Post-traumatic stress

As defined by INSERM (Institut Nationale de la Santé et de la Recherche Médicale), post-traumatic stress is classified as a psychiatric disorder that can occur after a traumatic event. PTSD (Post-Traumatic Stress Disorder) will have significant psychological consequences, long after the event.

Post-traumatic stress is present in around 5-12% of the population. However, like many other pathological conditions, it is likely to be underestimated, as some people are not diagnosed at all.

In other words, post-traumatic stress can be likened to a major emotional shock. This emotional shock will have a direct impact on the sufferer's day-to-day life, in a variety of ways.

Many symptoms accompany PTSD. The main symptoms include :

Reliving

Reviviscence is the repeated "reliving" of the event. People can relive their trauma in different ways: Through repeated flashbacks that make the person relive the entire scene; intrusions of involuntary thoughts and images related to the traumatic event; recurring nightmares. Any external event can bring the memory of the traumatic event to the surface: a noise, a light, a person, a place… These various external signals will automatically trigger anxiety symptoms.

Avoidance

Avoidance is one of the main reasons for maintaining post-traumatic stress. People tend to avoid trauma sites, objects or people, for example.

There are different types of avoidance: emotional avoidance (e.g., never again experiencing the same type of emotion as those present during the trauma); cognitive avoidance (e.g., avoiding thinking about the trauma that took place) and behavioral avoidance (e.g., not returning to the scene of the accident). This avoidance will be worked on in therapy. In fact, it is necessary, little by little, to avoid avoidance.

This avoidance can have a major impact on people's professional and personal lives. In particular, people can develop various phobias. We'll come back to this in a moment.

• Hypervigilance, concentration difficulties, sleep disorders… Various cognitive disorders may be linked to the trauma.
• Mood disorders, such as emotional outbursts (anger, sadness) or emotional blunting (reduced affectivity).

A variety of events can lead to post-traumatic stress disorder (PTSD). Among the most common are attacks, assaults, rapes, sudden deaths of loved ones, accidents of all kinds, natural disasters…

You don't have to have experienced a traumatic event to suffer from it; witnessing these same events can also be a source of PTSD.

As you can see, PTSD can develop when a person is faced with the threat of imminent death, when his or her physical integrity may be compromised, or when a loved one is significantly affected by a serious event.

There are two types of post-traumatic stress disorder:

• Type 1 "simple" PTSD

This type of trauma occurs after an isolated, single, brutal event. This type of trauma includes accidents, natural disasters, assaults, etc.

• Complex" type 2 PTSD

This type of trauma occurs following prolonged and repeated exposure to a certain type of event. Here, we find traumas linked to repeated physical or psychological abuse, sexual violence, harassment…

There are different ways of being a victim of a traumatic event.

• A person can be a direct victim, i.e. be directly exposed to the event.
• A person can also be an indirect victim: for example, someone who witnessed an incident, or relatives of direct victims.
• There is also a third category, that of secondary victims: in this category, we find people whose job it is to provide care, i.e. doctors, firemen, ambulance drivers…

Television viewers are also indirect victims of post-traumatic stress. Indeed, several studies have examined the impact of the media on the development of post-traumatic stress in people who did not witness the event. For example, we all remember that complicated period of regular terrorist attacks. These were omnipresent in the media. For example, a study was carried out on the mediation of the November 2015 attacks in Paris (Enguerrand du Roscoät et al.,).

This study shows that people who have had high or very high exposure to media images (from 2 to more than 4 hours a day) are likely to develop symptoms of post-traumatic stress. Thus, over-mediatization of images of the attacks is associated with an increase in post-traumatic stress symptoms in the general population.

Post-traumatic stress can have a major impact on the sufferer's daily life. Gradually, various phobias and psychiatric disorders may develop as a result of the trauma.

Associated disorders include phobias associated with public places, such as generalized anxiety, agoraphobia and social phobia.

Comorbidities often include alcohol addiction and depression.

As mentioned above, trauma can lead to significant psychological distress, impacting on different spheres of a person's life, whether personal or professional. The person will avoid certain situations. For example, a person who has been in a car accident may no longer be able to drive, as it causes them anxiety. Not being able to use the car will prevent them from taking part in certain activities with their loved ones. A person who develops agoraphobia as a result of post-traumatic stress will no longer be able to leave the house to go to work…

Post-traumatic stress can occur immediately after the event, but it can also occur several months or even years after the event. Disorders disappear within 3 months, or become chronic in 20% of cases. There is also a 20% risk of relapse in patients who receive treatment.

It is, of course, possible to reduce the risk of developing chronic post-traumatic stress, but psychotherapy is essential. These therapies will help you to better understand the event, the emotions felt afterwards, and the factors that led to the painful memories.

Among the therapies with the best results for post-traumatic stress are EMDR and CBT.

EMDR is a therapy that involves alternating bilateral (left/right) stimulation. This stimulation can take the form of eye movements, tapping or sound.

CBT stands for Cognitive Behavioral Therapy. These therapies have proved their worth in the treatment of post-traumatic stress. In particular, they enable progressive exposure to anxiety-provoking situations or situations reminiscent of the trauma. CBT works on the cognitive (modifying thoughts), behavioral (modifying maladaptive behaviors, avoiding avoidance) and emotional (learning to manage anxiety) levels. In the case of post-traumatic stress, the person will associate a place, a sound, a smell, an image… that recalls the event, with a danger. CBT enables the person to modify these associations.

CBTs use imaginative exposure and in vivo exposure. However, for several years now, exposure through virtual reality has also been proving its worth. In particular, virtual reality makes it possible to expose the patient in a much more progressive way, and to fully control the environment while keeping the person in a safe environment.

Numerous studies are underway to better understand the development of this type of disorder.

For example, a study by Butler et al. looked at the use of the game Tetris to limit the development of post-traumatic stress. In particular, they used it in conjunction with EMDR therapy. The results showed an increase in the hippocampus in people who had played Tetris in addition to EMDR therapy. This increase in hippocampus volume was associated with a reduction in PTSD symptoms, and a decrease in depressive and anxiety symptoms. In particular, the increase in hippocampal volume was associated with better maintenance of learning during EMDR therapy.

In all cases, as you've probably guessed, psychotherapy is necessary to limit the avoidance that prevents traumatic memories from being processed like other memories.