). For a recent review on the psychometric properties of the IES, please see Joseph (2000).

Using a sample of 229 men and women who suffered a serious MVA and responded to recruitment flyers at health clinics, newspaper advertisements, and referrals from health care providers, Coffey and colleagues compared various total scores on the IES and PSS for their ability to identify those individuals with and without PTSD ( Coffey et al., 2006). A widely used and psychometrically sound diagnostic interview (i.e., Clinical Administered PTSD Scale) was used to establish a PTSD diagnosis. By comparing total scores on the self-report measures with results from a diagnostic interview (i.e., the "Gold Standard"), three useful metrics can be calculated to assess the utility of the self-report measure: sensitivity, or the chance that a condition that is present will be detected, specificity, or the chance that a condition that is not present will be found to be absent, and overall correct classification, or the proportion correctly diagnosed by an instrument ( Kessel & Zimmerman, 1993). For the IES using a cutoff score of 27, sensitivity was .91, specificity was .72 and overall correct classification was .80. For the PSS-SR using a cutoff score of 14, sensitivity was .91, specificity was .62 and overall correct classification was .74.

It is important to note that use of the recommended cutoff scores for the PCL, IES, or PSS-SR will produce a relatively high rate of false positive cases. That is, the total score for an individual may exceed the recommended cutoff score but, using a diagnostic interview, the individual may not meet criteria for MVA-related PTSD. Relatively high false positives rates are seen as acceptable on screening measures given that the self-report measures only take a few minutes to complete and the primary goal of the screener is to have a measure with high sensitivity (i.e., capture the vast majority of true positive cases) that can then be followed by a more stringent, but time consuming, structured interview.

Diagnosing MVA-related PTSD

Following a positive screening for PTSD symptoms, a well established structured interview should be administered. While general structured interviews provide reliable and valid diagnoses, discussion within this article will be limited to a well established structured interview specifically designed to assess PTSD, the Clinician-Administered PTSD Scale (CAPS; Blake et al., 1995). The CAPS is a structured interview developed at the Boston branch of the National Center for PTSD, a multisite research, clinical, and education center within the Veterans Administration. The CAPS assesses the 17 symptoms of PTSD identified in DSM-IV. The CAPS includes standardized questions to determine the frequency and intensity of PTSD symptoms in the preceding month, using a 5-point Likert scale (e.g., 0 indicates that the symptom does not occur or does not cause distress and 4 indicates that the symptom occurs nearly every day or causes extreme distress and discomfort). The CAPS also includes standardized questions assessing subjective distress and impairment in social and occupational functioning due to these problems. Because of the prevalence of pain in MVA survivors, it is helpful to add probes to the interview to determine whether each symptom is related to PTSD or if it is better attributed to chronic pain. For example, if a patient reported difficulty sleeping, a clinician can assess whether this symptom is due to pain. If the symptom can be attributed to pain, a clinician may decide to not count the symptom toward a diagnosis of PTSD. This more conservative scoring approach of the CAPS has been used by researchers developing treatments and assessment approaches for MVA-related PTSD (e.g., Beck & Coffey, 2005). The CAPS has strong psychometric properties (e.g., Weathers, Keane, & Davidson, 2001) and has been shown to be sensitive to the detection of PTSD in individuals following a MVA ( Blanchard, Hickling et al., 1996). A common scoring procedure is to count a symptom toward a diagnosis of PTSD if both a rating equal to or greater than 1 is provided for the frequency of the symptom and a rating equal to or greater than 2 is provided on the severity of the symptom. A diagnosis of PTSD can be given if the number of positive symptoms meet or exceeds DSM-IV criteria and the participant reports distress or interference due to these symptoms. The CAPS is available from the National Center for PTSD at http://www.ncptsd.va.gov/publications/assessment/adult_interviews.html.

Exposure to trauma is a relatively common human experience. Trauma exposure was experienced by 60.7% of men and 51.2% of women in the NCS and 34.2% of men and 24.9% of women experienced exposure to more than one traumatic event ( Kessler et al., 1995). Therefore, in addition to assessing for MVA-related PTSD, it also recommended that MVA survivors be assessed for non-MVA potentially traumatic events (PTE). Although a number of measures are available to assess PTE, one reliable broad spectrum trauma assessment tool is the Traumatic Life Events Questionnaire (TLEQ; Kubnay et al., 2000). The TLEQ is a self-report measure that enables a clinician to assess a broad range of PTE and to establish whether the event satisfies the requisite stressor (i.e., Criteria A) for PTSD according to DSM-IV ( APA, 2000).

There are a number of other assessment devices available in the literature, in addition to the measures that are reviewed here. Although not all of these measures have been used with MVA survivors, a good starting point for an overview to these measures is Wilson and Keane (2004). In reviewing the available assessment instruments, it may be useful to consider which ones would be helpful to re-administer during the course of treatment, in order to index the impact of intervention on an individual's symptomatology.

Treatment of PTSD among MVA survivors

Within the empirical literature on psychological treatments of MVA survivors, one can find information about several different types of therapy. One collection of treatment approaches is designed to prevent the development of PTSD in individuals who have experienced a serious MVA. The second collection of treatments address diagnosed PTSD in MVA survivors. Each of these approaches will be reviewed below. An interesting aspect of treating MVA-related PTSD is that to receive standard psychosocial treatment, it is very likely the patient must engage in his or her most feared activity: driving or being driven in a motor vehicle. Engaging in the trauma-related activity so as to attend therapy is unique in the PTSD treatment field and in the section below entitled "Anxiety during treatment session" we describe attempts to cope with the in-session distress elicited by driving a motor vehicle to treatment.

Can early intervention prevent the development of PTSD in MVA survivors?

Several different preventative approaches have been examined with MVA survivors. The first approach includes studies that have applied one-session interventions to injured MVA survivors within a short interval following the traumatic accident. For example, Conlon, Fahy, and Conroy (1999) examined the impact that a single counseling session had on individuals presenting to a trauma center immediately following a MVA. In this trial, none of the participants sustained injuries serious enough to warrant hospitalization. Half of the participants were given a 30-minute counseling session, which encouraged the expression of emotions and thoughts about the MVA, as well as education about PTSD and possible coping strategies (psychological debriefing). The other participants did not receive debriefing. All individuals were re-assessed 65-210 days after the MVA. No differences were noted between individuals who had received debriefing and those who did not with respect to PTSD-related morbidity. Similar results were reported by Hobbs, Mayou, Harrison, and Worlock (1996), who worked with more seriously injured MVA survivors. In this trial, the 1-hour debriefing was administered 24 to 48 hours after the MVA in the hospital and again, did not appear to have helped participants. A 3-year follow-up with individuals who were involved in the Hobbs et al. (1996) study indicated that participants who had received debriefing had a significantly worse outcome (e.g., more self-reported psychiatric symptoms, greater anxiety about auto travel, greater pain, lower overall levels of functioning, and more financial problems, Mayou, Ehlers, & Hobbs, 2000). These studies, in combination, suggest that single session debriefing is not advised in the immediate aftermath of a serious MVA. It is salient to note that clinical researchers continue to seek effective prevention methods (e.g., Litz, Gray, R.A. Bryant, & Adler, 2002), an effort that needs to be conducted carefully, in light of the potential for negative outcomes. Based on the small available database, psychological first aid is an appropriate initial intervention although it does not serve a preventative or a therapeutic function ( Litz et al., 2002). Clearly this is an area that deserves much greater attention.

Although intervention immediately following a traumatic accident is not advisable, some studies suggest that in those instances where an individual is reporting Acute Stress Disorder (ASD), a brief cognitive behavioral treatment (CBT) may be helpful. The diagnosis of ASD is used to codify posttraumatic responses that occur between 2 and 28 days after a traumatic event ( APA, 2000). Although diagnostic criteria for ASD are somewhat similar to PTSD, they include greater emphasis on dissociative symptoms. Research suggests that individuals who develop ASD are at a substantially higher risk for PTSD, relative to those without ASD in the immediate aftermath of a trauma (e.g., Harvey & R. A. Bryant, 1998). Thus, it is salient to consider whether treatment can reduce the likelihood that an individual with ASD will develop PTSD.

To address this issue, R. A. Bryant, Harvey, Dang, Sackville, and Basten (1998) compared a brief CBT with brief nondirective supportive counseling for 24 individuals with ASD following a serious MVA or industrial accident. Both treatments involved 5 sessions (once weekly). CBT included education about expected reactions to trauma, relaxation training, imaginal and in-vivo exposure, and cognitive re-structuring. Supportive counseling included education about trauma reactions, in addition to general problem-solving skills and unconditional support. Following treatment, only 8% of the CBT group was diagnosed with PTSD, in contrast with 83% of those who had received supportive counseling. The relative ineffectiveness of supportive counseling in the prevention of PTSD suggests that although support and understanding may be appreciated by individuals with ASD, these elements alone do not seem to constitute an effective intervention. A related study by R. A. Bryant, Sackville, Dang, Moulds, and Guthrie (1999) examined a similar CBT package, in comparison with prolonged exposure and supportive counseling. Individuals in the prolonged exposure condition received treatment that concentrated on imaginal and in-vivo exposure, supplemented by supportive counseling. Participants included 45 survivors or either a serious MVA or a nonsexual assault, who were diagnosed with ASD and were treated within two weeks of their trauma. Fewer patients developed PTSD following prolonged exposure (14%) and CBT (20%), in comparison with supportive counseling (56%). These two studies when taken together strongly suggest that treatment that is oriented at trauma-related symptoms such as re-experiencing, hyperarousal, avoidance, and emotional numbing, has greater success at preventing individuals with ASD from developing PTSD in the aftermath of a serious auto accident. Clearly, more information about individual differences that might enhance or diminish the effects of CBT would be very useful.

