PTSD

A Post-Traumatic Stress Disorder Case Study:

One year ago Jacob had been driving his car and turned right at a set of filter lights. He drove in front of oncoming cars that were waiting at a red light. Jacob remembers seeing a car being driven at some speed approaching the lights where other cars were waiting. The speeding car went through the red lights and straight into the passenger side of Jacob’s car. Jacob remembers fearing for his life as the speeding car hit him and pushed him sideways into the barriers at the side of the road. Jacob remembers the sound of crunching metal and windows being smashed. Jacob remembers realising that there was nothing he could do accept brace for the final impact. When the car hit the barriers Jacob’s face hit the side window and he heard a crack. Jacob’s car was crushed on the side of the initial impact and the driver’s side was heavily damaged.

Jacob was taken to hospital and was found to have a broken cheek bone, which was operated on a week later. Jacob also had other cuts and bruises but these were not serious injuries.

Over the following year after the accident Jacob’s life changed dramatically. He experienced frequent flashbacks of the incident, where he acted and felt like he was back there at that time. He also experienced nightmares involving the car accident and was suffering from frequent intrusive thoughts, which means memories of the accident popped into his head when he was not meaning to think about it.

These re-experiencing symptoms would lead Jacob to feel very fearful. He found himself feeling anxious a lot and felt unsafe. He did not drive after the accident and developed some anxiety when crossing roads, walking by roads or while being on a bus. To avoid this anxiety he withdraw from social activities and only really went out for work, relying on his partner to shop for him.  He started to feel very depressed and would often get angry and irritable, especially with those he cared about. Jacob tried to avoid speaking and thinking about the accident. He would also demand this of his partner.

When Jacob came to therapy it was clear that his traumatic experience had changed his life and that he appeared to be experiencing post- traumatic stress disorder and travel phobia. It was explained to him that PTSD had been maintained by the way he had chosen to cope with the frightening memories. By avoiding thinking about the accident he had prevented himself from processing the memories. The memories were still distressing for Jacob to think about and he pushed them out of his head whenever he noticed he was thinking about it. As a result, instead of processing these memories he only managed to temporarily push them out only for them to come back in the form of intrusive thoughts, nightmares and flashbacks.

The start of treatment involved a process called reliving. This initially began with a full and detailed recollection of the traumatic event. After which, Jacob was asked to recall the events of that day in a particular way. He was asked to give a detailed description of the accident in the first person and present tense. People often find this process easier with their eyes closed so that they can imagine being back at the time. Jacob found this difficult initially and became distressed. This is understandable and was to be expected.

The second reliving session was recorded on Jacob’s phone and he listened to it twice everyday between sessions. Jacob spent the first week trying to avoid this. For example, he would listen to the recording while doing the washing up and so he was not completely focused on it. However, he reported that the more he listened to it the easier it became. This was certainly what I observed as the reliving process continued in session.

During the reliving process it appeared that Jacob would be more distressed at certain points. We looked at these ‘hotspots’ and it appeared that at these moments he would be thinking that he would die or be seriously injured. At another point he thought about his partner not being able to manage if he died. We looked at what ‘we know now’ and added this into the reliving session. This was to reconstruct the meaning of the ‘hotspot’ moments. So, instead of thinking ‘I am going to die’ we reconstructed this with ‘what we know now’ – which is that he did not die and his partner would not be without him. This reduced the intensity of the fear at those moments.

After three weeks of the reliving process Jacob was starting to see a massive reduction in the flashbacks, nightmares and intrusive thoughts. He also reported that he was not feeling distressed when reminded of the accident by certain cues, such as seeing drivers turning right and accidents on TV. As a result, his level of anxiety reduced significantly.

Jacob was asked to continue listening to the recorded session and we started work on reclaiming his life. He felt anxious about contacting his friends as he had felt unsafe for nearly a year. However, with his anxiety lowered he started attending social events and was pleasantly surprised that he had positive experiences. He started to socialise more regularly, which reinforced the idea he was safe to be outside.