How Post-traumatic Stress Disorder Works

Counseling for PTSD
Findings from a comprehensive study in the '80s and '90s on the ability for Vietnam veterans to readjust to civilian life yielded a great deal of insight into PTSD.
Findings from a comprehensive study in the '80s and '90s on the ability for Vietnam veterans to readjust to civilian life yielded a great deal of insight into PTSD.
Photo courtesy National Archives

Imagine sitting with your platoon, taking a break from patrol in the desert of Iraq. The sky is clear and blue. The sun is shining, and it's hot and dusty, but you and your buddies are cracking jokes. On the stereo, your favorite song is playing. You're still on guard, but for once you feel kind of relaxed.

Suddenly, out of nowhere, you encounter enemy fire. As shells zip past you and you return fire, you catch glimpses of the enemy firing from behind a burned-out truck. A buddy takes a bullet in his stomach and falls beside you, and you pull him to safety behind your patrol's armored car. You return fire again, and this time it's clear to you that you killed one of the enemies. After a few more minutes, your patrol manages to flush the enemy from behind the burned-out truck, killing several more people.

You're alive, unhurt. Your buddy has died.

As time progresses, you find that you can't escape the experience. You're haunted by your friend who died and the man you killed. Hearing your favorite song now, the one that played on the radio just before the fight, reminds you of every detail. The still of the sunny day, one of the things that had calmed you just before the fight, comes to be remembered as ominous.

Our fear memories are among our most powerful. They can even become distorted and distort other memories associated with the experience. People with PTSD don't wish to be reminded of them, and they don't feel like anyone can understand what they've gone through, which leads to a sense of isolation. This is what makes PTSD so difficult to treat. The memories of the traumatic event become so largely distorted that they become overwhelming in their importance and magnitude. Isolation keeps people with PTSD from their family, friends and counselors.

Some treatments have been proven to combat these symptoms of PTSD. Two of the most widely accepted forms of psychotherapy for treating the disorder are cognitive processing therapy (CPT) and exposure therapy. The aim of these treatments is cognitive restructuring. Through this process, exaggerated memories are reduced back to a manageable size. In the experience of PTSD, the enemies in the above scenario be seen as faceless phantoms; the wounds of the friend may become gorier. Cognitive restructuring helps the patient remember the event on a more acceptable level. In the CPT setting, the therapist may focus on the valor shown by the solider when he retrieved his friend in the attempt to save his life -- adding balance to the memory of the experience and helping to develop perspective [source: Perry]. CPT also allows the person to gain control of his unwanted recollections by allowing these memories to occur at a designated time of day, or investing protective associations in an everyday object.

In exposure therapy, patients are asked to purposely re-experience their trauma over and over -- either in a doctor's office or in the outside world in a setting similar to the one where they experienced their trauma. This is called imaginal therapy. The soldier in the scenario may be asked to recount the experience in detail repeatedly. The song that played which reminds him so much of the incident may be played repeatedly as well [source: NCPTSD].

Exposure therapy is based upon the idea that it's avoidance that continues to fuel the symptoms associated with PTSD. By bringing these memories to the forefront and addressing them, this therapy aims to bring about fear extinction in the patient, a process that takes place in the amygdala (the part of the brain that allows us to create our fear memories) and normally allows people to stop having a full, physical reaction to stimuli associated with the traumatic experience. Some find CPT more desirable than exposure therapy because the patient doesn't have to identify a specific trauma for it to work, which is of course required in exposure therapy.