Life can be wonderful; however, sometimes even the best lives endure difficult times. For some people these challenging moments temporarily outweigh the positives but usually the better times soon return. For individuals with Post Traumatic Stress Disorder (PTSD) these challenging moments may last months, years, or never fully go away. According to Psychology Today, PTSD “is a trauma and stress related disorder that may develop after exposure to an event or ordeal in which death, severe physical harm or violence occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or unnatural disasters, accidents, or military combat.” The stigma associated with having PTSD often prevents people from seeking or staying in treatment and results in prolonged symptoms.
Adam C Bradford, PsyD, clinical psychologist and a specialist in PTSD, led a training in Northern Nevada for behavior health professionals this past week. Utilizing personal examples from his work with veterans, his one-day class provided students with information on the etiologies of PTSD, best practices from Evidence Based Treatments, Co-occurring problems, and samples for measurement-based care. The training dove deep into important information for working with people who may have PTSD. During this presentation a simple theme flowed throughout: help guide the person to a place where they are ready to face their trauma. Dr. Bradford indicated that effective treatment includes some form of exposure exercises and strategies that help a person confront the activities they avoid. While many treatments last around twelve weeks, results vary significantly. He also reiterated the importance of approaching processing in incremental steps. Dr. Bradford shares further advice, recommendations, and useful information in a short interview found towards the end of this article.
PTSD Coach Online
Family and friends may be supportive to their loved ones suffering from PTSD; however, they often will not understand that person’s challenges nor know how to help. While consistent therapy is the best option, a person may not have the resources or be emotionally ready to commit to an intense regiment of treatment. Understanding these challenges, the Veterans Administration created an online tool called PTSD Coach Online that offers a variety of short courses on many of the major issues affecting individuals. The aim of PTSD Coach Online is to help individuals lead a more productive and happier life with themselves and others by gaining the skills and knowledge to (re)discover their direction in life. Clinicians and subject matter experts lead courses revolving around sleep, anxiety, anger, sadness and other challenges resulting from a trauma. The courses use real scenarios and are interactive to help people work on their individual issues. The PTSD Coach Online achieves many of the goals for effective treatment that Dr. Bradford recommended above.
Though the PTSD Coach was created for people with PTSD many of the videos can be useful for anyone suffering. Anxiety and depression, for example, affect people with and without PTSD. Better regulation of symptoms greatly improves a person’s quality of life. A New York Times article on teenagers and anxiety states anxiety has become the most common mental health issue in the US. The online PTSD course “Changing Negative Thinking Patterns” was created to help individuals with anxiety and worry. This multimedia course offers participants the chance to learn about the different negative thinking styles and to challenge their own thoughts. The user is prompted with questions to better expose their negative thoughts and then provided with helpful suggestions to start the change process.
If your clients or other individuals in your life need help or a new path to follow there is a lot of information out there. If therapy is not an option PTSD Coach Online is a great start. While the program won’t perfectly relate to every unique situation, it will provide answers and likely provoke internal dialogue with many of the foundational challenges a person with PTSD faces. Perhaps the information will lead to further understanding, guidance, and even some closure for a person dealing with PTSD. As PTSD Coach Online says in its introduction; “this tool is for anyone who needs help.” Trauma survivors, families, and friends can all benefit.
PTSD Coach Online is just one of many resources within the US Department of Veterans Affair’s National Center for PTSD. Below is a brief interview with Dr. Bradford going into more detail about his work, experiences, and suggestions on working with this population.
Interview with Adam Bradford, PsyD, Clinical Psychologist
What initially interested you in learning about and working with PTSD?
“During my doctoral training I did a practicum at a VA site. I was immersed in PTSD and evidence-based treatments. My supervisor at this site also happened to be an adjunct professor at my school, teaching us all about trauma and PTSD. Previous to this I worked at a state hospital for a number of years as a master’s level therapist. When working with schizophrenia and seriously mentally ill (SMI) individuals, it is often that you do not see progress for long periods of time, if any at all. This new VA experience with trauma-focused therapy and PTSD was just the opposite. I was noticing huge changes in my patients. I saw them taking their lives back, building better relationships, and making great strides in just a few short months. This was a bit of a spark of excitement for me. The more I learned the more interested I became. I shifted all my focus to PTSD: I did my dissertation on it, attended a post-doctoral fellowship focused on it, and made it my career. It is important for me to work in an area where I feel I can make the greatest impact. I know this would be true of any area I work in; however, I also saw the sheer numbers of men and women who are suffering with PTSD and knew I could make a significant impact in this area. After seeing so much positive change I decided that this is where I would be best utilized in my profession.”
