Cognitive Behavioural Therapy for PTSD

Whilst we will all have nightmares occasionally, studies show that people who have PTSD are more likely to have nightmares more often.

Nightmares, like flashbacks, are another part of the “re-experiencing” symptoms that occur within PTSD and occur as part of the brains desire to make sense of the traumatic event and process it into long term memory.  Of course, this leads to poor sleep, which can in turn lead to reduced functioning for the rest of the day.

Nightmares in PTSD can be specific to the traumatic event itself – e.g., replaying through what occurred during the traumatic incident – or can be about a more general sense of threat.

As part of your body’s “better safe than sorry” response to a traumatic event, people with PTSD will become hypervigilant to signs of danger. What this means is that sufferers can feel constantly on edge, always in fear that another traumatic event is going to happen.

We may observe what we call an exaggerated startle response, where the person is particularly jumpy in response to a related trigger.  You might have seen an example of this when PTSD is portrayed on TV – when we see the ex-military serviceman jump to the ground when he hears a car engine backfire.

Hypervigilance may result in the individual appearing irritable or impatient, and can result in changes to behaviour such as checking for danger or working hard to minimise any source of threat.

Memories are activated by triggers, and this is also true for flashbacks, which are after all just extra-ordinarily vivid memories of a traumatic event.  In PTSD, we will often find that the individual will start to avoid certain places which activate the flashback memory or which they associate the sense of threat with.

What tends to happen however is that, whilst there is one initial trigger that an individual may avoid – say a particular street in which a trauma event occurred, this will gradually generalise to include more broadly associated triggers.  So instead of a single street being avoided, pretty soon a whole area is also avoided.

Avoidance contributes to the sense of threat being maintained in that the individual is not given the opportunity to test out whether the particular trigger is always threatening, rather than it being a one-time trauma event.  As such, avoidance in PTSD is part of what keeps the problem going.

It is not uncommon for people with severe PTSD to experience avoidance so troublesome that even leaving the home becomes extremely anxiety provoking and difficult.

Emotional numbness refers to the absence of, or reduction in, emotional experience in sufferers of PTSD.  Whereas the individual may avoid the emotion of fear by deliberately avoiding situational reminders of the traumatic event, emotional numbness is subtly different – Emotional numbness is an involuntary shutting down of all emotional experience, not just the fear response.

It has been suggested that Numbness occurs as part of the “Freeze” response to threat – “Freezing” is one generally much less often talked about part of the “Fight, Flight or Freeze” response.  When the individual has exhausted fight or flight reponses to the threat, numbing kicks in, detaching them from the emotional experience related to the trauma.

We may see the Emotional numbness symptoms of PTSD displayed in the individual as a lack of positive emotion, a feeling of disconnection from other people and activities or a lack of hope for the future.