Talking about School Stress Disorder

It is reported that more than 50% of the general population has at least one traumatic exposure event in their lives; Among the people who have experienced traumatic events, about 10% ~ 20% will suffer from PTSD.

In other words, PTSD, like depression, is much more common than we thought!

PTSD is a response to traumatic events. Typical traumatic events include war, disaster (such as earthquake), accident (such as car accident), sexual or physical attack, and learning that you have been diagnosed with a life-threatening disease.

The main symptom of PTSD is the invasive memory of traumatic events. These invasive memories may appear in the brain in the form of recurring memories, nightmares or flashbacks (in this case, patients will feel that they are in a traumatic situation again).

In addition, individuals with PTSD tend to avoid internal or external clues related to trauma, which usually leads to feelings of emotional numbness or separation.

Patients will also experience increasing alertness, which leads to insomnia, chronic anger, inattention and a constant sense of danger.

It is worth noting that PTSD patients show a seemingly contradictory phenomenon, that is, there are too many memories related to traumatic events, and it is difficult to extract and recall traumatic events completely and systematically.

So, how do we diagnose PTSD?

The course of the disease requires that individuals who have experienced traumatic events must experience related symptoms for at least one month. If the symptoms last less than three months, it can be diagnosed as "acute PTSD", otherwise it can be diagnosed as "chronic PTSD". If the symptoms appear six months after the traumatic event, it can be diagnosed as "delayed onset PTSD".

Those who show similar symptoms within one month after a traumatic event can be diagnosed as acute stress disorder if their function is impaired for at least two days.

Anxiety two-factor theory can explain PTSD.

According to the two-factor theory of anxiety, the anxiety and other emotions experienced by individuals in traumatic events are related to the visual, auditory and other sensory memories produced by individuals in the process of trauma. This process constitutes a classical conditioned reflex. Therefore, when the traumatized individual encounters stress again after the incident, these traumatic visual, auditory and other sensory memory materials become clues to stimulate anxiety.

The range of clues that can induce anxiety is expanding with time, which mainly comes down to two processes: generalization (some new clues similar to the original clues gradually start to stimulate anxiety) and advanced conditioning (a neutral clue eventually becomes a clue that stimulates anxiety).

For example, a raped woman may start to feel scared when she walks home alone at night, not only afraid of walking outside alone at night (original clue), but also afraid of any dark place (generalization); In addition, she may start to be afraid of her therapist's office, because she is there to discuss her rape with the therapist (advanced conditioning).

The second part of the two-factor theory involves avoidance. It can arouse the anxiety clues of people who have experienced traumatic events, so they try to avoid these reminders. When a clue is avoided, the anxiety level of the parties will decrease. The reduction of anxiety plays a role of reward and return, which increases the possibility of parties avoiding clues in the future, so avoidance becomes a coping strategy.

Avoidance behavior helps patients to maintain the persistence of PTSD symptoms, because avoidance can reduce the anxiety level in a short time, but it prevents the parties from getting used to and adapting to the clues that trigger traumatic memories and emotions.

Therefore, substance abuse and other forms of escape hinder the natural recovery after trauma.

Regarding the treatment of PTSD, exposure therapy is often mentioned. There are three main exposed objects: (1) traumatic memory; (2) Other internal and external clues that cause anxiety and re-experience; (3) Avoid the situation. If the patient can complete the exposure of all three targets, then good results will be obtained.

The key of exposure therapy is that the exposure cannot be terminated until the patient experiences a decline in anxiety level. There are two reasons:

First of all, terminating the exposure when the patient feels very painful can only strengthen the connection between memory and pain;

Secondly, it is usually a very effective event for patients to experience pain relief for the first time during exposure.

It is found that exposure therapy has a good therapeutic effect on PTSD caused by different kinds of trauma, which can alleviate symptoms and prevent delay to a certain extent. Adaptive exposure therapy can also promote post-traumatic growth. However, with the gradual popularization of exposure therapy in the treatment of PTSD, ethical disputes have also arisen.

At present, the controversy about exposure therapy is still inconclusive, and the final result should be evaluated and selected by patients.

(References: Research progress on the prevalence of post-traumatic stress disorder at home and abroad, Xu, Sai; Treatment Plan and Intervention Methods for Depression and Anxiety Disorder (2nd Edition), by Robert L Leahy, Stephen ·J·f· Holland and Lata K McGinn, translated by Zhao Chengzhi, Tan, Qiao Huifen, Cui Jianfeng and Wei Zhaoguo; Psychiatry, by Shen Yuchun; Controversy of exposure therapy for post-traumatic stress disorder, Yuan Yuanyuan, Chang Yunli, Qi Cheng)