Following from these studies, Hickling, Blanchard, and Kuhn (2005) describe an abbreviated CBT for individuals with ASD that is designed to reduce direct contact time for both therapist and client. As noted by these authors, it can be somewhat difficult to engage individuals in psychotherapy shortly after their accident. Although there are no clear reasons for this difficulty, it is possible that a brief intervention which reduces the demands placed on clients may be more acceptable and tolerated to a greater extent, in the immediate aftermath of a MVA. Hickling and colleagues included two sessions, of 60 to 90 minutes' duration each, with a scheduled telephone session in-between. In the first session, CBT included psychoeducation about reactions to a trauma, instruction in the use of exposure-based techniques, relaxation training, and practice in developing and using coping self-statements. The second session began with a review of practice homework and included in-session exposure to the audiotaped description of the MVA. A series of three cases suggests that this abbreviated CBT may hold promise, although it deserves considerably more research prior to large-scale dissemination.

What are effective treatments for PTSD in MVA survivors?

Although preventative efforts ultimately may reduce the emotional toll of MVAs, the majority of patients do not seek help shortly after their MVA. More typically, individuals do not understand the emotional symptoms of PTSD and may not seek help for several years, which at that point, PTSD has become chronic and may be difficult to treat. Although four types of psychological interventions have been endorsed by a panel of experts ( Foa, Keane, & Friedman, 2000), only one of these treatments, (CBT) has been examined for its efficacy with individuals who have survived a serious MVA. In the next section, we review the treatment literature, which illustrates that CBT and to a lesser extent, supportive psychotherapy appear to be helpful for reducing PTSD in this population.

Cognitive Behavioral Therapy

As reviewed by Blanchard and Hickling (2004), the first reports of treatment of PTSD among MVA survivors originated from behavioral practitioners. These case presentations focused on the use of imaginal and in-vivo exposure, typically delivered in a massed schedule (termed 'flooding', e.g., Kuch, Swinson, & Kirby, 1985; McCaffrey & Fairbank, 1985). Subsequent efforts included inclusion of cognitive interventions, as well as efforts to increase the individual's social support network (e.g., Hickling, Blanchard, Schwarz, & Silverman, 1992; Horne, 1993). In 1999, Fecteau and Nicki published the first controlled treatment study in this literature. In this report, 20 individuals were assigned either to treatment or to an assessment only condition. Treatment was structured, involved four 2-hour sessions, and revolved around a cognitive-behavioral formulation. Interventions included psychoeducation, relaxation training, repeated exposure to the audio-taped description of the MVA, cognitive reappraisal training, and a small amount of in-vivo exposure. At the end of treatment, all of the control group continued to meet diagnostic criteria for PTSD, while only 60% of the treatment group satisfied diagnostic criteria. Although promising, it is clear that treatment of MVA-related PTSD required more than this initial four session approach.

Building on these findings, Blanchard and Hickling (2004) expanded and refined their CBT program. This treatment package is designed to be individualized, with varying degrees of emphasis placed on specific interventions depending of the individual's needs (see Table 1 ). Treatment may last between 8 and 12 sessions, with an anticipated mode of 10 sessions. This program places heavy importance on exposure-based interventions, which is in keeping with current theories of PTSD (e.g., Foa & Kozak, 1986) and available data that documents the central role that exposure-based interventions play in the treatment of PTSD, irrespective of trauma type (e.g., Rothbaum, Meadows, Resick, & Foy, 2000) . Importantly, its efficacy has been examined in two large-scale controlled trials. Blanchard et al. (2003) compared this CBT with supportive psychotherapy and a wait list, in an effort to examine the effectiveness of this treatment above and beyond provision of emotional support. Participants included 98 individuals (73% female) who met diagnostic criteria for PTSD or severely symptomatic sub-syndromal PTSD following a MVA. All participants had experienced their accident between 6 and 24 months prior to entering the study. Individuals were randomized to the CBT treatment, supportive psychotherapy (to be described in a following section), or a wait-list condition, wherein they were informed that treatment would be delayed for 2 to 3 months. Importantly, Blanchard et al. used experienced, community therapists for this study, ensuring that the results would be applicable to a typical practice setting. Both treatment protocols allowed the therapist flexibility in determining the number of sessions. As described by Blanchard and colleagues (2003), the sample included individuals with notable other problems in addition to PTSD (including Major Depressive Disorder, other anxiety disorders, and continuing physical limitations owing to injuries sustained during the MVA), which also ensures greater applicability of the findings to a typical practice setting.

Table 1

Session

Treatment components

1

○ Review symptoms and diagnosis

○ Psychoeducation about PTSD

○ Progressive Muscle Relaxation (PMR) training

2

○ Reading (aloud) written description of the MVA

○ Discussion of avoidance

3

○ Creation of avoidance hierarchy - exposure instruction ( in-vivo and imaginal)

○ Meeting with significant other

4

○ Discussion of avoidance hierarchy - exposure continued

5

○ Discussion of avoidance hierarchy - exposure continued

6

○ Discussion of avoidance hierarchy - exposure continued

○ Cue-controlled relaxation

7 - 9

○ Exploring existential issues (esp. concerning mortality)

○ Interventions to address estrangement and social isolation

○ Discussion of avoidance hierarchy - exposure continued

10

○ Review all treatment procedures

Results indicated that 27 individuals completed CBT, with 10 additional individuals discontinuing the trial early. Of the 21 individuals who met full criteria for PTSD prior to treatment, 76% ( n = 16) no longer satisfied criteria following treatment. Of the 6 individuals who reported severe sub-syndromal PTSD, 83% ( n = 5) no longer satisfied criteria for this classification after treatment. The benefits of CBT generalized to other disorders, with significant decreases in depressive and generalized anxiety disorders. The mean number of CBT visits was 9.8 (SD 1.2), suggesting that augmentation of the early CBT program enhanced the overall effectiveness of this treatment approach. CBT was significantly more effective than the wait list condition on all measures, which included both clinician ratings and self-report questionnaires. These results were maintained at a 3-month follow-up.

A very similar study recently was completed in Germany by Maercker, Zöllner, Menning, Rabe, and Karl (2006). The purpose of this study was to test the efficacy of a modified version of the CBT manual developed by Blanchard and Hickling (2004). The manual was translated and additional elements were added, including expansion of cognitive therapy to address accident-related cognitions as described by Ehlers and Clark (2000), inclusion of interventions to address guilt, and greater discussion of positive outcomes that accrued from the MVA, including personal growth. Maercker and colleagues were careful to replicate many of the methodological features of Blanchard et al. (2003), which allows for close comparison of these studies. Forty-two individuals completed the study, with 21 randomly assigned to CBT and the remainder to a wait list condition. Participants experienced chronic PTSD with an average of 5.3 years elapsed between their accident and participation in the trial. Maercker and colleagues report slightly lower rates of drop-out than Blanchard, with only two people discontinuing CBT prior to completion. An average of 11.4 (SD 3.2) sessions of CBT were delivered by community psychotherapists. At post-treatment assessment, 75% ( n = 9) of individuals who had originally met full criteria for PTSD did not receive the diagnosis. Of individuals reporting severe sub-syndromal PTSD, 78% ( n = 7) did not meet this classification at post-treatment. Results on both clinician and self-report measures were similar to those obtained by Blanchard and colleagues, with significant differences found in all contrasts with the wait list condition. Taken together, these two studies strongly support the effectiveness of CBT for MVA-related PTSD.

As positive as the development of an individual-format CBT has been in reaching the needs of individuals with MVA-related PTSD, some writers have noted that individual-format therapies are not terribly cost-effective (e.g., Miller & Magruder, 1999). In contrast, group-format treatment offers the possibility of reaching more individuals, while reducing the workload for any given therapist. Group therapy also costs less. However, adapting individual-format therapies to be appropriate for a group setting is not clear-cut. As discussed by Resick and others ( Hickling & Blanchard, 1999; Resick & Schnicke, 1993), when treating PTSD within a group setting, careful consideration must be paid to both the content and process of intervention. Recently, Beck and Coffey (2005) describe the adaptation of individual CBT to a group treatment setting. As part of the development of this group CBT, Beck and Coffey considered various features of individual CBT that would not easily translate to a group setting. For example, patients with MVA-related PTSD may be very anxious upon arrival for session, owing to the need to drive to get to therapy. These individuals may be preoccupied during treatment which can be somewhat "contagious" to other group members. This same issue can occur with group members who are highly irritable after observing a dangerous driver on the way to therapy. As such, management of the therapeutic environment within the group setting is salient. Additionally, detailed discussion of group member's MVAs has the potential to heighten everyone's feelings of anxiety, especially if similarities exist among group member's accidents ( Fedoroff, Taylor, & Koch, 1999). Consequently, management of the group includes setting norms for how information about each person's accident is shared and what information does not need to be discussed. It also is necessary to adapt exposure exercises for group treatment. Within individual format CBT, the patient reads aloud a description of their MVA. This procedure has a high likelihood of creating distress if conducted within group treatment. Thus, exposure exercises are modified for group therapy, with the majority of exposure occurring outside of session. Although this could dilute this important aspect of treatment, it is required by the group format. At present, preliminary outcomes for the group CBT with a sample of individuals with chronic PTSD after a MVA seem promising, with 88% of patients free of PTSD after treatment (in contrast with 31% who were diagnosis-free following a minimal contact control condition, Beck, Coffey, Foy, Keane, & Blanchard, 2006).

