Tuesday, May 8, 2012

Spirituality and Post Traumatic Stress Disorder



Abstract
Post Traumatic Stress Disorder is classified as a normal response to an abnormal situation. The way a person handles a traumatic event is all based on their emotional, physical, and psychological well-being. Many might argue that the nurture role has a lot to do with how one handles a particular situation. The theory is if one is raised in a nurturing environment then the likelihood is that one can handle a traumatic situation better than those that have not. Mental affliction can affect those of any race, gender, or economic status. That is not to say that mental afflictions do not find a greater rate of susceptibility within different races, genders, and economic classes. There are various treatment methods in place for combating PTSD which ranges from cognitive-behavioral therapy to drug therapy that can aid in reducing co-morbid conditions that often come with PTSD.
Spirituality and Post Traumatic Stress Disorder
What many of us know now about Post Traumatic Stress disorder was brought to light in the men and women of our armed forces. The most well-known group of veterans that have suffered and have gone untreated for PTSD is those who returned from Vietnam in the 1970s. The numbers state that, “the involvement of the USA in the Vietnam War (1964–1975), during which 20% of combatants witnessed atrocities or abusive violence, provided further stimulus to study and led to the development of the concept of PTSD” (Newman, 2009, p. 31). From that point on, it became a well-known and widely diagnosed mental illness. Further explained, “post-traumatic stress disorder (PTSD) is the term given to a constellation of symptoms that can follow exposure to a traumatic event, and may cause clinically significant distress or harm in social, occupational, or other important areas of functioning” (Newman, 2009, p. 31). Many of the symptoms include, but are not limited to reliving the trauma, isolation and avoidance of anything that reminds the victim of the trauma. Each person will go through a traumatic experience with different results. There are those who are more susceptible to being diagnosed with PTSD and those who have a greater chance of making it through a traumatic experience with little lingering trauma. This research will further analyze a general understanding of PTSD as well as an understanding of spirituality, factors necessary for successfully coping with the effects of PTSD and spiritual and professional approaches to treatment.


Understanding PTSD and Spirituality’s Role

There are many things that the average person does not understand about PTSD just as there are many unknowns about other mental illnesses. This disorder was popularized by being attached to military members starting in World War II, but can also be present in many other people as well. Other occurrences range from rape victims to young children who are present during a traumatic experience. Estimates are that 1.5% of the general population is suffering from PTSD, though the numbers for sure are unknown because many sufferers go undiagnosed and untreated. The numbers that account for the police force, firefighters as well as other emergency service men and women total roughly 15% whereas 30% are war veterans and 50% of civilians are bomb survivors and ramp victims (McDonald, 2008, P. 31). Women are more likely than men to be diagnosed and suffer from PTSD due to the high rape numbers; nearly 1 out of 5 women are raped.


What many people likely know about PTSD is that it is the mental illness where the victim relives the traumatic event to the point where they believe that they are back in the situation. Hollywood has put their own spin on PTSD and though it is a positive that PTSD and other mental illness are getting recognition, many times they do not come with adequate facts or a true understanding of the stigmatization of mental illness in general. PTSD is a comorbid multi-dimensional disorder. Often sufferers are diagnosed with one or more disorders, which could include major depressive disorder, panic disorder, other anxiety disorders and substance abuse or dependency (Bisson, 2007, p. 400). Even those who have the best relationship with the Lord can find themselves taken in by PTSD after a traumatic experience. Those with previous disorders or substance abuse with little to no social or family support are easier prey to the symptoms of PTSD following a traumatic experience.


Similarly, the nature of the incident has a role to play in whether or not someone develops PTSD or has a greater risk of developing PTSD. For example, “rape, sexual abuse and other personal assaults were associated with a higher risk of PTSD compared to less personally traumatic events such as serious accidents” (Hapke et. al., 2006, p. 299). Analysis shows that the “prevalence” of anxiety and depressive disorders tend to be greater in women and that substance abuse has a tendency to be greater in men (p. 300). Bottom line tends to be that there are wounds that do not show on the outside. A soldier can come home unharmed physically but be hurting in his heart and soul. Just as a raped woman’s physical wounds can heal over time but her soul aches over the tragedy she never imagined would happen in her life time.


