Let’s talk treatment: Different approaches to PTSD

Johanna Wender talks about trauma, ptsd and treatment options available for law enforcement officers.

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Law enforcement and first responders are not destined to walk away with Post Traumatic Stress Disorder (PTSD). They are, however, more likely to struggle with PTSD than the general population. As a spouse, you may be impacted by a situation or an incident and struggle with trauma yourself. Or maybe you’re concerned or worried about your officer as you see them continually impacted day in and day out. There is absolutely no reason for someone struggling with post-traumatic stress to suffer and continue to struggle. There are no honors or awards given for struggling in silence.

Treatment for PTSD has come a long way. There are multiple types of treatments that are evidence-based that can help resolve PTSD without years of therapy. Evidence shows that the impact of trauma is less when you address it timely, but even old traumas can heal with effective therapy.

Today I am speaking with Johanna Wender, who specializes in working with law enforcement and PTSD. We talk about trauma, PTSD, and the treatment options available for you to heal quickly from trauma or a critical incident.

“All officers will have PTSD” 

One misconception about PTSD is that if you do police work long enough, you’re inevitably going to have post-traumatic stress disorder or post-traumatic stress injury. This is simply not true. Trauma reactions are like a funnel where every LEO will experience trauma, a smaller amount will experience acute stress and then an even smaller amount are going to experience PTSD. Post traumatic stress disorder is five times higher in the police community than in the general public. About 35% of police officers meet the criteria for PTSD and a little over 7% of the general public meets the criteria for PTSD.

It is important to understand that having PTSD is the exception. It’s not the rule. People are wired for resilience and most of the time when there is a traumatic experience, a mental health diagnosis isn’t given. They recover naturally through neuroplasticity and have the ability to move forward from a situation or get through a difficult event. Trauma changes the makeup of our brain and how we respond in the future, but it doesn’t necessarily change us for the worse. It helps us adapt better for the future.

For example, think about a dangerous situation where you are walking down the street and you hear a loud noise. If you hadn’t been through anything scary before, you might not think anything of it, but if you’ve done police work or responded to natural disasters or crime, then then you might think a bit more of it and respond in a more adaptive way that could end up keeping you and others safe. The difference is how the body responds naturally to trauma and how it responds to an event identified as PTSD.

Acute Trauma vs PTSD

When you think about the number of events that an officer experiences in a given week that could be categorized as traumatic (accidents, physical assaults, sexual assaults, etc.), it’s huge compared to the average person. However, an officer may not interpret or experience the event as so. It is a rare occurrence that officers feel traumatized from routine calls. Maybe it was upsetting, or it was uncomfortable, but it doesn’t necessarily leave this lasting mark or its ability to affect someone on a weekly or even daily basis. Many people will experience a traumatic event and they might have a “post-traumatic stress-like” reaction after it, called acute trauma or acute stress disorder, but usually within 30 days, the person’s symptoms will resolve on their own. This accounts for the majority of cases of people who end up having that post-traumatic stress reaction.

PTSD

If somebody continues to struggle with post-traumatic stress reactions after 30 days, then it could be diagnosed as post-traumatic stress disorder. Some of the common symptoms are:

Intrusive memory.  When a person has trouble not thinking about the trauma even when they don’t want to think about the event. This can be nightmares, flashbacks, or reliving the moment so intensely that the person is not sure if they are back at the event or in the current moment.

Strong emotional changes.  Someone might feel scared often, depressed, angry, numb, or nervous.

Physical reactions.  People experience things like headaches, stomach aches, and muscle tightness.

Mindset.  Shifts in the way that people are thinking. They might have negative beliefs about how they handle themselves in the situation or negative beliefs about the world. There may also be a lack of trust in others or even themselves.

Withdrawal.  Isolation where people stop doing activities they enjoy and instead, stay home.

Risky behavior.  Engaging in risky behaviors due to valuing life less.

Unhealthy coping.  Using drugs and/or alcohol to numb feelings and/or memories.

Avoidance.  The hallmark symptom of PTSD is avoiding people and not facing what happened. This isn’t just avoiding talking and thinking about the event, but anything in the world that might be a reminder of it.

PTSD doesn’t have to be just one event!

It is important to understand PTSD doesn’t have to be from just one event. It can be an accumulation of events over time as well. This is common with people who have been in the field for decades where they never had a way of processing or working through traumatic calls that they were attending. It can also be attributed to the fact that years ago, agencies didn’t have protocols in place for handling peer support or critical incident stress debriefs. Avoidance was their way of working through trauma until it couldn’t be avoided any longer.

Post Traumatic Stress Injury  

Over time, PTSD has gone from a label in a diagnosis manual to an injury. Undoubtedly, injury is a better term because it captures what we know from extensive research about post-traumatic stress, which is that it can be healed. People can and do completely recover. To describe it as an injury is far more accurate than to describe it as a disorder, which suggests that it’s either a permanent condition or that there’s something inherently wrong with someone because they have a disorder. There needs to be a focus on helping people understand how it’s treated, whether it’s a disorder or injury, and getting people to the right treatment in order to feel better.

Getting help

When deciding to get treatment for PTSD as a first responder, there are two important questions to ask.

Do you specialize in first responders? A lot of therapists are trained in trauma treatment, but they have no experience with first responders.

Are you trained in a trauma focused model?  If a therapist cannot say how they treat trauma, then they are not a trauma provider because trauma is an area where you have to have some clinical expertise in it in order to effectively treat it.

