(Focus - India)
As the world grapples with ongoing epidemics, natural disasters, and political conflicts, the significance of Post-Traumatic Stress Disorder (PTSD) diagnosis and awareness cannot be underestimated. According to the National Center for PTSD, about 6 of every 10 men and 5 of every 10 women experience at least one trauma in their lives. While some may recover relatively quickly, others may struggle for months or even years, with symptoms surfacing long after the traumatic events have occurred.
Why do some individuals continue to suffer from persistent problems and ultimately receive a diagnosis of PTSD after encountering a traumatic event, even though fear is a common reaction among all people in such situations?
To learn more about it and delve deeper into the importance of diagnosing PTSD in today's world, we engaged in an enlightening conversation with Dr. Kinjal Goyal, a renowned Psychotherapist from India who highlights the need for early diagnosis and the challenges involved in identifying and managing PTSD. She emphasizes the need for psychoeducation, personalized treatment approaches, and the integration of new technologies like virtual reality exposure and artificial intelligence in PTSD treatment.
Dr. Kinjal Goyal is a Psychotherapist currently serving at Healthy Mind, Pune, Maharashtra, India.
The response to PTSD is highly individualized. For instance, if someone has received psychoeducation in the past and possesses an understanding that their experiences are not normal and require attention as PTSD, they are likely to seek help early on. However, in many cases, individuals are unaware that their symptoms go beyond mere fear or something to overcome, leading them to seek assistance at a later stage.
We understand that not all trauma leads to PTSD. What are the most common events that are linked to the development of PTSD?
Dr. Kinjal - The likelihood of experiencing PTSD varies greatly depending on the individual and their specific circumstances. However, certain situations, such as war-related experiences and prolonged exposure to combat, tend to have a more significant impact on people. Additionally, witnessing acts of violence, whether it be gun violence or road rage incidents, can also contribute to the development of PTSD. Natural disasters, accidents, and being confronted with situations where one has no control, such as witnessing a car accident or someone getting injured, can lead to intense PTSD symptoms. Furthermore, medical trauma is another significant event that is strongly associated with the onset of PTSD. The collective experience during the COVID-19 pandemic has shown us firsthand the effects of medical trauma, including the pain, financial burdens, and the pervasive sense of uncertainty, all of which contribute to the development of PTSD.
In all these traumatic scenarios that you described; it is common that we all feel afraid. Why do some people continue to experience problems and eventually get diagnosed with PTSD?
Dr. Kinjal - Not everyone will receive a diagnosis of PTSD. As you mentioned, individuals in similar circumstances may react differently, and various factors contribute to the development of PTSD. For instance, individuals who have previously experienced emotional trauma or are currently undergoing treatment for anxiety or depressive disorders are more susceptible to developing PTSD.
The second factor is not having a good support system. Consider a scenario where one individual has gone through a traumatic experience but has the advantage of returning to a highly supportive household and having close friends to confide in. In contrast, another person lacks such a support system and, as a result, faces a higher level of vulnerability. Additionally, various neurobiological factors come into play, as there exists a complex interaction between genetics, neurobiology, and environmental influences, all of which play a crucial role.
Based on your experience, do PTSD patients present to specialists at an earlier stage, or is there anything that hinders their presentation to you?
Dr. Kinjal - Once again, the response to PTSD is highly individualized. For instance, if someone has received psychoeducation in the past and possesses an understanding that their experiences are not normal and require attention as PTSD, they are likely to seek help early on. However, in many cases, individuals are unaware that their symptoms go beyond mere fear or something to overcome, leading them to seek assistance at a later stage.
Currently, there is an increase in awareness regarding PTSD in India. Let me explain how patients typically approach me seeking help for PTSD. Initially, they may visit other doctors for various psychosomatic conditions like migraines or even backaches, which may seem unrelated to their underlying issues. Eventually, these doctors recognize that something deeper is amiss and refer the patients to me. Thus, the process of reaching a PTSD diagnosis often involves a roundabout route.
The Department of Veterans Affairs reports that about 80% of people with PTSD have an additional mental or physical health issue.[1] What common psychiatric disorders do you see in your PTSD patients?
Dr. Kinjal - Depressive and anxiety disorders are common in PTSD patients. Anxiety disorder could be phobias, and it could be generalized anxiety disorder at different levels. Additionally, substance use disorder is commonly observed, as individuals who lack psychoeducation may resort to alcohol or drugs to numb their emotional pain without understanding the underlying issues they are facing. This emphasizes the importance of raising awareness about PTSD. Dissociative disorders, characterized by amnesia or a sense of detachment from reality, are relatively rare occurrences. Borderline personality disorder is another common comorbidity, with affected individuals displaying emotionally dysregulated behavior, unstable relationships, and outbursts. Lastly, sleep disorders are frequently observed, with individuals experiencing disturbances due to recurrent distressing dreams. These sleep disturbances can be attributed to the overall generalized anxiety and cumulative effects of the condition. It is important to acknowledge that there are numerous other disorders that can co-occur with PTSD.
