Researchers urge preventing effects of traumatic experiences

Post-traumatic stress disorder (PTSD) affects approximately 10% of road accident participants and as many as half of people who have experienced war, and victims of rape or violence. PTSD negatively affects the quality of life; it is also associated with greater costs of health care. That is why it is so important to prevent the effects of traumatic experiences, and if PTSD or other mental problems do occur—treat victims using evidence-based methods, argue scientists from SWPS University and the University of Warsaw.

Refugees are particularly vulnerable to post-traumatic stress. Three years ago, on February 24, 2022, Russia invaded Ukraine. Millions of people fled their home country to save their lives. Many of those forced to flee experienced war trauma associated with violence or a direct threat to life.

Refugees are a group at particular risk of mental health problems, including post-traumatic stress disorder (PTSD). Despite a number of studies that identify the most effective treatment methods, few people have received adequate help, especially in the area of psychotherapy. Many refugees may have needed it, because according to research, every war doubles the incidence of PTSD in its victims, who continue to struggle with its consequences long after the war has ended.

PTSD: Recurring memories, flashbacks and chronic arousal

Agnieszka Popiel, Ewa Pragłowska and Bogdan Zawadzki—authors of the paper “(Why?) evidence-based treatments for war-related posttraumatic stress disorder,” published in the journal Migration Studies—Studia Migracyjne—Przegląd Polonijny—emphasize that PTSD symptoms are not related to the type of experienced trauma. These symptoms include: recurring memories, flashbacks of the event (such as a bombing or a direct threat of death), a state of chronic arousal (which is why PTSD is a stress disorder), outbursts of anger, sleep problems, and avoiding situations that may be associated with trauma (reluctance to talk about it, avoiding shelters and people who were present in a given situation).

All of these symptoms negatively affect the quality of life and lead to a worse functioning of a person in many areas of life. Unfortunately, PTSD can be difficult to diagnose, because patients often avoid all bad memories and refuse to talk about them—which is why in many cases the problem remains undiagnosed.

Although, in the case of some people, “time heals wounds” and they regain mental balance after a few months, the condition of others deteriorates over time.

If there is no improvement, a professional diagnosis is necessary and patients should be provided with appropriate treatment based on scientific evidence. This concept is derived from the assumption that decisions regarding therapy should be supported by evidence, and not, for example, based on intuition or traditional beliefs.

The goal is to provide patients with the most effective help based on the current state of scientific knowledge, explains Agnieszka Popiel, Ph.D., a professor at SWPS University, head of Advanced Clinical Studies and Therapy Excellence Center at the SWPS University Institute of Psychology.

Proper treatment—what does it mean?

Treatment of mental disorders involves pharmacotherapy and/or psychotherapy. The former can be recommended by medical doctors, including primary care physicians. More complex cases may require a consultation with a psychiatrist, who will recommend the appropriate therapy for the given patient. Psychotherapy for PTSD, on the other hand, should be provided by psychotherapists (psychologists, medical doctors or other medical professionals), who, in addition to general psychotherapeutic education, are trained in verified and recommended PTSD treatment methods.

The selected treatment method must be suitable for the given type of disorder. A lot of research has been done on psychotherapy methods over the last 50 years, allowing to identify the most effective ones, and those that are ineffective or even harmful. However, some methods still have not been studied at all. That is why it is important for mental health professionals to take scientific evidence into account when choosing the treatment method.

The institutions that provide guidelines on this topic include the British agency National Institute for Clinical Excellence (NICE), the American Psychological Association, the American Psychiatric Association (APA) and the International Society for Traumatic Stress Studies (ISTSS). These organizations recommend psychotherapy for the treatment of PTSD, primarily including methods known as TF-CBT—trauma-focused cognitive behavioral therapy. Pharmacotherapy can also be considered if psychotherapy is momentarily unavailable, or impossible due to other factors, e.g. cultural ones.

PTSD also affects uniformed services and medics

The authors of the paper also emphasize that special attention should be paid to PTSD prevention in people who are unable to avoid traumatic events due to their profession or service. Although the statement “prevention is better than cure” is quite obvious, there is relatively little research on the effectiveness of PTSD prevention measures. One of the few sources of data on the efficacy of such interventions comes from the Polish PTSD prevention program for people at risk of occupational exposure to trauma, “Effective performance under stress.”

Untreated post-traumatic disorders affecting millions of people can have a negative effect on individuals and the entire society, and aid resources will always be limited. That is why the authors of the paper emphasize the need for careful planning during post-war periods in order to enable victims of conflicts to regain their pre-trauma lives.

Compliance with guidelines and selection of evidence-based treatments enables the assessment of timeframes and risks associated with any psychological and medical intervention.

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