Posttraumatic Stress Disorder and 9-11 (cont.)
In addition, stress inoculation training, a variant of exposure therapy, can be used for the management of anxiety. This therapy includes relaxation. It also involves carefully monitoring the patient's thoughts that follow from thinking about the traumatic event. Then, when thoughts of the trauma do occur, the patient uses a script that was created in therapy to attempt to change their thoughts that follow thinking about the trauma. At first, the patients may even need to imagine themselves as someone else (role playing) to bring about this change in their thought pattern. But then, the role-playing gradually becomes the reality.
Other types of therapy that are useful for anxiety are visualization techniques and confidence builders, such as positive self-talk and social skills training. In visualization techniques, patients train themselves to recall and visualize a particularly peaceful or pleasant place or situation whenever thoughts of the trauma occur.
Other avoidance symptoms, referred to as numbing, include emotional
unresponsiveness, detachment from others, and loss of interest in life's
pleasures. For the treatment of numbing, most experts recommend the cognitive
therapies, psychodynamic psychotherapy, and peer group support. In fact, numbing
symptoms are among the most difficult symptoms to treat. For these symptoms,
peer group support is extremely important.
After the initial 3 months of treatment, acute PTSD can be treated with group
or individual psychotherapy booster sessions every 2 to 4 weeks. Chronic PTSD
patients should be seen regularly for at least six months with booster sessions.
However, a small percentage of patients with PTSD, especially those with another
associated psychiatric disorder, remain quite symptomatic for longer periods of
time. For acute PTSD, the duration for continuing medication before considering
tapering is 6 to 12 months. For chronic PTSD with a good response, we can
consider tapering medication at 1 to 2 years. However, patients with chronic
PTSD with residual symptoms need to continue treatment for at least 2 years.
Others, however, may be more biologically (inherently or genetically) vulnerable, have a history of more trauma, or are more directly and/or deeply affected by the trauma. Still, these people usually will have transient (temporary) symptoms of posttraumatic stress syndrome that can be managed and treated effectively. In fact, in many cases, PTSD can be cured. The treatment includes early management (intervention), supportive critical incident stress debriefing, group and peer rapport, targeted psychotherapy (for most patients, exposure therapy, anxiety reduction, and cognitive therapy), and medications, especially SSRI's, such as sertraline.
Nevertheless, there is another small percentage of people who develop a more chronic (long duration) PTSD. Some of them may also develop other associated psychiatric disturbances that complicate the clinical picture of PTSD and make their full recovery more challenging. Finally, it is somewhat comforting to know that the various methods of treatment are highly effective and that there are trained clinicians experienced at handling the difficult problems of posttraumatic stress. But, of course, we hope that we will never have to experience a repeat of the traumatic tragedy of September 11th.Medical Author: Peter J. Panzarino, Jr. M.D. F.A.P.A.
Medical Editor: Leslie J. Schoenfield, MD, PhD
Last Editorial Review: 4/3/2002