Cognitive Behavioural Therapy (CBT)

What is CBT?
It is a way of talking about:
How you think about yourself, the world and other people
How what you do affects your thoughts and feelings.
CBT can help you to change how you think ("Cognitive") and what you do ("Behaviour)". These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the "here and now" problems and difficulties. Instead of focussing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now.
When does CBT help?
CBT has been shown to help with many different types of problems. These include: anxiety, depression, panic, phobias (including agoraphobia and social phobia), stress, bulimia, obsessive compulsive disorder, post-traumatic stress disorder, bipolar disorder and psychosis. CBT may also help if you have difficulties with anger, a low opinion of yourself or physical health problems, like pain or fatigue.
How does it work?
CBT can help you to make sense of overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you. These parts are:
A Situation - a problem, event or difficult situation
From this can follow:
Thoughts
Emotions
Physical feelings
Actions
Each of these areas can affect the others. How you think about a problem can affect how you feel physically and emotionally. It can also alter what you do about it. There are helpful and unhelpful ways of reacting to most situations, depending on how you think about them.

For example:
Situation:
You've had a bad day, feel fed up, so go out shopping. As you walk down the road, someone you know walks by and, apparently, ignores you.

Unhelpful
Helpful
Thoughts:
He/she ignored me - they don't like me
He/she looks a bit wrapped up in themselves - I wonder if there's something wrong?

Emotional:Feelings
Low, sad and rejected
Concerned for the other person
Physical:
Stomach cramps, low energy, feel sick
None - feel comfortable

Action:
Go home and avoid them
Get in touch to make sure they're OK

The same situation has led to two very different results, depending on how you thought about the situation. How you think has affected how you felt and what you did. In the example in the left hand column, you've jumped to a conclusion without very much evidence for it - and this matters, because it's led to:
a number of uncomfortable feelings
an unhelpful behaviour.
If you go home feeling depressed, you'll probably brood on what has happened and feel worse. If you get in touch with the other person, there's a good chance you'll feel better about yourself. If you don't, you won't have the chance to correct any misunderstandings about what they think of you - and you will probably feel worse. This is a simplified way of looking at what happens. The whole sequence, and parts of it, can also feedback like this:

This "vicious circle" can make you feel worse. It can even create new situations that make you feel worse. You can start to believe quite unrealistic (and unpleasant) things about yourself. This happens because, when we are distressed, we are more likely to jump to conclusions and to interpret things in extreme and unhelpful ways.
CBT can help you to break this vicious circle of altered thinking, feelings and behaviour. When you see the parts of the sequence clearly, you can change them - and so change the way you feel. CBT aims to get you to a point where you can "do it yourself", and work out your own ways of tackling these problems.
"Five areas" assessmentThis is another way of connecting all the 5 areas mentioned above. It builds in our relationships with other people and helps us to see how these can make us feel better or worse. Other issues such as debt, job and housing difficulties are also important. If you improve one area, you are likely to improve other parts of your life as well. "5 areas" diagram.
What does CBT involve?
The sessionsCBT can be done individually or with a group of people. It can also be done from a self-help book or computer programme. In England and Wales two computer-based programmes have been approved for use by the NHS. Fear Fighter is for people with phobias or panic attacks, Beating the Blues is for people with mild to moderate depression.
If you have individual therapy:
You will usually meet with a therapist for between 5 and 20, weekly, or fortnightly, sessions. Each session will last between 30 and 60 minutes.
In the first 2-4 sessions, the therapist will check that you can use this sort of treatment and you will check that you feel comfortable with it.
The therapist will also ask you questions about your past life and background. Although CBT concentrates on the here and now, at times you may need to talk about the past to understand how it is affecting you now.
You decide what you want to deal with in the short, medium and long term.
You and the therapist will usually start by agreeing on what to discuss that day.

The work
With the therapist, you break each problem down into its separate parts, as in the example above. To help this process, your therapist may ask you to keep a diary. This will help you to identify your individual patterns of thoughts, emotions, bodily feelings and actions.
Together you will look at your thoughts, feelings and behaviours to work out:- if they are unrealistic or unhelpful- how they affect each other, and you.
The therapist will then help you to work out how to change unhelpful thoughts and behaviours
It's easy to talk about doing something, much harder to actually do it. So, after you have identified what you can change, your therapist will recommend "homework" - you practise these changes in your everyday life. Depending on the situation, you might start to:
Question a self-critical or upsetting thought and replace it with more helpful (and more realistic) one that you have developed in CBT .
Recognise that you are about to do something that will make you feel worse and, instead, do something more helpful.
At each meeting you discuss how you've got on since the last session. Your therapist can help with suggestions if any of the tasks seem too hard or don't seem to be helping.
They will not ask you to do things you don't want to do - you decide the pace of the treatment and what you will and won't try. The strength of CBT is that you can continue to practise and develop your skills even after the sessions have finished. This makes it less likely that your symptoms or problems will return.

