PTSD (Post-Traumatic Stress Disorder)

Post-traumatic stress syndrome (PTSD) may occur when an individual has been exposed to a traumatic event and responds with fear, helplessness, or horror. It is now recognized that a small percentage of patients being treated for cancer experience PTSD. The trauma-related symptoms in patients with cancer have been under increasing study. Individuals with a history of PTSD are at a substantial risk for continued emotional difficulties so it is encouraged that these patients receive timely and effective treatment for this syndrome.

It is difficult to recommend a “best therapy” approach for PTSD. Most clinicians recommend a multimodality approach, using components of therapy that meet the specific needs of each patient, taking into account any concurrent psychiatric disorders such as depression or substance abuse.

A crisis intervention approach is often recommended in order to facilitate the adjustment of patients experiencing cancer. In this approach, the therapist takes an active stance focusing on problem resolution, teaching specific coping skills, and providing a safe and supportive environment. Cognitive-behavioral approaches have proven very effective. This approach includes the former in addition to the use of relaxation techniques, restructuring cognitions or negative thoughts, and providing exposure to opportunities that provide systematic desensitization of the symptoms being experienced. Support groups have also been shown to benefit people who experience PTSD. In the group setting, patients can receive emotional support from others who have experienced similar symptoms, thereby validating their own feelings and learning coping strategies from others.

For patients with severe symptoms, psychopharmacology may prove effective. Antidepressants may be used when the symptoms of depression occur with PTSD. Antidepressants are also useful in decreasing the hyperarousal and intrusive symptoms that often accompany PTSD. Antipsychotic medications may reduce flashbacks and antianxiety medications may help reduce arousal and anxiety. Therefore, the best therapeutic approach to PTSD may be a combination of therapies tailored to the individual’s experiences and symptoms. Most importantly, therapeutic intervention is highly recommended for any person experiencing any of the symptoms associated with PTSD. Post-traumatic stress syndrome (PTSD) may occur when an individual has been exposed to a traumatic event and responds with fear, helplessness, or horror. It is now recognized that a small percentage of patients being treated for cancer experience PTSD. The trauma-related symptoms in patients with cancer have been under increasing study. Individuals with a history of PTSD are at a substantial risk for continued emotional difficulties so it is encouraged that these patients receive timely and effective treatment for this syndrome.

It is difficult to recommend a “best therapy” approach for PTSD. Most clinicians recommend a multimodality approach, using components of therapy that meet the specific needs of each patient, taking into account any concurrent psychiatric disorders such as depression or substance abuse.

A crisis intervention approach is often recommended in order to facilitate the adjustment of patients experiencing cancer. In this approach, the therapist takes an active stance focusing on problem resolution, teaching specific coping skills, and providing a safe and supportive environment. Cognitive-behavioral approaches have proven very effective. This approach includes the former in addition to the use of relaxation techniques, restructuring cognitions or negative thoughts, and providing exposure to opportunities that provide systematic desensitization of the symptoms being experienced. Support groups have also been shown to benefit people who experience PTSD. In the group setting, patients can receive emotional support from others who have experienced similar symptoms, thereby validating their own feelings and learning coping strategies from others.

For patients with severe symptoms, psychopharmacology may prove effective. Antidepressants may be used when the symptoms of depression occur with PTSD. Antidepressants are also useful in decreasing the hyperarousal and intrusive symptoms that often accompany PTSD. Antipsychotic medications may reduce flashbacks and antianxiety medications may help reduce arousal and anxiety. Therefore, the best therapeutic approach to PTSD may be a combination of therapies tailored to the individual’s experiences and symptoms. Most importantly, therapeutic intervention is highly recommended for any person experiencing any of the symptoms associated with PTSD.

You are so right. The impact of a cancer diagnosis on the patient and family is reciprocal in nature. Essentially, the family is the "unit of care." What affects one individual in the family system will reverberate within the entire family. Therefore, if you suspect that you may be suffering from post-traumatic stress syndrome (PTSD) then the family as a unit may be suffering from the same symptoms.

PTSD is a response to events that involve actual or threatened death or serious injury or other threat to one's physical integrity, to which the person's response involves intense fear, helplessness, or horror. PTSD is a psychiatric diagnosis that is linked closely to an acute stress disorder resulting from experiencing a traumatic event. The actual Diagnostic and Statistical Manual of the American Psychiatric Society (DSM IV-TR, 2000) defines a life-threatening diagnosis such as cancer as a traumatic event. The National Cancer Institute (2010) estimates that approximately 35% of patients experiencing cancer may suffer symptoms of PTSD.

