There are multiple evidence-based treatments for reducing acute and chronic Posttraumatic Stress Disorder (PTSD) and associated sleep disturbances. PTSD is considered chronic when the duration of symptoms extends beyond 3 months. Several treatment guidelines are available to assist clinicians with the selection and implementation of appropriate treatments. Treatment guidelines typically recommend cognitive behavioral therapy (CBT) interventions, such as prolonged exposure therapy, cognitive processing therapy (CPT), and eye movement desensitization and reprocessing (EMDR). Additional treatment recommendations include stress inoculation treatment and pharmacotherapy. For acute traumatic stress reactions, a wait and see approach is recommended as a natural recovery process is believed to be activated posttrauma and should be respected. Overall, the establishment of a strong, positive therapeutic alliance is essential to providing a safe context in which clients can process their trauma experiences and regain a sense of psychological stability and empowerment.

Psychological trauma can occur when a person experiences an extreme stressor that negatively affects his or her emotional or physical well-being. Trauma can cause emotionally painful and distressing feelings that overwhelm a person’s capacity to cope and leave him or her with feelings of helplessness. Traumatic events can lead to Posttraumatic stress disorder (PTSD) and myriad other reactions, such as depression, substance abuse, sleep problems, and potentially chronic health problems, such as heart disease, diabetes, and cancer. Trauma exposure cuts across all walks of life, regardless of age, race, ethnicity, socioeconomic status, religion, and cultural background. The types of traumatic events includes child maltreatment, intimate partner violence/domestic violence, rape or sexual violence, military sexual trauma, sex trafficking, combat-related trauma, civilian war trauma and torture, disasters, serious accidents, and life-threatening medical illness. This book provides an overview of the rich and varied research conducted on psychological trauma over the past 3 decades.

Posttraumatic growth (PTG) refers to positive psychological changes in the wake of traumatic or highly challenging life events. Growth does not occur as a direct result of trauma. Rather, it is the individual’s struggle with the new reality in the aftermath of trauma that is crucial in determining whether posttraumatic growth occurs. PTG is part of many spiritual and religious traditions and is a common theme in literature and philosophy. Researchers have also examined the relationship between resilience and growth. Resilience is defined as exposure to traumatic events without developing psychopathology. Perceived growth is thought to arise when people try to make sense of what happened and cope with their emotional reactions. This process allows trauma survivors to reflect on their lives, observe new strengths, and find meaning in the event, often by seeing “the bigger picture”.

This chapter examines the ways in which the experience, interpretation, and response to trauma may vary by gender, race or ethnicity, and culture. Findings from large-scale epidemiological surveys indicate significant gender differences in trauma exposure and Posttraumatic stress disorder (PTSD). Various theories have been put forth to explain the differential gender risk for developing PTSD, including the situational vulnerability theory and the female vulnerability theory. Another area that has been examined to help explain gender differences in PTSD is posttrauma cognitions and coping responses. Empirical studies on gender differences in PTSD treatment outcomes, however, have been limited. Gender differences in exposure to certain types of traumas may partly explain this difference, with women reporting greater exposure to high-impact traumas. Moreover, certain discriminatory practices may be traumatic events in and of themselves, which increases exposure to trauma among racial and ethnic minorities.

Psychological trauma can have long-term effects on health. When considering the impact of trauma on health, most people tend to focus on immediate consequences, such as injury. And these needs can be substantial. Patients who reported four or more types of childhood adversity, including sexual, physical, and emotional abuse; exposure to domestic violence; and parental mental illness, criminal activity, and substance abuse, were at significantly increased risk for such diverse conditions as ischemic heart disease, cancer, stroke, chronic bronchitis, emphysema, diabetes, and hepatitis. Human beings are meant to have social relationships with others. Unfortunately, trauma survivors often have difficulties in their relationships. Depression and Posttraumatic stress disorder (PTSD) are common sequelae of trauma. Depression is one of the most commonly occurring sequelae of trauma. Given the serious often life-threatening conditions that trauma survivors often have, an adequate health care system response is perhaps the most pressing need of survivors of traumatic events.

A relatively new and controversial psychiatric diagnostic category, posttraumatic stress disorder (PTSD) is the only psychiatric disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM) that requires exposure to a traumatic event to meet the diagnosis. According to the DSM-IV-TR, a person could be diagnosed with PTSD only if he or she experienced a criterion A stressor, which comprises two components: The person experienced, witnessed events that involved actual threatened death/serious injury, or a threat to the physical integrity of self/others, and the person’s response involved intense fear, helplessness, or horror. The PTSD symptom clusters include re-experiencing symptoms, such as intrusive thoughts, nightmares, and flashbacks about the traumatic event, avoidance of trauma-related stimuli, such as memories, thoughts, feelings, or places associated with the trauma, emotional numbing, and hyperarousal symptoms, including difficulty falling/staying asleep, irritability/anger, and increased startle response.

Self-care is critical when someone works with clients or patients who have experienced trauma. Providers might also be dealing with their own trauma history. Burnout is possible, as are compassion fatigue and secondary traumatic stress. Burnout is a gradual process. Secondary traumatic stress can be gradual but can also happen suddenly. Burnout is a process during which a person disconnects from work and relationships. The common causes of burnout are overwork, unrealistic expectations, lack of sense of coherence, perfectionism, and codependency and overinvolvement. Compassion fatigue appears to be relatively common among those who work with abuse survivors. Countertransference is a psychoanalytic term that has relevance to trauma work. Providers should take time to take care of their bodies. This means getting enough sleep, eating nutritious foods, exercising, connecting with others, and maintaining a spiritual life.

This chapter describes that posttraumatic stress disorder (PTSD) can have a significant negative effect on families. In spite of difficulties, it is possible for family members to band together and weather the storm of PTSD. When one member of a family suffers, it affects the entire family. They may not have experienced the traumatic event, but they live every day with the consequences. They are collateral damage. PTSD can affect all members of a survivor’s family: parents, spouses, and children. Divorce is twice as common in families with PTSD. Spouses are at increased risk for domestic violence. People with PTSD are easily startled; they have nightmares, which can interfere with their family members’ sleep; and they can’t handle many social situations, often isolating their families from contact with the outside world. PTSD can also significantly alter the personality, making an individual seem like a different person.

Complementary and alternative medicine (CAM) includes a range of therapies and health care systems, practices, and products that are outside of standard medical practice in the United States (U.S.). CAM treatments generally have fewer side effects and address the range of symptoms that patients with complex disorders, such as posttraumatic stress disorder (PTSD), experience. The U.S. Department of Veterans Affairs (VA) is committed to providing cutting-edge, evidence-based treatment for all Veterans, including those seeking PTSD-related services. Acupuncture is one of the most mainstream of the CAM treatments. It is based on traditional Chinese medicine (TCM) and involves inserting very thin needles along meridian points to stimulate the flow of energy. Mindfulness is another CAM modality that has been integrated into trauma treatment. Another CAM treatment for trauma is expressive writing. One mechanism by which expressive writing was thought to be effective was in helping trauma survivors.