If the trauma symptoms described above do not fade away with an affected crew member, or if they even increase, the experiences should possibly be processed with professional help of a trauma therapist.
Cognitive Behavior Therapy
Procedures of cognitive behavior therapy are in their mode of actions well evaluated. There are two groups of the cognitive behavioural interventions:
- Exposure Therapy
- Cognitive Restructuring
This therapy concept assumes that the avoidance of trauma-related cues (sign-stimuli) and of the associated feelings and memories lead to the preservation of post-traumatic stress disorder. Thus new experiences and the normalization of traumatic memories are blocked, and possible coping with the experienced traumatic situation is hampered. In agreement with the patient and after an appropriate preparation, he or she is confronted with the trauma related sign-stimuli in the therapy. The target of this procedure is to let the traumatized patient repeatedly re-experience the emotions, thoughts and body sensations associated with the traumatic cues, until the perceived stress intensity has subsided. The feeling of subjective control over the trauma-related memory is an important feature of an incipient normalization.
According to the theoretical concept of cognitive restructuring, symptoms of PTSD are maintained by dysfunctional and inflexible thoughts and appraisals of the traumatic experiences and their reaction sequences. In therapy, these dysfunctional and affective cognitions should be identified and modified to the extent, that a more realistic perception and evaluation of the event emerge. This theoretical approach states, that the extremely negative perceptions and evaluations of the event are often related to frustration experiences and feelings of guilt: e.g., having failed in the extreme situation, or being responsible for the traumatic event. With support from the therapist, the patient recognizes his negative affective thoughts and appraisals, records them, and develops, step by step, alternative and supportive cognitions.
Eye Movement Desensitization und Reprocessing (EMDR)
This method of treatment was developed by Shapiro (28). Eye movement provides neurological and psychological effects that enhance the processing of traumatic memories. According to this terapy concept, trauma can “trigger off” a so-called “speechless terror”. This “speechless terror” is localized in form of images in the right cortex, while the speech-centre is suppressed. The traumatized person cannot put the extremely stressful event into words, and thus the processing of the experience is hindered. By frequent eye movements, a bilateral stimulation and, in this way, a synchronization of the two hemispheres takes place. The target of the therapy is to retrieve a speech approach to the “speechless terror”. After appropriate preparation, rapid eye movements of the patient are triggered by the therapist by means of quickly waving his fingers or his hand. The therapy can also be performed using sounds or touch stimuli. The target is that in this eye-movement phase the patient relives the traumatic experience again. The process is repeated until the patient has completely relived his traumatic memories, and until trauma-related sign-stimuli no longer trigger intensive physical and psychological stress responses. This therapy may be very useful for persons who don’t want to disclose shameful experiences.
Integrative Trauma Therapy (29)
The therapy includes the following phases:
Establishment of safety: differentiated treatment of symptoms, activation of social resources, learning of relaxation and breathing technique.
Stabilization: improving self-awareness and self-acceptance, activation of boundaries in interpersonal relationships.
Confrontation: cognitive and emotional confrontation with the effects of trauma, working with memory.
Integration: acceptance of the trauma and of the change.
Trauma therapy is indicated if symptoms and unfavourable psychological conditions after the traumatic event have not decreased after a period of four to six months. A chronified PTSD without treatment may lead to depression, aggressive behaviour, misuse of alcohol, drug consumption, etc. The prognosis of favourable outcome of therapy is the more likely the earlier the individuals start therapy.
Information and training related to possible traumatic events as well as psychological first aid and support are important measures for preventing PTSD.