The signs of PTSD may be similar to signs of other states such as depression and anxiety. In fact, a majority of patients who suffer from PTSD also suffer from another co-morbid condition such as depression, anxiety, panic disorder, or obsessive compulsive disorder. Therefore, it is important that a thorough evaluation be carried out so that the individual is appropriately treated.

One of the main signs that distinguishes PTSD from other disorders is the reexperiencing of symptoms related to the traumatic event. This reexperiencing is often in the form of recurrent dreams, recollections, or intrusive thoughts that are related to the traumatic event. In the case of a cancer diagnosis this could be recurring dreams about receiving chemotherapy or radiation therapy. Often these dreams or recollections can even consist of sensations from the event, including taste, smell, touch, and sound. It is not uncommon for a chemotherapy patient suffering from PTSD to say that they can "taste" the metallic taste of chemotherapy at different times with recurrent thoughts of the event.
Traumatic memories can be triggered by certain stimuli related to the trauma. For example, a patient who had chemotherapy in the doctor's office may feel slightly nauseated when going to see the doctor for follow-up treatment. The doctor's office and the doctor him/herself may be the trigger for this feeling. If chemotherapy was traumatic for the individual then this event may be reexperienced with objects that remind the patient of receiving chemotherapy.

Other signs of PTSD consist of avoidance and feelings of emotional "numbness." Reexperiencing the event in the present may cause the individual to avoid certain situations or stimuli that remind them of the trauma. For example, a patient with alopecia from chemotherapy may avoid going to their local grocery because everyone he/she meets may ask them, "How are you feeling?" bringing forth unwanted memories of the trauma they are experiencing. With avoidance comes feelings of detachment or isolation from other people or certain events. It is not uncommon for the patient with cancer to feel isolated in their feelings or to avoid certain social situations.

The anxiety component of PTSD is through the state of hyperarousal. The individual's nervous system always feels that it is on alert for danger! The "fight" and "flight" reaction is always on even though there is no present danger at hand. The individual has a heightened startle response and sleep patterns become disrupted. Individuals will many times complain of feeling "jumpy," "on-edge," or "irritable." They will also find it difficult to concentrate, to stay on task, or find that short-term memory is affected.

Overlapping symptoms of depression may also occur with PTSD. Individuals may have overwhelming feelings of grief and loss associated with feelings of helplessness, worthlessness, and sadness. Other signs of PTSD include somatic complaints such as chronic pain and the individual also runs the risk of substance abuse (which is a behavior to help mask the psychic pain). Lastly, an important sign of PTSD is that quality of life becomes diminished because the individual has difficulty in relationships, poor work performance, social impairments, and mood disorders.

You can see how many symptoms of PTSD may overlap with symptoms of depression and anxiety and also overlap with symptoms of the cancer diagnosis and treatment, e.g., short-term memory loss related to chemotherapy. That is why it is so important to have a professional person diagnose PTSD and initiate appropriate treatment. In addition, the individual with PTSD does feel isolated and lonely, making it imperative to have the correct treatment.

Treatment for PTSD can take on many forms. Psychopharmacology is very effective in treating PTSD. Medicines from antidepressants to anxiolytics help to decrease the co-morbid symptoms of depression and anxiety. Psychotherapy focused on the trauma is very important for individuals suffering from PTSD. A psychiatrist or psychologist should diagnose the disorder but there is an important role for therapy from counselors, psychiatric advanced practice nurses, social workers, etc., who are trained to treat individuals with PTSD. Cognitive-behavioral therapy is effective in helping the individual "re-frame" the traumatic experience and there is a definitive role for integrative medicine such as acupuncture, yoga, guided imagery and relaxation. You are so right. The impact of a cancer diagnosis on the patient and family is reciprocal in nature. Essentially, the family is the "unit of care." What affects one individual in the family system will reverberate within the entire family. Therefore, if you suspect that you may be suffering from post-traumatic stress syndrome (PTSD) then the family as a unit may be suffering from the same symptoms.

PTSD is a response to events that involve actual or threatened death or serious injury or other threat to one's physical integrity, to which the person's response involves intense fear, helplessness, or horror. PTSD is a psychiatric diagnosis that is linked closely to an acute stress disorder resulting from experiencing a traumatic event. The actual Diagnostic and Statistical Manual of the American Psychiatric Society (DSM IV-TR, 2000) defines a life-threatening diagnosis such as cancer as a traumatic event. The National Cancer Institute (2010) estimates that approximately 35% of patients experiencing cancer may suffer symptoms of PTSD.

