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Post-Traumatic Stress Disorder: What Is It?

August 5, 2024/in Articles /by Dr. Farhan Shahzad

Post-Traumatic Stress Disorder (PTSD) is an acute stress reaction after experiencing a traumatic event. Events could be a violent attack, a car accident, witnessing wars, famines, and other tragedies.

PTSD is especially common in war veterans, and, as such, there’s a great deal of support for those returning military professionals. PTSD is characterised by anxiety, depression, nightmares, trembling, hypervigilance, triggers that set off flashbacks, and flashbacks that feel like the trauma is happening again in real time. Those with PTSD are taught grounding techniques, and they will go on to get trauma-focused counselling from a highly trained practitioner.

People with PTSD present with a number of symptoms. The most commonly known are hypervigilance and flashbacks. People with PTSD often relive the traumatic event through distressing memories, flashbacks, nightmares, or intrusive thoughts. These experiences can be vivid and intense, causing extreme emotional distress.

Flashbacks will feel like a person is reliving the traumatic event in reality. It can be very unsettling for a person and they may become overwhelmed with emotion. Flashbacks appear so real that a person sees, feels, hears and smells the things they did at the initial trauma.

Individuals with PTSD may try to avoid reminders of the trauma. They may avoid certain places, people, or activities, and may also experience emotional numbness, which can manifest as feeling detached from others or unable to experience positive emotions.

Because a person has went through such a traumatic time, they may avoid situations that remind themselves of the event. They may stop going out, hiding away at home, fearing that they will be attacked if they leave the safety of their home. Avoidance can be very limiting for a person with PTSD and can actually reinforce the symptoms in the long run.

Those with PTSD can be constantly on edge. They may be easily startled, have trouble sleeping, experience irritability, and have difficulty concentrating. This heightened state of arousal can be exhausting and makes it challenging to function normally. Hyperarousal is also known as hypervigilance and can leave a person on edge, always on their guard for the next unsettling event.

Individuals with PTSD may have persistent negative thoughts and feelings about themselves or the world. They may blame themselves for the traumatic event and lose interest in previously enjoyed activities. Those with PTSD will present with low mood and anxiety. They may also experience insomnia as a result of the mood changes.

To be diagnosed with PTSD, these symptoms must persist for at least one month and cause significant impairment in daily life, including work, relationships, and overall well-being.

Treatment for PTSD typically involves psychotherapy (talk therapy), medication, or a combination of both. Effective therapies for PTSD include Cognitive-Behavioural Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), and exposure therapy. Medications, such as antidepressants and anti-anxiety drugs, can help manage some symptoms. We will be discussing more on this later.

A bit About Growth

In the US army, where many of the 1.1 million employees may suffer trauma, it is also relatively common for some to experience post-traumatic growth. They become better people after the traumatic event than what they were before the event. On one end of the spectrum are people that experience PTSD symptoms, anxiety, depression, and even suicide, then in the middle there are those that experience PTSD and then recover returning to normal after a month or so, then there are those people that experience all the symptoms of trauma, but then eventually recover better than what they were before the traumatic event. So, while PTSD can be a consequence of such trauma, doing better than ever is also something that may happen.

Personality Types and Stress

July 25, 2024/in Articles /by Dr. Farhan Shahzad

Type A behaviour has been discussed a lot. It is a personality type whose behaviour consists of high energy, go-getting, frenetic, hostility and time-urgency. These are the people who get things done; they’re driven and want to succeed.

There has been a long-standing association between Type A behaviour and stress, which poses a risk of burnout. Those with a Type A personality may be more prone to stress, not only from their composition of behavioural traits, but from their choice of profession too. They may actively choose professions that are known to be high stress jobs because these roles offer the challenges they need based on their personality type. Those with Type A personality often report higher levels of stress and are not as satisfied in their role, but because of their composition of traits, they may be better at certain professions than those with Type B personality (more laid-back, easy-going, less prone to stress, and more open to a relaxed profession). Different working conditions may also actively change a person’s personality, showing the transaction between work and individual is a fluid one. How an individual appraises their circumstances is also linked to whether they are Type A or Type B.

Along with Type A personality, locus of control, has also shown enhanced risk of stress. Locus of control attests to where an individual attributes control (externally or internally). Those with an external locus of control, known as external attribution error, will perceive their situation as being outside their control. Those with internal locus of control realise they are in control of their situation. Employees that have Type A behavioural traits and external locus of control are at risk of higher levels of stress and is linked to perceived levels of quantitative overload, which impact on their personal wellbeing and job satisfaction. External locus of control alone has been shown to have the greatest risk of perceived stress.

In one study on Type A personality and burnout, no association between Type A and exhaustion was found, but the authors acknowledged that this may be due to the fact that Type A personality has separate dimensions: the achievement striving type and the irritability/anger type that are associated with different responses. However, the association between Type A Personality and exhaustion has been found in multiple other studies ) linking this to their strong inner drive and they created more stress through increasing the amount of work they do. Type A behaviour also increases the impact of work overload and role conflict , meaning greater risk of burnout and has been linked to a number of health compromises, such as tension, more illness, coronary heart disease and other physical and emotional issues.

