7.7 million Americans over the age of 18 have post-traumatic stress disorder, which can occur after a person has experienced or witnessed a traumatic event.
Dr. Ciara Stigen, clinical psychologist with Courage Kenny Rehabilitation Associates in Coon Rapids, talks today about PTSD, who it affects, how to recognize it, and steps toward healing.
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Do You or a Loved One Suffer From Post-Traumatic Stress Disorder
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Learn more about Ciara Stigen, PhD
Ciara Stigen, PhD, LP clinical psychologist
Ciara Stigen, PhD, LP, is a psychologist with Courage Kenny Rehabilitation Associates in Coon Rapids. Her clinical practice focuses on cognitive-behavioral approaches to help patients recover from mood and anxiety disorders, trauma (including post-traumatic stress disorder), address emotional and interpersonal issues, and build resilience and mindfulness.Learn more about Ciara Stigen, PhD
Transcription:
Do You or a Loved One Suffer From Post-Traumatic Stress Disorder
Melanie Cole (Host): More than 7 million Americans over the age of 18 have Post-Traumatic Stress Disorder which can often occur after a person has experienced or witnessed a traumatic event. My guest today is Dr. Ciara Stigen. She's a clinical psychologist with Courage Kenny Rehabilitation Associates in Coon Rapids. Welcome to the show, Dr. Stigen. What is PTSD? People think of it as only for people who have served in the military, but that's not always the case, is it?
Dr. Ciara Stigen (Guest): Definitely not. Thank you so much for having me on today. When I describe PTSD with patients that I work with, I like to describe it as an interruption in the normal process of recovery from a traumatic event. And so, a good place to start is to say that lots of different events can be considered traumatic ranging from relatively small in scope to relatively major in scope, the main piece that would indicate something is traumatic is how much it tends to affect their worldview or their general sense of how the world works and how people work; that sort of thing. So, when their world view has been fundamentally altered in some way by an event that has happened to them, they tend to do things like avoid reminders of that event and you do this in a long enough time and in enough ways that life starts to get very small, the distress rises, and then we might be looking at calling it “PTSD”. Certainly not limited to things like combat or war zones, the two main events that lead to the development of PTSD are combat, but also sexual assault and that can include an even broader array of things including car accidents, natural disasters, sudden death of loved ones, that sort of thing.
Melanie: Are there certain people that are more predisposed to being able to, if they've had a traumatic event, to being somebody who has more trouble dealing with that event or who has these recurring nightmares about it? Is there something that predisposes you to that?
Dr. Stigen: That right there is essential the million-dollar question in clinical research on PTSD. So, we have some ideas in terms of sort of the risk factors for PTSD, but this is definitely an open question. Things that up the likelihood that someone may deal with PTSD versus bounce back with less issues would be certainly having a history of mental illness; the degree of physical injury is another aspect, if you are physically harmed by the trauma as well, that makes it more likely that something like PTSD could arise. The amount of social support that you have got in your immediate circle has a big protective effect for not getting PTSD, and then, lastly other things in your life that, you know, may complicate the picture, like if you lose your job as a result of the trauma, that also can up the risk for developing PTSD. Yeah, I mean, there are just lots of different things that probably play into it and it's a pretty complex interaction between the event itself and the characteristics and the coping abilities of the individual who goes through that event.
Melanie: And, what about the family members of a victim? If somebody was in the military and they saw some horrific things, or a woman was sexually assaulted and the families can experience this feeling as well, too, correct?
Dr. Stigen: Well, I think it's extremely common in the work that I have done, but also in the literature, to see pretty major emotional impacts on the family members and people who interact closely with someone who maybe is the experiencer of the PTSD themself. Certainly, we can have a lot of relationship difficulties that stem from PTSD very much related to that change in thinking and that change in behavior related to the PTSD thinking itself.
Melanie: So, how do you distinguish between an actual diagnosis of PTSD versus anxiety, major depression, clinical depression; any of those?