The signs of PTSD may be similar to signs of other states such as depression and anxiety. In fact, a majority of patients who suffer from PTSD also suffer from another co-morbid condition such as depression, anxiety, panic disorder, or obsessive compulsive disorder. Therefore, it is important that a thorough evaluation be carried out so that the individual is appropriately treated.

One of the main signs that distinguishes PTSD from other disorders is the reexperiencing of symptoms related to the traumatic event. This reexperiencing is often in the form of recurrent dreams, recollections, or intrusive thoughts that are related to the traumatic event. In the case of a cancer diagnosis this could be recurring dreams about receiving chemotherapy or radiation therapy. Often these dreams or recollections can even consist of sensations from the event, including taste, smell, touch, and sound. It is not uncommon for a chemotherapy patient suffering from PTSD to say that they can "taste" the metallic taste of chemotherapy at different times with recurrent thoughts of the event.
Traumatic memories can be triggered by certain stimuli related to the trauma. For example, a patient who had chemotherapy in the doctor's office may feel slightly nauseated when going to see the doctor for follow-up treatment. The doctor's office and the doctor him/herself may be the trigger for this feeling. If chemotherapy was traumatic for the individual then this event may be reexperienced with objects that remind the patient of receiving chemotherapy.

Other signs of PTSD consist of avoidance and feelings of emotional "numbness." Reexperiencing the event in the present may cause the individual to avoid certain situations or stimuli that remind them of the trauma. For example, a patient with alopecia from chemotherapy may avoid going to their local grocery because everyone he/she meets may ask them, "How are you feeling?" bringing forth unwanted memories of the trauma they are experiencing. With avoidance comes feelings of detachment or isolation from other people or certain events. It is not uncommon for the patient with cancer to feel isolated in their feelings or to avoid certain social situations.

The anxiety component of PTSD is through the state of hyperarousal. The individual's nervous system always feels that it is on alert for danger! The "fight" and "flight" reaction is always on even though there is no present danger at hand. The individual has a heightened startle response and sleep patterns become disrupted. Individuals will many times complain of feeling "jumpy," "on-edge," or "irritable." They will also find it difficult to concentrate, to stay on task, or find that short-term memory is affected.

Overlapping symptoms of depression may also occur with PTSD. Individuals may have overwhelming feelings of grief and loss associated with feelings of helplessness, worthlessness, and sadness. Other signs of PTSD include somatic complaints such as chronic pain and the individual also runs the risk of substance abuse (which is a behavior to help mask the psychic pain). Lastly, an important sign of PTSD is that quality of life becomes diminished because the individual has difficulty in relationships, poor work performance, social impairments, and mood disorders.

You can see how many symptoms of PTSD may overlap with symptoms of depression and anxiety and also overlap with symptoms of the cancer diagnosis and treatment, e.g., short-term memory loss related to chemotherapy. That is why it is so important to have a professional person diagnose PTSD and initiate appropriate treatment. In addition, the individual with PTSD does feel isolated and lonely, making it imperative to have the correct treatment.

Treatment for PTSD can take on many forms. Psychopharmacology is very effective in treating PTSD. Medicines from antidepressants to anxiolytics help to decrease the co-morbid symptoms of depression and anxiety. Psychotherapy focused on the trauma is very important for individuals suffering from PTSD. A psychiatrist or psychologist should diagnose the disorder but there is an important role for therapy from counselors, psychiatric advanced practice nurses, social workers, etc., who are trained to treat individuals with PTSD. Cognitive-behavioral therapy is effective in helping the individual "re-frame" the traumatic experience and there is a definitive role for integrative medicine such as acupuncture, yoga, guided imagery and relaxation.

PTSD stands for Post Traumatic Stress DISORDER.... is it possible to experience post-traumatic stress without it being "full-blown" PTSD? Thanks. Nightmares are a diagnostic criteria, but the flash backs involved in PTSD occur when a person is awake. The person has the experience of mentally and emotionally reliving the traumatic event in the present. There are a number of other criteria which must be met to have a PTSD diagnosis. A quick search of the web will provide you with the complete diagnostic criteria from the Diagnostic and Statistical Manual of Mental Diseases and Disorders (affectionately known as the DSM).

On that criteria alone, I wouldn't venture to say you have PTSD. More likely you are describing someone with a more common, short-lived condition called Adjustment Disorder with Mixed Disturbance of Emotion and Conduct. This can include a chronic form but typically resolves in 6 months to a year of the event, depending on treatment and the client's support system and resources.