How effective is CBT?
It is one of the most effective treatments for conditions where anxiety or depression is the main problem
It is the most effective psychological treatment for moderate and severe depression
It is as effective as antidepressants for many types of depression

What other treatments are there and how do they compare?
CBT is used in many conditions, so it isn't possible to list them all in this leaflet. We will look at alternatives to the most common problems - anxiety and depression.
CBT isn't for everyone and another type of talking treatment may work better for you.
CBT is as effective as antidepressants for many forms of depression. It may be slightly more effective than antidepressants in treating anxiety.
For severe depression, CBT should be used with antidepressant medication. When you are very low you may find it hard to change the way you think until antidepressants have started to make you feel better.
Tranquillisers should not be used as a long term treatment for anxiety. CBT is a better option.
Problems with CBT
CBT is not a quick fix. A therapist is like a personal trainer that advises and encourages - but cannot 'do' it for you.
If you are feeling low, it can be difficult to concentrate and get motivated.
To overcome anxiety, you need to confront it. This may lead you to feel more anxious for a short time.
A good therapist will pace your sessions. You decide what you do together, so you stay in control.

How long will the treatment last?
A course may be from 6 weeks to 6 months. It will depend on the type of problem and how it is working for you. The availability of CBT varies between different areas and there may be a waiting list for treatment.
What if the symptoms come back?
There is always a risk that the anxiety or depression will return. If they do, your CBT skills should make it easier for you to control them. So, it is important to keep practising your CBT skills, even after you are feeling better. There is some research that suggests CBT may be better than antidepressants at preventing depression coming back. If necessary, you can have a "refresher" course.

So what impact would CBT have on my life?
Depression and anxiety are unpleasant. They can seriously affect your ability to work and enjoy life. CBT can help you to control the symptoms. It is unlikely to have a negative effect on your life, apart from the time you need to give up to do it.

How can I get CBT?
Speak to your GP. They may refer you to someone trained in CBT - for example, a psychologist, nurse, social worker or psychiatrist.
The British Association for Behavioural and Cognitive Psychotherapies keeps a register of accredited therapists.
You can try 'self-help' - using a book, internet programme or computerised CBT. This is more likely to work if you also receive support from a professional.

What will happen if I don't have CBT?
You could discuss alternatives with your doctor. You could also:
Read more about the treatment and its alternatives.
If you want to "try before you buy", get hold of a self-help book or CD-Rom and see if it makes sense to you.
Wait to see if you get better anyway - you can always ask for CBT later if you change your mind.

CHANGE VIEW: 10 key facts about CBT
Change: your thoughts and actions
Homework: practice makes perfect
Action: don't just talk, do!
Need: pinpoint the problem
Goals: move towards them
Evidence: shows CBT can work
View: events from another angle
I can do it: self-help approach
Experience: test out your beliefs
Write it down: to remember progress