A related form of CBT also has been developed, which places substantially greater emphasis on cognitive interventions, relative to the CBT developed by Blanchard and Hickling (2004). Ehlers, Clark, Hackmann, McManus, and Fennell (2005) describe a cognitive therapy program that has three goals: 1) To modify excessively negative appraisals of the trauma and its sequelae, 2) To reduce re-experiencing by elaboration of the trauma memories and discrimination of triggers, and 3). To reduce dysfunctional behaviors and cognitive strategies (e.g., avoidance). These targets for treatment directly stem from Ehler and Clark's model of PTSD (2000), which places emphasis on the sense of threat that trauma survivors feel. Treatment is not scripted into a fixed number of sessions and no manual is available, reflecting the developers' belief that this form of treatment should be principle-driven rather than manual-driven. A randomized trial involving this form of CBT indicated that 79% of participants were free of PTSD following treatment, which contrasts quite favorably with 24% who were free of PTSD following use of a self-help book and 30% who were free of PTSD following repeated assessment alone ( Ehlers, Clark, Hackman, McManus, Fennell, & Herbert, 2003). The participants in this study had all experienced a serious MVA less than 6 months prior to entering the study and they were required to have sought medical attention following their MVA. It would be very important to test this form of CBT with individuals who have more chronic PTSD following a MVA, given its promise as an early intervention.

Supportive Psychotherapy

In addition to CBT, general supportive psychotherapy has been shown to be somewhat effective for MVA-related PTSD. Two treatment studies have included supportive psychotherapy as a comparison condition for CBT ( Blanchard et al., 2003; R. A. Bryant, Moulds, Guthrie, Dang, & Nixon, 2003). In each case, supportive psychotherapy was helpful, with 40% of participants diagnosis-free in the Bryant et al. study (2003) and 48% diagnosis-free in the Blanchard et al. study (2003). Thus, supportive psychotherapy can be useful but not necessarily as efficacious as CBT. Blanchard et al. (2003) describe their supportive psychotherapy as focused on normalizing the trauma experience and processing the MVA in the context of other losses and traumas that the individual may have experienced. Bryant et al. (2003) focused their supportive psychotherapy on general problem-solving skills. Both forms of supportive therapy emphasized provision of unconditional support, with prohibition of CBT-related techniques (which is understandable in light of the goals of each of these studies). Clearly, when considering chronic forms of MVA-related PTSD, supportive psychotherapy confers some treatment advantages, although it is not as helpful in eliminating PTSD as either form of CBT that has been studied.

Treatment process issues

Pain and the course of treatment

As cogently discussed by Sharp and Harvey (2001), pain and PTSD seem to create a synergy when present together. In the course of treatment, this synergy may manifest in several ways. First, individuals may have difficulty distinguishing between pain complaints and PTSD symptoms, given that both types of problems originated from the same event. Our clinical experience suggests that most patients regard their pain and PTSD symptoms as a common "lump" that was caused by the MVA. It is important for therapy to help the MVA survivor to differentiate between pain and PTSD, particularly since these two types of problems respond to different interventions. Additionally, there appears to be little generalization of treatment effects between these two problem areas (e.g., Shipherd, Beck, Hamblen, Lackner, & Freeman, 2003). Second, pain-related problems may be responsible for lifestyle changes that can occur to MVA survivors. These changes may include loss of physical mobility and strength, permanent disability from employment, and inability to perform everyday tasks. Changes in physical abilities often compound the person's perception of the MVA, in particular the "awfulness" of the accident. Because CBT focuses on helping the MVA survivor to strengthen coping skills and re-interpret dysfunctional cognitions, it is critical to differentiate between the actual accident and its aftermath (e.g., disability, on-going pain complaints). As noted, Blanchard and Hickling's CBT includes the option of discussing existential issues, which may include helping the individual come to terms with changes in their physical functioning, using cognitive therapy techniques.

Pain also can impact the process of treatment in other ways. Although early writers felt that pain may interfere with a patient's ability to engage in CBT for PTSD (e.g., Koch & Taylor, 1995), this fortunately has not been the case in published studies. For example, 91% of the sample in Blanchard et al. (2003) had lingering physical problems related to injuries sustained during the MVA. An examination of variables that might predict treatment response did not highlight chronic pain as salient in the outcome of either CBT or supportive psychotherapy ( Blanchard & Hickling, 2004). Shipherd et al. (2003) explicitly examined the influence of pain on CBT for MVA-related PTSD. In this multiple baseline report, five of six chronic pain patients did not meet criteria for PTSD after treatment. Four patients reported some decrease in pain, although continued to indicate discomfort. A notable decrease in time spent in bed was found, although this could have resulted from accompanying decreases in depression, PTSD, or general distress. Thus, the presence of pain complaints is not necessarily a sign that an individual will have a poor response to psychosocial treatment. However, pain-related problems require the therapist to carefully ascertain the reason(s) behind specific limitations. For example, some types of limitations may be functionally related to pain (e.g., back pain that prevents an individual from driving for long distances) whereas others may be related to PTSD (e.g., avoidance of driving on an interstate due to exposure to semi-trucks, a trigger for PTSD symptoms). As well, it is important for therapists to remember that chronic pain may necessitate adjustments such as allowing a patient to stand or lie down during treatment sessions.

Anxiety during the treatment session

MVA-related PTSD requires that the individual confront their trauma triggers in order to attend treatment. This makes treatment of this disorder particularly challenging, as individuals may arrive at treatment in a heightened state of anxiety or agitation. Our work in developing a Group CBT ( Beck & Coffey, 2005) suggested the utility of adding training in mindfulness meditation (e.g., Kabat-Zinn, 1990). Briefly, mindfulness meditation stresses the importance of focusing deliberate concentration on a chosen target (e.g., one's own breathing), in order to reduce acute distress and distraction. The goal is to direct attention to an event that is presently occurring, rather than attending to thoughts about past or future events. Although mindfulness meditation is not necessarily the only way to accomplish this goal, this skill also can be useful for improving focus in other arenas, such as when driving a car. In our clinical work, we have found that individuals with MVA-related PTSD need explicit assistance in re-directing their thoughts to be able to focus on treatment. In the absence of this assistance, it is difficult for many individuals to work effectively. When this occurs in group treatment, the group process can become chaotic and potentially harmful to patients.

When the MVA involved a fatality

When the individual was involved in a MVA that caused a fatality, additional issues may be present during treatment. Included among these issues are enhanced perceptions of responsibility, protracted feelings of guilt, and survivor guilt. Although this issue has not received extensive empirical study, Blanchard and Hickling (2004) suggest that individuals who are involved in a MVA that caused a fatality are at heightened risk of developing PTSD, even if the individual was not responsible for the accident (e.g., was not the driver). Intuitively, this is not surprising, although greater study of this issue is warranted before more solid conclusions can be made. When treating an individual who experienced a MVA that involved a fatality, the first step is to ascertain the specific role that perceptions of the fatality play within the individual's PTSD symptom picture. Clinically, we have observed individuals who are primarily focused on the existential facets of the fatality, including thoughts such as "it could have been me". These kinds of perceptions can be worked with using various aspects of cognitive therapy, including an examination of probabilities and in particular, over-estimation errors (see Ehlers et al., 2005). We also have observed individuals who are preoccupied with inflated notions of responsibility for the fatality, including perceptions that somehow they "should" have died instead of the individual(s) who did. Although poorly defined in the literature, these perceptions can be conceptualized as survivor guilt (e.g., Wayment, 2004). Gentle Socratic questioning can help the individual begin to question this type of belief, with particular emphasis on real versus imagined responsibility. Clinically, this is one of the more difficult issues for therapists in work with this population.

When conducting CBT within a group setting, the presence of a fatality is an extremely sensitive issue. In particular, this issue has the potential to increase other group member's anxiety, as it validates their worse fear, namely that they could have been killed. Although Group CBT for MVA-related PTSD does not emphasize sharing details of each group member's MVA (see Beck and Coffey, 2005), information about a fatality may be disclosed inadvertently. Such disclosure requires that the group therapists recognize the terrible nature of the individual's MVA and the associated emotions that it produces in the entire group. Handling this issue clinically takes precedence over the structured information for that session, particularly given the elevated anxiety that will consume the group atmosphere. Often, imaginal exposure (or exposure using an expanded version of the MVA description) can be helpful for the individual whose MVA included a fatality.

Practice outside of the treatment session

When using exposure therapy to treat MVA-related PTSD, we have observed a number of issues that may arise when individuals are asked to practice outside of the treatment session. Ideally, the individual should understand the principles behind exposure-based techniques and have some in-session experience with exposure prior to their practice outside of the treatment environment. Clinically, we have found it helpful to begin with therapist-assisted imaginal exposure during a session. Often, several practice exercises are necessary for anxiety reduction to occur, particularly for items at the upper end of the hierarchy (see Foa & Rothbaum, 1998 for a step-by-step description of how to conduct ET).

