In order to be part of the study I had to have physical exams, several psychiatric evaluations so they could determine the extent of my mental health issues. After all of my examinations I was accepted into the study. This was the first time I heard the words Post Traumatic Stress Disorder. It was a double blind study which meant that there was a placebo and the real medication. Each of the participants were given a medication to take daily and we didn't know which one we were on. The study consisted of weekly 1:1 sessions with the psychiatrist, group therapy and intensive cognitive behavioral therapy. The cognitive behavioral therapy consisted of being exposed to different stimuli that triggered my agoraphobia, panic and anxiety. It also consisted of learning how to deal with the "chatterbox" in my head. This meant I had to journal each week and then discuss my journal in group therapy. I had to write down all of the negative thoughts that popped into my head and interfered with my getting better.
It was very hard for me to be calm and centered. As part of the exposure therapy I had to learn to relax. I went home each week with homework. I had to draw a bath and set in it for five minutes the first week. This was very hard for me. That first five minutes were hell. By the end of the first week I had been able to sit in the bath for the five minutes each day. This sounds so trivial but it wasn't to me. I was proud of myself for sticking to it. I also had to journal how sitting in the bath made me feel, especially any emotions that came up with it. Then they were discussed in group therapy. I hadn't driven in almost a year, this was in response to the agoraphobia and my ex's refusal to let me drive. By the third week as part of my exposure therapy the psychiatrists over seeing the study insisted I drive to and from my weekly therapy sessions. My ex had a fit and didn't believe me. He thought I was lying. He would take me to therapy sessions each week and sit outside in the car waiting for me. When I got to the car after my therapy sessions and told him about driving he insisted on going back into the hospital and talking to the main psychiatrist. I was humiliated but there was nothing I could do. When the psychiatrist explained it was part of my therapy he relented. The first time I went to take the car for therapy he had taken the distributor cap off of the car so he would be forced to take me. I found it and put it back on and when he heard the car start he ran down stairs and tried to catch me so I couldn't leave without him. I just kept driving, my heart was pounding like crazy and I was terrified but felt free at the same time. I knew if I was able to gain control of my life then I would be able to leave my abusive marriage. When I got to therapy that day I told the group therapy class that I felt wonderful and empowered.
I was convinced I was on the "real" medication because my anxiety, agoraphobia and panic symptoms subsided some. By the fourth week I was able to be in the bath for fifteen minutes each night, I was going out some and was feeling calmer. When I got to my therapy the fourth week the two psychiatrists who were running the study asked to meet with me. They told me that I was on the placebo and that they felt I needed to be taken out of the study. They told me that I was the worst agoraphobic they met up to that point and that they felt ethically I needed to be on an antidepressant. They allowed me to remain in the group and exposure therapy. I was amazed at this I had been convinced it was the "medication" that was responsible for my being able to be calmer and go out more. This is the first time I realized I was in control of my life and it felt so awesome. They also gave me the imipramine for free. This was the first time in my life that I was put on any type of medication to help my mental health symptoms. When I got home and shared this with my ex he had a fit and threaten me that he wasn't paying for the medication. I told him they were giving it to me for free and he threatened to throw it out. I actually had to hide it in order to take it. He was glad I was able to do more things but was convinced that once I got myself together the marriage was over. So his way to keep the marriage was to continue to be abusive towards me.
This cognitive behavioral therapy was helping me in many ways. I was learning that the panic attacks weren't going to kill me, even though I felt like they would. I learned that up until I received the therapy through Yale that I was never relaxed and was always on heightened alert. Most of the time my panic attacks would last for hours. Once I was able to change some of the "chatter" in my head when I was having them they became lessened. I was able to stand in a line at the grocery store. Something that always triggered a panic attack. When you have panic attacks you attribute that where you have them is a trigger so you avoid them. This is exactly what I had done. My exposure therapy helped me to gain control over this. I learned new ways of talking to myself when I had a panic attacks. This treatment lasted for eight weeks. I had no insurance which made it hard to get a therapist where I lived. The main psychiatrist still saw me each week and the hospital continued to give me my imipramine, which had started at 5 mg a day and by this time was up to 25 mg a day. The psychiatrist worked on and found me a local therapist.
