Post-Traumatic Stress Disorder (PTSD) is one of the most difficult conditions for anyone to bear. Many who encounter life-threatening events or situations that threaten physical or emotional safety become burdened by a variety of intense symptoms, including intrusive memories, flashbacks and nightmares. People with PTSD often become hypervigilant and employ desperate coping strategies to avoid situations that remind them of their trauma. They may experience mood, anger and anxiety problems, unexplained aches and pains, addictions, and difficulties in work, relationships, self-esteem, faith and worldview. Many who have suffered physical injuries carry a burden of chronic pain and disability. Plus, other mental health issues may worsen.
Fortunately PTSD has been thoroughly studied and evidence-based treatments developed to help people heal from the impact of severe trauma. In Conquering Post-Traumatic Stress Disorder, Victoria Lemle Beckner, Ph.D. and John B. Arden, Ph.D., present many of the most current treatment tools in a self-help format. They organize their book in a sequence as outlined in one of their concluding sections:
Conquering Post-Traumatic Stress Disorder offers “a journey from trauma toward growth,” starting “with learning about the struggles that emerge following trauma – the symptoms of anxiety, avoidance, and depression, the harmful ways people sometimes cope with drugs and alcohol, the relationship difficulties.” It teaches about “the nature of these problems” and gives “strategies for overcoming them. Next, it helps people confront “the trauma itself – the memories, the meaning of the event and how it’s challenged” their beliefs and revealed important things about themselves and their lives. Finally, it teaches “how to draw on your trauma experience to transform your life in important ways.”
Brief summaries of each chapter follow:
- Chapter 1 begins with portraits of six different trauma survivors and develops these stories to illustrate healing techniques.
- Chapter 2 educates readers about the body’s stress alarm system and the symptoms this activates. It differentiates normal stress responses from the difficulties that occur when the alarm system doesn’t turn off. Next it details the symptoms of PTSD, including re-experiencing and hyperarousal, numbing and avoidance, and depression. It describes coping strategies that don’t work and tells readers where these are addressed in the book.
- Chapter 3 introduces anxiety-reducing techniques and methods for modifying stress responses. It provides a subjective scale for determining one’s level of anxiety, skills for recognizing false alarms, instructions for riding out the anxiety until it dissipates, grounding exercises to get reoriented in the present, and introduces relaxation techniques.
- Chapter 4 offers more detail about overcoming avoidance, helping readers recognize avoidance triggers and how avoidance expands beyond trauma cues. Readers will learn about conditioning and how to overcome it, as well as how to do exposure therapy for themselves. It concludes with a warning that trauma memories may surface as readers practice exposing themselves to anxiety-provoking situations. I would have liked to see that warning at the beginning of the chapter.
- Chapter 5 helps readers recognize depression symptoms and heal dysfunctional thoughts in a graduated way. It also teaches activity scheduling, counsels those who aren’t helped immediately to persist in activities that prime the pump of positive feelings, and recommends exercise and exposure to light. The authors offer guidelines on when to seek professional help, emphasizing that anyone with recent suicidal thoughts should seek an appointment with a mental health resource and seek emergency help if they are actively considering suicide.
- Chapter 6 discusses ways to promote a healthy brain, including sleep practices, better eating, and medication if needed. The sleep section reviews things that both promote and interfere with sleeping well. A section on medication offers recommendations, cautions, and pointers for being an informed consumer.
- Chapter 7 asks readers who may be substance abusers to list reasons they want to use, reasons they want to quit, and to consider whether they are ready to quit completely or cut back. It’s written simply, without jargon, but follows such best practices as motivational interviewing, proven theories of change, and harm reduction.
- Chapter 8 helps survivors who have withdrawn from relationships to re-engage with friends and family and rekindle romance.
- Chapter 9 teaches how to understand and turn angry responses into more effective communications. This chapter is sufficiently well-written that I would recommend it to non-trauma patients with anger management issues.
- Chapter 10 tells readers how the experience of trauma and the apparent indifference of the perpetrator or nature itself can threaten anyone’s sense of meaning. The authors counsel readers in healing altered beliefs about safety, power and control, self-esteem, relationships, world, faith, and life purpose. Self-esteem, for instance, can deteriorate badly if a person feels guilty about involuntarily freezing under extreme threat, and it is important to heal this with understanding and forgiveness.
- Chapter 11 directly addresses processing the trauma memories themselves by putting them into words through journaling or psychotherapy. It includes a warning that more properly belonged at the beginning of the book—cautioning people not to begin processing trauma through journaling if they are suffering from severe depression; thoughts of hurting themselves or others; overwhelming anxiety; excessive alcohol or drug use; psychotic or severe dissociative symptoms; significant difficulty functioning at home, work or school; being in a potentially traumatic situation like an abusive relationship; or simply not feeling emotionally ready right now. This should be recommended to any trauma survivor who wonders whether to try a self-help approach vs. seeking professional help.
- Chapter 12 offers suggestions on talking about trauma and PTSD with others. It suggests that survivors discuss the impact of the trauma instead of its details. It also has a section for friends and family members, teaching them how to listen and provide emotional support without advice-giving or problem-solving.
- Chapter 13 suggests methods for using the healing process itself to grow and find meaning. It has a moving section on grieving the people, abilities or other things that were lost and offers reassurance on how doing so truly heals instead of opening up a bottomless well of grief. They point out that although survivors may suffer shame from having their courage tested through trauma, re-engagement in life and healing are courageous acts themselves.
No single text offers a complete healing path for all people, and the authors do suggest that readers ideally should work with a psychotherapist for healing trauma. They encourage survivors to start their healing process and comment that some therapists “shy away” from working on trauma memories “because it is a frightening and painful process.” I believe this statement minimizes a more complex issue instead of offering a needed explanation. Consider the difference between an emotionally mature adult who survived an industrial accident vs. a child who was repeatedly molested from ages 2 to 10. The accident survivor had a fully formed identity and coping skills, but the child failed to develop a stable core identity. Thus the accident survivor is far more likely to understand and cope than the abused child.
Conquering PTSD does have some shortcomings:
- It doesn’t give clear instructions upfront to help readers assess whether they should try this self-help approach instead of seeking professional counseling before proceeding.
- Although the authors mention the availability of resources, they don’t provide lists that readers might pursue.
- Consistent single-page formatting of exercises and skills summaries would make photocopying easier.
- Chapter numbers at the bottom of every other page would help readers flip through the book without referring to the table of contents.
Overall, however, the book’s clear, simple language, its logical sequencing of material, the simplicity of exercises, and its evidence-based methods are appealing. The authors try to alleviate readers’ fears and convey optimism that many PTSD symptoms can be overcome. Survivors of simple, identifiable traumas who are not a danger to themselves or others; don’t suffer from active addictions or a major mental illness; and can keep up with essential responsibilities even if facing and overcoming distressing trauma symptoms probably will benefit most from it. However, it is also a valuable tool for survivors who do not meet these criteria but are guided in its use by a psychotherapist who specializes in trauma.
Conquering Post-Traumatic Stress Disorder
By Victoria Lemle Beckner and John Arden
Fair Winds: Quayside, 2008