Types of Treatment

The three big evidence-based treatment models for treating post-traumatic stress disorder are Cognitive Processing Therapy (CPT), Eye Movement, Desensitization and Reprocessing (EMDR), and Prolonged Exposure (PE.) There are some common core elements that all three models have.

Commonalities

First, they all involve some element of psychoeducation, which is giving someone relevant information about the diagnosis, what it means, how it started, what the prognosis is, and what treatment looks like.

The second thing that they all have in common is using some sort of exposure to trauma reminders during treatment. There’s going to be exposure to thinking and talking about the trauma, to re-acclimating yourself to the memory to start healing. This can be done in a variety of ways. Sometimes it is talking about it, writing about it, thinking about it, or even revisiting the location where it occurred. It’s about having people reengage with the memory in order to work through it.

This does a couple of things. It helps people understand that while it’s difficult to think about, they can handle it. The more they think about it and talk about it, the easier it gets. They learn to have control over the memories and that the memories don’t have to control them. They can reclaim their lives! In an acute trauma phase, it’s important to work through the memory immediately so it doesn’t turn into post-traumatic stress. Working through the emotions as they come up is easier than trying to deal with 15-year-old emotions.

Please do this with the guidance of a mental health professional who is trained in one of these models. Do not attempt this on your own!

The last thing these models have in common is that they’re all relatively short-term treatments. A lot of the time PTSD can be resolved within 10 to 20 sessions. In the case of cumulative trauma, it can sometimes take longer, but it gives relief to know that even though the intensity of these sessions can be high, there is light at the end of the tunnel. There’s an end in sight. You’re not going to be attending therapy for years and years.  It may be uncomfortable to say you are getting treatment or going to therapy because it’s incredibly vulnerable! However, think about how the discomfort will be worth it so PTSD doesn’t have to continue to impact your life.

Cognitive processing therapy (CPT)

CPT focuses on identifying what your cognitive distortions or “stuck points” are. How are you making sense of this traumatic event or this experience? What are you telling yourself about it? Ultimately CPT intervenes with post-traumatic stress by trying to change how you’re making sense of the event. For example, take a child death scenario. Sometimes someone can convince themselves that if they arrived sooner, the child might be alive right now. It is called magical thinking. It is the stuck point in the event, and this is where CPT would intervene.

There are different strategies for catching and challenging these stuck points. One strategy is to have someone do writing assignments over and over to help correct and train themselves to think about more realistic ways of making sense of it. A reframe stuck point might be something like, “I got there as fast as I could, but not everything is within my control.”  Trying to understand it in a more realistic way often is what helps resolve PTSD.

Prolonged exposure (PE)

Prolonged exposure is helping someone expose themselves to the traumatic memory in a couple of ways. One of which is talking about the memory in session and recording them talking through it. Then they will take that audio recording and listen to it throughout the week until their next session. Vivo exposure is also part of PE. It helps identify the things in life that are reminders that they are avoiding.

This could be avoiding movies that have action scenes in them or avoiding going out to eat. PE helps figure out how to safely get someone back to doing some of these things again and reclaiming their life.

Eye Movement Desensitization Reprocessing (EMDR)

EMDR is an eye movement therapy similar to prolonged exposure in that you’re talking about the memory paired with sort of stimulus. It could be tracking a light with your eyes, or tapping, but the thought is that doing so helps your brain reprocess the trauma and work through it. It’s about the right and left hemispheres of the brain communicating together through eye movement to regulate emotional content. The facts of the memory will still be there, but the feeling associated with the memory will be gone.

With each model, it is important to learn about all of them while in treatment and choose the one that best fits you for success in healing from PTSD! If you feel like you have more control over your treatment, you are more likely going to be fully committed to the process.

How to help someone who is struggling

Approach them with love!

If you’re a spouse or if you’re an officer and you think maybe your spouse or a peer is struggling, approach the person with love and respect. Try to express to someone objectively that you have noticed changes in them. Instead of saying, “I think you feel depressed” or “You seem really angry,” give them an example. “I’ve noticed that you seem to be awake a lot of the night.” or “I’ve noticed that you’re starting to drink more.” Point out an objective behavior because that’s harder to refute. Remind them that counseling is an act of taking care of yourself.

Leaders, share your experience!

In law enforcement, we need leaders to talk about their own experiences in therapy. If you’re comfortable sharing your own experiences with therapy, it will help destigmatize the process and make it seem more normal.

Support, Support, Support!

Show your support for your spouse/peer getting treatment. Whether it be finding referrals to get therapy started, taking them to their appointments, or offering a safe space for them to talk about treatment, show your support.

If you are struggling in some way, there is no reason for you to keep struggling. There are a lot of different research-based modalities and methods that can help you move through those traumas and get to the other side.

If you want to get with Johanna for therapy visit: BravuraCounseling.com (WA and in TX)

@Firstrespondercounselor for follows!

Johanna is a Licensed Professional Counselor and a licensed mental health clinician. She is a police spouse of 20 years of a police veteran and has a private practice in Washington and Texas. She focuses on first responders and serves as an expert in treating post-traumatic stress disorder and fostering resilience and mental wellness.

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Let’s talk treatment: Different approaches to PTSD

Johanna Wender talks about trauma, ptsd and treatment options available for law enforcement officers.

Share:

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