PTSD

Many American veterans, after having served their country, face new challenges when they return home. As a result of experiencing the trauma of war, they often have difficulty reconnecting with their families and former life and some experience anger, hyperarousal, nightmares and anxiety. These issues, if not addressed, can lead to alcohol and drug addiction as well as family and work problems.

Humans tolerate mild to moderate stress with few repercussions. In fact humans often find mildly stressful situations fun and exciting. Imagine the positive stress of going on a roller coaster ride or skiing down a snowy slope. We even seek these stressors to add fun and excitement to our lives. These stressors are usually controllable and predictable and only rarely result in extreme fear, injury or death. From childhood we develop coping skills that enable us to tolerate the normal, moderate stress of daily life.

Humans, however, are not designed for extreme stress, and those who experience traumas like combat, sexual abuse or terrorism may develop a condition called posttraumatic stress disorder (PTSD). PTSD is a normal response by normal people to an abnormal or highly stressful situation. We say that PTSD is a normal response to an abnormal event because the condition is completely understandable. The symptoms make perfect sense because what happened has overwhelmed normal coping responses.

A trauma is a wound, and PTSD represents the unseen deep emotional wounds suffered by those who are exposed to extreme stress. The traumatic events that lead to PTSD are typically so extraordinary or severe that they would distress almost anyone. These events are usually sudden. They are perceived as dangerous to self or others and they overwhelm the person's ability to respond adequately. ¹

The Ranch - PTSD and Trauma Related Disorders Treatment

The Ranch is located on 2,000 historic acres in Nunnelly, Tennessee where Native American artifacts are plentiful and a Southern Plantation once stood. Used cooperatively as a hunting ground by Shawnees, Cherokees, Creeks and Chickasaws, the land nourishes the body and spirit today as it did centuries ago.

The Ranch was established in 1999 with the belief that traumatic experiences underlie many substance use and psychiatric disorders. Numerous studies support this hypothesis. Researchers have found incidences of traumatic stress as high as 64% in populations being treated for a serious mental illness. Likewise, there is a high correlation between substance use disorders and traumatic stress with some studies finding incidence rates as high as 82%. Now with eight successful years of trauma treatment experience, the Ranch is opening a new Posttraumatic Stress Disorder program for veterans and others who have disorders of extreme stress. The Ranch provides in-depth, evidence based trauma treatment including Cognitive Behavioral Therapy and EMDR in conjunction with spiritual renewal, healthy lifestyle management, healing ceremonies and family support. Together these treatments eliminate or significantly reduce the symptoms of PTSD including hyper-vigilance, extreme arousal, anger and sleep disturbances. Therapists at The Ranch are Master’s level trauma specialists who hold Level II EMDR training. Experienced milieu managers provide support and containment continuously during the day and night at our recovery homes. Visitors to The Ranch often say they feel a healing presence. Healing is witnessed at The Ranch every day.

How Common is Posttraumatic Stress Disorder (PTSD)?

PTSD is common. In the entire population, an estimated 6.8% of Americans will experience PTSD at some point in their lives. About 5.2 million adults have PTSD during the course of a given year. In people who have experienced a traumatic event, about 8% of men and 20% of women develop PTSD after trauma. The traumatic events most often associated with PTSD for men are rape, combat exposure, childhood neglect, and childhood physical abuse. The most traumatic events for women are rape, sexual molestation, physical attack, being threatened with a weapon, and childhood physical abuse.

PTSD is more common in ‘at-risk’ groups such as those serving in combat. About 30% of the men and women who served in Vietnam experience PTSD. An additional 20% to 25% have had partial PTSD at some point in their lives. More than half of all male Vietnam veterans and almost half of all female Vietnam veterans have experienced “clinically serious stress reaction symptoms,” PTSD has also been detected among veterans of other wars. Estimates of PTSD from the Gulf War are as high as 10%. Estimates from the war in Afghanistan are between 6% and 11%. Current estimates of PTSD in military personnel who served in Iraq range from 12% to 20%.

Who is most likely to develop PTSD?

Most people who experience a traumatic event will not develop PTSD. However, the risk for developing PTSD increases if a person:

• was directly exposed to the traumatic event as a victim or a witness
• was seriously injured during the trauma
• experienced a trauma that was long lasting or very severe
• saw them self or a family member as being in imminent danger
• had a severe negative reaction during the event, such as feeling detached from one’s surroundings or having a panic attack
• * felt helpless during the trauma and was unable to help them self or a loved one.

Individuals are also more likely to develop PTSD if they:

• have experienced an earlier life threatening event or trauma
• have a current mental health issue
• have less education
• are younger
• are a woman
• lack social support
• have recent, stressful life changes

Understanding PTSD Symptoms

• military combat
• violent personal assault (sexual assault, mugging, torture)
• natural or manmade disasters
• observing the serious injury or unnatural death of another person
• learning about the sudden, unexpected death of a family member

The person’s response to the event must involve intense fear, helplessness, or horror (Criterion A2).