For a definition of PTSD, “the Manual of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), as well as the International Classification of Mental Diseases of the World Health Organization (ICD-10) define that a PTSD may follow a wide range of traumas experienced by individuals in war or in civil life” (p. 300). The difference in personality, genetic make-up, as well as environment all creates a “definition” of what a “traumatic event” really is to an individual. True, rape is rape, a horrific event and war is war, a horrific place to be, but how each person handles these traumatic events is key to the likelihood that PTSD will develop. How one views their relationship to God also helps with finding hope and facilitates resiliency. In particular, regarding our service members, “the reality, also, is that wounds of the heart, soul, and spirit are not addressed adequately by government services. Despite the valiant efforts of chaplains and many organizations and the commitment of billions of dollars, there remains a serious gap – the faith and hope gap” (Dees, 2008, p. 2). Spiritualty fosters a belief in something greater than our world can offer. The belief that God is a just, loving and caring father assists in fending off maladaptive thoughts that could make it difficult to treat and assist those who suffer from PTSD.


Factors necessary for successfully coping with the effects of PTSD
Hope is one of the most important factors that any client with PTSD could have in order to work through and possibly overcome the mental illness. Creating an atmosphere of hope will assist in tackling maladaptive thoughts which include negative thoughts about one’s self as well as the role the victim played in the traumatic experience. For instance, a soldier will often wonder why it was they who survived after fellow soldier has died and will often blame themselves for not being able to save a friend and fellow soldier. Similarly, a woman who is raped will create maladaptive thoughts that could possibly overcome her as she begins to feel her worth as a woman slip away. Hope can facilitate an environment of trust where a victim can begin to open up and share all fears and eventually, hope for what the future could hold.


Another important factor is social support and an identity of self. Research shows, “from a systems perspective, social support has been identified as a key resource in the environment leading to improved mental health and other positive physical outcomes” (Galek, 2011, p. 638). Those with PTSD have a tendency to fall into a world of seclusion because of fear. Fear that their symptoms are going to overcome them at any moment, leaving them vulnerable and perhaps frighten their loved ones. Worse yet, their maladaptive thoughts could create feelings that “I don’t deserve love” or “no one understands what has happened, so why bother trying to share”. With a strong family or friend support system, a victim has a greater chance of coming to terms with maladaptive thoughts, as well as treating the symptoms of PTSD. Though the professional assistance of a counselor or psychologist is always recommended, the ability to confide in someone and share the traumatic experience and the flood of feelings and fears can go a long way in recovery. A family and friend base is built in, if a positive environment is established from an early age; secure attachment to parents is necessary in order for a child to be able to confide in parents. However, a family or friend support does not guarantee success in treating PTSD; it goes a long way in assisting.


Another important factor is a faith base of an individual, “generally, research has found that people who believe God loves, caring, forgiving, and approving have higher self-esteem (Benson and Spilka 1973; Francis et al. 2001) positive mood (Levin 2002), and life satisfaction (Kirkpatrick and Shaver 1992)” (Flannelly et. al., 2010, p. 248). Such as predictive factors could show who is more susceptible to developing PTSD, faith based beliefs could be a predictor of how those who develop PTSD work through their mental illness. The continued research also continues to show that those who belief the opposite of God, that He has abandoned them or is punishing them has lower self-esteem, greater likelihood of depressive moods as well as lower quality of life (p. 248). This type of belief in God or maladaptive thought could prove difficult in treating PTSD. Certainly this thinking does not mean that PTSD could not be treated but the road to creating a hopeful and a trusting environment will need to begin from far different areas than those who believe that God is trusting and loving. Studies have shown that “indeed, some see God not only as Approving and Forgiving, but as a personal cheer-leader in their struggle to deal with a variety of social situations” (p. 255-256). Those with PTSD can view God as someone who is always in their corner even if they do lack the social support that others may have.

