Post-traumatic Stress
versus
Post-traumatic Growth
What is trauma?
The word is derived from the Greek word for “wound” and indicates that it has been a concept that has been considered for ages.
In the 19th century Pierre Janet and Sigmund Freud began to write about the characteristics and clinical implications of trauma for those in the mental health field.
Defined as a psychological or emotional response to an event or an experience that is deeply distressing or disturbing (Center for Anxiety Disorders).
Common effects of trauma
A range of physical, emotional, mental and behavioral symptoms are associated with traumatic experiences. Here are some examples:
Emotional: feeling alone or afraid, anger/frustration, mood swings, feeling sad or hopeless, problems with sleep, helplessness, feeling numb, anxiety/panic, nightmares, lack of confidence
Mental: Loss of concentration, disorientation/confusion, memory loss, obsessive thoughts, distractibility, indecisiveness, thoughts about death and dying, racing thoughts
Physical: Aches/pains, fatigue/tiredness, racing heart, nausea/vomiting, shakiness/trembling, headaches, numbness/tingling, diarrhea, hot flashes
Behavioral: Withdrawal from others, impulsive behavior, aggression, crying, arguing with loved ones, increased sleep, changes in appetite, being startled easily, increased drug or alcohol use.
(TEDESCHI & MOORE, 2016)
Post-traumatic Stress Disorder (PTSD)
Symptoms of Post-Traumatic Stress Disorder
Intrusive symptoms: pervasive and intrusive memories, nightmares, flashbacks/disassociations, extreme distress associated with reminders of the event, increased physiological reaction associated with reminders of the event
Avoidance symptoms: avoidance of trauma-related thoughts, feelings, or memories, avoidance of reminders of the event (people, places, things)
Negative thoughts and mood: trauma-related memory problems, negative beliefs and expectations about self/others/the world, persistent blaming self and others, negative and distressing emotions, loss of interest and pleasure in things, feeling disconnected from others, lack of positive emotions
Arousal and activity: irritable/angry/aggressive behavior, reckless behavior, always on guard, difficulty concentrating, difficulty falling or staying asleep
(DSM-5, 2013; TEDESCHI & MOORE, 2016)
Diagnosing PTSD
Symptoms must last for more that 1 month
Symptoms must create distress or functional impairment (problems in social or occupations functioning)
Symptoms cannot be caused by medication, substance use or other illnesses.
All of the symptoms areas (listed above) must be seen for a person to meet the criterion for a PTSD diagnosis.
Even if your symptoms do not meet criteria for PTSD, if they are creating an impact on your daily functioning it is important to get help.
Cancer Patients and PTSD
It is estimated that about 3/4 of adults over 65 have been exposed to at least 1 traumatic events in their lifetime and about 8% of Americans will develop PTSD
Studies reveal that as many as 20% of cancer patients experience symptoms of PTSD following their diagnosis and continue to struggles with symptoms long after treatment has been completed
PTSD symptoms put patients a greater risk for distress, avoidance of doctor appointments, and decreased quality of life
(CHAN ET AL., 2017; KILPATRICK ET AL., 2013; MILLS ET AL., 2011)
Risk factors for PTSD
Lower financial and educational status
History of mental illness
Physical injury or illness
Having seen people hurt, maimed or killed
Feeling a sense of helplessness, horror or fear after trauma
Little or no support from family, friends or the community
Managing other stressors such as unemployment, death of a loved one, health issues, loss of a relationship, financial or legal problems
(TEDESCHI & MOORE, 2016)
Protective Factors for PTSD
Being part of a support group
Relying on family or friends
Absences or low levels of guilt, shame, embarrassment related to the event (illness)
Being naturally optimistic
The ability to maintain a sense of humor
Being older and having more life experience
Successful experiences death with difficult life events in the past
Effective coping strategies
(TEDESCHI & MOORE, 2016)
Maintenance Factors for PTSD
Drug or alcohol use; abuse of prescription medications
Self-demeaning thoughts (my fault, will never get better, I’m damaged etc.)
Withdrawal from family, friends and other support
Not seeking professional help when needed
Anger, resentment and depression
(TEDESCHI & MOORE, 2016)
Where to Get Help
Therapist - talk therapy to assist with trauma-related symptoms (psychologist, social worker or marriage and family therapist; should specialize in trauma treatment)
Psychiatrist - medication to manage trauma-related symptoms (should have experience in working with trauma and feel comfortable working with cancer survivors)
Medical Team - referral for mental health assistance
Trauma Resilience and Post-Traumatic Growth
The 5 Gifts of Conquering Adversity
Developing the ability to see new possibilities
Increased emotional strength and confidence
More meaningful relationships
Greater appreciation for the gifts of life
Spiritual growth
(Roser, 2015)
Increased Personal Strength
Often people find a strength to handle a situation they never imagined they could and that they have endured.
While it may be hard to admit it is helpful to acknowledge the strength you have as survivor of cancer.
Look at ways that you have seen a greater sense of self-reliance, engaged in better problem-solving or made significant changes in your life.