-Psy.Visesh,
Treasurer, APCPA,
94401 35779

An Early Psychologist: The Buddha

Buddhist Psychology is based on the example and teachings of the man who came to be called "The Buddha." In many ways the teachings of the Buddha, known as "the dharma," sound more like psychology than what most of us think of as religion. Who was he; what was his story?
Born more than 2500 years ago, the Buddha was born a prince in a small kingdom in northern India. The king, following tradition, asked a soothsayer to offer predictions about his son's future. He was told that his son would grow up to be either a great spiritual teacher or a great monarch. The king, like many powerful men, wanted his son to follow him in the family business. To that end, the king made sure that his son, who was known then as "Siddhartha," didn't hear about spiritual things. Instead, he made sure that the young prince was surrounded by every possible luxury and pleasure. There were musicians and dancing girls, rich fabrics and clothing, delicious foods and fine wines. He lived within the walls of the palace compound and was indulged in all of his desires-as long as they didn't have anything to do with spirituality. Even more, he was protected from seeing anything unpleasant.
Once, when the king had a festival to oversee, he took his son along. The boy was left sitting under a tree while the king attended to his royal duties. Tradition has it that Siddhartha sat under a rose apple tree and had an experience of being simply present and awake. He glimpsed the nature of reality-what we have called "brilliant sanity" in an earlier blog entry. In that moment he was clear, open, and filled with compassion for all beings. And then, the moment passed and was forgotten-as such moments often are for all of us.
As young Siddhartha grew to become a man, he became curious about what lay beyond the palace walls. He convinced his chariot driver to take him on a tour outside the walls. That trip changed his life. There are many versions of that chariot ride, but they all agree that the prince saw things he had never seen before, living as he had in a protected, royal environment. He saw an old man-wrinkled and stooped over. Imagine if you had never seen an old person. How strange he would look! The prince asked his driver, "What is wrong with that man?"
"He is old. If we live long enough, all of us will grow old and look like that."
Next he someone who was sick. Perhaps he saw a woman who was young though barely able to walk, who was gaunt and feeble, whose skin was covered with sores. "What is wrong with her?" he may have asked.
"She is ill. We all become ill."
Then, they saw a dead body by the side of the road. "What is wrong with that person?"
"Ah, this person has died. We all die."
I imagine how shocking these experiences must have been for the prince whose protected life had shielded him from old age, sickness, and death. The next person who caught the prince's attention was a wandering religious mendicant: a spiritual seeker. Such people were common in India at that time. This monk seemed radiant, joyful and calm. The prince had never seen anything like it before.
When I think of that spiritual seeker, I think of great spiritual teachers I have had the good fortune to meet in my life: people like the Dalai Lama and other Tibetan masters. Perhaps you have met such people in your own life: people who seem to exude a quality of peacefulness and wakefulness. Such people may seem "more real" than others, yet they are still very much human beings, not gods.
The prince asked about this man, too. "He is a spiritual seeker," came the answer.
Upon his return to the palace, Siddartha had much to think about. His eyes had been opened to the reality of pain and suffering. He had also seen the spiritual seeker and had glimpsed another way of being. How he had been living his life up to that point now seemed hollow and without meaning, and he couldn't imagine simply returning to it. What was he to do?
Next time, we will continue the story of how Siddhartha left the palace and eventually became the master teacher known to this day as "The Buddha," the "Awakened One."
-Psy.Visesh,
Treasurer, APCPA,
94401 35779

Broken Symmetry: Nobel physicist explains why you miss old places, friends

The bittersweet sad intense pain of missing a place, a person, a crew, a time. What's with that? How does that happen? Here's a take on it you probably haven't heard before. I'll start way back with the big bang. If everything was all concentrated and homogeneous at the origin, how did our universe ever get so lumpy, with separate things like stars and planets, you and me? The 2008 Nobel Prize in physics was awarded to scientists who identified the source as broken symmetry. A first pass explanation of their idea is simple. You know how you can easily balance a broomstick on the palm of your hand? If it's centered, symmetrically upright, it tends to stay there. But if it tips asymmetrically toward one direction, then it becomes increasingly difficult to balance. The symmetry was broken. The tipped get tippier. The butterfly effect is the most familiar version of this. Remember it? Conceivably a butterfly's wings flapping could lead to major shifts in weather patterns. People latched onto that idea as evidence of uncertainty and the potential for miracles. We like ideas that suggest that life has shoots-and-ladder-like qualities, so it's not just stepwise plodding. It gives us hope of rag-to-riches leverage but also allows that if we don't end up fulfilling our ambitions we have an explanation that makes it not our fault: "I tried, but life has surprising shoots and I fell down one." Shoots and ladders aside, the butterfly effect is really about broken symmetry, how a little thing can start a big thing. How just as a slight tip can cause the broomstick to fall or how a shout can cause an avalanche. Think of it also as the way a meteorite passing the earth could fall under our gravitational influence, being taken off course. The closer it gets to the earth, the stronger the earth's gravitational pull. That's broken symmetry too.With the big bang everything flew apart. It would have flown apart evenly but the tiniest little micro-variation got things tipping. Not falling over as like the broomstick but comparable. The universe got lumpy by the same basic process that made our moon. The moon formed when a meteor hit the earth kicking up an enormous dust cloud. Imagine that the dust started out almost evenly distributed, but little variations caused the gravitational pull in some regions to be greater than in others. The dense grew denser. And now most of that dust is concentrated in that great lump of green cheese. A little difference in distribution causes a big difference in concentrations. Broken symmetry explains seperateness and difference.There's broken symmetry in thought and culture too. You meet someone, fall under their gravitational influence, start hanging out, fall further. For good or ill--it could be the love of your life or a heroin dealer. Either way a little tipping becomes a lot. And these days we're rarely tipped in just one direction. In ancient tribal days, you could be born into a tribe that tipped you strongly into its ways there, in the tribe you would stay for all your days. Now, we're under diverse influences. You move a thousand miles to be with your new partner, but miss your old town and people. You design your whole life around a job you love and then they lay you off and you have to find a new place to orbit. Broken symmetry implies something really fundamental about the universe but also about your life. If the universe is lumpy, then this notion that we are all one and that everything is connected needs to be refined. We are all one but some of us are more one than others of us. Everything is connected but not equally. There are plenty of people who have negligible influence on you. They are off in their own lumpy region under their own influences. They're not part of your tribe and therefore are different from you. But then you happen to meet. You've been on independent pages a long time so you start out on different pages. But vive la difference, you like each other. Being with each other you start to influence each other. But lumpy life that it is, you're not just under their influence. You've got other influences operating on you from before and they still tug. So you miss what you had even while your drawn into what you're having. We are all planets under changing influences falling in with some and tearing away from others. Something like that. There's more to this story of course. In particular I'll want to say more about influence. How does influence happen? For that we get into another one of these new scientific concepts: Constraint propagation.

