Post Traumatic Stress Disorder (PTSD)

11th of September 2001 (9/11) was a day of terror. The whole world was shocked on this very day when two hijacked airplane crashed into the World Trade Center (WTC), and wreaked havoc. As the WTC was collapsing, blocks and chunks of concrete fell like missiles showering down from the sky. Panic stricken people were seen jumping off the building to escape and landing dead on the ground. The crowds on the street scattered and ran for their lives in torrents. Within an hour or two, WTC was brought to the ground, and lower Manhattan was covered in debris. The scene was horrifying.

Thousands of people died that day. As for the survivors, cleanup and rescue workers who were exposed to the hazardous dust cloud at the scene, most of them suffered permanent health complications. However, what lays subtle is their mental well being after the traumatic experience. Probable psychiatric disorders that could arise are post traumatic stress disorder (PTSD), major depressive disorder and panic disorder (Stellman et al, 2008). In addition, one of the most enduring health consequences of 9/11 attacks is proven to be PTSD (Bio-medicine, 2009). In fact, the symptoms of PTSD can last as long as five or six years after the incident (Bio-medicine, 2009).

In general, PTSD is “an anxiety disorder that some people get after seeing or living through dangerous event” (National Institute of Mental Health, 2009).

Symptoms
Three categories of symptoms categorize PTSD

1. Reexperiencing the traumatic event
• distressing memories of the event
• distress dreams about the event
• reliving of the event by acting or feeling as if the event were recurring
• intense psychological and physiological distress when exposed to situations reminiscent of the event
2. Emotional numbing and detachment
• avoidance of thoughts, feelings, or conversations about the event
• avoidance of activities, places or people associated with the event
• trouble recalling important aspects of the event
• loss of interest in activities
• feelings of detachment from others
• inability to have loving feelings toward others and a general restriction of feelings
• sense that the future is bleak
3. Hypervigilance and chronic arousal
• difficulty falling or staying asleep
• irritability or outbursts of anger
• difficulty concentrating
• hypervigilance (means: abnormal increase in arousal, responsiveness or awareness)
  
• exaggerated startle response

Common Causes

According to DSM-IV-TR, Post Traumatic Stress Disorder (PTSD) occurs when someone had experienced, witnessed, or had been confronted with traumatic events (Nolen-Hoeksema, 2004). There are four types of events that commonly cause PTSD: natural disasters, abuse, combat, and war-related traumas (Nolen-Hoeksema, 2004).

Survivors of natural disasters such as earthquakes, hurricanes, tornadoes and tsunamis are highly susceptible to PTSD (Nolen-Hoeksema, 2004). All of a sudden, there are too many losses to cope with when a natural disaster strikes, such as shelter and family, threatening their safety and security (Nolen-Hoeksema, 2004). Victims of abuse may have prolonged PTSD as well (Nolen-Hoeksema, 2004). They might be victims of physical abuse which occurs frequently in battering relationship, sexual abuse of rape and incest, and emotional abuse which may happen when someone is continuously ridiculed (Nolen-Hoeksema, 2004). People who have fought in war or those who were taken as prisoners of war are prone to PTSD (Nolen-Hoeksema, 2004). “Combat fatigue syndrome”, “war zone stress”, and “shell shock” are well-documented cases faced by the soldier and prisoners of the two world wars as well as the Korean War (Nolen-Hoeksema, 2004). When something threatens our personal safety and security, it is likely that it will cause PTSD as well (Nolen-Hoeksema, 2004). When people are taken as hostage, being tortured or forced to be relocated, they will feel the constant fear in them, causing them to have prolonged distress (Nolen-Hoeksema, 2004).

PTSD Vulnerability

Why are some people more prone to suffering from PTSD than others? The answers to their vulnerability to PTSD lie within their social factors, psychological factors and biological factors (Nolen-Hoeksema, 2004). Victims of a particular traumatic event may suffer from different severity of PTSD (Nolen-Hoeksema, 2004). To what extent did the traumatic event impact the life of the victim (severity), how long did the victim undergo the unsettling situation (duration), and how close was the victim with the causes or losses in the distressing incident (proximity) (Nolen-Hoeksema, 2004)? Who is more likely to suffer more? A victim who lost his family and home? Or one that is mildly shocked? Apart from that, victims are more capable in healing process when there are continuous support from others, a channel to talk out their problems and a place to pour out their emotions (Nolen-Hoeksema, 2004). Various mental health programs were developed by World Health Organization (WHO), Japan International Coorperation Agency (JICA) focusing on social support (WHO, 2005; JICA, 2005).