Once the individual is ready for exposure practice outside of the treatment environment, handouts that illustrate the anticipated rise and fall of anxiety during exposure can remind the individual to stay with the exposure exercise until their anxiety has reduced by half. We have observed some patients who try to "push the envelope" when practicing exposure in-between treatment sessions. In essence, these individuals select a practice item that is fairly high up on their hierarchy, feeling that if they just "tough it out", this will somehow facilitate their recovery. Typically, the opposite occurs, with the person feeling overwhelmed and perhaps a bit pessimistic about the outcome of treatment. Although appreciative of the motivation behind this approach to exposure, we actively discourage patients from taking on exposure items that are too far up their hierarchy, particularly during the beginning treatment sessions. It is essential for patients to remember to take exposure one step at a time, particularly when selecting items to practice outside of treatment. Because exposure can be difficult, particularly exposure that involves driving situations which are not always able to be planned or choreographed, careful selection of homework items can result in greater benefits from this important treatment ingredient. For a full discussion of the clinical issues involved in using exposure therapy to treat MVA-related PTSD, please see Beck and Coffey (2005) or Blanchard and Hickling (2004).

There are occasions when patients do not seem to be able to comply with homework and as such, do not derive a large measure of help from treatment. As discussed more thoroughly ( Beck & Coffey, 2005), we cite the example of a woman who was inconsistent with her exposure-based homework throughout the course of Group CBT. While group was in-session, she was also experiencing a number of serious life stressors (e.g., her husband lost his job, one of her children left the home to attend college in another state, her disability claim was denied), which distracted her from exposure practice. At the post-treatment assessment, this woman showed some reduction in PTSD symptomatology yet was clearly reporting notable re-experiencing, avoidance, and hyperarousal symptoms. One month after this assessment, she completed a self-report battery and reported very low levels of these symptoms. When we contacted her by phone, she indicated that some of the life stressors had resolved and stated that she had begun to do her homework, with particular emphasis on exposure-based exercises. In considering this example, it is salient that this woman clearly had learned the principles of exposure, as she was applying these effectively in her own post-treatment homework. Although perhaps a bit unusual, we feel strongly that teaching the principles behind CBT is an important aspect of treatment, particularly given the possibility that an individual can be exposed to a serious MVA again in their life, which would necessitate use of these skills to prevent a relapse.

Summary and conclusions

As highlighted throughout this article, MVAs can have serious psychological consequences. We have focused on PTSD, with particular emphasis on the assessment and treatment of this disorder in this population. In our work with individuals diagnosed with MVA-related PTSD, we have noted that their mental health needs may not have been recognized by other health care providers. Certainly, given emerging evidence concerning the psychological consequences of MVAs, this lack of awareness is likely to change. Fortunately, the empirical literature on the treatment of PTSD after a collision provides some good information with respect to interventions that have proven efficacy, as well as those that may cause harm. The treatment of PTSD in MVA survivors can be a clinically rewarding experience, particularly given the extent of lifestyle restriction that these individuals experience as a result of this disorder. Although work in this area has made substantial progress, many issues remain, including determination of individual difference factors that may influence treatment response, development of alternative modes for the delivery of exposure-based interventions and expanding available models of care for individuals who do not respond to the available treatments. We hope that this review can facilitate continued clinical research in this arena.

Acknowledgments

This work was supported in part by a grant from the National Institute of Mental Health (MH64777).

References

Fedoroff I, Taylor S, Koch W. Posttraumatic Stress Disorder due to motor vehicle accidents: Patterns and predictors of response to cognitive-behavior therapy; Paper presented at the annual meeting of the Association for the Advancement of Behavior Therapy; Toronto, ON. 1999. Nov, [Google Scholar]

Maercker A, Zöllner T, Menning H, Rabe S, Karl A. Dresden PTSD treatment study: Randomized controlled trial of motor vehicle accident survivors. BMC Psychiatry. 2006. p. 29. Retrieved July, 2006 from [http://www.biomedcentral.com/1471-244X/6/29. PMC free article] [PubMed]

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Assessment and treatment of PTSD after a motor vehicle collision: Empirical findings and clinical observations

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Individuals who experience a serious motor vehicle accident (MVA) are at increased risk for psychological problems, particularly Posttraumatic Stress Disorder (PTSD). In this article, we review the literature on PTSD among MVA survivors, with particular ...

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Where do you start with recovery?

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How to Cope with Trauma After an Accident

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ADAA Blog Content and Blog Comments Policy ADAA provides this Website blogs for the benefit of its members and the public. The content, view and opinions published in Blogs written by our personnel or contributors - or from links or posts on the Website from other sources - belong solely to their respective authors and do not necessarily reflect the views of ADAA, its members, management or employees.

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Some statistics on car accidents: What causes them?

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Joking shows can help bring a lighter side to traumatic events and help with exposure for patients who experience PTSD

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Kids' artwork from Ukraine and the war.

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Working with sexually abused in Art Therapy

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Working with sexually abused in Art Therapy

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Kids' drawings and expressions of how they feel.

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This video explains a bit about childhood PTSD.

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Symptoms and Strategies for PTSD in Children and Teens

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This is an article I liked because it gives parents ways to help their child with PTSD.

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Having a child receive a post-traumatic stress disorder (PTSD) diagnosis can be overwhelming and scary. The pediatric mental health specialists at CHOC provide expert help to kids and teens experiencing PTSD, to help them achieve full and healthy lives and to help preserve the magic of childhood.

What is PTSD?

Post-traumatic stress disorder (PTSD) is a mental health condition caused by a traumatic or scary event. Responses to traumatic events are different for everyone and can look different in children than in adults. Some people experience distress immediately after the event, while others may experience it months or years later. If fear and anxiety make it hard to cope with daily life, mental health experts may diagnose post-traumatic stress disorder. Psychologists, therapists and psychiatrists can help children with PTSD deal with hurtful thoughts and negative feelings by facilitating the development of PTSD coping skills, allowing your child to live a normal life.

What causes PTSD in children and teens?

Children may experience post-traumatic stress disorder after experiencing or seeing a traumatic event. Traumatic events come in different forms and may include:

Serious accidents, such as car or train wrecks

Hospitalization

Serious illness or injury

Invasive medical procedures

Animal bites

Natural disasters

Violent attacks

Death of a loved one, such as a family member, friend or pet

Physical or sexual assault

Emotional abuse or bullying

Neglect

What are the signs and symptoms of PTSD in children and teens?

Children with PTSD feel a lot of emotional and physical distress when exposed to situations that remind them of the traumatic event they witnessed. Some may relive the trauma over and over. Signs and symptoms of PTSD in children may seem similar to stress, anxiety and depression. They may have nightmares or scary memories during the day. Other symptoms of PTSD in children include:

Problems sleeping

Feeling depressed or grouchy

Feeling nervous, jittery or extra alert and watchful

Losing interest in things they used to enjoy

Seeming or feeling detached or emotionally numb

Isolating from others or having trouble feeling affectionate

Acting more aggressive than before, even violent

Avoiding certain places or situations that bring back the scary memories

Having flashbacks, such as images, sounds, smells or feelings

Believing the event is happening again

Losing touch with reality

Reenacting an event for seconds or hours or, in rare cases, days

Having problems in school

Having trouble focusing

Worrying about dying at a young age

Acting younger than their age, such as thumb-sucking or bedwetting

Having physical symptoms, such as headaches or stomachaches

Note that signs and symptoms of PTSD vary by age. Young children and toddlers may be more likely to have tantrums, poor appetite, separation anxiety and physical complaints such as stomachaches or headaches. Older children may worry about safety, suffer academically or become aggressive or easily startled. Teenagers may become lonely, panic easily, develop risky behaviors, avoid school or have trouble sleeping.

How is PTSD diagnosed?

Pediatric mental health experts can diagnose PTSD through a mental health evaluation. It is important to seek help from professionals specializing in mental health conditions in children. CHOC's pediatric mental health team is here to help your family through this scary time.

It is important to note that not every child who experiences a traumatic event will develop PTSD. It is diagnosed typically only if symptoms keep happening for more than 1 month and are negatively affecting the child's life and ability to function. For children with post-traumatic stress disorder, signs and symptoms most often start within 3 months after the traumatic event, but they can also start months or years later.

PTSD Treatment

PTSD can be treated, but the best PTSD treatment for your child depends on their symptoms, age and general health. It is important to seek help from a pediatric mental health expert early on to help ease symptoms, enhance childhood development and improve quality of life.

PTSD treatment may include:

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): An evidence-based PTSD treatment for ages 3 to 18 years focused on working with the parent and the child as they navigate the child's traumatic experience. TF-CBT educates the parent/s about reactions the child may experience and helps the child build coping skills and explore the traumatic event through drawing or writing. The child's work is then shared with the caregiver and assists in enhancing communication between caregiver and child, which builds trust and validation.

Cognitive Behavioral Intervention for Trauma in Schools (CBITS): This school-based approach has been used for students from 5th through 12th grade who have witnessed or experienced a traumatic event. It includes building coping skills, learning problem-solving techniques, cognitive restructuring and exposure.

Families Overcoming Under Stress (FOCUS): This short-term PTSD treatment (6-8 sessions) was initially designed for military children and families and been expanded into LA school districts and the foster care system. It focuses on building resilience in children and families in order to help them overcome challenges and traumatic stressors.

Medication: Medication for depression or anxiety may be a helpful way for a child to cope trauma symptoms by balancing the hormones such as serotonin that cause stress responses.