An exciting development is the integration of artificial intelligence (AI) in therapy. It opens up meaningful avenues for reaching out to patients who previously did not have access to psychotherapy. These advancements offer great potential for progress, and I believe we will continue to make significant strides.
What approaches do you take to reduce the risk of getting an additional psychiatric disorder in PTSD patients?
Dr. Kinjal - Typically, when patients come to me, they already have other ongoing issues. Therefore, prevention is not a luxury I can afford at that point. Instead, my approach involves addressing both the existing conditions and PTSD simultaneously. I aim to provide psychoeducation to the patient, helping them understand the various complexities occurring in their minds and bodies. Through a gradual and steady treatment process, I work towards resolving all the symptoms they are experiencing.
Talking about treatments, we have heard about cognitive behavioral therapy and exposure therapy. Do you see any recent advancements in these therapies?
Dr. Kinjal - Absolutely, there have been significant advancements in the field of therapy for PTSD. For instance, when we mention cognitive behavior therapy (CBT), we now have cognitive processing therapy (CPT) available. CPT is a targeted treatment that focuses on challenging and addressing distressing thoughts, unhelpful beliefs, and fears, showing promising results.
Moreover, virtual reality exposure therapy has emerged as a valuable tool, despite being relatively new. It proves highly effective in systematically desensitizing individuals to traumatic experiences. When combined with acceptance and commitment therapy, it becomes even more beneficial. These approaches help regulate emotions and equip patients with coping strategies that continue to be useful even after treatment concludes.
Another exciting development is the integration of artificial intelligence (AI) in therapy. It opens up meaningful avenues for reaching out to patients who previously did not have access to psychotherapy. These advancements offer great potential for progress, and I believe we will continue to make significant strides. Rather than relying on a one-size-fits-all approach, therapists increasingly employ transdiagnostic methods, tailoring treatment to suit each patient's specific needs.
It is crucial to extend psychoeducation efforts to society as a whole since the interactions patients have with others can greatly impact their healing process. Sensitivity and providing appropriate support at the right time from the individuals around them can significantly expedite the healing journey.
As you mentioned, participating in virtual reality exposure (VRE) therapy may decrease the frequency and intensity of trauma-related memories.[2] In this context, could you highlight the benefits of extended reality (XR) exposure therapies?
Dr. Kinjal - Again, extended reality is a very broad term; there's virtual reality exposure, augmented reality exposure, and mixed reality exposure. The crux of all these therapies is to facilitate patients in gradually re-engaging with the environments that initially caused their trauma. With virtual reality, they can only see but not interact. With augmented reality, they can start interacting with the environment, which has triggered them slowly. Mixed reality, of course, is a mix of both.
It is crucial to acknowledge that substantial training is necessary to effectively utilize these techniques. Many therapists may be unfamiliar with the specific methodologies and equipment involved. Thus, it is of utmost importance to ensure that these techniques are widely accessible and properly introduced to the market.
What are the challenge that you face in treating and managing PTSD patients?
Dr. Kinjal - One primary obstacle we face is ensuring that patients reach us promptly before other issues exacerbate their mental and physical well-being. Thus, psychoeducation and raising awareness pose significant challenges. Additionally, it is crucial to extend psychoeducation efforts to society as a whole since the interactions patients have with others can greatly impact their healing process. Sensitivity and providing appropriate support at the right time from the individuals around them can significantly expedite the healing journey.
To conclude our session, what advice do you have for someone who is struggling with PTSD or knows someone struggling with PTSD?
Dr. Kinjal - If you find yourself as a patient, I encourage you to seek professional help without hesitation. It is important to recognize that reaching out for assistance is not a sign of weakness or inferiority. Rather, it is an acknowledgment that you are experiencing an illness that can be effectively treated by a trained professional. If you are unsure of where to begin, consider consulting your general practitioner (GP) who can provide referrals to appropriate psychiatrists or therapists. By seeking professional help, you empower yourself to receive the necessary support and guidance. Educate yourself about the symptoms of PTSD so that you can better understand your experiences and avoid coping in unhealthy ways. Dealing with emotional pain can be incredibly challenging, so it is essential to seek accurate knowledge and guidance from reliable sources.
If you are a caregiver supporting someone with PTSD, it is crucial to educate yourself about the condition to gain a better understanding of what your friend or family member is going through. Healing from PTSD takes time and patience, and it is not an overnight process. It is important to be understanding and patient with them. PTSD patients can have triggers and heightened sensitivity to various stimuli, so it is vital to respect their boundaries and allow them the space they need. Avoid passing judgment or minimizing their experiences. Instead, validate their feelings by acknowledging the intensity of their emotions and expressing acceptance. This creates a safe and supportive environment for their healing journey.
Thank you so much for your insights!
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