What is the hardest and most rewarding part of doing your work with clients with PTSD?
“I would say that the hardest part of doing my work with clients who have PTSD is the aspect of ‘avoidance.’ This is a key feature of the diagnosis; however, many times it hinders and slows progress. Avoidance keeps the ‘no-show’ rate on the high end. It is sad to see someone make some progress and then drop out of treatment.
Another difficult aspect is lack of information, misinformation, and stigma. It can be difficult to engage in PTSD treatment when patients, or their family receive negative feedback from others regarding the diagnosis. Many believe that they will “never get better.” Some patients are afraid they will lose their jobs if they are diagnosed or engage in treatment (and some have). The lack of information, misinformation, and stigma also make it difficult because people would rather not know if they have PTSD, may not seek treatment, drop out of treatment, or relate their symptoms to something else. This creates barriers to treatment and the potential to create a very negative self-image for people suffering with PTSD.
The most rewarding part is watching the change. When people are able to buckle down and really do the work that the Evidence Based Treatments (EBTs) ask them to do, they typically make great strides. In some cases, it really is a bit magical. It is very rewarding and exciting to be a ‘change agent’ with a diagnosis that can be so debilitating for such a long period of time. It is also very rewarding to engage in training and consultation activities with clients, their families, spouses, the public, and other practitioners to create effective change across the board.”
What are your favorite books or research articles on the topic and why?
“This is a very loaded question. If I were to cut and paste my favorite books and research, there would be a long list to fumble through. I tend to lean towards those articles that provide research on EBTs and their effectiveness. There are so many to sift through. I also enjoy reading about new treatments, that address other areas/symptoms that are part of the PTSD diagnosis (especially the ones that ‘think outside the box).’ Articles relating to other effective treatments or ideas, which include Image Rehearsal Therapy (IRT) for nightmares related to PTSD, physical exercise studies that show a reduction of hyper arousal symptoms, CBT for Insomnia (CBT-I), and the list goes on. As for books, I like to read those written by people who have experienced PTSD first hand. Writing about personal trauma is no doubt therapeutic for the writer, but it is also beneficial for the treatment provider to get a thorough account of the experience and really understand the manifestation of symptoms of PTSD. Of course, technical books about PTSD are always good, but to then read an actual account and recognize the symptoms, and how they are truly experienced by someone, is always fascinating and impactful. Karl Marlantes’ book, What it is Like to Go to War, is a great example.”
What is the most important piece of advice you would give someone working with a client with PTSD?
“Take your time. The most important thing I have noticed over the years is that people with PTSD have a very difficult time with trust. It can take time to build that trust. My team will joke with me about my constant treatment plan suggestion of, ‘Individual supportive therapy leading to future trauma focused therapy.’ Some practitioners will start an EBT right from the first or second session. If the person is engaged, yet very avoidant, they may not divulge the details of their trauma. They may not see any benefit from treatment because they are avoiding the true index trauma. In many cases this is because they do not trust the provider (or simply due to the strong nature of avoidance). Frequently, the individual with PTSD has never told anyone their trauma before. Time is needed to not just build rapport, but to build a real sense of trust within the patient. Even patients who build trust will sometimes not divulge the true details/ nature of their trauma for a very long time (my longest was weekly sessions for 15 months before I got the whole, detailed account of the actual trauma). So definitely take your time.”
Where do you get more training?
“Training is everywhere. I am certain that some trainings are better than others, but I have only been exposed to excellent training thus far. I would suggest anything offered by the VA. The VA has a great deal of treatment history with PTSD. The National Center for PTSD is VA based and has a variety of excellent resources related to PTSD, combat related trauma, and military sexual trauma (MST). They also have resources for learning. I would suggest that any training is going to be useful. I am a bit biased towards finding those trainings that are presented by the VA or VA staff, or other identified specialists in the field. Although I admit to bias in that area, I have been involved in and received training from many different individuals and organizations that have provided excellent information.”