Spiritual and professional approaches to treatment


Doctor David Jenkins, psychologist and professor mentions three treatment principles of treating PTSD in his video lecture: “address symptoms and co-morbid conditions, improve adaptive functioning and return client to a state of safety and trust, limit generalization of initial trauma and protect against relapse”. Treating those who suffer from PTSD can be a taxing road to go down. The decision to treat someone with PTSD has to be a solid from the very beginning. Once a counselor or psychologist begins treating someone with PTSD they need to make a firm commitment, which is very important for creating an honest, hopeful and trusting environment. Three treatment domains per Dr. Jenkins for treatment include exposure, cognitive-behavioral strategies and medical. Another option for treatment, which can be paired with other treatments, includes a holistic or spiritual method of treatment.


Faith based healing can be helpful as “previous studies have associated positive spiritual coping with fewer symptoms of psychological distress” (Meisenhelder & Marcum, 2009, p. 47). As previously stated, spirituality can be a key factor in treating PTSD because of the security people feel when they believe the Lord is a loving and caring God. “Studies on posttraumatic stress support the positive impact of prayer, religious beliefs, and meaning on lowering stress and depression in both victims and those experiencing secondary posttraumatic stress” (p. 47). Spiritual coping can be done in various methods such as prayer, faith community (attending church) as well as with significant others. Major General (Retired) Bob Dees, US Army Executive Director, Military Ministry a Division of Campus Crusade for Christ International appropriately cities the word of God through David, who appeared to have suffered from PTSD himself lamenting in Psalm 55:4-5 (NASB) “My heart is in anguish within me, and the terrors of death have fallen upon me. Fear and trembling come upon me, and horror has overwhelmed me.” Dees continues stating: “and we read about David’s trust in God for his ultimate healing” (Dees, 2008, p. 2). Additionally, Psalm 55:18 reads “He will redeem my soul in peace from the battle which is against me.” What Dees is trying to express is that the belief in God, in order to treat PTSD, is as important today as it was in David’s age. The love of the Lord is timeless and helped thousands of years ago and for years to come. Dees explains that there is a hope and faith gap and that “for Christians, addressing this gap starts with the premise that God is the true healer and that Jesus Christ is the avenue to experience true recovery from the ravages of combat trauma, particularly those visited on the mind and emotions” (p. 2). Military Ministries hope to help combat related PTSD by assisting chaplains as well as commanders in facilitating the spiritual well-being of their troops and families. This training is conducted at boot camps, operations locations, on ROTC and academy campuses as well as other various locations. The truth of the matter is, PTSD does not only affect those in combat related trauma’s but in other areas of civilization and life as well such as in cases of rape or other extreme traumatic experiences. As a Christian counselor, one can offer the hope of the Lord through direct means (i.e. direct speak of God) if the client is comfortable doing so or through their actions. One never knows where a PTSD sufferer is in their relationship or belief in God lies, so careful attention is going to be important. Mathew 19:26 (New International Versions) reads: “Jesus looked at them and said, "With man this is impossible, but with God all things are possible." Without a doubt, through any treatment option, through God will treatment be possible.


Other treatment options include one of the most popular Cognitive-Behavioral approaches which is used to correct maladaptive thinking. Dr. Jenkins cites some maladaptive thoughts to be, protection and risk is not under my control, the world is dangerous and unpredictable or the self is inadequate, incapable, and unworthy” CBT has the most empirical support as a useful means of psychologically treating PTSD. Further research has shown that “studies of psychological treatment have demonstrated prolonged exposure and cognitive therapies to be equally beneficial, whereas eye movement desensitization and reprocessing may be useful but perhaps less effective in the long term” (Creamer & O’ Donnell, 2002, p. 163). Other treatment options include Pharmacotherapy, which is the use of drugs to treat symptoms of PTSD but should be used in conjunction with counseling whether in a group setting or personal setting. Furthermore, drugs may be used to “treat co-morbid conditions, such as depression, which may interfere with the treatment of core PTSD symptoms” (p. 165).