Support Groups: A support group can help children get to know others who have experienced similar trauma and may help them to feel less alone. There are also support groups for parents, caregivers and family members of those with PTSD.

Recovery and treatment from PTSD varies for everyone. Some children recover within months. Others may have symptoms for much longer. Recovery can depend on several factors, such as coping skills, resilience, family support and parent involvement.

PTSD and Co-occurring Illnesses

Some kids and teens with PTSD can experience a co-occurring illness, or a second condition brought on by the PTSD. These can include:

It's important to see a pediatric mental health expert to help figure out the best treatment for your child's combination of symptoms.

Call 911 or visit the nearest pediatric emergency department if your child expresses thoughts of harming themselves or others.

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Post-Traumatic Stress Disorder (PTSD) in Children and Teens | CHOC

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What is PTSD? Read more to learn about PTSD in children, signs, symptoms, treatments and coping skills.

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Here is the difference of a child's brain when scanned.

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ADHD and PTSD can have overlapping indications.

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This documentary series explores the horrifying, yet relatively unknown story of the Christian church La Luz del Mundo (LLDM) and the sexual abuse that scores of members, many of them minors, say they have suffered at the hands of its successive leaders, known as the “Apostles.” Told from the point of view of the survivors who met to share their stories of abuse, the series chronicles the history of one of the most powerful religious groups not only in Mexico where it was founded, but also in the United States, while giving voice to the men and women who were brave enough to stand up and call out the heinous crimes.

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Unveiled: Surviving La Luz Del Mundo | Official Trailer | HBO

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Being in-between; exploring former cult members’ experiences of an acculturation process using the cultural formulation interview (DSM-5)

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To explore the experiences of acculturation into secular Swedish society of former members of cults, with particular focus on mental health, needs and resources.Qualitative method using the Cultural Formulation Interview (CFI) from the DSM-5 as an interview…

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Recognizing the Signs of a Cult
Warning signs include: Undue Influence: The group exerts excessive control over members' lives, dictating personal choices, relationships, and finances. Isolation: Members are encouraged or forced to cut ties with family and friends.

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The phrase "drinking the Kool-Aid" is an expression that can have multiple meanings, including negative, ironic, humorous, neutral, or positive:
Negative
Can refer to someone who believes in a dangerous idea because of potential rewards. For example, in 1978, Jim Jones ordered over 900 followers of the Peoples Temple movement to drink poisoned Kool-Aid in Jonestown, Guyana, resulting in the deaths of more than 900 people. The phrase is strongly associated with this event.

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Keep Sweet: Pray and Obey is an American documentary miniseries on Netflix, surrounding the polygamous Fundamentalist Church of Jesus Christ of Latter-Day Saints, an offshoot of mainstream Mormonism, and its current leader Warren S. Jeffs.

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Keep Sweet: Pray and Obey | Official Trailer | Netflix

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Some red flags that you might be in a cult include:Undue influence: The group has excessive control over your life, including your finances, relationships, and personal choices.Isolation: You might be encouraged or forced to cut off ties with friends and family.Fear tactics: The group uses fear to control you, such as the threat of physical harm, shunning, or eternal damnation.Black-and-white thinking: The group promotes a simplistic worldview that positions itself as good and the outside world as evil.Information control: The group withholds or distorts information, or lies, to minimize or discourage access to non-cult sources of information.Authoritarianism: The group has absolute authoritarianism without accountability and zero tolerance for criticism or questions.Financial exploitation: The group requires inordinate sacrifices and money from followers.Unreasonable fears: You might have unreasonable fears about the outside world, such as evil conspiracies or impending catastrophe.Beliefs about leaving: You might believe that there is no legitimate reason to leave, or that former followers are always wrong for leaving.Beliefs about the leader: You might believe that the leader is always right. 

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Its members believed Satan would become reconciled to Jesus, and they would come together at the end of the world to judge humanity. Manson soon had the first of his groups of followers, most of them female. They were later dubbed the "Manson Family" by Los Angeles prosecutor Vincent Bugliosi and the media.

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Some tips to recover after a traumatic experience

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What is it called when you believe in science instead of God? Scientism is the view that science and the scientific method are the best or only way to render truth about the world and reality.

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Cult members can acquire PTSD, depression, anxiety, and many other forms of mental illnesses as a result of cult manipulation. As a result, their hippocampuses will become smaller. Their memories will become very distorted as well, and their emotions will grow unstable.

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QUESTION EVERYTHING! Never follow anyone or anything blindly. Make informed decisions, have your own opinions. 

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Questioning everything helps to understand the world around us and Why we do what we do? How do we do that is about technical issues and What we do is usually known. Why reflects beliefs, reasons, purpose and objectives of an institution that eventually motivate its members to adopt them. Caution, failures of human psychology can induce people to consider a single factor. Responsible answers to questions can help to improve the quality of What we do. In addition, observations combined with curiosity and questions help us to learn WHY we do things.

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My written abstract from my PTSD in children

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My written abstract from my PTSD in children

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Sexual abuse can happen in many forms of manipulative and non consensual acts aimed at engaging certain individuals in sexual activities against their will or without their full understanding and consent. This violation of a persons autonomy mostly includes a strategy of manipulation. Victims may find themselves not fully comprehending the nature of the abuse. These abuses can manifest in many forms, ranging from acts of physical assault to forms of psychological and emotional manipulation.

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This article delves into the impact experienced by individuals who fall victim to sexual harassment, acknowledging both the definition of sexual harassment and its profound implications on the mental well-being. Explaining the unwelcome touching and groping people face in work enviorment. The article mentions the impact of sexual assault, specifically focusing on the development of post-traumatic stress disorder (PTSD) among survivors. Dr. Patti Feuereisen, an experienced psychotherapist, passionately mentions that PTSD is a important diagnosis among those who have experienced sexual abuse. Symptoms like intrusive memories, nightmares, and constant fear often persist long after the traumatic event. Also, survivors commonly report feelings of depression, anxiety, and anger, along with physical manifestations such as eating disorders and insomnia.

Research shows that the symptoms of PTSD can happen for extended periods, with almost one-third of survivors still experiencing them nine months after the assault. The article encourages a shift away from the harmful "boys will be boys" mentality and urges survivors to seek help from qualified professionals for treatment options like psychotherapy and medication. It also emphasizes the importance of survivors' voices in raising awareness and fostering support for those who have experienced similar trauma.

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It's nothing new, but it may seem that way.

Unwelcome touching or groping. Sexually explicit and lewd comments or emails. All against a woman's will.

That's sexual assault or harassment, and the floodgates have opened with a seemingly continuous loop of accusations. In exposing themselves physically, these men, in turn, are exposing themselves to scrutiny. Bill Cosby, Harvey Weinstein, Matt Lauer, Bill O'Reilly, Charlie Rose. This list, unfortunately, is far from complete.
Learn More: What Is Considered Sexual Assault?
The viral #MeToo movement, begun by activist Tarana Burke and promoted by actress Alyssa Milano, swiftly gained momentum. Time magazine recently recognized the "Silence Breakers"-people who have spoken out against sexual harassment and sexual assault-as its 2017 Person of the Year. Time credits the celebrities and millions of other people who have come forward to share their stories as the "voices that launched a movement."

In hearing accounts from others, some women gained the necessary empowerment to un-silence their voices that had remained hidden for so long. Many times, the victim feels powerless because she is young or intimidated by a person of authority. Other times, she is physically overpowered and unable to fight back, or her livelihood or other relationships might be in jeopardy if she says no or reports the experience.
PTSD is not uncommon
One of the most troubling and lingering results of a sexual assault is post-traumatic stress disorder (PTSD), a pattern of symptoms people experience following a traumatic event.

"Post-traumatic stress disorder is a common diagnosis for sex abuse survivors," says psychotherapist Dr. Patti Feuereisen, author of Invisible Girls: The Truth About Sexual Abuse. Feuereisen, who has been counseling sexual abuse survivors for over 30 years.

For so many, the memories linger long after the event occurred. "After the trauma, the survivor may be haunted with recurrent and intrusive memories and nightmares and be fearful of it happening again," says Feuereisen. Many victims also report feelings of depression, anxiety, anger or sadness. Shame, guilt, self-blame, fear, helplessness, flashbacks and panic attacks may also occur. And then, there are untold physical symptoms of the trauma like eating disorders, insomnia, substance abuse, fatigue, headaches and immune system responses.

A study of women who were raped found that 94 out of 100 experienced symptoms of PTSD during the two weeks following the event. But the feelings can linger long beyond that: Nine months later, almost one-third were still dealing with the pattern of symptoms that included nightmares, jumpiness, irritability, difficulty sleeping and concentrating and negative thoughts and feelings.

Let's hope women have reached their tipping point, where they will no longer tolerate this harassment and abuse. Let's hope that voices give strength to other voices so that they, too, can find the strength to come forward.

The "boys will be boys" mentality can no longer pervade our society. If you are suffering from PTSD, know that it is treatable with psychotherapy, medication or a combination of both. Don't hesitate to reach out to a qualified health care professional, who can tailor a program to your needs.

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With the recent accounts of sexual assault and harassment, it's important to remember that one of the most troubling and lingering results of a sexual assault is post-traumatic stress disorder, or PTSD.

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Recognizing the signs of sexual harassment.

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Recognizing the signs of sexual harassment.