Dr. Stigen: Sure. So, that's essentially the task of the clinician when we first are having the session or two to get started is because there is such a strong overlap in terms of some of these symptoms that they may arise simply because of depression or anxiety on its own, but there are also major mood and emotional pieces of the PTSD picture. So, one of the first things that we will do is look at is the depression, or the anxiety, is that a new thing that has come about and become much worse since the traumatic event or is that something that has been an issue for a while and it's been made worse by the traumatic event? We do our best to tease apart if the anxiety and depressed symptoms are strictly or solely related to the trauma or if it's something broader that we also need to address. Now, granted, a lot of the techniques that we would use to deal with PTSD are very similar, often with a small or I guess a major tweak to them, so when we use the packages for treatment that are designed for PTSD, very, very commonly we see the depression and the anxiety come quite a bit down during the process of psychotherapy.
Melanie: So, what does treatment look like?
Dr. Stigen: Sure. So, the main treatments for people with PTSD at this point, essentially, are psychotherapy and there is some work with some medication, but the research is still pretty limited in terms of having any kind of a recommendation or gold standard there. Now, there are a few different gold standard psychotherapies or talk therapies for PTSD and I want to tell you a little bit about those because that's something that I do quite a bit. So, there are basically several major psychotherapies that have had a broad base of evidence and what I mean by that is researchers and universities across the country and, for that matter, across the world, have done major, randomized clinical trials where there have looked at tens of thousands of individuals dealing with PTSD and they have created and they've refined treatment packages that they have found to be the most effective tool that we've got to reduce the severity of the fear responses and the avoidance or reduce the severity of the alterations in how we think about the world and other people. So, that's the sort of thing that I would do is we're going to use one of these gold standard, proven, tested therapies and we're going to use that treatment more or less as a package because that way, we have at least got the reassurance of knowing we are doing the most effective thing that we have got scientific evidence for. So, the common factors in these different therapies for PTSD definitely include some education about trauma, about PTSD, about its known effects, and then depending on the therapy, we're either going to delve into some of the specific memories related to the trauma itself, so we can process them, work through them, and assign some meanings to them that are a little easier to live with. Or, we're going to go directly at the thinking process itself; we're going to help people make sense of bad memories; we're going to go through feelings like guilt or shame; we're going to look at basically ways of helping people to understand themselves a little bit better, to change their relationships to thoughts or reminders of the trauma in a way that helps them to regain access to the positives in their lives that are so often lost due to PTSD.
Melanie: What about medicational intervention? When is that required?
Dr. Stigen: Sure. Well, I'm going to defer to psychiatry in this in every case, but I do know that some folks with antidepressant medications, and certainly it's common to use anti-anxiety medicine, but there are pros and cons to those. There aren't a whole lot of head-to-head comparisons between the talk therapies and the medications, so I typically suggest they talk to me and they also talk to someone from psychiatry about that so they can decide if one or the other, or maybe a combination of the two, will best meet their needs.
Melanie: So, what is your best advice, Dr. Stigen, for family members who believe a loved one may be struggling, and they're having trouble figuring out how to help this person?
Dr. Stigen: Sure. I think the main thing that I've heard over and over again from folks I used to treat or do treat that are dealing with PTSD with regard to their family members is feeling like people don't understand the experiences that they're dealing with. And, certainly this may be the case if someone has been in a combat zone or they've dealt with the military type setting, there's that sometimes, disconnect, but even broader than that, I would suggest that the family members take some time, whether it be online or via conversations with medical providers, to learn about PTSD, understand the symptoms, understand things like flashbacks or nightmares, and, you know, as much as one can without having lived that themselves be in a place where you can understand what you're looking at and, for that matter, hopefully, come at it from a perspective that the person is not choosing to act in some of those ways that can be so difficult. So, that's often a good place to start and that will allow you to offer emotional support and help encourage them to speak with professional providers to get some of that help in a place that feels a little more easy to tolerate. So, learning about PTSD, offering support and encouragement, you know, validate what you can see they're going through, as best as you can, and then, encourage them, if you think it would be helpful, to maybe set up an appointment for an initial meeting. Possibly go with them if they would like some of that emotional support, and just kind of make sure that you're there to listen and give them a place to convey whatever it is that they're going through.
