The Post-Traumatic Stress Disorder SOURCEBOOK Second Edition ALSO BY GLENN R. SCHIRALDI World War II Survivors: Lessons in Resilience The Self-Esteem Workbook The Anger Management Sourcebook Conquer Anxiety, Worry and Nervous Fatigue: A Guide to Greater Peace Ten Simple Solutions for Building Self-Esteem Facts to Relax By: A Guide to Relaxation and Stress Reduction Hope and Help for Depression: A Practical Guide Stress Management Strategies The Post-Traumatic Stress Disorder SOURCEBOOK Second Edition @ A GUIDE TO HEALING, RECOVERY, AND GROWTH @ Glenn R. Schiraldi, Ph.D. @ New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2009 by Glenn R. Schiraldi. All rights reserved. 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Contents Acknowledgments ix Introduction xi PART I ABOUT PTSD Chapter 1 PTSD Basics 3 Chapter 2 Making Sense of the Bewildering Symptoms: Understanding Anxiety and Dissociation 13 Chapter 3 Associated Features 28 Chapter 4 Frequently Asked Questions 38 PART II ABOUT HEALING, RECOVERY, AND GROWTH Chapter 5 Principles of Healing, Recovery, and Growth 51 Chapter 6 Treatment Approaches: Professional, Medication, Group, and Self-Managed 59 PART III PREPARING FOR THE RECOVERY PROCESS Chapter 7 Stabilization and Balance 73 Chapter 8 Taking Care of Your Health 78 PART IV MANAGING SYMPTOMS Chapter 9 Affect Management 91 Chapter 10 Reducing General Arousal 96 Chapter 11 Breathing Retraining 100 Chapter 12 Relaxation 109 Chapter 13 Managing Anger 119 v vi Contents Chapter 14 Eye Movement 134 Chapter 15 Intrusion Management 137 Chapter 16 Before Starting Memory Work: Helpful Strategies 144 PART V TREATMENT Chapter 17 Principles of Memory Work 159 Chapter 18 Cognitive Restructuring 162 Chapter 19 Confi ding Concealed Wounds 185 Chapter 20 Resolving Guilt 194 Chapter 21 Eye Movement Desensitization and Reprocessing (EMDR) 211 Chapter 22 Thought Field Therapy 217 Chapter 23 Other Brief Processing Techniques 220 Chapter 24 Prolonged Exposure 228 Chapter 25 Dream Management and Processing 234 Chapter 26 Healing Imagery 238 Chapter 27 Healing Rituals 243 Chapter 28 Grieving Losses 248 Chapter 29 Making Sense of Trauma: Coming to Terms with Suffering 259 Chapter 30 Hypnosis 262 Chapter 31 Expressive Art Therapies 265 Chapter 32 Life Review 274 Chapter 33 Building Self-Esteem 285 Chapter 34 Unfi nished Business: Resolving Anger 299 Chapter 35 Innovative Treatments 309 Chapter 36 Complementary Approaches 316 PART VI MOVING ON Chapter 37 Transitioning 321 Chapter 38 Intimacy and Sexuality 326 Chapter 39 Meaning and Purpose 340 Chapter 40 Spiritual and Religious Growth 344 Chapter 41 Happiness, Pleasure, and Humor 350 Chapter 42 Relapse Prevention 362 Chapter 43 Summing Up 372 Contents vii Appendix A The History of PTSD 375 Appendix B Assessing Abuse 377 Appendix C The Brain and Memory 379 Appendix D Psychiatric Disorders 381 Appendix E 72-Hour Emergency Preparedness 384 Appendix F Meditation 386 Appendix G Rape and Sexual Assault Facts and Myths 388 Appendix H Medication Facts and Guidelines 390 Appendix I Victim, Survivor, Thriver 394 Endnotes 397 Bibliography 419 Additional Resources 425 Index 435 This page intentionally left blank Acknowledgments In recent years, so much has been learned about post-traumatic stress disorder (PTSD). No one compiles a synthesis such as this one without relying on the cumulative efforts of many brilliant theorists, researchers, and clinicians who have advanced our understanding of PTSD and its treatment. I am grateful to dissociation pioneers Drs. Pierre Janet, Richard P. Kluft, Frank W. Putnam, and Richard J. Loewenstein. I am thankful to Dr. Bessel van der Kolk for his insights regarding the brain and trauma and to Drs. George S. Everly, Jr., Charles R. Fig- ley, Edna B. Foa, Judith L. Herman, Mardi Horowitz, Donald Meichenbaum, James W. Pennebaker, Beverly Raphael, Francine Shapiro, John P. Wilson, and many others who have so diligently labored to further our knowledge. I am most grateful for those who gave so generously of their time to review this book and suggest helpful improvements. These include Drs. Bethany Brand, George S. Everly, Jr., Charles R. Figley, David Keller, Donald Meichenbaum, Raymond M. Scurfi eld, Francine Shapiro, Mary Beth Williams, John P. Wilson; and Robert L. Bunnell, John W. Downs, Esther Giller, and Mary Beth Quist. It is rare to fi nd an editorial team that functions with such conscientious, thoughtful, and sensitive attention to detail; my thanks to Rachel Chance, Julia Anderson Bauer, and John Aherne. Finally, I am exceedingly grateful to the survivors of trauma—in all walks of life—who have battled to overcome their symptoms and by their courage, inspired us all. ix x Acknowledgments Portions of this book have been adapted from some of my previous works: Conquer Anxiety, Worry and Nervous Fatigue: A Guide to Greater Peace; The Anger Management Sourcebook; The Self-Esteem Workbook; Facts to Relax By: A Guide to Relaxation and Stress Reduction; Hope and Help for Depression: A Practical Guide; and Stress Management Strategies. Introduction We are never prepared for what we expect. —James A. Michener, Caravans A fi refi ghter cradles a lifeless little girl. Seven months later, he leaves his beloved profession because of post-traumatic stress disorder (PTSD). In a dimly lit cam- pus parking lot, a bright coed is assaulted. Three weeks later she drops out of college. PTSD has claimed yet another victim. Life doesn’t prepare us for trauma. Following exposure to traumatic events, millions of people develop PTSD or lesser forms of this condition—with symp- toms ranging from nightmares to headaches, fl ashbacks, withdrawing from people, profound sadness, anxiety, anger, guilt, fatigue, pessimism, sexual prob- lems, and emotional numbing. Unless proper treatment is found, many, perhaps most, of these people will secretly and needlessly battle distressing symptoms for life. The good news, however, is that PTSD can be treated successfully. With the right treatment, victims can begin to heal and return to the journey of joyful living. This book is written for all victims of trauma. You will fi nd it useful if you are a survivor of rape, abuse of any kind, domestic violence, war, crime, natural disasters, industrial disasters, accidents, terrorism, and other traumatic events.