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The signs of sexual harassment can come out in many ways, often showing discomfort or distress experienced by the victim. Common signs include changes in behavior, such as withdrawal, anxiety, or avoidance of certain individuals or situations. Victims may show physical symptoms like stress-related emotions, insomnia, or changes in eating habits. Emotional indicators may include heightened levels of stress, anxiety, or depression, along with feelings of humiliation, shame, or guilt. Also, victims might express concerns about their safety or well-being in the workplace or other environments where the harassment occurs. Recognizing these signs is important for addressing and preventing instances of sexual harassment and providing support to those affected.

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Survivors of sexual abuse and the PTSD that follows.

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Survivors of sexual abuse and the PTSD that follows.

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Survivors of sexual harassment often go through psychological effects, with many developing symptoms consistent with post-traumatic stress disorder (PTSD). The traumatic nature of the harassment can lead to intrusive memories, nightmares, and flashbacks, relentlessly re-experiencing the distressing events. These individuals may become hyper-vigilant, constantly on edge, and easily startled, their sense of safety shattered. Avoidance behaviors, such as steering clear of triggering situations or people, can dominate their lives, hindering their ability to function effectively. Persistent negative alterations in mood and cognition may also emerge, manifesting as feelings of detachment, guilt, or persistent fear. Relationships, work, and daily activities may be profoundly impacted as survivors navigate the complex terrain of their trauma, striving to reclaim a sense of control and security amidst the enduring aftermath of harassment. Recognizing the stresses that follow sexual abuse and manipulation is crucial.

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The Effects of Divorce on Children - Khiron Clinics

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Parental divorce is a potentially traumatic event in a child’s life. Trauma is anything that overwhelms the psyche and has a lasting negative impact on a person’s health and well-being. Parental divorce can rupture a child’s sense of safety and security in the family dynamic. It can be perceived and experienced as a time of […]

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When children experience divorce they often struggle to express their feelings and thoughts during those traumatic moments. This little boy expresses how his parent's actions are affecting him at the moment and how they will play a huge role in who he becomes as an adult.

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Key points

Ongoing conflict between parents after they split up is deeply unsettling for children.

Except under extreme circumstances, children are much better off keeping regular, ongoing contact with both parents.

Divorced parents should try to co-parent together in a constructive, cooperative, and respectful way.

Nearly half of married couples in the United States eventually get divorced, according to some estimates. Because it occurs so often, it's easy to forget just how difficult and traumatic divorce can be for children. Research published by sociologist Lisa Strohschein showed that, even before marital breakup, children whose parents later divorce exhibit higher levels of anxiety, depression, and antisocial behavior than peers whose parents remain married. There is a further increase in anxiety and depression in children when parents do divorce. U.S.-based psychologist Sharlene Wolchik and colleagues found that parental divorce is associated with significant risks for children and adolescents, including substance abuse and addictions, mental and physical health problems, and poor educational outcomes.

Traumatic Loss of Divorce

There is not always enough support or even acknowledgment of what a traumatic loss divorce can be for couples and their children. Whatever the reasons for the split, there are usually feelings of grief, sadness, anger, betrayal, guilt, and shame. Marital breakdown can leave both parents feeling devastated, and the stress can evoke primitive and powerful feelings of abandonment, isolation, and fear. This can lead to anxiety or depression. It's not easy to give your children what they need when you are highly vulnerable and emotionally fragile. Practically and logistically, things can be harder for you and your children when a marriage breaks down. Divorce often brings financial strain and social difficulty. Children can believe themselves to be the cause of their parents' divorce. Guilt and shame can make them feel worthless, anxious, and depressed. Every part of their lives-living arrangements, extra-murals, decisions about schooling, and holidays-can be fraught with conflict if the parents are not able to co-operate with one another.

You might not like or trust your ex, especially early on in the separation and divorce process. It can feel deeply painful and upsetting as well to be separated from your children while they are in the care of their other parent-quite possibly your least favourite person under the circumstances. There may be realistic concerns-sometimes related to the use of drugs or alcohol -about the safety of children in the care of your ex. Some parents even worry about different kinds of abuse when their children are with the other parent. But, for the most part, the children have to find a safe place for themselves in two separate homes. It is essential that they are helped to feel at home in both places. It can sometimes even be a relief, after a divorce, for children to be in an environment where there is peace and an absence of tension.

Parents at War

When their mother and father are in enemy camps, a child has to try to figure out who is right and who is wrong, who is "good" and who is "bad." If a mother believes, for example, that her ex-husband is dangerous or evil, a child might feel unsafe and mistrustful of his father. The child might reject the father to keep himself and his mother psychologically safe. It can be hard for a child to love and trust a parent who is hated by the other.

Kate Scharff, author of Divorce and Parenting Wars, writes that the legal system often brings a highly adversarial tone to divorce. Unless your circumstances are such that you can't avoid it, try not to enter into a win/lose battle with an ex. Children are almost always victims in this conflict. They can feel torn apart when their parents cannot manage a civil, amicable, respectful dissolution of their marriage. Canadian psychologist Arthur Leonoff explains in his book The Good Divorce why divorce is so difficult for children and what parents and their therapists can do to help them. Preserving the child's treasured mental image of herself with her two biological parents is vital, according to Leonoff, because this mental image forms the basis of the child's identity.

An important message for parents after marital breakdown is to try to preserve, as much as possible, the ongoing relationship with your ex-who will always, for better and for worse, be your children's other parent. For the sake of your children, try to co-parent together in a constructive, cooperative, and respectful way.

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Why growing up in two homes is so hard, and what can help.

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Dealing with the effects of sexual harassment.

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Dealing with the effects of sexual harassment.

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Dealing with the effects of sexual harassment can be a scary and a complicated journey, but there are strategies to help cope and heal explained in the article by Sherri Gordon. Firstly, it's explained that its crucial to prioritize self-care and seek support from trusted friends, family members, or mental health professionals. Processing emotions and experiences in a safe and supportive environment can create healing and resilience. Engaging in therapeutic techniques such as cognitive-behavioral therapy (CBT) or mindfulness practices can help manage symptoms of anxiety, depression, and trauma. Creating healthy boundaries and communicating needs can empower survivors in reclaiming their sense of agency and autonomy. Also, participating in support groups can create validation, solidarity, and a sense of community. The article explains that It's important to remember that healing is a nonlinear process, and it's okay to seek help and take time to heal at one's own pace. By prioritizing self-care, seeking support, and advocating for oneself, survivors of sexual harassment can navigate their journey towards healing and reclaiming their sense of well-being.

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Sexual harassment is defined as any unwelcome comments, sexual advances, requests, or other conduct of a sexual nature. Sexual harassment can cause a victim to experience everything from depression and anxiety to shame, guilt, and self-blame.

At a Glance

The Law and Sexual Harassment

One of the first steps in overcoming sexual harassment is to acknowledge what happened to you and recognize that it was wrong. In fact, sexual harassment is such a serious issue that it is regulated by the law. For instance, the U.S. Equal Employment Opportunity Commission (EEOC) says that it is against the law to harass a person because of that person's sex.

What's more, sexual harassment is not limited to male-to-female abuse even though it is by far the most common form of harassment. Female-to-female sexual harassment, male-to-male sexual harassment, and female-to-male sexual harassment also take place and are against the law.

While the law does not usually apply to isolated incidents of teasing or offhand remarks, it becomes harassment when it creates a toxic work environment or when it results in adverse employment conditions such as being fired or reprimanded due to sexual harassment.

How to Deal with Sexual Harassment

How Sexual Harassment Affects Victims

While every person deals with the trauma of sexual harassment differently, if you have been victimized by sexual harassment, you may start off feeling shocked and then move to denial. These responses are normal and are usually followed by feelings of victimization, which can lead to low self-esteem.

Other symptoms that sexual harassment can lead to might include headaches, difficulty concentrating, forgetfulness, stomach issues, and elevated blood pressure.

You might also feel betrayed, angry, powerless, hopeless, and out of control. And in extreme cases, victims may experience depression, anxiety, and thoughts of suicide.

Tips on Healing From Sexual Harassment

Moving on after being sexually harassed at work can seem like a daunting task. You may feel stuck or hopeless about your situation. Self-care is essential. Joining a support group can also be very helpful, and you may benefit from speaking to a mental health professional. They can help you make sense of your experience, heal from it, and move on.

Here are some steps every victim must take in order to heal from sexual harassment.

Accept What Happened

What this means is to validate your experience. Do not minimize what happened or make excuses for the perpetrator. It is also important to allow yourself to experience your emotions. Do not bottle up the hurt and anger you are feeling.

Talk to Someone About the Harassment

It always helps to talk with a safe person. Try to find someone who will respect your feelings and your perspective. Don't share your thoughts and feelings with someone who is going to tell you that you are overreacting or being emotional.

Journal About Your Experience

Describe how sexual harassment affected you. Explore the different emotions you are feeling. Sometimes it is helpful to include in your journal a letter to the person who harassed you. Say all the things you wish you would have said, but didn't.

It can be very healing to get all of that out of your system. Journaling also may help you make sense of what happened to you. And it is a safe place to say whatever is on your mind without trying to filter anything out.

Stop Blaming Yourself

What happened to you was not your fault. You did not cause it and you could not control the other person. Remind yourself too that you have nothing to be ashamed of and you should not feel guilty. Blaming yourself will slow your healing.