Melanie: Thank you so much for being with us. It's such great and such important information. You're listening to The WELLcast with Allina Health and for more information, you can go to www.allinahealth.org. That's www.allinahealth.org. This is Melanie Cole. Thanks so much for listening.
Do You or a Loved One Suffer From Post-Traumatic Stress Disorder
Melanie Cole (Host): More than 7 million Americans over the age of 18 have Post-Traumatic Stress Disorder which can often occur after a person has experienced or witnessed a traumatic event. My guest today is Dr. Ciara Stigen. She's a clinical psychologist with Courage Kenny Rehabilitation Associates in Coon Rapids. Welcome to the show, Dr. Stigen. What is PTSD? People think of it as only for people who have served in the military, but that's not always the case, is it?
Dr. Ciara Stigen (Guest): Definitely not. Thank you so much for having me on today. When I describe PTSD with patients that I work with, I like to describe it as an interruption in the normal process of recovery from a traumatic event. And so, a good place to start is to say that lots of different events can be considered traumatic ranging from relatively small in scope to relatively major in scope, the main piece that would indicate something is traumatic is how much it tends to affect their worldview or their general sense of how the world works and how people work; that sort of thing. So, when their world view has been fundamentally altered in some way by an event that has happened to them, they tend to do things like avoid reminders of that event and you do this in a long enough time and in enough ways that life starts to get very small, the distress rises, and then we might be looking at calling it “PTSD”. Certainly not limited to things like combat or war zones, the two main events that lead to the development of PTSD are combat, but also sexual assault and that can include an even broader array of things including car accidents, natural disasters, sudden death of loved ones, that sort of thing.
Melanie: Are there certain people that are more predisposed to being able to, if they've had a traumatic event, to being somebody who has more trouble dealing with that event or who has these recurring nightmares about it? Is there something that predisposes you to that?
Dr. Stigen: That right there is essential the million-dollar question in clinical research on PTSD. So, we have some ideas in terms of sort of the risk factors for PTSD, but this is definitely an open question. Things that up the likelihood that someone may deal with PTSD versus bounce back with less issues would be certainly having a history of mental illness; the degree of physical injury is another aspect, if you are physically harmed by the trauma as well, that makes it more likely that something like PTSD could arise. The amount of social support that you have got in your immediate circle has a big protective effect for not getting PTSD, and then, lastly other things in your life that, you know, may complicate the picture, like if you lose your job as a result of the trauma, that also can up the risk for developing PTSD. Yeah, I mean, there are just lots of different things that probably play into it and it's a pretty complex interaction between the event itself and the characteristics and the coping abilities of the individual who goes through that event.
Melanie: And, what about the family members of a victim? If somebody was in the military and they saw some horrific things, or a woman was sexually assaulted and the families can experience this feeling as well, too, correct?
Dr. Stigen: Well, I think it's extremely common in the work that I have done, but also in the literature, to see pretty major emotional impacts on the family members and people who interact closely with someone who maybe is the experiencer of the PTSD themself. Certainly, we can have a lot of relationship difficulties that stem from PTSD very much related to that change in thinking and that change in behavior related to the PTSD thinking itself.
Melanie: So, how do you distinguish between an actual diagnosis of PTSD versus anxiety, major depression, clinical depression; any of those?
Dr. Stigen: Sure. So, that's essentially the task of the clinician when we first are having the session or two to get started is because there is such a strong overlap in terms of some of these symptoms that they may arise simply because of depression or anxiety on its own, but there are also major mood and emotional pieces of the PTSD picture. So, one of the first things that we will do is look at is the depression, or the anxiety, is that a new thing that has come about and become much worse since the traumatic event or is that something that has been an issue for a while and it's been made worse by the traumatic event? We do our best to tease apart if the anxiety and depressed symptoms are strictly or solely related to the trauma or if it's something broader that we also need to address. Now, granted, a lot of the techniques that we would use to deal with PTSD are very similar, often with a small or I guess a major tweak to them, so when we use the packages for treatment that are designed for PTSD, very, very commonly we see the depression and the anxiety come quite a bit down during the process of psychotherapy.