As I was becoming better the domestic violence became worse. The more control I took over my life the more control my ex tried to display over my life. I was able to deal with it until he got to the children and threatened to get custody of them. There was no way I was going to let him have custody of them. They needed to have the best life possible and I knew that his domestic violence wouldn't end with the end of our marriage. I started this therapy in June of 1991 and by September of 1991 I was ready to take control over my life and started to plan divorcing my ex. In September I had started to go to a domestic violence support group. My ex would leave with the car as a way to keep me from going but I had a wonderful friend who would come, pick me up and watch the children while I was at the meeting. When my ex got home and the children and I weren't home he started calling people to find me. When I got home he refused to let me attend the group any more. I told him there was no way I wasn't attending.
By November 1991 I had made the decision to apply for welfare. I was at no place to hold a full time job and I needed to have plans in place to get out of the marriage. I finally got the courage to call the police on him he was arrested but allowed to come back home with a protective order. He was furious and insisted I drop the charge and I explained I didn't press the charges the State of Ct had. The protective order did keep him from physically abusing me. Then right before Thanksgiving 1991 he verbally berated me for hours threatening me that he was taking the children and going to Maine and I would never see them again. After about four hours of this I lost it and threatened to harm him if he took the children. He called the police on me. When they got there he admitted he had been berating me for four hours and they took him, cuffed him and took him away. He was dumbfounded. The police explained to him that he violated the protection order by verbally abusing me. After he left I called friends and family to let them know. I was also told by the domestic violence support group leader that I needed to go to a safe house. This was because when a woman tries to get away from an abuser that is the greatest risk of harm. More women get killed each year when they are trying to get away from their abusers. I refused to leave where I was living. They told me that they were very concerned for my safety. I explained that for the first time in my adult life I had a wonderful support system, that my children would have to change schools, I would have to find another therapist and I felt that I would be worse off if I left the area. I did leave and hide for a couple of days mostly in order to get an emergency order of custody of the children.
I was able to finally get the courage to leave my abusive marriage which lead to the journey to get where I am in my life today. All because I had intensive cognitive behavioral therapy. I will always be grateful for this. Going through this therapy helped me in so many ways. Gaining control over my life was precious. It allowed my children to have a better childhood. I feel very blessed by this. Rosie
Treatment of PTSD
Today, there are good treatments available for PTSD. When you have PTSD, dealing with the past can be hard. Instead of telling others how you feel, you may keep your feelings bottled up. But talking with a therapist can help you get better.
Cognitive behavioral therapy (CBT) is one type of counseling. It appears to be the most effective type of counseling for PTSD. The VA is providing two forms of cognitive behavioral therapy to Veterans with PTSD: Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) therapy. To learn more about these types of therapy, see our fact sheets listed on the Treatment page.
There is also a similar kind of therapy called eye movement desensitization and reprocessing (EMDR) that is used for PTSD. Medications have also been shown to be effective. A type of drug known as a selective serotonin reuptake inhibitor (SSRI), which is also used for depression, is effective for PTSD.
Types of cognitive behavioral therapy
What is cognitive therapy?
In cognitive therapy, your therapist helps you understand and change how you think about your trauma and its aftermath. Your goal is to understand how certain thoughts about your trauma cause you stress and make your symptoms worse.You will learn to identify thoughts about the world and yourself that are making you feel afraid or upset. With the help of your therapist, you will learn to replace these thoughts with more accurate and less distressing thoughts. You will also learn ways to cope with feelings such as anger, guilt, and fear.
After a traumatic event, you might blame yourself for things you couldn't have changed. For example, a soldier may feel guilty about decisions he or she had to make during war. Cognitive therapy, a type of CBT, helps you understand that the traumatic event you lived through was not your fault.
What is exposure therapy?
In exposure therapy your goal is to have less fear about your memories. It is based on the idea that people learn to fear thoughts, feelings, and situations that remind them of a past traumatic event.By talking about your trauma repeatedly with a therapist, you'll learn to get control of your thoughts and feelings about the trauma. You'll learn that you do not have to be afraid of your memories. This may be hard at first. It might seem strange to think about stressful things on purpose. But you'll feel less overwhelmed over time.
With the help of your therapist, you can change how you react to the stressful memories. Talking in a place where you feel secure makes this easier.
You may focus on memories that are less upsetting before talking about worse ones. This is called "desensitization," and it allows you to deal with bad memories a little bit at a time. Your therapist also may ask you to remember a lot of bad memories at once. This is called "flooding," and it helps you learn not to feel overwhelmed.
You also may practice different ways to relax when you're having a stressful memory. Breathing exercises are sometimes used for this.
What is EMDR?
Eye movement desensitization and reprocessing (EMDR) is another type of therapy for PTSD. Like other kinds of counseling, it can help change how you react to memories of your trauma.While thinking of or talking about your memories, you'll focus on other stimuli like eye movements, hand taps, and sounds. For example, your therapist will move his or her hand near your face, and you'll follow this movement with your eyes.
