The third and final webinar of the 2022 Summer Series was held on August 28th. Well over 100 members attended the Zoom meetings, which were held at three different times of the day/night. Foundation’s clinical advisor, Dr. Mark Besen, a clinical psychologist in private practice in North Carolina who specializes in psychological and neuropsychological assessment/testing, and numerous related activities, provided the educational session.  The webinar was conducted in a Question & Answer format, where participants were asked to respond to ten true or false questions.  As the attendees listened to Dr. Mark discuss the topic presented in the question, they could determine if the statement was true or false.

1. Q: Post Traumatic Stress Syndrome, PTSD, can be caused by a virtual experience, such as repeatedly witnessing a traumatic event on television. True or False

Dr. Mark’s response: Post Traumatic Stress Disorder. So what is it? It's a clinical syndrome. It is a group of symptoms that occur following a perceived life-threatening event. To be diagnosed with post-traumatic syndrome, you actually have to either have personally experienced an event where you believed your life safety was at risk, observed somebody else being in a situation where they were killed, or their life safety was at risk, or in some cases, it could be virtual exposure through media, repeated media experiences witnessing traumatic events. 

    First responders also who see repeated situations that are extremely disturbing would qualify as the type of situation that will be classified as trauma related to post-traumatic stress. It's not any stressful life event. It's not the typical things that people experience within the course of their normal daily activities. It's something out of the ordinary where you really believe your life is at risk or you've seen something else that's extremely disturbing, involving the threat of dying; sexual assault would also fit under that category. 

    The kind of things that a person would need to receive a diagnosis of Post Traumatic Stress Disorder would be a couple of different categories. And the way that it works in the clinical manual that we all go by is that you must have a couple of symptoms from each category. The first is re-experiencing the trauma in some fashion. Typically this is through intrusive thoughts, the thoughts that pop into your head whether or not you're trying to think of what happened. You can re-experience the event through dreams. So when I'm doing clinical interviews, I'll ask about nightmares. Sometimes you have dissociative experiences. Those would be things like leaving your right back in the situation. It's occurring all around you. So that's your flashbacks. But you'd be looking for some type of re-experiencing of the trauma regularly. The next thing would be avoiding situations that remind you of whatever the traumatic experience is. So going out of your way to avoid places or people or exposure to anything that might trigger a memory of the traumatic event. 

    The third category is increased arousal. So that would be being overly vigilant to your immediate environment. A lot of times in clinical interviews, I'll ask if people feel uncomfortable with other people behind them. They sit with their backs to the wall in a restaurant. You know where the doors and exits are when you enter a situation. But you are very on guard for potential threats, potentially being hurt, and you experience extreme arousal to stimuli that remind you of whatever the situation is. But there's hyper-arousal, hyper vigilance. The next set of symptoms has to do with something called negative alterations and cognition. What that means is that you have negative thoughts about yourself. Typically it's guilt, feeling guilt for not doing something enough to help, for surviving the circumstance where other people have died. 

    Depressive kinds of symptoms also go along with that. But you must have that entire picture to have a full-blown diagnosis of Post Traumatic Stress Disorder. It can happen right away after the trauma, where there could be delayed expression, where it happens months or longer afterward.

2. Q: To be diagnosed with PTSD, specific symptoms must be present for 30 days or longer. True or False? 

Dr. Mark’s response: So the question is, what is the difference between an acute stress disorder and post-traumatic stress disorder? And the duration of symptoms involved? Actually would, according to the latest DSM, which is the statistical manual that psychiatric behavioral health professionals use to come up with diagnoses, an acute stress disorder is having symptoms that fit within the category of post-traumatic stress disorder that occur from three days to 30 days following trauma. If the symptoms persist for 30 days, it would then meet criteria for post-traumatic stress disorder. 

    Now, most post-traumatic stress disorders actually resolve within a couple of months. So it's the exception that people experience chronic symptoms of post-traumatic stress that are even more infrequent than just an acute stress disorder after a trauma happens. But post-traumatic stress symptoms can last months, years, sometimes much longer, often decreasing in severity over the course of time. So then we know in this situation that the PTSD diagnosis is 30 days or longer. However, what's really important is that the acute stress disorder, for many people who go through the kinds of traumas, like what you all are trained in and what you're working with, many people will have symptoms initially during what we call the acute phase. 

    And we know then that it doesn't mean that someone is sick or that they have the disorder. It simply means they're normal people who went through a really unusual event, and it stays around a little bit longer. The brain tries very quickly within any of us to integrate whatever the experience is, but for some people, it takes longer.

3. Q: A person experiencing symptoms of post-traumatic stress should only seek help if they're diagnosed with PTSD. So should you only go for help if you have PTSD or if you're having some of the stress associated with trauma? Would you also then seek help? True or false?

