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Evidence-based treatment for stress injuries

This is the second part of a two-part series on stress injuries and their warning signs. Part one focused on the stigma surrounding stress injuries for law enforcement officers as well as the warning signs and possible indicators of a stress injury or PTSD. Part Two addresses defining what is (and is not) PTSD, as well as evidence-based treatment for stress injuries.

All law enforcement officers have been or will be exposed to highly traumatic events over the course of their career. Most of the time, officers will experience symptoms within the weeks following a traumatic event—most people do. It’s normal to be deeply impacted by horrible situations and experiences. Images of the event will be stuck in your mind, you will have nightmares and poor sleep, you will be distracted, you will question your actions and motives, you will be on edge and you will retreat socially. This is essentially how we recalibrate and figure out how to make sure we are never in that situation again. It’s how we’ve evolved to protect ourselves and learn from dangerous situations—we step back, reassess the world and our place in it. We relive the event until we can make some sense of it, then we move on with better awareness and understanding. This is known as natural recovery.

Sometimes, however, we get stuck. The mechanisms that we use to recover simply won’t shut off. Put simply, Post Traumatic Stress Disorder (PTSD) is a dysregulation in the nervous system where the stress response does not shut off long after the threat or danger has passed. We get stuck in that fight, flight or freeze response, locked in an endless loop of reliving the worst experiences of our lives.

Think of stress response like a smoke detector. It’s a very good thing to have and it’s difficult to imagine wanting to live in a home without one. That would be reckless and dangerous. So, let’s pretend we left a pan of food on the stove. The alarm goes off—exactly what it designed to do to keep us safe. But, if the smoke detector then starts misfiring and going off frequently or at random, it would no longer be helpful and would make it really hard to relax in our home. That is what happens with PTSD.

It is important to understand that this is not a conscious decision. No one chooses to have a problem with their stress response system. PTSD is an injury to our stress response system. It is not a mental illness. It is not a disease. It is a result of a trauma that happens to us (originates outside of us and) and, for a myriad of reasons, our recovery becomes blocked.

To develop PTSD, a person must have experienced a traumatic event, witnessed a major trauma to others, heard details of a traumatic event happening to a family member/friend, or experienced repeated or extreme exposure to details of trauma to others as a first responder, investigator, lawyer or researcher.

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Symptoms include:

• Re-experiencing events through nightmares or unwelcome/untimely images that come at you unbidden, or experiencing a bodily sense that the event is recurring;
• Avoidance of people, places, things, emotions or situations that remind you of the events. Unchecked avoidance often start seeping into every area of your life and soon, nothing feels safe or trustworthy;
• Negative thoughts about yourself and the world such as extreme cynicism, self-blame, shame, low trust and over-generalizing about certain groups of people or authority figures;
• Hyper-arousal which may show up as constantly scanning for threats/danger, being easily startled, finding it exceedingly difficult to relax or sleep, and/or struggling to focus and concentrate.

These symptoms take a huge toll on your body, mind, heart and spirit. Having your worst memories arise unexpectedly can be extremely jarring and upsetting. Many people with PTSD report feeling isolated, lonely and detached from others. Some lose their sense of purpose and meaning. They may be persistently anxious (which often shows itself as chronic irritability or anger) and most have a growing desire to avoid. Let’s be clear: the more you avoid, the smaller your life gets and the worse you feel about yourself. These negative thoughts can easily lead to depression.

Violence, abusive behaviour, addictions, lying, cheating and any form of exploitation or manipulation are not symptoms of PTSD. Each of these constitutes a separate issue to be addressed. Clinicians make assessments about the presenting issues and then evaluate which one takes precedence in treatment. For example, if a client develops a severe drinking problem, then addiction is the presenting issue. The addiction needs to be treated by an addictions specialist before any kind of meaningful PTSD treatment (PTSD treatment is very challenging and requires clear thinking). If a client discloses they are using violence against their partner, blaming the violence on their PTSD, the clinician must then assess the risk to the partner and themselves. They must address accountability and have some frank and uncomfortable discussions about what is and what is not acceptable behaviour before any kind of PTSD treatment can be considered.

The good news is that PTSD can be treated. There are several well-researched and highly reputed treatments that can help reduce (and sometimes eliminate) symptoms. PTSD treatment helps you discover where your recovery is stuck and take the steps to put the trauma in the past. The first two treatments are highly recommended and the third is gaining ground.

Treatments include:

1. Cognitive Processing Therapy (CPT) is a structured protocol of 12-15 sessions where you learn skills to identify and confront self-limiting beliefs. CPT builds cognitive skills and flexibility. It focuses on safety, trust, power and control, intimacy and self-esteem. Once complete, you take those skills with you for the rest of your life.
2. Prolonged exposure (PE) is a structured protocol and is usually completed within 8-15 weekly sessions. PE is a behavioural approach that involves rating distress and learning how to approach (rather than avoid) traumatic associations both in and between sessions. Over the course of treatment, clients set up exercises to expose themselves to things they have been avoiding, such as walking through an area of town or listening to a recording of sirens. They repeat these exercises until those things are no longer upsetting, then they can tackle something a little more challenging. Finally, they record themselves recounting their most traumatic memories and listen to it repeatedly until it becomes less distressing. Then they keep going until they have fully “digested” it and can recount the events without becoming overwhelmed.
3. Eye Movement Desensitization and Reprocessing Therapy (EMDR) is a treatment that involves you recounting traumatic memories while simultaneously moving your eyes or hands. The theory is that the movements allow you to focus on something neutral so that you can approach the memories and reprocess them so that they are less psychologically disruptive.

If you are struggling with symptoms of a stress injury, start by seeking help from a trained therapist who specializes in one of the treatments outlined above.

Colleen Stevenson is a clinical counsellor based in Victoria, B.C., specializing in the treatment of PTSD. Prior to counselling, she worked as an educator and graphic facilitator and worked in Ghana, Mexico and with Indigenous communities across North America. She was also the trauma counsellor at a maximum-security jail.