Module 6: Post Traumatic Stress Disorder Management and Prevention - Treatment, Recovery and Implications for Industry

TREATMENT:

Neuro-Physiology:

• Persistent amygdala reactivity

Psycho-Education:

• Information.
• Correction of expectations.

Psychotherapy:

• Cognitive-behavioural therapy (CBT).
• Exposure therapy.
• Eye Movement Desensitisation and Restructuring (EMDR).

Pharmacotherapy:

• Symptom reduction only.
• Fluoxetine.
• Paroxetine.
• Sertraline.

Normal recovery from trauma:

• Three to four weeks.

Recovery from PTSD:

• 30% complete, 40% mild symptoms, 20% moderate, 10% unchanged or worse.

DETERMINANTS OF RECOVERY:

Factors of the person:

• Age.
• Psychiatric history.
• Trauma history.
• Personality.
• Social supports.
• Other stressors.

Factors of the traumatic incident:

• Type of incident.
• Injury or bereavement.
• Unpredictability.
• Likelihood of recurrence.
• Subjective experience / cognitive attributions.

Factors of recovery environment:

• Debriefing / counselling ?
• Medication ?
• danger of benzodiazepines,
• danger of pathologising,
• problem of delayed onset.
• Social supports - the importance of validation.
• Early identification and treatment.

IMPLICATIONS FOR INDUSTRY:

• Decreased efficiency.
• Absenteeism.
• Staff turnover.
• Disability claims.
• Litigation, employer’s responsibility.

Compensation fund (circular instruction 172):

• PTSD is an injury on duty.
• Medical aid.
• Disability.
• Prevention.

Issues specific to work related trauma:

• Social supports - management, colleagues.
• Avoidance.
• Medical attention.

Proposed model for management of work related trauma:

• Typical reactions following trauma is defined as normal and functional.
• Evaluation of risk factors.
• Early treatment intervention.
• Optimising recovery - guiding social supports, correcting expectations, correcting self-defeating cognitions.
• Strategies for countering avoidance.
• Training of managers.
• Training of trauma vulnerable staff.
• Training of other professionals.