Dr. Mark’s response: The question is, when should people seek help when they're having symptoms of post-traumatic stress, whether it meets full criteria for post-traumatic stress disorder or not. And I can tell the majority of people who I actually see in practice and do evaluations with don't meet criteria for full post-traumatic stress disorder. In fact, I typically will give a diagnosis called other Specified Trauma and Stressor Related Disorder, which means you have some of the symptoms of traumatic stress, not the full-blown picture. So the label really doesn't matter as much as if symptoms are interfering in the quality of your life and your ability to do things that you need to do or interfering in other ways with you having a productive, meaningful life. So, yes, the person should definitely seek help if they feel that their symptoms are interfering with their ability to function in the way that they feel they should be functioning. And there are many interventions that can help with post-traumatic stress, and I'm assuming we'll get to that in other questions. But yes, a person should definitely seek help for anything that they think might be interfering with the quality of their life.

4. Q: Both medication and therapy may be prescribed as treatments for symptoms of post-traumatic stress or PTSD. True or False? 

Dr. Mark’s response: So the question is, what types of treatments exist for post-traumatic stress disorder or other stressor-related disorders? And I want to start out by talking about medications because I understand that there is some discomfort with people being able to pursue medications to treat symptoms of a psychiatric disorder, particularly post-traumatic stress disorder. Unfortunately, there is a stigma when discussing psychiatric medications versus other types of medications. In reality, the medications that are prescribed for post-traumatic stress disorder are no different from medication for any kind of chronic health condition that a person may have. High blood pressure, cholesterol, diabetes, type two diabetes. The kinds of medications that are typically prescribed for post-traumatic stress disorder help take the edge off some of the anxiety-related symptoms that interfere with life. 

    So there are medications, for example, anti-hypertensive medications, which may be prescribed for heart conditions that help a person with their nightmares or help a person be able to manage anxiety better. In addition to the traditional psychiatric medications like anti-depressants or anxiety-tics that are prescribed for post-traumatic stress, the most common medication prescribed in the United States today is an anti-depressant medication that's the most common class. So it's not that there's anything unusual or weird or strange about receiving medications that could help take the edge off. In addition to medications, though, the kinds of things that you would do in therapy for post-traumatic stress is increasing awareness of the type of thinking that you're engaging in when you're responding to situations that remind you of past trauma.

    So cognitive therapy is a really effective tool in addressing the negative alterations in cognition. So feelings of guilt and depressive symptoms go along with post-traumatic stress. The reason a person experiences stress is how we interpret what's going on around us. And people will respond differently to highly stressful situations based on whatever filter their brain brings to the situation. So if we're interpreting a high amount of threat or potential harm or loss in a situation and that exceeds our ability to cope with the situation the way that we're looking at it, we're going to experience a higher degree of stress. 

    Therapy can help create awareness of if my initial interpretation of what's going on is actually truthful, if there's the amount of risk that I believe there really is in a situation, or if I'm adding to the situation. Also, is the way I think about the situation helpful to me? Because a lot of times, people will focus on what they have absolutely no control over instead of focusing on things that can be productive and help them get through a situation. So therapy can really help with being able to manage symptoms of post-traumatic stress daily. You can also learn techniques to be able to improve emotional regulation and manage anxiety through lifestyle changes, meditation, relaxation, through other kinds of behavioral strategies that don't involve medication. 

    So there's an awful lot that can be done in treating post-traumatic stress disorder. It's not only medication, but I also want to advocate that medications are not a bad thing. They're a helpful tool in combination with other tools.

5. Q: Negative life experiences could predispose someone to PTSD. 

True or False? 

Dr. Mark’s response: So the question is, why would two people react differently to the same circumstance when developing symptoms of post-traumatic stress disorder? So I guess where I'd like to start is why do people generally experience stress. And if you think of it, it's like a mathematical equation. So it's how much perceived threat or harm is there versus what are your resources to be able to cope with the situation? And, of course, the other mediating factor is your interpretation of your brain of how you understand the situation. 

    So two people are going to have very different backgrounds and life experiences, which programs your brain to be able to respond to situations differently. If I believe that I've got the resiliency and resources to cope with the situation, I'm not going to be as affected as if I don't. Research on post-traumatic stress disorder shows there's a higher prevalence or incidence of post-traumatic stress disorder in individuals who have backgrounds where there has been significant life trauma, which may have predisposed a person to have a negative self-thinking, to look at the world as a potentially dangerous place. So, somebody who might come into a situation with those types of thinking patterns will be more likely to be more severely impacted by trauma. It's genetic. 

    So there's evidence that the incidence of post-traumatic stress disorder does run in biological relatives. So there's a relationship between life stress and genetic predisposition. Pre-existing anxiety disorders, and depressive disorders, also would contribute to a person having a more severe reaction to post-traumatic stress. 

    Often a person who has had a series of life traumas, whatever the event is, reinforces previous life traumas. So the experience that someone brings to a situation, their tendencies of how they interpret situations, and the resources they have to cope. So I know that one of the things that you guys do, which is wonderful, is you help people with very practical things in situations. Sometimes just having food, shelter, rest, and support is all person needs to be able to tip that scale and get through a situation that seems insurmountable. So really, that mathematical equation and kind of what's going on in a person's life before the event happens, as well as their biological makeup to genetic predisposition. So we know then that absolutely someone's life experience can have a lot to do with whether or not they develop PTSD and how trauma affects this period.