Experts are still learning how EMDR works. Studies have shown that it may help you have fewer PTSD symptoms. But research also suggests that the eye movements are not a necessary part of the treatment.
Medication
Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant medicine. These can help you feel less sad and worried. They appear to be helpful, and for some people they are very effective. SSRIs include citalopram (Celexa), fluoxetine (such as Prozac), paroxetine (Paxil), and sertraline (Zoloft).Chemicals in your brain affect the way you feel. For example, when you have depression you may not have enough of a chemical called serotonin. SSRIs raise the level of serotonin in your brain.
There are other medications that have been used with some success. Talk to your doctor about which medications are right for you.
Other types of treatment
Some other kinds of counseling may be helpful in your recovery. However, more evidence is needed to support these types of treatment for PTSD.Group therapy
Many people want to talk about their trauma with others who have had similar experiences.In group therapy, you talk with a group of people who also have been through a trauma and who have PTSD. Sharing your story with others may help you feel more comfortable talking about your trauma. This can help you cope with your symptoms, memories, and other parts of your life.
Group therapy helps you build relationships with others who understand what you've been through. You learn to deal with emotions such as shame, guilt, anger, rage, and fear. Sharing with the group also can help you build self-confidence and trust. You'll learn to focus on your present life, rather than feeling overwhelmed by the past.
Brief psychodynamic psychotherapy
In this type of therapy, you learn ways of dealing with emotional conflicts caused by your trauma. This therapy helps you understand how your past affects the way you feel now.Your therapist can help you:
- Identify what triggers your stressful memories and other symptoms.
- Find ways to cope with intense feelings about the past.
- Become more aware of your thoughts and feelings, so you can change your reactions to them.
- Raise your self-esteem.
Family therapy
PTSD can affect your whole family. Your kids or your partner may not understand why you get angry sometimes, or why you're under so much stress. They may feel scared, guilty, or even angry about your condition.Family therapy is a type of counseling that involves your whole family. A therapist helps you and your family to communicate, maintain good relationships, and cope with tough emotions. Your family can learn more about PTSD and how it is treated.
In family therapy, each person can express his or her fears and concerns. It's important to be honest about your feelings and to listen to others. You can talk about your PTSD symptoms and what triggers them. You also can discuss the important parts of your treatment and recovery. By doing this, your family will be better prepared to help you.
You may consider having individual therapy for your PTSD symptoms and family therapy to help you with your relationships.
How long does treatment last?
CBT treatment for PTSD often lasts for 3 to 6 months. Other types of treatment for PTSD can last longer. If you have other mental health problems as well as PTSD, treatment may last for 1 to 2 years or longer.What if someone has PTSD and another disorder? Is the treatment different?
It is very common to have PTSD at that same time as another mental health problem. Depression, alcohol or drug abuse problems, panic disorder, and other anxiety disorders often occur along with PTSD. In many cases, the PTSD treatments described above will also help with the other disorders. The best treatment results occur when both PTSD and the other problems are treated together rather than one after the other.What will we work on in therapy?
When you begin therapy, you and your therapist should decide together what goals you hope to reach in therapy. Not every person with PTSD will have the same treatment goals. For instance, not all people with PTSD are focused on reducing their symptoms.Some people want to learn the best way to live with their symptoms and how to cope with other problems associated with PTSD. Perhaps you want to feel less guilt and sadness. Perhaps you would like to work on improving your relationships at work, or communicating with your friends and family.
Your therapist should help you decide which of these goals seems most important to you, and he or she should discuss with you which goals might take a long time to achieve.
What can I expect from my therapist?
Your therapist should give you a good explanation for the therapy. You should understand why your therapist is choosing a specific treatment for you, how long they expect the therapy to last, and how they will tell if it is working.The two of you should agree at the beginning that this plan makes sense for you. You should also agree on what you will do if it does not seem to be working. If you have any questions about the treatment, your therapist should be able to answer them.
You should feel comfortable with your therapist and feel you are working as a team to tackle your problems. It can be difficult to talk about painful situations in your life, or about traumatic experiences that you have had. Feelings that emerge during therapy can be scary and challenging. Talking with your therapist about the process of therapy, and about your hopes and fears in regards to therapy, will help make therapy successful.
If you do not like your therapist or feel that the therapist is not helping you, it might be helpful to talk with another professional. In most cases, you should tell your therapist that you are seeking a second opinion.
No comments:
Post a Comment