Post-Traumatic Stress - Fact Sheet

Post-traumatic Stress Disorder can occur in countless ways, especially with a Traumatic Brain Injury. The events, setting and feelings at the time of the injury can lead to ongoing stress.

• What is Post Traumatic Stress Disorder?
• PTSD and Traumatic Brain Injury
• Treatment methods for Post Traumatic Stress Disorder
• Self-coping methods
• How family and friends can help.

What is Post Traumatic Stress Disorder (PTSD)?

Post Traumatic Stress Disorder (PTSD) is an anxiety disorder characterised by a collection of specific symptoms such as hypervigilance, being easily startled, and sensitivity to loud noise. Post-traumatic stress disorder (PTSD) can occur after a traumatic event that leads to a brain injury (e.g. an assault, near drowning or a motor vehicle accident). This is generally in the case of mild to moderate brain injury, in which some of the traumatic event may be remembered. Symptoms of Post-traumatic Stress Disorder can develop if the event is enough to cause significant shock or fear, or be seen as life-threatening⁴.

Signs of Post-Traumatic Stress include:

• Re-experiencing the trauma through nightmares and vivid memories of the event
• Difficulty sleeping
• A person frequently thinking that they might die or that something bad will happen
• A pounding heart, shortness of breath, dizziness, chest pain, sweating, or flushes
• Feeling detached from the world or a sense of unreality
• Avoiding situations or thoughts related to the event
• Having a desire to escape
• A sense of losing control
• Being easily startled
• Experiencing episodes of panic.

A person experiencing both Post-Traumatic Stress and effects of a Traumatic Brain Injury requires a high level of understanding and support. Due to the unpleasant feelings a person may avoid various situations which act as reminders of the trauma or avoid thoughts and feelings associated the event. As the person continues to avoid these feelings and situations, it is easy to maintain the idea that it is unsafe to think about or be in such situations. As a result a person may become restricted from various activities and maintain high levels of anxiety.

PTSD and Traumatic Brain Injury

In the past it was believed that Post -Traumatic Stress Disorder (PTSD) could not occur following a traumatic brain injury. In fact it has been considered a protective factor against PTSD as the loss of consciousness was thought to prevent encoding of information related to the event and therefore the ability to remember1. However, more recent studies have provided evidence of PTSD following mild to moderate Traumatic Brain Injury (TBI) in soldiers returning from war^2,3. One study found that 11.3% of patients met the criteria for PTSD during the first six months of recovery after mild to severe Traumatic Brain Injury. These patients also showed greater impairments in psychosocial well-being compared to those without PTSD³.

Both Post-Traumatic Stress Disorder and mild brain injury are prone to misdiagnosis. This is largely due to the similarity of symptoms in brain injury and PTSD. The sleeping disorders, irritability, depression and emotional problems that can be due to a mild brain injury can be misdiagnosed as an effect of PTSD. This may also occur in reverse, leading to inappropriate treatments.

After horrific accidents, a person with Traumatic Brain Injury may have no signs of PTSD because they have no memories of the actual accident—often their earliest memories are of being in rehabilitation weeks later. However, it is important that any suspicions of PTSD be checked thoroughly by professionals with an understanding of Traumatic Brain Injury.

Treatment for Post Traumatic Stress Disorder

Treating and recovering from PTSD is often a gradual process. It is a process of healing and gradually coming to terms with the traumatic event and this can take time. It’s about learning to cope with the thoughts and feelings associated with the event and continue with life without these thoughts or feelings of the event interfering with daily life. Below are some common forms of treatment for PTSD.

Two forms of therapy that are particularly helpful are Behavioural and Cognitive-Behavioural Therapies. These involve providing education and information about PTSD, learning ways to control anxiety and anger, and being exposed to feared situations, feelings and any memories related to the event⁵. Unhelpful thoughts and beliefs are replaced with more rational thoughts. In the case of mild TBI, simply talking to a psychologist about the traumatic experience may help to manage difficult feelings.

Due to the effects of Traumatic Brain Injury it is preferable that therapy be sought by a psychologist or psychiatrist with an understanding of Traumatic Brain Injury. This way a program may be tailored to your specific needs. Contact your Brain Injury Association for options in your area.

Medications may be used to treat symptoms of PTSD such as anxiety and depression. Selective Serotonin Reuptake Inhibitors (SSRIs) have proved effective in open trials of PTSD⁵. However, care is needed to see if SSRIs interfere with other prescription medications. Consult your GP or a psychiatrist about the potential benefits and side effects of medication while maintaining awareness of the effects of an existing brain injury.

There are several support groups available for people suffering the effects of PTSD or an anxiety disorder. The links below provide the contact details of groups in Brisbane and Queensland.

Coping methods for Post-Traumatic Stress Disorder?

Learning about something you may be experience can promote feelings of being in control and help you to understand what you are feeling and what may help.

Learning to talk about the trauma with someone you feel comfortable and has an understanding of what you have been through can have positive outcomes. This may help you to feel less alone with your feelings and help to process some of the difficult feelings associated with the event.

There are many professional counsellors and psychologists that can provide support and guidance with coping with traumatic events. Contact your Brain Injury Association for options.

Relaxation exercises include breathing exercises, medication, yoga, swimming, listening to music and going for long walks. Each of us will have the ones that best suit us, so work on finding the one that is most helpful for you. Some exercises will take regular practice. Also, many libraries will have relaxation CD’s or tapes with exercises that you can use to guide you in relaxation. Be aware that is it possible for some relaxation exercise to increase distress by focussing your attention on physical sensations that you may find disturbing, so only continue with such exercises when well tolerated.

How family and friends can help

• If a family member feels comfortable tell your loved one or friend that you are willing to listen if they would like to talk.
• Educate yourself on PTSD and Traumatic Brain Injury, so you have an understanding of each of the effects.
• Be aware of negative coping mechanisms such as social withdrawal and alcohol and drug abuse or avoidance in your loved one and encourage them to seek counselling.
• Maintain a non judgmental approach when providing support.

LINKS

Australian Centre for post-traumatic mental health: http://www.acpmh.unimelb.edu.au/trauma/ptsd_programs.html#qld

QLD Anxiety Disorder Support Groups: http://www.anxietynetwork.com.au/Support%20Groups/qld/support%20gps.htm

REFERENCES

1. Bryant, R. A., Marosszeky, J. E., Crooks, J., & Gurka, J. A. (2000), Post-traumatic Stress Disorder After Severe Traumatic Brain Injury, AM J Psychiatry, 157, 629-631.
2. Hoge, C. H, McGurk, D.,Thomas, J. L., Cox, A. L., Engel, C. C and Castro, C. A. (2008), Mild Traumatic Brain Injury in U.S. Soldiers Returning from Iraq, The New England Journal of Medicine, 358, 453-463.
3. Bombardier, C. H., Fann, J, R., Temkin, N., Esselman, P. C., Pelzer, E., Keough, M., & Dikmen, S. (2006), Post-traumatic Stress Disorder Symptoms During the First Six Months After Traumatic Brain Injury, The Journal of Neuropsychiatry and Clinical Neurosciences, 18, 501-508.
4. MedicineNet (2007), Post-traumatic Stress Disorder (PTSD), http://www.medicinenet.com/posttraumatic_stress_disorder/article.htm#what
5. Anxiety Australia, Post-Traumatic Stress Disorder, http://www.anxietyaustralia.com.au/anxiety_disorders/post_traumatic.shtml
6. Brain Explorer, http://www.brainexplorer.org/ptsd/PTSD_Treatment.shtml