Stress is a feature of everyday life and is often defined as the autonomic 'alarm' response to perceived threat in the environment, involving a hyper-vigilant state, adrenaline (epinephrine) production facilitating short-term 'fight-or-flight' resistance, followed by physical and mental exhaustion.

Stress is commonly understood as a mismatch between the external demands on an individual and their ability to cope (resilience). Many, attribute their physical illness to it, from headache to cancer.

 

Individuals vary in their resilience to stress. Some actively search for and thrive in stressful environments, seeking out extreme sports or highly demanding careers. Others shun it and 'stress' at work often means an inability to cope, leading to unhappiness, absenteeism and actual illness. Life events such as bereavement, divorce and unemployment are all important 'stressors' and may have consequences for mental health, but it is important not to 'medicalise' normal adjustment reactions to these types of events.

 

Post-traumatic stress disorder (PTSD) has a different magnitude and develops in response to stress of a severe and abnormal nature.

PTSD develops following a stressful event or situation of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone. PTSD symptoms may not appear immediately, some symptoms may appear directly after the stress ends, while some may experience delayed expression, in which symptoms don’t appear until at least 6 months following the event.

 

PTSD was recognised in the First World War in men who had been subjected to prolonged and intensive bombardment including gas attacks. It was called 'shell shock' and many soldiers on both sides were discharged to a pitiful existence with severe psychiatric problems. It was poorly managed and misunderstood and, in some instances, afflicted soldiers were executed as 'deserters'.

It was not until 1980, following the traumas of the Vietnam War, that the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) recognised PTSD formally as a medical entity. Combat exposure increases the risk of PTSD by approximately three-fold compared to non-deployed troops but PTSD is not exclusive to military or civilian populations exposed to warfare and can be caused by a multiplicity of traumatic events.[2]

 

Research suggests that the neurobiology of PTSD involves the autonomic system and the hypothalamic-pituitary-adrenal axis and that noradrenaline (norepinephrine) is the main neurotransmitter involved in this pathway.[3]Reconsolidation - the means by which the brain reconstructs memories and associated emotional responses - appears to be an important process in the development of PTSD.[4]An understanding in the underlying neurophysiology of PTSD opens up possibilities for novel treatments of this condition.

 

 

 

Risk Factors [7]

  • Usually the event is perceived as, life-threatening. Examples include, serious accidents, hostage taking, natural disasters, rescues, terrorist incidents and violent assault. However, it can also result from sexual assault, following rape or child sexual abuse.

 

  • First responders - eg, police, ambulance personnel, fire brigade, life savers - are by definition more likely to be exposed to traumatic events. The fact that they have selected such an occupation suggests some inherent resilience. Amongst these organisations, risk factors for PTSD include:[9]
  • Duration of combat exposure.
  • Low morale.
  • Poor social support.
  • Lower rank.
  • Unmarried.
  • Low educational attainment.
  • History of childhood adversity.

 

  • A history of previous psychiatric disorders increases the risk of PTSD.

 

  • One study found that females were as much as twice as likely to develop PTSD as men were - the degree of gender difference, however, depending on the circumstances. Women were more vulnerable to PTSD after disasters and accidents, followed by loss and non-malignant diseases. In violence and chronic disease, the gender differences were smallest.[10]

 

  • Approximately 1-2% of women have PTSD postnatally.[11]

 

Signs and Symptoms of PTSD, there are 3 primary categories:

 

Intrusive Symptoms:

  • Flashbacks where it seems as if the event were happening again.
  • Trauma related dreams or nightmares, which are common and repetitive.
  • Distressing images or other sensory impressions from the event, which intrude during the waking day.
  • Distressing reminders of the traumatic event provoke distress.
  • Feelings of fear and anxiety as though he or she is back in danger.

 

Avoidance Symptoms:


Those with PTSD avoid reminders of the trauma, such as people, situations or circumstances resembling the event or associated with it. They may try to suppress memories or avoid thinking about the worst aspects. Many withdraw inwards or become emotionally numb in order to cope with the intensity of feelings he or she is experiencing, others ruminate excessively and prevent themselves from coming to terms with the experience.

  • Why did it happen to me?
  • Could it have been prevented?
  • How can I take revenge?
  • Loss of interest in any and all parts of daily life including once-enjoyed activities
  • Active, extensive avoidance of anything that may remind the soldier or other of the combat experiences, including thoughts, activities, places, people, memories, feelings, and conversations
  • Feeling detached from others, finding it a challenge to feel lovingly toward other people or experiencing any strong emotions whatsoever
  • Feeling a strong disconnect from world around you and the things that happen to you
  • Making an effort to restrict the emotions you feel
  • Shutting down and becoming emotionally numb as a means to protect yourself
  • Feeling of surreality of things around you
  • Experiencing weird physical sensations
  • Difficulty recalling important parts of the traumatic events
  • Loss of ability to feel physical pain or other sensations

Hypervigilance or emotional numbing symptoms:
This may manifest as:

  • Hypervigilance for threat and amnesia for salient aspects of the trauma.
  • Exaggerated startle responses and panic attacks.
  • Irritability.
  • Difficulty concentrating.
  • Sleep problems.
  • Difficulty experiencing emotions.
  • Feeling of detachment from others and giving up previously significant activities.

Prevention

 

  • We cannot eliminate risk, fear and unpleasant events and most of us will experience at least one major trauma in our lives. Traditional 'Health and Safety' approaches to risk management, which attempt to reduce exposure, have not been successful and may actually increase risk aversion and reduce resilience. People are not intrinsically risk-averse, provided they can see purpose in accepting risk.[32]Exposure to risk is not inevitably harmful. Claims for compensation delay recovery.[33]Culturally, we need to respect courage and resilience but not to stigmatise breakdown. PTSD is not just a medical but a social and political issue too.[34]

How the Kokoda Track can help:

In the past 23 years facilitating personnel from the ADF, NSW, VIC, NT Police services, NSW Ambulance and Fire Brigades as well as host of individuals, we have observed many improvements with PTSD participants resulting in better comprehension and control of symptoms, leading to long term successful plans.

The facilitation of the Kokoda Track over an 8 day period, allows us to observe participant behaviour as it occurs and gives participants an opportunity in a supportive environment and culture, to process and come to terms with their combat experience or other, gain mastery over reactions, and re-establish a sense of hope, personal efficacy, and control over their life.

The challenge, concentration, isolation and nature of the Kokoda Track allows us to teach mindfulness and essential resilience skills, ways to remain in the present, techniques for reestablishing relationships, methods to help you regulate your emotions, and skills for tolerating extreme emotions and distress.

With the Kokoda Track, using Cognitive-behavioral therapy, we help participants to challenge and replace negative, painful, intrusive, uncontrollable thoughts related to their traumatic experiences. Challenging feelings and replacing it with accurate beliefs can help one come to terms with how they feel. Once participants learn to restructure negative thought patterns to realistic, positive thoughts, they will have gained control over their thoughts and the effects they have on their emotions and behaviors.

The experiential challenge and structure of the Kokoda Track also creates an interpersonal environment that supports participants to adjust to new roles in life and helps them to learn to better handle interpersonal role disputes with significant others.

 

 

 

 

Bibliography

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