PTSD Symptom Cluster: Re-Experiencing, Avoidance/Numbing, Hyper arousal

PTSD Symptom Cluster
PTSD Symptom Cluster

PTSD Symptom Cluster: Re-Experiencing, Avoidance/Numbing, Hyper arousal

Abstract

Many people tend to develop Post Traumatic Stress Disorder, (PTSD), after witnessing a life threatening events such as terrorism, road accidents, veteran wars, fire accidents, as well as natural disasters such as earthquakes and floods. While treatment approaches have always been used to help individuals to recover from PTSD symptoms cluster: re-experiencing, avoidance/numbing, and hyper arousal, major aspects of spirituality can also be applied to promote recovery.

In this regard, both Christian counseling and clinical group therapy can help to eliminate the PTSD symptoms cluster: re-experiencing, avoidance/numbing, and hyper arousal. Ideally, Christian counseling and clinical counseling are intended to achieve a common goal about five major areas including; duration of treatment, the relevance of truth, the role of a community of support, possession of faith and motivation to persevere, as well as the role played by acceptance and hope in healing.

Post-Traumatic Stress Disorder Symptom Cluster: Re-Experiencing, Avoidance/Numbing, Hyper arousal

1.0 INTRODUCTION

 Following severe traumatic events, victims commonly present with psychological changes that occur as they try to recall either what they saw or felt during the event. These psychological reactions may lessen if proper counseling interventions are applied immediately after the traumatic event. However, if not managed quickly, individuals may suffer constant mental problems accompanied by emotional distress, a condition that is often referred to as post-traumatic stress disorder (PTSD) (Sareen, 2014).

Sareen (2014) defines PTSD as a mental disorder that occurs as a result of either witnessing or directly experiencing a life-threatening event. With the rapid rise in traumatic events such as terrorism, road accidents, veteran wars, fire accidents, as well as natural disasters such as earthquakes and floods, PTSD is becoming a health concern in the society that needs to be addressed with a lot of commitment.

Effective interventions should be implemented to help prevent serious health problems that may occur from PTSD symptoms cluster: re-experiencing, avoidance/numbing, and hyper arousal (Cohen and Scheeringa, 2009; & Wilkins, Lang, and Norman, 2011).

 Effective elimination of PTSD symptom cluster requires a combination of, psychological, spiritual, and pharmacological approaches to treatment (Walker, Scheidegger, End, and Amundsen, 2012). The thesis statement that guides current research states that group therapy intervention for managing PTSD symptoms cluster: re-experiencing, avoidance/numbing, and hyper arousal, is based on significant aspects of spirituality.

The purpose of this research is to explore the major aspects of spirituality that are related to group therapy management for PTSD symptoms cluster: re-experiencing, avoidance/numbing, and hyper arousal, while citing teachings of the Bible as well as information obtained from some theoretical resources.

2.0 PTSD SYMPTOMS CLUSTER: RE-EXPERIENCING, AVOIDANCE/NUMBING, AND HYPER-AROUSAL

2.1 Re-experiencing

            Before analyzing the significant aspects of spirituality that are related to PTSD symptoms cluster, it is important to understand the specific symptoms that a clinical psychologist and a Christian counselor intend to help their clients to recover from. In the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR (1), the American Psychiatric Association has documented specific symptoms that clinicians should substantiate during PTSD diagnosis.

According to the American Psychiatric Association’s DSM-IV, PTSD should be diagnosed based on three symptoms cluster namely; re-experiencing, avoidance/numbing, and hyper arousal (Goldstein, Bradley, Ressler and Powers, 2017, p. 319). As far as re-experiencing criterion is concerned, people with PTSD individual persistently recall what was either felt or observed during a traumatic event. To prove that a client regularly recalls the happenings of the traumatic event, he or she must present with at least one of the documented five ways. 

The five documented presentations include; repeated and disturbing recollection of the happenings of the traumatic event accompanied by perceptions, images, and thoughts; repeated disturbing dreams related to the event; behaving as if the traumatic event was happening again; severe psychological disturbance whenever one comes across issues that look like the life threatening event; and physiologic disturbance any time an individual comes across things that resemble the life threatening event.

As Kleim, Graham, Bryant, and Ehers (2013) explain, it has been discovered that survivors of traumatic events have a tendency of constantly recalling those happenings, and that people often react differently depending on the degree of psychological impact that they have faced from those events.

2.2 Avoidance/Numbing

Concerning avoidance/numbing criterion, an individual who is suffering from PTSD is believed to have a tendency of constantly escaping from stimuli that are related to the distressing event. Furthermore, these people often become less responsive to activities accompanied with feelings of isolation, which did not occur before the life-threatening event.