The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion B)

• recurrent and intrusive recollections
• recurrent distressing dreams
• dissociative states during which components of the event are relieved (flashbacks)

• deliberate efforts to to avoid thoughts, feelings, or conversations about the traumatic event
• avoid activities, situations or people who arouse recollections of the event
• “psychic numbing” or emotional anesthesia
• feeling detatched or estranged from other people
• having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness, and sexuality
• sense of a foreshortened future (not expecting to have a normal lifespan, career, marriage or children.)

• increased anxiety
• difficulty falling or staying asleep
• exaggerated startle response
• irritability or outbursts of anger
• difficulty concentrating or completing tasks

The full symptom picture must be present for more than 1 month (Criterion E).
And the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F).
The symptoms may be acute, chronic or with delayed onset.

The Etiology of Combat-Related PTSD

• an immediate phase characterized by strong emotions, disbelief, numbness, fear, and confusion accompanied symptoms of autonomic arousal and anxiety;
• a delayed phase characterized by persistence of autonomic arousal, intrusive recollections, somatic symptoms, and combinations of anger, mourning, apathy, and social withdrawal, then finally;
• a chronic phase including continued intrusive symptoms and arousal for some, disappointment or resentment or sadness for others, and for the majority a re-focus on new challenges and the rebuilding of lives (Benediket al., 2001; Ursano et al., 1994)

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Principles of Healing and Recovery

Why Seek Help at The Ranch?

PTSD symptoms influence your life and relationships.

PTSD is disabling and related to other health problems.

Evidence Based Treatment for PTSD

Treatment of PTSD

Motivational Interviewing

Cognitive Behavioral Therapy

What is cognitive therapy?

What is exposure therapy?

Group therapy

Eye Movement Desensitization and Reprocessing (EMDR)

Medication

Family therapy

Healing Ceremonies

• A location might be a sacred religious structure, a place where someone experienced a traumatic event, or a beloved spot in nature.
• A symbol helps people to experience their feelings. The Vietnam Veterans Memorial is a powerful symbol. The visitor descends into what feels like a dark valley of death, pauses to pay sacred respect to the fallen individuals, then walks upward toward life and light again. A family at the grave symbolizes a new family – not diminished but unified.
• Props. These include flowers, candles, photos, or written speeches.
• Personal Support. People verbalize love and support, and communicate it nonverbally through hugs, touch, or caring expressions.
• Healing words.
  • Remembrances help to put traumatic events and individuals’ lives in perspective.
  • Meaningful poems, songs, or music and invoking divine comfort can also promote healing.
  • Expressions of hope for the future and enduring commitment to relationships helps survivors see beyond the traumatic event.
• A knowledgeable, trusted guide or director. This might be a recognized leader, like a clergy person, or one who has gone through similar difficult times and rituals before. Sometimes it is simply a family member or friend who is perceived as trusted and caring. Some people may also choose to lead their own ritual.
• Farewells. Placing a rose at a memorial site communicates acceptance of a person’s passing, the wish to preserve loving memories, and the reality of moving into the future.

What to Expect from Treatment

How long does treatment last?

What if someone has PTSD and another disorder? Is the treatment different?

What will be worked on in therapy?

• When a client begins therapy, they, along with their therapist, should decide together what goals they 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 they want to feel less guilt and sadness. Perhaps they would like to work on improving their relationships at work, or communication issues with their friends and family.
• The therapist should help to decide which of these goals seems most important, and they should also discuss which goals might take a long time to achieve.

What to expect from a therapist?

• A therapist should give a client a good explanation for the therapy. Clients should understand why the therapist is choosing a specific treatment, how long they expect the therapy to last, and what they expect the results to be.
• The two should agree at the beginning that this plan makes sense and what will happen if it does not seem to be working. The therapist should answer any questions about the treatment.
• Clients should feel comfortable with their therapist and feel they are working as a team to tackle the problems. It can be difficult to talk about painful situations in life, or about traumatic experiences. Feelings that emerge during therapy can be scary and challenging. Talking with a therapist about the process of therapy, and about hopes and fears in regards to therapy, will help make therapy successful.
• If a client does not like their therapist or feel that the therapist is not helping, it might be helpful to talk with another professional. In most cases, the client should tell their therapist that they are seeking a second opinion.

Relapse Prevention

• Understanding the dynamics of relapse
• Identifying and anticipating high-risk situations or cues
• Developing a sound coping plan
• Rehearsing the plan
• Trying out the plan in “real life”
• Evaluating and making improvements if needed.

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