Recovery: Post Traumatic Stress Disorder
By: David Kinchin

BSTTW
Translations
Perhaps the most common question asked by PTSD survivors is "When will I get better?" It is a perfectly natural question. If a person suffers appendicitis or a broken leg there is a

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typical recovery period and there are definite stages before good health is regained. Stitches are removed or the plaster cast is taken off. With PTSD there are no such readily identifiable stages of recovery, and each individual's progress will be different.

In many ways, PTSD sufferers find themselves playing a game of emotional snakes and ladders. The game board represents the road to recovery, divided into one hundred squares. A series of ladders helps the person on the way towards recovery but between these ladders are the snakes, which may take the victim backwards towards the start of the game, experiencing previous anguish and turmoil.

The Snakes and Ladders Model of Recovery

The traumatic event takes place on square one. From this position recovery begins. Some survivors may shake the dice scoring five, four, three, and then one to reach square 100, thus achieving recovery in just four shakes of the dice. In less than four weeks these persons have recovered from an acute stress reaction (ASR) and they do NOT go on to develop PTSD. Other survivors have to journey around the board going up the ladders and down the snakes as they slowly progress to the end of the game. Tragically, a few people may never finish the game.

Furthermore, they may never roll the correct number on the dice to finish exactly on square 100, or more tragically, they may give up and walk away from the game board taking unrelinquished trauma with them.

The game of snakes and ladders is very complex. Study the game board in detail. It is possible for a player to be on square 97, only to shake a one, two, five, five, five and one. These throws take a player back to square 4! Thankfully, on a true snakes and ladders board no snake can take a person all the way back
to square one.

So a person can finish the game in four moves, or can be taken back 94 squares in just six moves. Describing PTSD in such a way may aid a greater insight into the complicated road to recovery from PTSD. This analogy is probably more realistic than the very simple idea that recovery is a case of two steps forward

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and then one step back. Recovery is not smooth. Neither is it predictable nor it will incorporate a wealth of stages, which extend far beyond the models described by such researchers as Williams( 1993) and Horowitz (1979).

Examples of Snakes and Ladders; Which Might Affect A Person's Recovery:

Ladders

1. Good medication, such as antidepressants, can be seen as an essential aid to recovery for many child survivors. The withdrawal of medication has to be slow and sympathetic or this 'ladder' can quickly become a 'snake'.
2. Therapy, which includes counselling, and any other form of support in which the survivor has confidence (Kinchin 1997).
Relaxation techniques can be taught, and practised.
Realisation that there is a "trauma bond" or a feeling of empathy which exists between those who have suffered traumatic events. It is a realisation that "you are not alone", and "you are not going mad".
0Individual or group support is an essential part of recovery.

Snakes

1. Panic attacks can become a major 'snake' in the path of recovery. Because the fear of panic is so great many survivors develop avoidance strategies in an attempt to stay away from anything, which might cause a panic attack.
2. Depression can manifest itself any time. A deep trough of depression can cause a survivor to walk away from the game board altogether. Consequently, this is the most dangerous 'snake' of all.
3. Alcohol & non-prescribed drugs can act as an initial 'crutch', but dependency on these products can seriously hinder any real progress towards recovery. This is particularly true of adolescent survivors.
4. Adverse publicity can heighten the state of a survivor's feelings of guilt.
5. Anniversaries are often obstacles, but a successfully handled anniversary can also be turned into a very positive milestone towards recovery.
6. Non-acceptance of PTSD by professionals and laypersons can be a serious problem for survivors who feel the severity of the traumatic response is being disregarded or belittled.

The examples above illustrate some of the events and issues, which may affect anyone on the road to recovery. Many PTSD sufferers and their carers tend to set themselves goals or targets. Often these targets will be linked to the calendar:

1. "I will return to school by 1st June"
2. "I want to have stopped sleeping with the main light on by Christmas"
3. "I intend to go out shopping on my own during my holiday"

Formulating goals and targets is a very good strategy provided the

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targets are within reach. If the target is too difficult, then the sufferer is in danger of setting unrealistic goals, which serve no useful purpose. Rather, sufferers should be encouraged to set themselves sensible, attainable, targets. Dates for accomplishing tasks should be within a reasonable time scale. If the target is reached before the date, a treat may act as a positive reward. For children in particular, it is vital they are enabled to achieve small steps towards recovery.

Inevitably, some targets will not be achieved. Life is full of unpredictable events, which may hinder progress. That's life! Therefore, unexpected events should be allowed for in the preparation of targets and breathing spaces need to be allowed between achieving a goal and embarking on the next hurdle. Targets are wonderful when they are achieved, but terrible if the survivor is defeated by them.

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