-Psy.Visesh,
Treasurer, APCPA,
94401 35779

ALL PHOTOS OF THE CONFERENCE

Dear friends,

Here I am uploading all the photos of the conference. You can download whatever you want.

PARICIPANTS

CONSELING PSYCHOLOGIST ASSOCIATION

MAILING ADDRESS

Krishna Bharath
D no 2-12-83
Rajyalakshmi nagar
Sthambhalawgareivu
Guntur
Phone number 9985428261

K V Prasad
H no 3-12-13
Kumarpally, bommala
Vepachettu,hanmakonda
Warangar-506001
Phone number 9703543523

Devarapalli Koteshwarakai
Icti counceller
Govt hosipital
Rom no 13
Nuzvid-521201
Phone number 9392710280

Thota Satheesh Babu
13-4-16
Mission hospital road
15 ward bhimavaram-534201
Phone number 9491351445

S M Reedy
Thanmai institute of mind secrets
Flat no 2,bandaru bhavan
Hyderabad-500073
Phone number: 9391167389

Kunaparaju Girija Kumari
Jaimini ashram
Sri Kali gardens, nambur
Guntur-522508
Phone number 9885644788




Kola Parimala Sujani
D no 7-1-401/a/19,flat no 305,
Anuradha estates, behind sr nagar
Hyderabad-500038
Phone number 9390011852

M v l ravi manohar
18-1-720i,bhavani nagar
Tiruapti-517591
Phone number 2230466

CH V Kalyani
D no 30-5-26,koka street
Near vijaya talkies
Vijayawada-520002

Jaladurgam Rama Chandrudu
10-4-771/4/1a,2nd floor
Zakirvilla,sriramnagar cloiney
Masabtank,Hyderabad
Phone number 9849397000

Ranga Venkateshwar
10-3-7,Gandhi chowk
Po bellampalli-504251
Phone number 04024044880

Gillella Venugopal Reddy
H no 3-13-94/5/a
Near tirumala hosipital
Ramanthapur,hyderabad-500031
Phone number 9989923184

B M Hara Om Prakash
H no 4-116,vellulla
Metapally,karimnagar-505325
Phone nmuber 9441970583

Anumula Uma Pathi
Velkatoor,nangunoor
Medak,siddipet-502375
Phone number 9440036097





P Jawaharlal Nehru
2-1-532,street no 9
Nallakunta,Hyderabad-500044
Phone number 04027606040

Thiyam Kiran Singh
Vimhans hospital ,vv rao street
Suryaraopet,vijayawada-520002
Phone number 9885719053

Nabi B S
7-4-513,venkateshwara colony
Mahabubnagar-509001
Phone number 9885508744

Mohd Ibraahim
6-3-1240/55/a/1,opp raj bhavan
M s maqta,somajiguda
Hyderabad -500082
Phone number : 9346925109

Bramandabheri Somanatha Raju
2-11-252,shankarnagar
Near hanumantemple
Vidyamyapuri,hanamkonda-506009
Phone number 9989291954

Kolli Srinivas Reddy
H no 7-982,adovokate cloney
Huntev road,humankonda
Phone number 9866460824

Konda Srinivas
H no 4-5p/12,opp preston school
Jangoan,warangal-506167
Phone number – 9533794220

Kantamsetty Durga Prasad Rao
b-2,sheshadri towers
sivaraopeta,bhimavaram-534202
phone number 08662432329




Mutyam Srinivas
2-2-1166/a/4,room no 1
3rd foolr vinak bank
Tilak nanar Hyderabad-500044
Phone number 9652056654