The only guilty person is the perpetrator. They made a choice to sexually harass you. The only choice you have in the matter is how you are going to deal with what happened to you.

Bring Closure to Your Experience

An important part of the healing process is putting the past behind you and detaching from the trauma you experienced. Sometimes this means changing jobs or careers.

It also could mean discovering more about yourself. Too many times, a person's identity is tied to their work. Instead, rediscover what makes you you.

Start a new hobby and develop new interests. And most importantly, do not dwell on what happened to you. Find a healthy way to put the past behind you and try to remain optimistic about things in your life.

Use the Experience to Help Others

Sometimes, you can bring meaning to what happened to you by integrating your experience into your life in some way. For instance:

Write a blog about what you have experienced and offer suggestions to readers

Lead a support group, build a website for harassment victims, or speak to others

Volunteer with non-profit groups that address sexual harassment

The key is taking a negative experience and turning it into something positive. Doing so helps build your resiliency.

Talk to a Counselor or Therapist

If you find it difficult to move on after your experience, you may benefit from seeing a counselor who specializes in dealing with workplace sexual harassment. Counselors that specialize in sexual assault or abuse may also be helpful.

Additionally, if you have been harassed at work or school, advocates advise not using your school or employer's mental health staff. Sometimes the lines of confidentiality get blurred and the counselor will share your information about you to others in the organization. In extreme cases, they may even try to protect the organization from liability.

It is generally best to find a counselor outside of where the sexual harassment occurred. Not only is it an added protection for your privacy, but you may find it easier to open up to someone that is not associated with the organization where the harassment occurred.

Get Help Now

Tips for Friends of Sexual Harassment Victims

If you have a friend or family member who is dealing with the aftermath of sexual harassment, you may want to help, but just don't know where to start. Simply being there to listen and be supportive is often all that is required.

They need to know that they are safe with you and that you believe them. You also could remind them that the harassment was not their fault.

Other ways that you can help support a friend as they deal with sexual harassment include:

Don't Blame or Judge

Remember not to judge them. Try to understand their feelings and offer support. Be there for them when you can and encourage them to talk to others as well.

Stay Connected

Encourage them to stay connected. The worst thing your friend can do is become isolated or spend a lot of time alone. While it is common for any victim of harassment to withdraw from others, this is not helpful to their healing. Nudge them to stay connected to you and other people.

Respect Their Boundaries

While it is important to stay in touch, you also need to make sure that your observe their boundaries. Give them space if they need it. Remember, their boundaries were violated when they were sexually harassed so they will likely fight pretty hard to develop new ones.

Realize That Healing Takes Time

Allow them to heal at their own pace. Do not rush them or try to fix things. Everyone heals at different rates. Try to be patient if they are taking longer to get over their experience than you think they should.

Be Supportive

Support their decisions even if you do not agree with them. It is very important that your friend makes their own decisions. They need the space and the control takes back their life on their terms. While it is fine to make suggestions, do not try to control them or tell them what to do.

Keep in Mind

Dealing with the trauma of sexual harassment is something that should not be put off or ignored. It is important that you explore your underlying feelings and find healthy ways of dealing with these emotions. Too many times people try to numb their feelings with other things like busy work or food.

Some will even resort to drugs and alcohol to numb the pain and forget for a period of time. But these are not healthy ways of coping. If you find that you cannot develop good coping skills on your own, be sure to ask your doctor for recommendations for a reputable counselor. Remember, it is not a sign of weakness to get counseling. In fact, it is a sign of wisdom and courage.

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7 Tips for Healing From a Sexual Harassment Experience at Work

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Moving on after sexual harassment is not easy, but there are things you can do to process and heal from your experience. Learn how to deal with sexual harassment.

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Children of divorced parents are at a higher risk of developing PTSD (Post-Traumatic Stress Disorder) due to disruption in their family structure and the emotional upheaval associated with the divorce process.

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Feeling exhausted? On edge? A little out of sorts? You're not alone.

More than two years into the coronavirus pandemic, and facing uncertainty around the globe, studies have shown increases in stress and anxiety among U.S. adults, with some experiencing symptoms of post-traumatic stress, or what is being called post-COVID stress disorder.

According to Dr. JoAnn Difede, attending psychologist at NewYork-Presbyterian/Weill Cornell Medical Center, an increase in feelings of moodiness, difficulty sleeping and concentrating, irritability, and anxiety, among other symptoms, is to be expected. Though some people may be more at risk for these symptoms than others, the effects of experiencing or witnessing a traumatic event, whether that be a car accident, severe illness, or any perceived threat to you or a loved one's life, takes a toll on your nervous system no matter who you are.

The stress and anxiety can be explained in three words: fight, flee, or freeze - activating your sympathetic nervous system, which is your body's involuntary response to dangerous or stressful situations, causing a cascade of psychobiological events, like changes in cognition, a flood of hormones to boost alertness and heart rate, and an influx of blood to the muscles to prepare the body for action.

"As humans, we often think that if the problem seems enormous, the solution has to be, and that isn't really the case."
- Dr. JoAnn Difede

Though it's an evolutionary advantage, Dr. Difede points out, the problem is the body doesn't always know how to turn off these feelings.

"We don't know how to dial down the risk," says Dr. Difede, who is also a professor of psychology in psychiatry at Weill Cornell Medicine. "Our brain continues to look for the enemy." This can lead to avoidance, increased substance use, intrusive thoughts, flashbacks, and lingering feelings of stress or a sense of vigilance.

Complicating that response is the fact that COVID has been an invisible, prolonged threat.

"Often, a person's threat is clear to them and they are faced with a choice of what to do, but since the threat of COVID-19 is invisible and society has been facing that threat for so long, your body is constantly preparing to fight, flee, or freeze, perceiving danger literally everywhere," says Dr. Difede.

For two decades, Dr. Difede has worked to develop innovative treatments for post-traumatic stress disorder (PTSD), including virtual reality exposure therapy, which immerses people in detailed scenarios based on their experiences to help them gradually approach trauma-related memories, feelings, and situations in order to reduce PTSD symptoms. To date, she and her team have treated hundreds of patients, including active military, veterans, burn victims, cancer and 9/11 survivors, as well as firefighters, police officers, disaster rescue and recovery workers, and healthcare workers. Today, as a pioneer in the field, she is spearheading research and focusing on developing treatments for healthcare and other essential workers and COVID-19 survivors facing pandemic-related PTSD. This research includes projects focused on medical music intervention to address sleep disturbances related to PTSD, as well as narrative writing, interpersonal therapy and prolonged exposure therapy, a type of cognitive behavioral therapy to gradually approach trauma-related memories.

She emphasizes that no matter who you are, this has been a uniquely challenging and traumatic time in many ways, compounded by reduced social connection as we retreated into our homes or isolated away from our loved ones for a time to reduce the spread.

"Everyone has the same vulnerability, whether civilian or first responder," she says. "There's a dose relationship with trauma, and while health care workers and other front line workers may have had higher doses of trauma, we're all human and our brains are wired the same way."

"As humans, we often think that if the problem seems enormous, the solution has to be, and that isn't really the case," she says.

Dr. Difede shares her tips on how to prioritize and recover your mental health during difficult times.

9 Ways to Recover Your Mental Health

1. Follow a schedule

2. Prioritize rest and diet

3. Exercise regularly

4. Make social connections

5. Practice perseverance

6. Embrace the power of positivity

7. Carve out downtime

8. Seek out help

9. Practice acceptance

Prioritize rest and diet.

If you don't need to be up at 7 a.m. to go to work, that's OK, but make sure to normalize getting up at a regular hour and going to bed at a regular hour. While an extra dessert or a glass of wine is OK sometimes, avoid overindulging.

Embrace the power of positivity.

There is abundant research on positive psychology and happiness. Showing gratitude and optimism is not only nice to do, it's good for your health. When you do something nice for someone else, it not only makes them feel good, but it also makes you feel better too.

Talk to your doctor. The concept of seeking help for your mental health may seem daunting, but if your doctor told you that you had high cholesterol, you would take the necessary steps to correct it. Think of your mental health in the same terms because it is essential. Don't discriminate against your brain. If you are feeling symptoms for a prolonged period of time, like difficulty sleeping, a hard time concentrating, or irritability, talk to your health care provider.

You can also take advantage of mental health and mindfulness apps, which can be accessed easily on a computer or smartphone and provide you with some relief.

Learn more about trauma treatment at the Program for Anxiety and Traumatic Stress Studies and find psychiatry and behavioral health services offered at NewYork-Presbyterian.

Consult an Expert

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Understanding Pandemic PTSD and How to Recover Your Mental Health

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Feeling exhausted? On edge? A little out of sorts? You're not alone. More than two years into the coronavirus pandemic, and facing uncertainty around the globe, studies have shown increases in stress and anxiety among U.S. adults, with some experiencing symptoms of post-traumatic stress, or what is being called post-COVID stress disorder.

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This article tells what happens if PTSD is left untreated.

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Understanding Post-Traumatic Stress Disorder (PTSD) in Children

Post-traumatic stress disorder (PTSD) is a mental disorder that can develop in children and adolescents after experiencing or witnessing a traumatic event. Traumatic events can include physical or sexual abuse, natural disasters, accidents, and violence. Children with PTSD may suffer from intense fear, anxiety, and helplessness, and may struggle to cope with their emotions.

