Post-traumatic stress reactions

CBT treatments for PTSD have been widely researched and experimentally validated (Foa et al. 1991 Follete et al. 1999 Horowitz 1986 Keane 1997 Kulka et al. 1990 Resick and Schnicke 1992 Resick et al 1981). Behavioural approaches emphasize the central role of anxious arousal and phobic avoidance in the PTSD syndrome. For example, the two-factor theory (Kilpatrick et al 1982) proposed that anxiety is conditioned to previously neutral cues at the time of the traumatic event. These cues then serve as subsequent triggers to the post-traumatic stress reaction. Avoidance develops in response to the anxiety and is reinforced by reduction in arousal associated with the avoidance. 

In this phase, the therapist educates the patient about post-traumatic stress reactions. This involves giving the patient information about the consequences of exposure to traumatic events and the development of PTSD symptoms. 

The knowledge that the events experienced are the result of deliberate action rather than simple bad luck also appears to be associated with an increased risk of adverse post-traumatic stress reactions. The lesson is to recognise that such reactions are normal, although not universal, and that they should be managed promptly and sympathetically. 

Features of post-traumatic stress reactions may involve emotional, cognitive, behavioural or personality effects (Box 7.2). Alternatively ttiey may manifest as physical symptoms such as difficulty sleeping, with or without nightmares. 

The development of mild forms of anxiety and neuroveg-etative and/or cognitive responses to stress may represent an adaptive evolutionary step against environmentally (external) or self-triggered (internal) threats, but maladaptive reactions have also emerged in human evolution. Thus, anxiety disorders are maladaptive conditions in which disproportionate responses to stress, or even self-evoked responses, are displayed. Anxiety disorders are one of the most frequent psychiatric illnesses, and have a lifetime prevalence of 15- 20% [1, 89]. The most common presentations are generalized anxiety disorder, with a lifetime prevalence rate of close to 5% [1, 89] social anxiety disorder, with very variable lifetime prevalence rates ranging from 2 to 14% [90] panic disorder, with rates from 2 to 4% [1,89] and post-traumatic stress disorder (PTSD), with a prevalence rate close to 8%. Specific phobias, acute stress and obsessive-compulsive behavior are other clinical presentations of anxiety disorders. 

Post-Traumatic Stress Disorder Reaction Index for Children Private, via author, A.M. La Greca, Ph.D., Department of Psychology, 4100 Malaga Ave, Miami, FL 33133-6325... 

Adjustment reaction Phobic disorders Panic disorders Generalized anxiety disorder Obsessive-compulsive disorder Post-traumatic stress disorder... 

Humans who have experienced some severe psychological traumatic event may even develop an altered psychological state to deal with the event. The sudden death of a loved one, involvement in a serious car accident, or combat experience can produce a traumatic reaction that may include a denial state characterized by sleep disturbances, amnesia, fatigue, and headaches (Smith, 1998). Post-traumatic stress disorder (PTSD), also called shell shock or battle fatigue is common to those who have had to face extreme distress in military or civilian Ufe. PTSD is characterized by negative emotional reactions beyond coping. 

Stress reactions Adjustment disorders Acute stress reaction Post-traumatic stress disorder (PTSD) Fugue/dissociative states Establish history of stressor(s) and timeline... 

Among them, post-traumatic stress has a tremendous importance and it needs to be attended since the very beginning after the production of damages. Fast and planned prearranged reaction facing up them are so necessary as facing up killed or physical injured people. These situations lead to similarly serious consequences both in psychical and... 

Acute transient reactions characterised by numbness, feeling dazed, insomnia, impaired concentration, restlessness and autonomic arousal may immediately follow a traumatic event. Symptoms usually occur williin minutes of the stressful event and disappear within a few days. If symptoms last longer, a diagnosis of post-traumatic stress disorder (PTSD) may be made. Avoidance behaviours may occur, as may maladaptive coping mechanisms such as substance or alcohol misuse. Transient flashbacks are common, but in most cases will stop relatively quickly. The vast majority of reactions fall within this group. 

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