Post-traumatic stress

To return to the definition of INSERM (National Institute of Health and Medical Research), the post-traumatic stress is classified in the psychiatric disorders that can occur after a traumatic event. PTSD (POST-Traumatic Stress Disorder) will have significant psychological consequences, long after the event.

Post-traumatic stress is present in approximately 5 to 12% of the population. However, like many of the figures concerning pathologies, the latter is surely underestimated, due to the lack of diagnosis in certain people.

In other words, post-traumatic stress can be related to emotional shock important. This emotional shock will come directly impact daily life of the person who suffers from it and this in different ways.

Many symptoms accompany PTSD. The main symptoms include: 

Revivscience

Reviving is the act of “reexperiencing” the event repeatedly. People can relive their trauma in different ways: through repeated flashbacks which will make the person completely relive the scene; involuntary intrusions of thoughts and images linked to the traumatic event; repeated nightmares. All external events can bring the memory of the traumatic event to the surface: a noise, a light, a person, a place... These different external signals will automatically trigger anxiety symptoms 

Avoidance

Avoidance is one of the main reasons for maintaining post-traumatic stress. Indeed, people will have a tendency to avoid places of trauma, objects or people for example.

There are different kinds of avoidance: we find emotional avoidance (e.g. never again feeling the same type of emotion as those present during the trauma); cognitive avoidance (e.g.: avoiding thinking about the trauma that took place) and behavioral avoidance (e.g.: no longer returning to the link to the accident). This avoidance will be worked on in therapy. Indeed, it is necessary, little by little, to avoid avoidance. 

This avoidance can significantly impact people in their professional or personal lives. In particular, people can develop various phobias. We will come back to this a little later. 

• Hypervigilance, difficulty concentrating, sleep disorder… Different cognitive disorders can be linked to the trauma.
• Mood disorders such as emotional outbursts (anger, sadness) or conversely emotional blunting (decreased affectivity).

Different elements can cause the patient to subsequently develop post-traumatic stress. The most common include attacks, assaults, rapes, sudden deaths of loved ones, all types of accidents, natural disasters, etc. 

It is not necessary to have experienced a traumatic event to suffer from it; witnessing these same events can also be a source of the appearance of PTSD. 

As you will have understood, PTSD can develop when the person is faced with an imminent threat of death, when their physical integrity can be compromised or even when a loved one is significantly affected by a serious event.

Thus, we can find two types of post-traumatic stress: 

• So-called “simple” PTSD type 1

This type of trauma occurs after an isolated, single and brutal event. In this type of trauma, we can find everything that is accident, natural disaster, aggression… 

• So-called “complex” PTSD type 2

This type of trauma occurs followingprolonged and repeated exposureto a certain type of event. Here, we will find trauma linked to repeated physical or psychological abuse, sexual violence, harassment... 

There are different ways to experience a traumatic event. 

• The person may be a direct victim, that is, be directly exposed to the event. 
• A person can also be an indirect victim: for example a person who witnessed an incident or relatives of direct victims.
• There is also a third category which is the secondary victims: in this category, we find people whose profession of care, that is to say doctors, firefighters, ambulance drivers, etc.

Among the indirect victims of post-traumatic stress, we can also find the viewers. Indeed, several studies have looked at the impact of the media in the development of post-traumatic stress in people who did not witness the event.  For example, we all remember this complicated period of regular attacks. The latter were omnipresent in the media. For example, a study was carried out on the mediation of the November 2015 attacks in Paris (Enguerrand du Roscoät et al.,). This study demonstrates that people who have had high or very high exposure to media images (from 2 to more than 4 hours per day) are likely to develop symptoms of post-traumatic stress. Thus, the over-media coverage of images of attacks is associated with an increase in post-traumatic stress symptoms in the general population.

When the event is part of post-traumatic stress, it can have a significant impact on daily life of the person who suffers from it. In fact, little by little, different phobias or psychiatric disorders following this trauma.

Among the associated disorders, we can mainly find phobias linked to public places such as generalized anxiety, a agoraphobia or a social phobia.

In comorbidities it is not uncommon to also find problems of addiction with alcohol or depressive comorbidity.

As mentioned previously, a trauma will lead to the development of significant psychological distress which will impact different areas of one's life, whether personal or professional life. The person will enter avoiding certain situations. For example, a person who is the victim of a car accident is no longer able to drive because it causes them anxiety. No longer being able to take his car will prevent him from participating in certain activities with his loved ones. A person developing agoraphobia following post-traumatic stress will no longer be able to leave the house to go to work...

Post-traumatic stress can, of course, occur immediately after the event but can also be declared several months after the event, or even several years after the latter. The problems disappear within 3 months or become chronic in 20% of cases. There is also a risk of relapse of the order of 20% among patients who are treated.

It is of course entirely possible to limit the risk of developing chronic post-traumatic stress, for this it is essential to be supported by psychotherapy. Indeed, it is these therapies that will make it possible to better understand the event, the emotions felt subsequently, to understand which promotes the appearance of painful memories.

Among the therapies found to have the best results for post-traumatic stress we can name theEMDR and the CBT.

TheEMDR is a therapy which consists of carrying out a bilateral stimulation (left/right) alternate. This stimulation can be done through eye movements, tapping or even sounds.

The CBT as for them are the Cognitive-Behavioral Therapies. These therapies have now largely proven themselves in the treatment of post-traumatic stress. In particular, they will make it possible to make progressive exposure to anxiety-provoking or trauma-reminiscent situations. The CBT will work on the cognitive (edit thoughts), the behavior (modify maladaptive behaviors, avoid avoidance) and emotions (learn to manage your anxiety). In the context of post-traumatic stress, the person will associate a place, a sound, a smell, an image, etc. which recalls the event, with danger. The CBT will therefore allow the person to modify these associations put in place.

The CBT use imaginative exposures and in vivo exposures. However, for several years, the exposure by virtual reality has also largely proven itself. Virtual reality will notably make it possible to expose the patient in a much more progressive, of fully control the environment while keeping the person in a safe environment.

Numerous studies are underway to better understand the development of this type of disorder.

For anecdote, a study by Butler et al. was carried out on using the Tetris game in order to limit the development of post-traumatic stress. They used it in particular in complement to therapy EMDR. The results demonstrate a enlarged hippocampus in people who played Tétris in addition to therapy EMDR. This increase in the hippocampus is associated with reduction in PTSD symptoms, a decrease in depressive and anxiety symptoms. The gain in volume of the hippocampus would notably allow better maintenance of acquired knowledge during treatment. EMDR.

In all cases, you will surely have understood, psychotherapy is necessary in order to limit avoidance which prevents the traumatic memory from being treated like other memories.