Melanie: So, what does treatment look like?
Dr. Stigen: Sure. So, the main treatments for people with PTSD at this point, essentially, are psychotherapy and there is some work with some medication, but the research is still pretty limited in terms of having any kind of a recommendation or gold standard there. Now, there are a few different gold standard psychotherapies or talk therapies for PTSD and I want to tell you a little bit about those because that's something that I do quite a bit. So, there are basically several major psychotherapies that have had a broad base of evidence and what I mean by that is researchers and universities across the country and, for that matter, across the world, have done major, randomized clinical trials where there have looked at tens of thousands of individuals dealing with PTSD and they have created and they've refined treatment packages that they have found to be the most effective tool that we've got to reduce the severity of the fear responses and the avoidance or reduce the severity of the alterations in how we think about the world and other people. So, that's the sort of thing that I would do is we're going to use one of these gold standard, proven, tested therapies and we're going to use that treatment more or less as a package because that way, we have at least got the reassurance of knowing we are doing the most effective thing that we have got scientific evidence for. So, the common factors in these different therapies for PTSD definitely include some education about trauma, about PTSD, about its known effects, and then depending on the therapy, we're either going to delve into some of the specific memories related to the trauma itself, so we can process them, work through them, and assign some meanings to them that are a little easier to live with. Or, we're going to go directly at the thinking process itself; we're going to help people make sense of bad memories; we're going to go through feelings like guilt or shame; we're going to look at basically ways of helping people to understand themselves a little bit better, to change their relationships to thoughts or reminders of the trauma in a way that helps them to regain access to the positives in their lives that are so often lost due to PTSD.
Melanie: What about medicational intervention? When is that required?
Dr. Stigen: Sure. Well, I'm going to defer to psychiatry in this in every case, but I do know that some folks with antidepressant medications, and certainly it's common to use anti-anxiety medicine, but there are pros and cons to those. There aren't a whole lot of head-to-head comparisons between the talk therapies and the medications, so I typically suggest they talk to me and they also talk to someone from psychiatry about that so they can decide if one or the other, or maybe a combination of the two, will best meet their needs.
Melanie: So, what is your best advice, Dr. Stigen, for family members who believe a loved one may be struggling, and they're having trouble figuring out how to help this person?
Dr. Stigen: Sure. I think the main thing that I've heard over and over again from folks I used to treat or do treat that are dealing with PTSD with regard to their family members is feeling like people don't understand the experiences that they're dealing with. And, certainly this may be the case if someone has been in a combat zone or they've dealt with the military type setting, there's that sometimes, disconnect, but even broader than that, I would suggest that the family members take some time, whether it be online or via conversations with medical providers, to learn about PTSD, understand the symptoms, understand things like flashbacks or nightmares, and, you know, as much as one can without having lived that themselves be in a place where you can understand what you're looking at and, for that matter, hopefully, come at it from a perspective that the person is not choosing to act in some of those ways that can be so difficult. So, that's often a good place to start and that will allow you to offer emotional support and help encourage them to speak with professional providers to get some of that help in a place that feels a little more easy to tolerate. So, learning about PTSD, offering support and encouragement, you know, validate what you can see they're going through, as best as you can, and then, encourage them, if you think it would be helpful, to maybe set up an appointment for an initial meeting. Possibly go with them if they would like some of that emotional support, and just kind of make sure that you're there to listen and give them a place to convey whatever it is that they're going through.
Melanie: Thank you so much for being with us. It's such great and such important information. You're listening to The WELLcast with Allina Health and for more information, you can go to www.allinahealth.org. That's www.allinahealth.org. This is Melanie Cole. Thanks so much for listening.