Wednesday, October 16, 2013

Acute Stress Disorder and Posttraumatic Stress Disorder


Whereas traumatic stress in acute stress disorder (ASD) persists for at least two days to four weeks, the stress associated with post traumatic stress disorder (PTSD) is longer term and the repercussions from the trauma are ongoing and become chronic (Laureate Education, Inc., 2012). The symptoms of ASD and PTSD are similar in that the experiences of the incident or event are frightening or fear inducing. The primary difference between these two stress disorders is the biological component of PTSD and the sequelae associated with the trauma, specifically the dysfunction of the HPA axis stress response, an overactive amygdala, and the reduction in size of the hippocampus (Laureate Education, Inc., 2012). The ramifications of these brain changes are dysruptions in the normal functioning of emotions and memory, incapacitating stress, the chronic revisiting of the stressful event(s).

Potential PTSD Symptoms in Military Health Worker

Although an abundance of contemporary research exists on PTSD, there is a paucity of research on the post traumatic stress of military healthcare professionals (Akbayrak et al., 2006; Gibbons, Hickling, & Watts, 2012; Ikin, 2004). Military health workers are as apt to experience psychological trauma as anyone in any other occupation (Akbayrak et al., 2005). Kolkow (2007) found that up to 9% of military health workers fill the criteria for PTSD. Biological changes in the brain can cause these workers to continue to recall the memories of their experiences inaccurately, recalling the stress and trauma of the death of many individuals, rather than the helping element of their role in the military. The potential exists for them to consider medical professionals as ineffectual in their roles as doctors and nurses because of the skewed perception of their own distressing experiences (Akbayrak et al., 2005).

Female nurses working in the Vietnam war experienced a chronic ongoing danger to themselves because of ongoing attacks and explosions close by to where they worked (Gibbons, Hickling, & Watts, 2012). A common experience for military health workers with PTSD is to feel unsafe even in safe circumstances, and to feel the constant pressure of threat to one's personal safety (Kolkow, 2007). Protective for this group of nurses working in Vietnam was social support, having a sense of purpose, and keeping a positive outlook (Gibbons et al., 2012). Another symptom of nurses was a general sense of inadequacy from being on the frontlines of disaster without effective means to mediate the needs of their patients (Akbayrak et al., 2005). Because the female gender experiences a higher rate of the symptoms associated with post traumatic stress, these feelings may be gender specific (Akbayrak et al., 2005).

Whatever the trauma, and whoever experiences it, the ramifications of these experiences should be taken seriously despite whether the individual fills the criteria of PTSD (Akbayrak et al., 2005). Experiences post trauma can cause a range of psychological and social problems (Akbayrak et al., 2005). Biological ramifications of trauma include permanent biological alterations in the brain (Laureate Education, Inc., 2012). It may not be unreasonable to believe that traumas that may not cause a diagnosable case of PTSD, can cause damage, and should be attended.

Effective Intervention Techniques

Joseph (2004) found incidences of post-traumatic growth, however, for many individuals, the effects of traumatic events after the fact can cause chronic symptoms (Laureate Education, Inc., 2012). Proactive interventions such as self-care and social support groups have been proven effective for female military personnel in health care positions, although in these circumstances, women seem to be more resilient than men (Gibbons et al., 2012).

It may be effective to teach military personnel about PTSD, and teach them techniques to manage stress and anxiety (Hourani, Council, Hubal, & Strange, 2011). Coping skills training may be effective for military personnel and has been successful in secular populations. Psychoeducation, for example, providing information on psychological symptoms experienced after traumatic events, may encourage these workers to seek help, rather than to remain reticent about stress, depression, and chronic feelings of fear, which are common experiences in PTSD (Hourani et al., 2011). However, there is a paucity of research on psychoeducational interventions and little empirical evidence that it is helpful overall in encouraging military personnel to seek help (Hourani et al., 2011).

Stress inoculation training (SIT) has been effective when implemented during pre- and post-deployment. SIT has been effective for reducing stress and increasing coping skills in military personnel by preparing them psychologically and fostering resilience against the stress of wartime (Houdini et al., 2011). In addition, developing peer and social support systems prior to deployment may be as effective as it was for nurses in Vietnam (Gibbons et al., 2012). For example, creating a buddy system or small groups of workers who meet for the sole purpose of discussing stress and the trauma of war settings may create a valuable social support system.

References

Akbayrak, N., Oflaz, F., Aslan, O., Ozcan, C., Tastan, S., & Ci├žek, H. (2005). Post-traumatic stress disorder symptoms among military health professionals in Turkey. Military Medicine, 170(2), 125-129.

Dougall, A. L., & Swanson, J. N. (2011). Physical health outcomes of trauma. In R. J. Contrada & A. Baum (Eds.), The handbook of stress science: Biology, psychology, and health (pp. 373–384). New York, NY: Springer Publishing Company.

Gibbons, S. W., Hickling, E. J., & Watts, D. D. (2012). Combat stressors and post-traumatic stress in deployed military healthcare professionals: an integrative review. Journal Of Advanced Nursing, 68(1), 3-21. doi:10.1111/j.1365-2648.2011.05708.x

Hourani, L. L., Council, C. L., Hubal, R. C., & Strange, L. B. (2011). Approaches to the primary prevention of posttraumatic stress disorder in the military: A review of the stress control literature. Military Medicine, 176(7), 721–730.

Ikin, J. F. (2004). War-related psychological stressors and risk of psychological disorders in Australian veterans of the 1991 Gulf War. The British Journal of Psychiatry, 185(2), 116-126. doi: 10.1192/bjp.185.2.116

Joseph, S. (2004). Client-centered psychotherapy, post-traumatic stress, and post-traumatic growth: theoretical perspectives and practical implications. Psychology and Psychotherapy: Theory, Research and Practice. 77(1), 101-119.

Kolkow, T., Spira, J., Morse, J., & Grieger, T. (2007). Post-traumatic stress disorder and depression in health care providers returning from deployment to Iraq and Afghanistan. Military Medicine, 172(5), 451-455.

McCauley, M., Hughes, J., & Liebling-Kalifani, H. (2010). Wellbeing of military mental health staff. Mental Health Practice, 14(4), 14-19.

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