I recently attended the Second International Conference for Trauma and Mental Health in Jerusalem, Israel. With the theme of topics discussed being on the “Impacts of Trauma and Adversity on Mental Health”, for me, the highlights were listening to leaders in the field, including Prof Barbara Rothbaum from the USA, Prof Tine Jensen from Norway, Prof Richard Bryant from Australia and Prof Yair Bar-Haim from Israel on their insights into the challenges and innovations facing the prevention and treatment of Post-Traumatic Stress Disorder (PTSD). It was a fabulous opportunity for me as a professional to learn more about the latest techniques and methodologies that support the mental health of both children and adults.
I would like to share some of my take-home messages from the conference. Firstly, not everyone who experiences a traumatic event will develop a disorder such as PTSD. PTSD is a serious psychiatric illness that develops from exposure to an upsetting traumatic event. The exposure could be direct or indirect.
PTSD symptoms fall into the following four categories and can vary in severity:
1. Intrusion: Intrusive thoughts such as repeated, involuntary memories; distressing dreams; or flashbacks of the traumatic event. Flashbacks may be so vivid that people feel they are re-living the traumatic experience or seeing it before their eyes.
2. Avoidance: Avoiding reminders of the traumatic event may include avoiding people, places, activities, objects and situations that may trigger distressing memories. People may try to avoid remembering or thinking about the traumatic event. They may resist talking about what happened or how they feel about it.
3. Alterations in cognition and mood: Inability to remember important aspects of the traumatic event, negative thoughts and feelings leading to ongoing and distorted beliefs about oneself or others (e.g., “I am bad,” “No one can be trusted”); distorted thoughts about the cause or consequences of the event leading to wrongly blaming self or other; ongoing fear, horror, anger, guilt or shame; much less interest in activities previously enjoyed; feeling detached or estranged from others; or being unable to experience positive emotions (a void of happiness or satisfaction).
4. Alterations in arousal and reactivity: Arousal and reactive symptoms may include being irritable and having angry outbursts; behaving recklessly or in a self-destructive way; being overly watchful of one’s surroundings in a suspecting way; being easily startled; or having problems concentrating or sleeping.
For a person to be diagnosed with PTSD, symptoms must last for more than a month and must cause significant distress or problems to daily functioning. Many individuals develop symptoms within 3 months of the trauma, but symptoms may appear later and often persist for months and sometimes years. PTSD frequently occurs with other related conditions, such as depression, substance use, memory problems and other physical and mental health problems. PTSD is relatively common, with studies indicating a lifetime prevalence of 6.8%.[1]
Mental health difficulties that result from traumatic experiences can be treated effectively. Evidence-based Psychological treatments for PTSD include Prolonged Exposure (PE), Trauma-Focused Cognitive Behavioural Therapy (TF-CBT), Eye Movement Desensitisation and Reprocessing (EMDR) and Cognitive Processing Therapy (CPT). There is insufficient evidence to suggest that pharmacological treatments alone will assist in the recovery of PTSD.
There are also a lot of exciting innovations in the field of trauma treatment including the use of virtual reality to assist with exposure therapy, as well as the use of psychodelic-assisted psychological therapy. We shall have to wait and see what future research shows in terms of the effectiveness of these new treatments, but there is a lot of hope out there.
As an ironic epilogue, on my return from the conference in Jerusalem to Tel Aviv, I myself directly experienced a traumatic event. I was physically assaulted and verbally abused by the taxi driver who was driving me to my hotel. I must strongly emphasise that this was not at all in line with my impression of the Israeli people and culture. Up until that moment I had felt very safe as a solo traveller in this absolutely beautiful country. This is what made it so shocking and unexpected for me. My initial reports to family and friends shortly after the event were understated in comparison to the reality of the situation, perhaps a coping mechanism on my behalf. Thankfully, my experience was very minor in comparison to what many other people experience. As a clinician, I know that there are a vast majority of people who are exposed to very severe, and sadly, often repetitive traumatic experiences. However, I started experiencing common symptoms that result from such experiences including intrusive thoughts/flashbacks, avoidance, changes in my thoughts and mood, as well as being hypervigilant and unable to sleep. In the days and weeks following such an exposure, these symptoms are considered a normal fear-related response to trauma. For most people, that fear extinguishes over time. But for a significant minority of people, that fear will not extinguish – the result is PTSD. Given the timing of my experience, I started self-engaging in some of the techniques I had learnt at the conference and I have also reached out to my own Psychologist for regular sessions in the aftermath.
The psychological effects of childhood abuse and neglect, partner abuse and violence, refugee and war-related trauma, military-related trauma, moral injury, as well as the impact of the Covid-19 pandemic are all too prevalent in today’s society. If you have experienced trauma and adversity – whether it be recent or a long time ago, there is hope. You don’t have to suffer through it alone – please reach out for professional support.
I endeavour to write more blog posts in the near future on other key elements on the impacts of trauma and adversity on mental health with the hope that it will be of help to some of you out there.
[1] Kessler, R.C., Berglund, P., Delmer, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6): 593- 602.