PTSD symptoms in children can vary depending on the child's age and the severity of the traumatic event. Some common symptoms of PTSD in children include:

Flashbacks or nightmares of the traumatic event

Avoiding things that remind them of the trauma

Feeling numb or detached from others

Being easily startled or frightened

Difficulty sleeping or concentrating

Physical symptoms such as headaches and stomachaches

Untreated PTSD in a child can have serious long-term effects on their mental health and well-being. Children with PTSD may struggle with depression, anxiety, and substance abuse later in life. They may also have difficulty forming healthy relationships and may experience problems at school or work. It is important to seek professional help if you suspect that your child is suffering from PTSD.

If you suspect that your child is suffering from PTSD, it is important to seek professional help as soon as possible. A mental health professional can help your child learn coping skills and strategies to manage their symptoms. You can also support your child by creating a safe and stable environment at home, listening to their feelings and concerns, and helping them to establish healthy routines.

Causes and Triggers of PTSD in Children

Posttraumatic stress disorder (PTSD) in children can be triggered by various traumatic events. Trauma refers to a distressing event that overwhelms a child's ability to cope. Traumatic events may include natural disasters, domestic violence, mugging, rape, torture, kidnapping, physical abuse, neglect, and bullying.

Children who witness or experience these events may develop PTSD. Witnessing a traumatic event, such as domestic violence or a car accident, can be just as traumatic as experiencing it firsthand. Children who experience multiple traumatic events are more likely to develop PTSD.

The severity and duration of the traumatic event can also affect the likelihood of developing PTSD. For example, a child who experiences a one-time traumatic event, such as a natural disaster, may be less likely to develop PTSD than a child who experiences ongoing trauma, such as ongoing physical abuse.

Other factors that can contribute to the development of PTSD in children include a lack of social support, pre-existing mental health conditions, and a family history of mental illness. Additionally, children who have experienced trauma in the past may be more susceptible to developing PTSD after another traumatic event.

It is important to note that not all children who experience trauma will develop PTSD. However, it is crucial to seek professional help if a child is exhibiting symptoms of PTSD after a traumatic event. Early intervention can help prevent long-term negative effects on a child's mental health and overall well-being.

Symptoms and Signs of PTSD in Children

Post-traumatic stress disorder (PTSD) is a mental health condition that can occur in children who have experienced a traumatic event. Children with PTSD may experience a range of symptoms and signs that can impact their daily lives.

Some common symptoms of PTSD in children include anxiety, depression, numbness, nightmares, anger, flashbacks, irritability, hypervigilance, hyperarousal, regressive behaviors, and stress symptoms. Children with PTSD may also experience physical symptoms such as headaches and stomachaches.

PTSD can cause children to have difficulty sleeping and become easily startled. They may also feel sad or angry and have trouble concentrating. Some children may exhibit regressive behaviors, such as bed-wetting or thumb-sucking, and may avoid activities or situations that remind them of the traumatic event.

It is important to note that not all children with PTSD will exhibit the same symptoms and signs. Some children may have more severe symptoms than others, and symptoms may vary over time or in response to different triggers.

If you suspect that your child may have PTSD, it is important to seek help from a mental health professional. With proper treatment, many children with PTSD are able to manage their symptoms and improve their quality of life.

Consequences of Untreated PTSD in a Child

Untreated PTSD in a child can have a significant impact on their development and future well-being. Here are some of the potential consequences of leaving PTSD untreated in a child:

Problems in school: Children with untreated PTSD may struggle academically and have difficulty concentrating in class. They may also have behavioral problems, such as acting out or being excessively withdrawn.

Substance abuse: Children with untreated PTSD are at a higher risk of developing substance abuse problems later in life. This is because they may turn to drugs or alcohol as a way to cope with their symptoms.

Suicide: Children with untreated PTSD are at a higher risk of suicide. They may feel overwhelmed by their symptoms and unable to cope with their emotions.

Feeling numb: Children with untreated PTSD may feel emotionally numb and disconnected from their surroundings. They may struggle to form meaningful relationships with others and may have difficulty experiencing joy or pleasure.

It is important to seek treatment for PTSD in children as soon as possible. With the right treatment, children can learn to manage their symptoms and go on to lead healthy, fulfilling lives.

DSM-5 Criteria for Diagnosing PTSD in Children

If you suspect your child has PTSD, it is important to seek professional help. A psychiatrist or psychologist can diagnose PTSD based on your child's symptoms, medical history, and a psychological evaluation.

The DSM-5 criteria for diagnosing PTSD in children includes exposure to a traumatic event and the presence of at least one intrusion symptom, one avoidance symptom, two negative alterations in cognition and mood symptoms, and two arousal and reactivity symptoms.

Intrusion symptoms include recurrent and distressing memories of the traumatic event, nightmares, or flashbacks. Avoidance symptoms include avoiding thoughts, feelings, or reminders of the traumatic event. Negative alterations in cognition and mood symptoms include negative thoughts or feelings, detachment from others, and inability to experience positive emotions. Arousal and reactivity symptoms include irritability, hypervigilance, and exaggerated startle response.

A psychological evaluation is an important part of diagnosing PTSD in children. It includes a discussion of your child's signs and symptoms and the event or events that led up to them. The evaluation also assesses your child's mental health history, family history, and current stressors.

Psychological evaluation helps to identify any co-occurring mental health conditions that may be contributing to your child's symptoms. It also helps to determine the severity of your child's PTSD symptoms and the appropriate treatment plan.

Epidemiology of PTSD in Children

PTSD is a common mental health condition in children. According to the National Center for PTSD, about 15-43% of girls and 14-43% of boys experience at least one traumatic event by the age of 18. Of those who experience a traumatic event, about 3-15% of girls and 1-6% of boys develop PTSD.

It is important to note that not all children who experience a traumatic event develop PTSD. Risk factors for developing PTSD include the severity of the trauma, the child's age, and the child's support system.

What is the best way to treat PTSD in children?

Treating PTSD in children requires a comprehensive approach that addresses the emotional, psychological, and behavioral symptoms of the disorder. The most effective treatment strategies for children with PTSD include therapy, medication, and support from family and friends.

Cognitive behavioral therapy (CBT) is a type of psychotherapy that has been proven to be effective in treating PTSD in children. This type of therapy helps children to identify and change negative thoughts and behaviors that may be contributing to their symptoms. Eye Movement Desensitization and Reprocessing (EMDR) is another type of therapy that has been shown to be effective in treating PTSD in children.

In addition to therapy, medication may be prescribed to help manage symptoms of PTSD, such as anxiety and depression. However, it is important to note that medication should not be the only form of treatment, and should only be used under the guidance of a mental health professional.

Parents and caregivers can also play a critical role in supporting children with PTSD. Providing a safe and stable environment, offering emotional support, and encouraging healthy coping strategies can all help to manage symptoms of PTSD.

How can Parents and Caregivers Support Children with Untreated PTSD?

If your child is experiencing PTSD symptoms, it's important to seek professional help as soon as possible. However, as a parent or caregiver, there are several things you can do to support your child while they wait for treatment or after they have received treatment.

First and foremost, it's essential to create a safe and supportive environment for your child. This means being patient and understanding, and providing a sense of stability and routine in their daily life. Children with untreated PTSD may feel anxious, scared, or overwhelmed, so it's important to be a source of comfort and reassurance.

In addition to emotional support, parents and caregivers can also help children with PTSD by encouraging healthy habits and behaviors. This includes getting enough sleep, eating a balanced diet, and engaging in physical activity. These habits can help reduce symptoms of anxiety and depression, which are common in children with PTSD.

It's also important to educate yourself about PTSD and its symptoms so that you can better understand your child's experiences. This can help you provide more effective support and communicate more effectively with your child's healthcare providers.

Finally, it's important to seek support for yourself as well. Caring for a child with PTSD can be challenging, and it's important to have your own support system in place. This can include friends, family members, or support groups for parents of children with PTSD.

How can Coping Skills and Resiliency Help Prevent PTSD in Children?

PTSD is a serious mental health condition that can have long-term effects on a child's well-being. Therefore, it is essential to take steps to prevent the development of PTSD in children. Coping skills and resiliency are some of the most effective ways to prevent PTSD in children.

Coping skills are techniques that help children manage and reduce stress. They can include deep breathing, visualization, mindfulness, and physical exercise. These techniques can help children feel more in control of their emotions and reduce the severity of their symptoms.

Resiliency is the ability to adapt to difficult situations and bounce back from adversity. Children who are resilient are better equipped to handle stress and recover from traumatic events. Parents and caregivers can help children build resiliency by providing a supportive and nurturing environment, encouraging positive self-talk, and promoting healthy coping skills.

Preventing PTSD in children requires a multi-faceted approach. Parents and caregivers can take steps to create a safe and supportive environment, teach children coping skills, and promote resiliency. By doing so, they can help children build the skills they need to manage stress and prevent the development of PTSD.

*This article is intended solely for informational purposes and should not be regarded as a replacement for professional medical advice. While the content has undergone Sabino Recovery's thorough editorial review process, it may not necessarily represent the opinions, policies, or procedures of our facility or staff. We strive to ensure that our content is medically accurate; however, treatments evolve, and we cannot guarantee the current accuracy or reliability of the information provided. For medical emergencies, call 9-1-1 immediately.

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What Are the Consequences of Leaving PTSD Untreated in a Child?

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Learn About the Causes, Symptoms & Long-term Effects of PTSD in Children. Find out How to Seek Professional Help & Support Your Child Through Their Recovery.