Some treatments take a more holistic approach to treating PTSD though not necessarily spiritual in nature to Christian beliefs, approaches such as using a Mantra. This type of program used “a spiritually based group intervention that teaches a series of focusing strategies using mantram repetition, slowing down, and one-pointed attention” (Borrman et. al., 2008, p. 109). These were often completed within a group setting. Though veterans from the Korean War and Vietnam War era were receptive and found it useful, there was difficulty recruiting those from recent wars. “Reasons for this may have been because of (a) daytime hours of our groups that conflicted with employee or school scheduling, (b) fears of stigma related to mental illness or a PTSD diagnosis, and/or (c) having less time because of family and children responsibilities” (p. 114).

Conclusion

PTSD is a treatable and preventable mental illness. Though we cannot stop the likelihood of a traumatic event occurring, we can work with those of our armed services to prepare them for the road ahead and the trauma one might see while on duty. In addition, we can work with the civilian world to facilitate an understanding of what the symptoms of PTSD look like in those of traumatic experiences including rape victims. Only with better understanding of mental illness, in general, and real world symptoms, can we begin to help those heal with PTSD. Training for family members or pamphlets to hand out at time of crisis would be pertinent in treating PTSD as well as psychological first aid available after trauma. The overall importance is that each treatment can be dual in treatment because the love of the Lord can heal many nations and many hearts.


References (text is not in proper APA structure)


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intervention for combat veterans with posttraumatic stress disorder: Feasibility study.
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Creamer, M., O’Donnell, M. (2002). Post-traumatic stress disorder. Current Opinion in
Psychiatry, 15, 163-168.

Dees, B. (2008). Spiritual solutions for combat trauma. Military Ministry, 1-4

Flannelly, K., Galek, K., Ellison, C. & Koening, H. (2010). Beliefs about god, psychiatric
symptoms, and evolutionary psychiatry. Journal of Religion and Health, 49, 246-261.
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Galek, K., Flannelly, K., Greene, P. & Kudler, T. (2011). Burnout, secondary traumatic stress,
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Hapke, U., Schumann, A., Rumpf, H., John, U. & Meyer, C. (2006). Post-traumatic stress
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Liberty. (n.d.). Treatment protocols [Video File]. Retrieved from http://www.liberty.edu/

MacDonald, P. (2008). Post-traumatic stress disorder. Practice Nurse, 35 (9), 31-33.

Meisenhelder, J., Marcum, J. (2009). Terrorism, post-traumatic stress, coping strategies, and
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Newman, M. (2009). Post-traumatic stress disorder. Broader Horizons, 28 (1), 31-33.
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Work created for Cris 304: Post Traumatic Stress Disorder and Combat Related Trauma through Liberty University



Where Have the Years Gone

Snoopy Rock in Sedona, AZ

It has been 2 years, 5 months, 23 days since my husband has been Honorable discharged from the Army. Where has the time gone, it seem like just yesterday that I saw him in his "Pickle Suit" (his words, not mine). I am nearing the end of my Bachelor's degree school work and recently found a great place that I am hoping to get in to for my internship, Army Strong Community Center. Currently I am studying PTSD and combat training, which means that I am going through a lot of information on military family and life. Along with a military event through my work, I am brought right back into that mind set, if I dare say I ever lost it.

The last few months has been rather hectic. The husband return from Arizona, where he spent 17 months in school. The last four months has been a challenge to say the least. In November Michael was in a motorcycle accident (Miracle) and survived then on his way home he was in another accident (another miracle) with his 78' pick-up truck and our RV (don't get me started on this situation). All in all he was able to get a job, which unfortunaly puts him out of the house quite often and all around the state, but such is life. We are now struggling to find the balance between home life, work life, and school life for myself and our two beautiful children. I am hoping to chronicle my life as a wife, mother, and student. I am just about done with my last two courses before the big "internship" and then degree. Thereafter, another several years before I earn my masters degree then a few more until I reach my Ph D. stay tuned....