Gade Bhavani
g-2 triveni heights,balaji nagar
kukatpally Hyderabad
phone umber : 9912254937

Harindra nath J S
H no 1-30-1
Plot no 4,akash nagar
Bowenpally,secunderabad-500011
Phone number 9440055449

Dr Satyavathi Kollu
Plot no 582/a,peoples hosipital
Pragathi nagar,kukatpally
Hyderabad-50090
Phone number 9949651540

Khasim Shaik
H no 12-21-92
Sateesh road
Prakash nagar
Narasaraopeet-522602
Phone number 9440915819

Dr Biray Srinivas
Samskar nature cure college
Akbarnagar,rudrur,varni
Nizambad-503188
Phone number 9848966888

Kolluri Sudhamadhavi
H no 14-115
Rajasrinivas cloney
New munjaigndal
Secbad
Phone number 9849322490





Botla madhavi
Flat no 202,mrr residency
Beside kk towers yousfuda
Hyderabad-500073
Phone numbers 9246874692

Rajendra Prasad Nalluri
Plot no 352,gangasthan
Phase 2,nizambad-503002
Phone number 9440756922

Kondaveeti Gandi
H no 3-1-326,flat no 172
Mythrgnagar l b nagar
Hyderabad -500074
Phone number 9394068506

Madduri Anasuya Preetam
g-6,b13,prajay shalters
bollaram road miyapur
Hyderabad-500049
Phone number 9246353368

Dr SA Thasleeru
Abhaya ranigunta-517520
phone number 9346402089

Boora Bhisha Pathi
H no 2-12-293/20
Vijayanagar cloney
Gopalpur road hanumankonda
Warangal-506009
Phone number 9866612717

Jayanthi Veeturi Yananandra
D no d-38/10,lab aprts
Kanchenbagh hyderabad-500058
Phone number 04024346314

A Prasad
2-114ª obanapalli
Pantrampalli post
Santhapet,chitoor-517004
Phone number 9441643245

Gampa Nageshwer Rao
3-6-771/776,shailaja heights
Street no 14,himayathnagar
Hyderabad -500029
Phone number 984900026

C N Reddy
Kb campus,brahamanapally road
Turkayamjal,sagar road
Hyderabad-501510
Phone number 9000803050

NB Sudhakar Reddy
Nrsr innovative school
18-4-111/2 raiwa cloney
Tirupathi-517501
Phone number 944058440

Sammena Yaseem
3-6-369/a/116,steet no 1
Himayathnagar,Hyderabad-500029
Phone number 9247237845

M A Kareem
2-7-322,mukarampura
Karimnagar-505001
Phone number 9440488571

Vedanthan RangaNath
Postal assistant
Subashnagar
Nizambad-503002
Phone number 9848254720

Bheemaneni Srinivas Goud
1-8-289,near ekasilla park
Balasamudram,hanamudram
Warangal-506001

Kesshipeddy Venkateshwar Raju
H no4-5-23
Kothur market street,hanamkonda
Warangal-506001




N V Pruthidhar Raju
12-2-823/c/72,flat no 301
Swathigruha apts,mehidipatyam
Hyderabad-500028
Phone number 9885337338

Devabhaktuni Vasudeva Rao
Govt ups,vinayak nagar
Nizambad-503003
Phone number 09848016590

T Anjana Murthy
2-1-427/2,street no 4
Nallakunta,Hyderabad-500055
Phone number 9391150586


Dr BV PattabhiRam
Prashanthi counseling center
Samrat complex
Secreatarit road
Hyaderabad
Ph no ౨౩౨౩౩౨౩౨

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PHOTOS

PHOTOGRAPHS

Our Brains Have The Amazing Ability To Be Energy Efficient!

Our brains, it turns out, are eco-friendly, reveals study. A study published in Science and reviewed by F1000 Biology members Venkatesh Murthy and Jakob Sorensen reveals that our brains have the amazing ability to be energy efficient.

Brain cells generate and propagate nerve impulses, or action potentials, by controlling the flow of positive sodium and potassium ions in and out of the cells. Re-establishing the ion equilibrium after an action potential requires energy.The amount of energy needed for action potentials was previously estimated using a giant nerve cell from squid. Now, researchers at the Max-Planck Institute for Brain Research in Germany show that squid cell studies overestimated the amount of energy necessary to generate an action potential by almost a factor of four, suggesting human brains have the same potential to be energy efficient.

The researchers used a novel technique to record the voltage generated by nerve cells to "show that a rather subtle separation between the timing of sodium entry and potassium exit during action potentials can determine how much energy is expended to maintain the ionic gradients," Murthy says.