An individual must demonstrate at least three of the seven behavioral characteristics that have been documented in DSM-IV regarding PTSD diagnosis. The seven features that have been documented by the American Psychiatric Association include; struggling to avoid perceptions, discussions, or feelings associated with the life threatening event, struggling to keep off people, places, or activities that might remind them of the traumatic event, loss of memory of the crucial aspects of the event, lack of interest in taking part in activities, feeling of isolation, inability to have feelings of affection, and loss of hope to plan for the future.

Several studies have been conducted to confirm the presence of avoidance/numbing characteristics among populations with PTSD. For instance, Naifeh, Tull and Gratz (2012) have found that persistent emotional avoidance is a common problem among patients with severe PTSD.

2.3 Hyper-arousal

            As far as hyper-arousal is concerned, individuals who suffer from PTSD often exhibit constant symptoms of excitement, which did not exist before the occurrence of a distressing event. For hyper-arousal to be confirmed in an individual, one must present with at least two of the documented characteristic behaviors. These signs include sleep problems, aggressiveness, extreme alertness, lack of concentration, and extremely astound response. As Weston (2014) explains, of the three signs that form PTSD symptoms cluster, hyper-arousal is the most predominant and that should be eliminated first.

3.0 CLINICAL APPROACH VERSUS SPIRITUAL APPROACH

As they interact with people with PTSD, both the clinical psychologist and the Christian counselor often utilize approaches which are aimed at eliminating PTSD symptoms cluster: re-experiencing, avoidance/numbing, and hyper arousal (Walker et al., 2012). Although the Bible does not give any information concerning PTSD symptoms cluster, Christian counselors often rely on biblical teachings to help individuals to recover from symptoms of PTSD.

Specifically, a clinical psychologist will utilize group dynamics to help their clients to recover from PTSD cluster symptoms, while a Christian counselor will rely on the teachings of the Bible to promote healing for PTSD clients. The use of group dynamics by a clinical psychologist to help eliminate PTSD symptoms cluster: re-experiencing, avoidance/numbing, and hyper arousal, is based on some major aspects of spirituality (Walker et al., 2012).

3.0 THE MAJOR ASPECTS OF SPIRITUALITY INVOLVED IN THE TREATMENT OF PTSD

3.1 Treatment Takes Time

Both the clinical therapist and the Christian counselor strive to help individuals with PTSD to recover from re-experiencing, avoidance/numbing, and hyper arousal symptoms by encouraging them that gaining healthy functioning is a process that will take time. The Christian counselor compares the recovery process to Paul’s teachings in the Bible. In 2nd Corinthians Chapter 12, from verse 7 to verse 10, Paul has written about “thorn in the flesh” (The New King James Version).

Paul says that God provides healing at a time when He feels appropriate. He further asserts that, during times of painful experiences, God provides the suffering with enough grace to help them bear difficult situations. The Christian counselor compares re-experiencing, avoidance/numbing, and hyper arousal symptoms to the pain of a thorn. By using Paul’s teachings, an individual with PTSD gets to understand the need to be patient and develops a motivation to continue attending counseling sessions repeatedly.

In Lamentations Chapter 3, and in 1st Corinthians Chapter 1, verse 4 to 9, the Bible says that those who are in suffering should continue to present their problems to God because He is always faithful (The New King James Version). A Christian counselor uses these biblical teachings to help people with PTSD to see the need of remaining focused on the spiritual aspect of recovery.

            Like spiritual counseling, group therapy by a psychologist emphasizes the need to be patient if recovery from re-experiencing, avoidance/numbing, and hyper arousal symptoms is to be realized. In psych educational group intervention, the group therapist often encourages individuals with PTSD that recovering from the three symptoms is a process that will take time. For this reason, the therapist always plans to use sessions that are extended over a given period.

This requires the group members to meet on a daily or weekly basis over some time before the three symptoms can be eliminated (Bahredar, Farid, Ghanizadeh, and Birashk, 2014). According to Substance Abuse and Mental Health Services Administration (2014), people who are exposed to traumatic events are likely to experience various impacts based on the nature and degree of the life-threatening situation.

For this reason, a group therapist must take the time to understand individual characteristics as well as the degree of psychological impact that has been created by a traumatic event for him or her to be able to help clients to recover from re-experiencing avoidance/numbing, and hyper arousal symptoms. This will require repeated interactions between the therapist and the affected individuals who will take some time (Bahredar et al. (2014).