Type D Personality and Burnout

Another personality type associated with burnout is the Type D personality. Those with Type D are prone to worry, irritability and have a negative and gloomy outlook. They also tend to hold themselves back, through their reticent, reserved nature. They are known to have negative affectivity and social inhibition. Due to their worrying nature and negative outlook, they are prone to illness, with many studies showing an association to burnout that can be mediated through exercise.

In a study on health care professionals, Karadag et al (2016) found an association between Type D personality and the burnout components: emotional exhaustion and depersonalisation. Although, given the nature of working in healthcare, it is difficult to know whether personality pre-determined the risk of burnout, or whether the personality had changed due to the nature of the work. Those with Type D personality were found to have passive and maladaptive coping that places them at greater risk. Type D personality has been found to be a vulnerable personality, five times more susceptible to burnout, in a study on nurses.

Overall, personality types and the behavioural traits that can encompass them, have a direct association to stress and possibly burnout, meaning moderating the behavioural traits is important.

Mindfulness for Depression and Anxiety

June 27, 2024/in Articles /by Dr. Farhan Shahzad

Jon Kabat Zinn is said to be the forefather of modern mindfulness. He is the man responsible for bringing this Eastern practice to the West. He defines mindfulness as:

“paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally. It’s about knowing what is on your mind.”

One of the first studies that Kabat-Zinn performed was in 1979 where he recruited chronically ill patients who were not responding to mainstream treatments for mental ill health. Kabat-Zinn’s study allowed for participants to participate in his eight-week stress reduction program, which he called the Mindfulness-Based Stress Reduction (MBSR). This proved successful and has since seen a substantial body of research providing more evidence of its efficacy. The research shows that mindfulness can improve mental and physical health comparably to other psychological interventions. Furthermore, mindfulness offers clients the ability to self-teach and use the tools anytime anywhere.

Everyone will experience restless nights and lack of sleep on occasion. However, if sleep is disrupted for weeks or months, insomnia can become a nightmare. Sleep disorders such as sleep apnea require medical attention as they can really reduce the quality of life of the individual suffering, but for those suffering from insomnia, anxiety can be the root cause.

There are different types of insomnia. Chronic insomnia is where there is disturbed sleep for at least 3 days a week for more than 3 months and it affects around 7-13% of the population. Genetics, environmental issues, and long-term stress can be the cause of chronic insomnia. Primarily older people, “worriers”, and females, tend to be more at risk. Also, those with health complications such as obesity can be at further risk. The above factors, plus a stressful situation may be enough to cause a good sleeper to develop insomnia. Similarly, adrenaline pumping events can also influence sleep.

Once a sleep problem has begun, a person may worry about being unable to fall asleep which can cause the cycle to continue. The more a person is worrying about not sleeping, the worse their problem gets. Rather than counting sheep, mindfulness can help with insomnia by breeding an awareness of what comes into mind from paying attention to the present moment and being nonjudgemental of thoughts.

Mindfulness can help us let go of the past and stop worrying about the future. It is essentially embracing the thought, showing compassion to it, and letting it go. Jon Kabat-Zinn noticed a marked improvement in sleep quality for those that participated in mindfulness-based interventions. Mindfulness can improve sleep by breaking the cycle of rumination- unhelpful worrying-and worrying about not sleeping or having enough sleep. By letting go, clients can embrace the fact that sleep will come at its own time.

Practising relaxation in bed through mindfulness-based interventions can also be very beneficial, promoting both sleep, and energy for the following day. Mindfulness also reduces stress and anxiety and can break the vicious cycle whereby clients read electronic devices or watch TV before bed. This blue light interferes with the sleep-awake cycle by affecting the hormone, melatonin, and keeps people awake longer than they should be. Mindfulness and Chronic Pain and Depression Kabat-Zinn’s work also focused on how mindfulness can help those with chronic pain and depression.

Alongside his colleagues, Segal and others, Kabat-Zinn wrote the book The Mindful Way Through Depression, and states that by not focusing on the pain, worrying about it, or trying to eliminate it, chronic pain sufferers open up space to enjoy other happier and joyous life moments. Those with chronic pain will often agonise and worry about their health and suffering, often to the point that the stress and worry exacerbates symptoms. By opening up room where the patient does not focus solely on their pain and suffering, clients can then begin to enjoy small moments within the day and gradually more as they work their way through practising mindfulness.

In those that suffer from depression, Kabat-Zinn argues to start small and focus on breathing. They can eventually work their way up to tackling their negative emotions. What the focus is on is for clients to anchor themselves and so when a negative emotion comes to the surface it doesn’t automatically trigger a whole heap of associations for the person. These can render a person helpless and ruminate in their trauma. When the person is anchored and negative thoughts can leave easily, the person can mindfully choose a response to deal with the thoughts. They move from reactive to responsive and are in a much more controlled state.

Segal, a colleague of Kabat-Zinn, argues that when a person has received mindfulness training, their responses to sadness change. When someone without mindfulness training experiences sadness, a part of the brain that seeks to diagnose is activated. This causes the person to become overwhelmed because they feel far more than just allowing themselves to feel the feeling. In those that have received mindfulness training, the two parts of the brain are able to balance each other out and the person can respond in a more responsive, controlled manner. Research into the effectiveness of MBCT for those with chronic or potentially recurring depression have shown that MBCT is 43% effective in reducing relapse in sufferers of depression and is seen to be as effective as antidepressants. Furthermore, those that have done mindfulness training begin to see if as a way of life as opposed to a treatment.

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