Murthy goes on to say that "[these results] are important, not just for a basic understanding of brain metabolism, but also for interpreting signals detected by non-invasive brain imaging techniques." Sorensen concludes that "the amazing thing is that we didn't realize the result a long time ago!"

Source-Eurekalert

-Psy.Visesh, 94401 35779

Novel ‘Mind Reading’ Device To Detect Depression In An Hour

Researchers at Monash University are developing a 'mind reading' device that may diagnose depression in an hour.
Brainchild of the university's Brian Lithgow, a biomechanical engineer, the machine is called an 'ECG for the mind'. It analyzes the brain's electrical signals in the same way an ECG can detect heart problems, its creator says.The revolutionary device works by plugging an electrode into the subject's ear, then strapping them to a tilt chair that triggers changes in their balance system, reports The Age.

The balance system is closely connected to primitive parts of the brain relating to emotions and behavior.

While working with psychiatrists from Monash University's Alfred Psychiatry Centre (MAPrc), Lithgow is conducting tests to see if he can identify the unique electrical signals attached to mental illness such as depression, schizophrenia and bipolar disorder.

The head of MAPrc, Professor Jayashri Kulkarni, said the device could prove a major breakthrough in the diagnosis of serious mental illness.

"It is going to lift us, I think, into an era where mental illness can be better understood and better treated," she told ABC radio.

Source-ANI

Psy.Visesh, 94401 35779

Post-Traumatic Stress Disorder (PTSD)

What is post-traumatic stress disorder, or PTSD?

PTSD is an anxiety disorder that some people get after seeing or living through a dangerous event.

When in danger, it’s natural to feel afraid. This fear triggers many split-second changes in the body to prepare to defend against the danger or to avoid it. This “fight-or-flight” response is a healthy reaction meant to protect a person from harm. But in PTSD, this reaction is changed or damaged. People who have PTSD may feel stressed or frightened even when they’re no longer in danger.

Who gets PTSD?

Anyone can get PTSD at any age. This includes war veterans and survivors of physical and sexual assault, abuse, accidents, disasters, and many other serious events.

Not everyone with PTSD has been through a dangerous event. Some people get PTSD after a friend or family member experiences danger or is harmed. The sudden, unexpected death of a loved one can also cause PTSD.

What are the symptoms of PTSD?

PTSD can cause many symptoms. These symptoms can be grouped into three categories:

1. Re-experiencing symptoms:

· Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating

· Bad dreams

· Frightening thoughts.

Re-experiencing symptoms may cause problems in a person’s everyday routine. They can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing.

2. Avoidance symptoms:

· Staying away from places, events, or objects that are reminders of the experience

· Feeling emotionally numb

· Feeling strong guilt, depression, or worry

· Losing interest in activities that were enjoyable in the past

· Having trouble remembering the dangerous event.

Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.

3. Hyperarousal symptoms:

· Being easily startled

· Feeling tense or “on edge”

· Having difficulty sleeping, and/or having angry outbursts.

Hyperarousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic event. They can make the person feel stressed and angry. These symptoms may make it hard to do daily tasks, such as sleeping, eating, or concentrating.

It’s natural to have some of these symptoms after a dangerous event. Sometimes people have very serious symptoms that go away after a few weeks. This is called acute stress disorder, or ASD. When the symptoms last more than a few weeks and become an ongoing problem, they might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months.

Do children react differently than adults?

Children and teens can have extreme reactions to trauma, but their symptoms may not be the same as adults.¹ In very young children, these symptoms can include:

· Bedwetting, when they’d learned how to use the toilet before

· Forgetting how or being unable to talk

· Acting out the scary event during playtime

· Being unusually clingy with a parent or other adult.

Older children and teens usually show symptoms more like those seen in adults. They may also develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge. For more information, see the NIMH booklets on helping children cope with violence and disasters.

How is PTSD detected?

A doctor who has experience helping people with mental illnesses, such as a psychiatrist or psychologist, can diagnose PTSD. The diagnosis is made after the doctor talks with the person who has symptoms of PTSD.

To be diagnosed with PTSD, a person must have all of the following for at least 1 month:

· At least one re-experiencing symptom

· At least three avoidance symptoms

· At least two hyperarousal symptoms

· Symptoms that make it hard to go about daily life, go to school or work, be with friends, and take care of important tasks.

Why do some people get PTSD and other people do not?

It is important to remember that not everyone who lives through a dangerous event gets PTSD. In fact, most will not get the disorder.