Psychological factors play an important role in determining a person’s susceptibility to PTSD(Nolen-Hoeksema, 2004). According to Nolen-Hoeksema (2004), people who believe in shattered assumptions are more prone towards suffering from PTSD. These unrealistic believes are hindering them from thinking and reasoning logically, hence fall prey into faulty pattern of thoughts (Nolen-Hoeksema, 2004). The three assumptions brought up by Nolen-Hoeksema (2004) were "personal invulnerability", "just world believe" and "bad things won't happen to good people". People who think that they are invulnerable believe that serious incidents like natural disasters or accidents would not happen on them, thus have a lower expectency and psychological preparation traumatizing events(Nolen-Hoeksema, 2004). Therefore, when they were really involved in such situations, they would be shocked and would not know how to react (Nolen-Hoeksema, 2004). Another group of people believe that "the world is meaningful and just", so, "things happen for a good reason" (Nolen-Hoeksema, 2004). Hence when dreadful things happen to them, they will engage into self-blame - another faulty pattern of thoughts (Nolen-Hoeksema, 2004). Traumatic event brings about a lot of distress to the victims. Hence, for people with pre-existing distress, a sudden misfortune may increase the misery, causing the victim to be more vulnerable to PTSD (Nolen-Hoeksema, 2004). Personal coping style is also a determinant for individual vulnerability in PTSD (Nolen-Hoeksema, 2004). There were three types of coping styles that were discussed by Nolen-Hoeksema (2004), ruminative, dissociation and making sense coping style (Nolen-Hoeksema, 2004). To ruminate is to question or think over and over again. Unlike making sense, ruminating over a fear or unsettling event without reasoning will only augment the negative effect of the incident (Nolen-Hoeksema, 2004). While some people keeps thinking over the event, others avoid thinking about it by all means, including avoiding things that reminds them of the traumatic event (Nolen-Hoeksema, 2004). As a result, there will be rebound effect, where troubling memories will haunt them (Nolen-Hoeksema, 2004).

Biological factors plays an important role in determining an individual's vulnerability to PTSD as well (Nolen-Hoeksema, 2004). Twin studies have shown that genetics maybe a cause for individual differences in their susceptibility to PTSD.

Treatments for PTSD
Cognitive-Behavioral Therapy (CBT)
The goals for CBT is to challenge distorted thoughts and extinguish them. There are two techniques used in CBT, systematic desensitization and imaginal flooding. Systematic desensitizaton starts with less painful thoughts of the trauma, then slowly work up to more painful memories (Nolen-Hoeksema, 2004). Whereas in imaginal flooding technique, the anxiety-provoking scenes need to be identified at the beginning, then the survivor will be asked to recall specific details from the scene, allowing them to relive the trauma slowly and carefully to have better understanding of what the event mean to them (Nolen-Hoeksema, 2004).

Stress Management
In the thought-stopping technique, individuals were taught to extinguish negative thought patterns by snapping a rubber band around their wrist (Nolen-Hoeksema, 2004). After which the intrusive thoughts have been ceased, individuals can replace negative emotions with a positive memory of some other event to elicit pleasurable feeling (Nolen-Hoeksema, 2004). Various relaxation technique is also thought when dealing with people who suffers from PTSD, such as breathing and muscle tensing.

Biological Treatments
Various medication can be prescribed to reduce the symptoms of PTSD, so that they can live through daily lives easier, such as anti-depressants, anti-anxiety and anticonvulsants (Halgin & Whitbourne, 2008).

Sociocultural Perspective
When dealing with people who suffer from PTSD, it is important to take note of cross-cultural issues, because they may have different standard of values and beliefs (Nolen-Hoeksema, 2004). Besides, community level interventions can serve as a platform to the survivors where they can provide social support to one another.



References
Bio-medicine. (2009). For many, 9/11-linked trauma emerged years later. Retrieved August 13, 2009 from the World Wide Web: http://www.bio-medicine.org/medicine-news-1/For-Many--9-11-Linked-Trauma-Emerged-Years-Later-53661-1/.
JICA, 2005. News from the Field: Emergency Rehabilitation and Reconstruction Support Following the Major Earthquake Off the Coast of Sumatra and Tsunami in the Indian Ocean. Retrieved August 28, 2009 from the World Wide Web: http://www.jica.go.jp/english/news/field/archive/2005/sumatra/indonesia_3.html
Halgin, R. P. & Whitbourne, S. K. (2008). Abnormal Psychology: Clinical Perspectives on Psychological Disorders. 5th Ed. New York: McGraw Hill.
National Institute of Mental Health. (2009). What is post-traumatic stress disorder, or PTSD. Retrieved July 10, 2009 from the World Wide Web: http://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-ptsd/what-is-post-traumatic-stress-disorder-or-ptsd.shtml
Nolen-Hoeksema, S. (2004). Abnormal Psychology. New York: McGraw Hill.
Stellman, M. J., Smith, R. P., Katz, C. L., Sharma, V., Charney, D. S., Herbert, R., Moline, J., Luft, B. J., Markowitz, S., Udasin, I., Harrison, D., Baron, S., Landrigan, P. J., Levin, S. M. & Southwick, S. (2008). Enduring mental health morbidity and social function impairment in World Trade Center rescue, recovery, and cleanup worker: the psychological dimension of an environmental health disaster. Environmental Health Perspectives, 116, 1248-1253. Retrieved July 29, 2009 from EBSCO database.
WHO, 2005. WHO Recommendations for Mental Health in Aceh. Retrieved August 28, 2009 from the World Wide Web: http://www.who.or.id/eng/contents/aceh/WHO_Recommendations_Mental_Health_Aceh.pdf

Optimism

Do You See the Donut or the Hole?

