Occupational Therapy for Post Traumatic Stress

Occupational therapy practitioners (OTPs) are skilled in helping people with PTSD increase functional performance by addressing barriers to occupational performance.

Post Traumatic Stress Disorder (PTSD) is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event, series of events, or set of circumstances. PTSD does not appear in everyone. However, according to the American Psychiatric Association, one in 11 people will be diagnosed with PTSD in their lifetime.

Recommended course: Understanding Post-Traumatic Stress Disorder, 2nd Edition

Women are twice as likely as men to have PTSD. Latinos, African Americans, and Native Americans/Alaska Natives are disproportionately affected and have higher rates of PTSD than non-Latino whites. Children are as susceptible to PTSD as adults.

What causes PTSD?

Causes of PTSD can include:

• Childhood trauma
• War
• Emotional, sexual, or physical abuse
• A near-death experience
• Witnessing a traumatic event

PTSD can be widespread. The tragic events of the 9/11 terrorist attacks in New York City, for example, scarred far more than just the NYC skyline. Even those who didn’t lose loved ones in the attacks nevertheless witnessed horrific destruction, and the entire nation experienced an unprecedented loss of personal safety. In fact, according to ny.gov, PTSD is the most common health concern resulting from the 9/11 attacks.

PTSD symptoms

Symptoms of PTSD fall into four categories, and these symptoms can vary in severity.

• Intrusive thoughts such as repeated, involuntary memories, distressing dreams, or flashbacks of the traumatic event. Flashbacks may be so vivid that people feel they are reliving or seeing the traumatic experience before their eyes.
• Avoidance of trauma reminders such as places, activities, objects, and situations that can trigger distressing memories. People may try to avoid remembering or thinking about the traumatic event and resist talking about what happened or how they feel about it.
• Alterations in cognition and mood can cause an inability to remember important aspects of the traumatic event. A traumatized person can also have negative thoughts and feelings about themselves or others and feel devoid of happiness.
• Alterations in arousal and reactivity demonstrated by self-destructive, reckless behavior, difficulty sleeping or concentrating, and difficulty managing emotions.

PTSD can cause secondary problems such as depression, substance abuse, and chronic pain. Singer and actor Lady Gaga has been open about how her PTSD from a sexual assault has caused chronic pain, as well as her struggle with fibromyalgia. An article published in the Expert Review of Neurotherapeutics recommends that patients with fibromyalgia should also be screened for PTSD.

PTSD’s effects on occupational performance

PTSD can adversely affect a person’s ability to engage in current and future occupations by creating cognitive, social, and physical alterations to their baseline state. The person living with PTSD can exhibit maladaptive behaviors that hinder their social, physical, or mental participation in functional activities.

Areas of impaired occupational performance include:

• Leisure activities
• Activities of daily living
• Social activities
• Educational activities
• Pre-vocational and vocational activities

Reportedly, rock star Mick Jagger’s doctor ordered him not to tour for 30 days after his diagnosis of PTSD resulting from his long-time girlfriend committing suicide in the apartment they shared. His doctor was concerned that touring would exacerbate his current condition.

Even though their job is to assist with the traumatic events of others, first responders can, and often do, have PTSD. The Institutes of Health reports that 80% of first responders experience traumatic events on the job. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), roughly 1 in 3 first responders develop PTSD, a rate much higher than that of the general population.

Occupational therapy can address barriers to occupational performance

Occupational therapy practitioners (OTPs) are skilled in helping people with PTSD increase functional performance by addressing barriers to occupational performance. As a part of a multi-disciplinary team, OTPs can provide clients with age-appropriate, client-centered techniques and treatments.

Evidence-based treatments for PTSD that a multi-disciplinary team can use can include:

• Cognitive Behavioral Therapy (CBT)
• Cognitive Processing Therapy (CPT)
• Prolonged Exposure (PE)
• Prolonged Exposure (PE)
• Eye Movement Desensitization Reprocessing (EMDR)
• Accelerated Resolution Therapy (ART)

OTPs can also help clients with PTSD by making recommendations to the physical or temporal environment, helping the client modify tasks, and helping them identify ways to increase their social circle. OTP interventions and recommendations can include:

• Assisting the client with locating local PTSD support groups.
• Assisting the client with identifying activities that support a mind-body connection such as yoga.
• Assisting the client with identifying activities that decrease anxiety such as meditation, exercise, or leisure activity engagement.

Medication for PTSD

Pharmacology methods can be used to treat PTSD as well. Medications can address the chemical imbalance caused by the trauma. It can also be used to manage the secondary effects of PTSD such as depression and anxiety.

Service delivery considerations

A multi-faceted approach to care can improve client outcomes and help them return to occupational engagement. This approach not only considers the type of treatment and the type of provider, but also considers how the services are provided. A client with PTSD may benefit from service delivery options such as telehealth versus clinic-based care or a hybrid model.

Recommended course: Telehealth for Physical and Occupational Therapy, 2nd Edition

Conclusion

Post Traumatic Stress Disorder signs and symptoms can be addressed with both psychological and pharmacological means. PTSD can be addressed by a team of multidisciplinary healthcare providers that include OTPs. Services can be provided using in-person or a telehealth service delivery model.