Many factors play a part in whether a person will get PTSD. Some of these are risk factors that make a person more likely to get PTSD. Other factors, called resilience factors, can help reduce the risk of the disorder. Some of these risk and resilience factors are present before the trauma and others become important during and after a traumatic event.

Risk factors for PTSD include

· Living through dangerous events and traumas

· Having a history of mental illness

· Getting hurt

· Seeing people hurt or killed

· Feeling horror, helplessness, or extreme fear

· Having little or no social support after the event

· Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home.

Resilience factors that may reduce the risk of PTSD include

· Seeking out support from other people, such as friends and family

· Finding a support group after a traumatic event

· Feeling good about one’s own actions in the face of danger

· Having a coping strategy, or a way of getting through the bad event and learning from it

· Being able to act and respond effectively despite feeling fear.

Researchers are studying the importance of various risk and resilience factors. With more study, it may be possible someday to predict who is likely to get PTSD and prevent it.

How is PTSD treated?

The main treatments for people with PTSD are psychotherapy (“talk” therapy), medications, or both. Everyone is different, so a treatment that works for one person may not work for another. It is important for anyone with PTSD to be treated by a mental health care provider who is experienced with PTSD. Some people with PTSD need to try different treatments to find what works for their symptoms.

If someone with PTSD is going through an ongoing trauma, such as being in an abusive relationship, both of the problems need to be treated. Other ongoing problems can include panic disorder, depression, substance abuse, and feeling suicidal.

Psychotherapy

Psychotherapy is “talk” therapy. It involves talking with a mental health professional to treat a mental illness. Psychotherapy can occur one-on-one or in a group. Talk therapy treatment for PTSD usually lasts 6 to 12 weeks, but can take more time. Research shows that support from family and friends can be an important part of therapy.

Many types of psychotherapy can help people with PTSD. Some types target the symptoms of PTSD directly. Other therapies focus on social, family, or job-related problems. The doctor or therapist may combine different therapies depending on each person’s needs.

One helpful therapy is called cognitive behavioral therapy, or CBT. There are several parts to CBT, including:

· Exposure therapy. This therapy helps people face and control their fear. It exposes them to the trauma they experienced in a safe way. It uses mental imagery, writing, or visits to the place where the event happened. The therapist uses these tools to help people with PTSD cope with their feelings.

· Cognitive restructuring. This therapy helps people make sense of the bad memories. Sometimes people remember the event differently than how it happened. They may feel guilt or shame about what is not their fault. The therapist helps people with PTSD look at what happened in a realistic way.

· Stress inoculation training. This therapy tries to reduce PTSD symptoms by teaching a person how to reduce anxiety. Like cognitive restructuring, this treatment helps people look at their memories in a healthy way.

Other types of treatment can also help people with PTSD. People with PTSD should talk about all treatment options with their therapist.

How Talk Therapies Help People Overcome PTSD

Talk therapies teach people helpful ways to react to frightening events that trigger their PTSD symptoms. Based on this general goal, different types of therapy may:

· Teach about trauma and its effects.

· Use relaxation and anger control skills.

· Provide tips for better sleep, diet, and exercise habits.

· Help people identify and deal with guilt, shame, and other feelings about the event.

· Focus on changing how people react to their PTSD symptoms. For example, therapy helps people visit places and people that are reminders of the trauma.

Treatment after mass trauma

Sometimes large numbers of people are affected by the same event. For example, a lot of people needed help after Hurricane Katrina in 2005 and the terrorist attacks of September 11, 2001. Most people will have some PTSD symptoms in the first few weeks after events like these. This is a normal and expected response to serious trauma, and for most people, symptoms generally lessen with time. Most people can be helped with basic support, such as:

· Getting to a safe place

· Seeing a doctor if injured

· Getting food and water

· Contacting loved ones or friends

· Learning what is being done to help.

But some people do not get better on their own. A study of Hurricane Katrina survivors found that, over time, more people were having problems with PTSD, depression, and related mental disorders. This pattern is unlike the recovery from other natural disasters, where the number of people who have mental health problems gradually lessens. As communities try to rebuild after a mass trauma, people may experience ongoing stress from loss of jobs and schools, and trouble paying bills, finding housing, and getting health care. This delay in community recovery may in turn delay recovery from PTSD.

In the first couple weeks after a mass trauma, brief versions of CBT may be helpful to some people who are having severe distress. Sometimes other treatments are used, but their effectiveness is not known. For example, there is growing interest in an approach called psychological first aid. The goal of this approach is to make people feel safe and secure, connect people to health care and other resources, and reduce stress reactions.There are guides for carrying out the treatment, but experts do not know yet if it helps prevent or treat PTSD.