3.2 Truth is a Key Component of Recovery

When handling clients with PTSD symptoms cluster: re-experiencing, avoidance/numbing, and hyper arousal, both the Christian counselor and the group therapist inform their clients that they have to tell the truth for them to be able to recover from their psychological problems. Both counselors depend on the true information provided by their clients to develop and implement the best intervention for recovery (Walker et al., 2012).

During spiritual counseling sessions, the Christian counselor reminds clients with PTSD that God is always loving, and since He sees value in His people, He is always ready to forgive everyone irrespective of the nature and degree of sins they have committed (1 John 1:8–9, The New King James Version).

Also, the Christian counselor informs his or her clients that the most important thing that they should consider when evaluating their deeds is to know what God says about them but not what others speak of them. Therefore, instead of viewing themselves as either perpetrators or victims, they should identify themselves as beloved children of God as documented in Ephesians Chapter 1, verse 3 to 6, Romans Chapter 8, verse 14 to 17, and in 1st John Chapter 3, verse 1-3 (The New King James Version).

For those people who have lost their relatives and loved ones as a result of a traumatic event, the Christian counselor encourages them that God has a purpose for everyone’s life and that He protects His people by the power of the Holy Spirit (Ephesians 1:13-14, The New King James Version). By having a feeling that God loves, values, and forgives, clients can recover quickly from PTSD symptoms cluster: re-experiencing, avoidance/numbing, and hyper arousal (Walker et al., 2012).

Like it is with spiritual counseling, a group therapist in clinical counseling relies on the true statements provided by every group member to establish the most appropriate intervention plans for them (Scott et al., 2016). Ideally, for a group therapy session to be effective in eliminating re-experiencing, avoidance/numbing, and hyper arousal symptoms, clients must identify as either victim of executors of traumatic events.

Furthermore, clients must speak the truth of the specific problem behaviors that they experience as this information helps the therapist to distinguish whether the PTSD symptoms cluster are either mild or severe. The clinical psychologist who is handling PTSD clients in group therapy sessions often formulate interventions based on the truthfulness of the information provided by group members (Asher et. al., 2015).

3.3 Healing is Enhanced by a Community of Support 

When handling clients with PTSD symptoms cluster: re-experiencing, avoidance/numbing, and hyper-arousal, both the Christian counselor and the group therapist have an understanding that having a community to offer support will help clients to develop a deep understanding of their problems and to perform tasks that promote recovery.  The Christian counselor encourages his or her clients to feel free to disclose their problems to the therapist to receive assistance from the group members.

In Romans Chapter 8 verse 35 to 38, the Bible says that nothing can separate Christians from the love of God. Also, it is documented in Hebrews Chapter 4 verse 14 to 16 that Christians should feel free to approach God and explain their problems to Him (The New King James Version). Since God can use people’s situations for His Glory, He also has the powers to restore healthy psychological functioning in individuals who are suffering from PTSD symptoms cluster: re-experiencing, avoidance/numbing, hyper-arousal (Walker et al., 2012).

The clinical psychologist who is handling PTSD patients in groups relies on support from group members to help clients to recover from re-experiencing, avoidance/numbing, and hyper-arousal symptoms. According to Norton and Kazantzis (2016), one of the advantages of group psychotherapy is the ability to obtain support from the dynamic relationships within the groups.

For this reason, the therapist strives to formulate rules that promote group cohesion as he or she acknowledges the support that every group member is likely to bring to the group (Caqueo-Urizar, Rus-Calafell, Urzua, Escudero and Gutierrez-Maldonado, 2015). As Caqueo-Urizar (2015), point out; having a community of support when caring for people with mental problems is very important because the community helps with establishing whether clients have adhered to tasks that promote healing.

3.4 Faith and a Motivation to Persevere Promote Healing

Success is achieved from Christian counseling and from clinical counseling when clients are encouraged to have faith and to demonstrate a willingness to persevere from PTSD symptoms cluster: re-experiencing, avoidance/numbing, and hyper-arousal. The Christian counselor perfectly understands that managing mental health problems associated with PTSD is a huge challenge for individuals.

For this reason, the counselor repeatedly informs individuals with PTSD that they should surrender their problems to God who is always ready to show His compassion and love to the suffering. In 2nd Corinthians Chapter 1, verse 3 to 5, Paul says that God is the Father of compassion who always comforts those in trouble (The New King James Version). By relying on this biblical teaching, Christians with PTSD should have faith in God and healing, as they should develop a motivation to share in the suffering of Christ as written by Paul (Walker et al., 2012).