Optimism is the personality trait where people expect good things to happen (Burger, 2007). It helps to improve both physical and mental health in a few ways:

1. Optimism is linked to positive health

o Optimists had lower levels of Cortisol (Stress hormone), which contributes to heart attacks and stroke (Ardell, 2008).

o Optimists catch fewer contagious diseases because they have a stronger body immune system than pessimists (Ardell, 2008).

o Optimists are also less likely to have high blood pressure, diabetes or smoke cigarettes (Ellis, 2009).

o In a 30 years longitudinal study, 2,300 older adults’ physical and mental healths were measured and tracked. This study supported that optimistic people showed substantial health and life quality benefits (Ardell, 2008).

2. Optimism improves speed of recovering from medical procedures.

o A four-year study involving 616 adult males showed optimism facilitated recovery from heart surgery (Ardell, 2008).

o In another study, optimistic woman who had breast cancer surgery showed better adjustments compared to pessimistic woman (Burger, 2007).

3. Optimistic is linked to resilience.

o Optimists are more likely to take constructive action compared to pessimist when both of the group is in an out-of-control situation (Mills & Dombeck, 2005).

o They believe that bad situations will become better and are motivated to change the situation. For example, they are more likely to seek health advice early (Mills & Dombeck, 2005).

o They also tend to solve the problem before it is getting worse, so they usually end up having to solve fewer tough life problems compared to pessimists (Mills & Dombeck, 2005).

4. Optimists live a longer life.

o Researchers at the University of Pittsburgh reviewed questionnaires that surveyed the personality traits of more than 100,000 women aged 50 and over. They tracked the women’s rates of death and chronic health conditions for an average of eight years. Optimistic were 14 percent less likely to die from any cause and 30 percent less likely to die from heart disease compared to pessimists (Ellis, 2009).

5. Optimism improves people’s ability to develop friendship and supportive relationships

o Optimists think that people like them; thus, they are more likely to develop friendship with people. Having social supports helps reduce people's risk for illness, particularly the recurrence of chronic disorders (Mills & Dombeck, 2005).



References
Ardell, D.B. (2008). A Wellness Take on Optimism. Retrieved September 2, 2009
from EBSCO database.
Burger, J.M. (2007). Personality. USA: Wadsworth.
Ellis, M. (2009). Optimism may have life-extending benefits. Retrieved September 2, 2009
from the World Wide Web: http://www.healthnews.com/family-health/mental-health
/optimism-may-have-life-extending-benefits-2762.html
Mills, H & Dombeck, M. (2005). Resilience: Optimism. Retrieved September 2, 2009 from
the World Wide Web: http://www.mentalhelp.net/poc/view_doc.php?type=doc&
id=5789&cn=298


Get Happy: Ways to be more OPTIMISTICS in Life!!!

A true optimist will deal with the rough spots and move on.

“Expect the best, prepare for the worst, and celebrate it all.”

---Willie Jolley
(Author of A Setback is a Setup for a Comeback)

Here are the ways to make your world brighter:
(a) Live by the one-day principle

~ Live everyday as if it were your last.
~ Let go of the past, stop worrying of the future & make this one day your best.
~ “The only day you have is the day you wake up”

–Tom Bay
(Author of Look Within or Do Without)

(b) Pay Attention to your personal needs

~Put yourself at the top
~ Take care of yourself first and you’ll have plenty of enthusiasm, energy & optimism to give others.


(c) Let go of things that drain your energy

~ “As we lose ourselves and get more busy, we often lose our optimism”

--Shirley Garrett,
(A professional speaker, writer and facilitator in Georgia)

(d) Feed your mind with positive thoughts

~ Quit watching news that always bring you down
~ Read a book that makes you feel good. See a movie.

(e) Chase rainbows

~ Listen to your dream and go after them.




(f) Keep a feel-good journal

~ Buy a blank journal and fill it with things that make you smile.
~ Stick only positive things in your journal and open it up whenever you’re feeling down.

(g) Laugh

~ There’s a reason we always feel great after a good laugh.
~ When you laugh, Endorphins rush through your body like a burst of happy energy.

(h) Enjoy the simple things


(i) Indulge your passions