Honor ways in which you have been able to make room for and tolerate difficult emotions.
Know that acceptance of what you have experienced is not the same as giving up. However, working toward accepting what you have been through and what has changed in your life can be a strong sense of strength and resilience.
(TEDESCHI & MOORE, 2016)
Improved or More Meaningful Relationships
Developing the ability to find a accept support is an important part of the post-trauma experience.
Sometimes thinking of others as a part of your team can help you increase your ability to accept help.
Learning to accept our own limitation and vulnerability is also an important aspect of healing.
Many report an increase in their ability to be empathetic and compassionate toward others.
It is important to understand that there will be people who were or are unable to support you and that you can forgive those people in time.
Many cancer patients also often find that they are able to explore deeper and more meaningful relationships following their experience of cancer.
(TEDESCHI & MOORE, 2016)
Greater Appreciation of Life
Developing the ability to find a accept support is an important part of the post-trauma experience.
Sometimes thinking of others as a part of your team can help you increase your ability to accept help.
Learning to accept our own limitation and vulnerability is also an important aspect of healing.
Many report an increase in their ability to be empathetic and compassionate toward others.
It is important to understand that there will be people who were or are unable to support you and that you can forgive those people in time.
Many cancer patients also often find that they are able to explore deeper and more meaningful relationships following their experience of cancer.
(TEDESCHI & MOORE, 2016)
New Life Path and Possibilities
These changes can be complicated as a change in career or as simple as increasing the amount of time you give to others who have been diagnosed with cancer.
Sometimes the changes are due to a focus on a new set of priorities or they can be the result of other doors being closed due to changes related to cancer.
It is helpful to focus on what would be most satisfying, most important and how they new ideas can be the basis for new goals.
Know that you may experience some grief in the change process.
(TEDESCHI & MOORE, 2016)
Spiritual Change or Development
This can be a change in the meaning and purpose in life and does not have to focus on religious beliefs.
The change comes from a struggle to to figure out how to fit what has happened into existing beliefs (e.g. how a someone who is vegan and a yoga instructor was diagnosed with cancer).
Some of life’s struggles from before cancer may now seem trivial or unimportant.
Development of a new perspective may come easily or may take time to understand and can involve an intensive and even long struggle with the major questions about what is the meaning and purpose of your life. The focus is on finding your own truth for how to live life well.
Changes can take place in your spiritual understanding, your religious beliefs or your philosophy in life.
You may come to these answers with the help of others or from a deep examining of yourself and your ideas.
(TEDESCHI & MOORE, 2016)
Understanding Your Own Growth
The growth that takes place after trauma can be uncomfortable and may take time.
The goal is focus on leaning in to this change rather than avoidance of the discomfort.
You may have to explore a number of life experiences in order to find your own path for growth and development.
Look for signs that you are changing because you may miss them if you aren’t working to notice (e.g. you notice that you are more engaged with friends rather than avoiding them)
Three areas to focus on when looking for strengths are in how your life has changed related to family, work and other social relationships.
(TEDESCHI & MOORE, 2016)
Coping Mechanisms That Help
Meditation
Deep breathing/relaxation
Humor/laughter
Reading/watching tv/go to the movies/listen to music
Take a bath/shower
Pray/go to church/engage in spiritual activities
Draw/paint/color/write
Talk with friends/family
Garden/knit/other hobbies
Exercise
Take a nap
(TEDESCHI & MOORE, 2016)
Finding Good Social Support
Find people who can support you
The most important trait these people can have is that they are easy to be with
Someone who can be with you when you are happy, sad or angry and everything in-between
It is important to have a person who understands that much of their role is passive and involves supporting you in your journey
These people have faith in your ability to understand your own journey and are comfortable with the idea that the endpoint may not be clear
As guides in this process these people can provide feedback on things you may not see while still trusting your own process
(TEDESCHI & MOORE, 2016)
References
American Psychiatric Association. (2013).Diagnostic and statistical manual of mental health disorders (DSM-5). 5th edition. Washington, DC: American Psychiatric Association.
Chan, C. M. H., Ng, C. G., Tabib, N. A., Wee, L. H., Krupat, E., Meyer, F. (2018). Course and predictors of post-traumatic stress disorder in a cohort of psychologically distressed patients with cancer: a 4-Year follow-up study. Cancer, 124(2): 406-416.
Kilpatrick, D. G., Resnick, H.S., Milanak, M. E. , Miller, M. W., Keyes, K. M. & Friedman, M. J. (2013). National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria. Journal Traumatic Stress, 26(5): 537-47.
Mills, K. L., McFarlane, A. C., Slade, T., Creamer, M., Silove, D., Teesoon, M., & Bryant, R. (2013). Assessing the prevalence or trauma exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria. Journal of Traumatic Stress, 26(5): 537-547.
Tedeschi, R. G. & Moore, B. A. (2016). The posttraumatic growth workbook. Oakland, CA: New Harbinger Publications, Inc..
What is Trauma retrieved from center for anxietydisorders.com