In single-session psychological debriefing, another type of mass trauma treatment, survivors talk about the event and express their feelings one-on-one or in a group. Studies show that it is not likely to reduce distress or the risk for PTSD, and may actually increase distress and risk.

Mass Trauma Affects Hospitals and Other Providers

Hospitals, health care systems, and health care providers are also affected by a mass trauma. The number of people who need immediate physical and psychological help may be too much for health systems to handle. Some patients may not find help when they need it because hospitals do not have enough staff or supplies. In some cases, health care providers themselves may be struggling to recover as well.

NIMH scientists are working on this problem. For example, researchers are testing how to give CBT and other treatments using the phone and the Internet. In one study, people with PTSD met with a therapist to learn about the disorder, made a list of things that trigger their symptoms, and learned basic ways to reduce stress. After this meeting, the participants could visit a Web site with more information about PTSD. Participants could keep a log of their symptoms and practice coping skills. Overall, the researchers found the Internet-based treatment helped reduce symptoms of PTSD and depression.¹⁰ These effects lasted after treatment ended.

Researchers will carry out more studies to find out if other such approaches to therapy can be helpful after mass trauma.

What efforts are under way to improve the detection and treatment of PTSD?

Researchers have learned a lot in the last decade about fear, stress, and PTSD. Scientists are also learning about how people form memories. This is important because creating very powerful fear-related memories seems to be a major part of PTSD. Researchers are also exploring how people can create “safety” memories to replace the bad memories that form after a trauma. NIMH’s goal in supporting this research is to improve treatment and find ways to prevent the disorder.

PTSD research also includes the following examples:

· Using powerful new research methods, such as brain imaging and the study of genes, to find out more about what leads to PTSD, when it happens, and who is most at risk.

· Trying to understand why some people get PTSD and others do not. Knowing this can help health care professionals predict who might get PTSD and provide early treatment.

· Focusing on ways to examine pre-trauma, trauma, and post-trauma risk and resilience factors all at once.

· Looking for treatments that reduce the impact traumatic memories have on our emotions.

· Improving the way people are screened for PTSD, given early treatment, and tracked after a mass trauma.

· Developing new approaches in self-testing and screening to help people know when it’s time to call a doctor.

· Testing ways to help family doctors detect and treat PTSD or refer people with PTSD to mental health specialists.

How can I help a friend or relative who has PTSD?

If you know someone who has PTSD, it affects you too. The first and most important thing you can do to help a friend or relative is to help him or her get the right diagnosis and treatment. You may need to make an appointment for your friend or relative and go with him or her to see the doctor. Encourage him or her to stay in treatment, or to seek different treatment if his or her symptoms don’t get better after 6 to 8 weeks.

To help a friend or relative, you can:

· Offer emotional support, understanding, patience, and encouragement.

· Learn about PTSD so you can understand what your friend or relative is experiencing.

· Talk to your friend or relative, and listen carefully.

· Listen to feelings your friend or relative expresses and be understanding of situations that may trigger PTSD symptoms.

· Invite your friend or relative out for positive distractions such as walks, outings, and other activities.

· Remind your friend or relative that, with time and treatment, he or she can get better.

Never ignore comments about your friend or relative harming him or herself, and report such comments to your friend’s or relative’s therapist or doctor.

How can I help myself?

It may be very hard to take that first step to help yourself. It is important to realize that although it may take some time, with treatment, you can get better.

To help yourself:

· Talk to your doctor about treatment options.

· Engage in mild activity or exercise to help reduce stress.

· Set realistic goals for yourself.

· Break up large tasks into small ones, set some priorities, and do what you can as you can.

· Try to spend time with other people and confide in a trusted friend or relative. Tell others about things that may trigger symptoms.

· Expect your symptoms to improve gradually, not immediately.

· Identify and seek out comforting situations, places, and people.

Where can I go for help?

If you are unsure where to go for help, ask your family doctor. Others who can help are listed below.

Mental health resources

· Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors

· Health maintenance organizations

· Community mental health centers

· Hospital psychiatry departments and outpatient clinics

· Mental health programs at universities or medical schools

· State hospital outpatient clinics

· Family services, social agencies, or clergy

· Peer support groups

· Private clinics and facilities

· Employee assistance programs

· Local medical and/or psychiatric societies.

You can also check the phone book under “mental health,” “health,” “social services,” “hotlines,” or “physicians” for phone numbers and addresses. An emergency room doctor can also provide temporary help and can tell you where and how to get further help.