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  • Writer's pictureIbrahim Ismayilov

PTSD Avoidance, Intrusion, how to heal? The answer: Trauma Therapy

Years ago, someone was in a car accident on an icy road in Ontario and was deployed in combat in Iraq as a soldier. They witnessed death, rape and other atrocities, or their loved ones faded away from lung cancer. It’s also possible that a person was a refugee or a victim of domestic abuse, whose persecutors demolished his house, this was many years ago, when his parents were going through a nasty divorce during early childhood or adolescence? The child was often left unattended, cold and hungry? Time passed, and this person felt frustrated and depressed; he felt angry and in despair.

However, he thought things were getting better for him, and he resumed his daily activities, school and work. He felt that he was doing better after six months. But something changed. This person started avoiding going to the grocery store when it's hectic and now feels uneasy in crowds. He avoided certain people that reminded him of the past trauma. He felt shy meeting new friends and thought he was awkward around people. He thought he was just introverted and went on with life, missing out on meeting new friends, networking contacts and meeting his future life companion.

His sleep became disturbed. Sometimes he woke up, and his heart was beating fast, and it was difficult to go back to sleep. Every other night he had various nightmares. These nightmares did not seem relevant. However, the person felt tired after not sleeping well at night. These avoidances and intrusions are very simple and easy to miss. We get accustomed to living with them. They're essential to consider when we're dealing with PTSD. So how do we treat this condition that many people experience in their lifetime? Well, we have to start with the assessment of the condition first. Psychotherapists assess the client who went through "criterion a." Criterion a traumatic event that a person went through that was terrifying in nature, or they witnessed their loved one go through that event. It can be illness, threats, disputes, physical injury, or sexual assault.

We will look at the avoidance that a person engages in and how disturbed sleep is. It will include a thorough sleep assessment. Do you go back to sleep and wake up after half an hour of feeling miserable? Do you wake up in cold sweat after nightmares? Or are you simply feeling tired after sleeping nine hours without any obvious cause? We will administer psychometric tests to measure these intrusions and avoidances. Once we have established that someone has the symptoms of PTSD, we will offer a psychotherapy treatment plan. Often Psychotherapists who treat PTSD are referred to as trauma therapists. Trauma therapists typically provide one of several psychotherapy treatments, such as prolonged exposure therapy, cognitive processing therapy, EMDR, or cognitive behavioral therapy with an exposure component. but how do I go about choosing my trauma therapist?

Do you want someone who will understand you, who is passionable? I like to remain professional when providing trauma therapy.

However, I also understand that there is a need to relate to a client personally without crossing professional boundaries. I like to make clients feel at ease and be very personable with them to feel that I care about their experience and that I am available. If I needed a trauma therapist myself, I would like someone who is empathic. However, everyone is different, and some clients prefer a more formal medical approach. You want somebody specializing in trauma treatment and has a certificate attached to their name. This blog will consider the treatment called prolonged exposure therapy for PTSD. It's a very structured approach, where a Psychotherapist follows certain steps. In the initial treatment steps, the Psychotherapist will collect information about the specific trauma or traumas that the client went through in the past. The goal is to identify one index trauma.

This trauma will be most disturbing to the client. The more disturbing the trauma, the more effective the treatment can be if administered appropriately. Having identified the trauma, the therapist will move on to collect in vivo exposure items. These are the activities that the client used to enjoy in the past. However, they can no longer engage in them due to high anxiety and stress levels. We will use subjective units of the stress scale or SUDS to measure this avoidance to see how disturbing they are to a client. We want to make a list of 18 to 20 items if possible. However, we can also start with just five or six items. During the psychotherapy sessions, we will engage in imaginal exposure. Imaginal exposure involves a client causing their eyes, imagining that the trauma is happening again. And describing what is happening at the moment, specifically paying attention to sensations they were experiencing. The task itself will be disturbing, and the therapist will check in to see the disturbance levels at the time of recall. We will also ask the client to record the sessions and listen to them at home as part of the homework. Another type of homework will assign an in vivo exposure hierarchy. For this type of homework, we will start with the items that the client avoids that are not as disturbing. We will ask the clients to engage in these activities between the sessions, which are usually one week apart. With time, the SUDS levels will reduce. The client will engage in more tasks that they used to avoid in the past, the anxiety will lower as well. Once we break the vicious cycle, the client will feel less depressed and become more functional.

There is significant research behind this treatment methodology. It has been used widely with soldiers who have experienced combat trauma, sexual assault, victims of car accidents, and many other types of PTSD. The research shows that this method is effective and safe. The client will typically require 18 sessions, the other one and a half hours long. The psychotherapy sessions will not feel great at first. There will be some anxiety coming to the sessions, and your therapist can address these issues. However, it should get better with time, there will be hope for achieving the set goals.

Finally, the therapist needs to provide some documentation of the trauma assessment, the treatment progress, and what strategies worked for specific clients. We will often measure suds initially and then compare them as the treatment progresses throughout the 18 sessions. We will also measure PTSD with psychometric tests such as PCL-5 or a trauma inventory. At the end of the sessions, we will compare and see how the PTSD levels have reduced with treatment.

We offer prolonged exposure therapy for PTSD at our clinic, crocuscaresolution here in Ottawa both in person and virtually. We accept clients both in Ottawa and outside of Ottawa. We often get phone calls from the Toronto and GTA area and are always happy to help clients if it's a good fit.

Until we meet again, and for now, take good care of yourself and your loved ones.



Ibrahim Ismayilov, Registered Psychotherapist who learned these concepts in his clinical practice and taking a course in prolonged exposure therapy and reading book By (author) Edna Foa , Elizabeth A. Hembree , Barbara Olasov Rothbaum , Sheila Rauch

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