            Similarly, the success of group psychotherapy greatly relies on faith and perseverance. People with PTSD symptoms cluster: re-experiencing, avoidance/numbing, and hyper-arousal, should have faith that the tasks that are assigned to them by the group leader will promote healing. Also, they must be ready to face the hardships associated with the assigned tasks as their commitment to adhering to group tasks is what will determine whether they will recover from PTSD or not. Eventually, positive health outcomes are always generated through a combination of faith and motivation to persevere (Reisman, 2016).

3.5 Acceptance and Hope are Key Components of Recovery

Both Christian counseling and clinical counseling emphasize on the need to accept past occurrences and to have hope for the future. According to Wilkins, Lang, and Norman, (2011), re-experiencing occurs in people with PTSD because they have a tendency of recalling what they either saw or felt during a traumatic event.

These re-experiencing symptoms can be eliminated if clients are assisted to come to terms with experiences of a traumatic event, and this can occur if they learn to accept the past. Furthermore, people with PTSD tend to lose hope in the future and lose interest in engaging in activities that promote personal growth (Naifeh, Tull, and Gratz, 2012). Therefore, the goal of the Christian counselor, as well as the clinical group therapist is to help clients to accept the past occurrences and to have hope in the future.

            The Christian counselor assists individuals with PTSD symptoms cluster: re-experiencing, avoidance/numbing, and hyper-arousal, that it is important to have Hope in God because He has the powers to provide good health. The Bible says in 1st Peter Chapter 5 verse 6 to 7 that human beings should humble themselves under the powerful hand of God so that they may be exalted at the right him (The New King James Version).

In addition, in the same verse, the Bible teaches Christians that they should cast their anxieties and troubles on God because He is caring. The Christian counselor helps clients with PTSD to understand that Jesus himself experienced traumatic events and he increasingly approached God for hope. In a similar manner, by seeking help and understand from God, they will be able to recover from the mental impacts of trauma.

Like a Christian counselor, the clinician counselor always strives to assist group members to accept past occurrences and to be hopeful that they can still acquire an improved mental health (Walker et al., 2012).

4.0 CONCLUSION

            In conclusion, group therapy intervention for managing PTSD symptoms cluster: re-experiencing, avoidance/numbing, and hyper-arousal, is based on major aspects of spirituality. This paper has critically explored the major aspects of spirituality that are related to group therapy management for PTSD symptoms cluster: re-experiencing, avoidance/numbing, and hyper-arousal. Explanations about the interdependence between major aspects of spirituality and group therapy management for PTSD symptoms cluster have been provided while citing teachings of the Bible as well as information obtained from a number of theoretical resources.

References

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Bahredar, M. J., Farid, A. S, Ghanizadeh, A. & Birashk, B. (2014). The efficacy of psycho-educational group program on medication adherence and global functioning of patients with bipolar disorder type 1. International Journal of Community Based Nursing and Midwifery, 2(1): 12-19

Caqueo-Urizar, A., Rus-Calafell, M., Urzua, A., Escudero, J. & Gutierrez-Maldonado, J. (2015). The role of family therapy in the management of schizophrenia: Challenges and solutions. Neuropsychiatric Disease and Treatment, 11: 145-151.

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Naifeh, J. A., Tull, M. T. & Gratz, K. L. (2012). Anxiety sensitivity, emotional avoidance, and PTSD symptom severity among crack/cocaine dependent patients in residential treatment. Cognitive Therapy and Research, 36(3): 247-257

Norton, P. J. & Kazantzis, N. (2016). Dynamic relationships of therapist alliance and group cohesion in trans-diagnostic group CBT for anxiety disorders. Journal of Consulting and Clinical Psychology, 84(2): 146-155.

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Substance Abuse and Mental Health Services Administration (US). (2014). Trauma-informed care in behavioral health services. Center for Substance Abuse Treatment (US): Author

The Bible: The New King James Version

Walker, K. R., Scheidegger, T. H, End, L. & Amundsen, M. (2012). The misunderstood pastoral counselor: Knowledge and religiosity as factors affecting a client’s choice. Retrieved from https://www.counseling.org/resources/library/vistas/vistas12/Article_62.pdf

Weston, C. S. (2014). Posttraumatic stress disorder: A theoretical model of the hyper arousal subtype. Frontiers in Psychiatry, 5:37. Doi:  10.3389/fpsyt.2014.00037

Wilkins, K. C., Lang, A. J. & Norman, S. B. (2011). Synthesis of the psychometric properties of the PTSD Checklist (PCL) military, civilian, and specific versions. Depression and Anxiety, 28(7): 596-606.

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