Lynn Schloemann
Unfortunately in our modern time of so many technological breakthroughs it still does not preclude exposure to trauma. Sexual abuse, physical abuse, natural disaster, urban violence, school violence, and terrorism result in significant numbers of people presenting with posttraumatic stress disorder (PTSD) symptoms. In this paper I will be comparing and contrasting PSTD and the Resistance Phase of the GAS and the biochemical and neuroanatomical changes that occur. It also investigates into what possible stress management techniques would be useful in posttraumatic stress disorder and the protocols of treatment that could help to address some of the symptoms of this disorder.
Change is the only thing certain in life. Our lives are constantly moving and evolving. Many times it is in directions that are not by our choice. The change that occurs with a traumatic event can be a slight momentary shift or a gigantic and radical movement from one point to another within us. Sometimes when the changes come in an unsuspected manner or in a violent way it can create stress.  If the event is perceived as threatening then it can be categorized as a stressor. This broad term has been used a lot in the past decade and is now showing up in the vocabulary of children. Just the other day my niece who is eight was saying how stressful her life is with all the activities such as ballet, poms, and school. Stress can be a healthy thing or an impacting deleterious event or trauma. It is in this paper that I examine two facets of the outcomes of stress – Post Traumatic Stress Disorder (PTSD) and the Resistance Phase of the General Adaptation Syndrome (GAS). We will compare and contrast the two in their physiology of the body, and also discuss how stress management techniques may benefit clients with PTSD and improve their health outcome.Â
Post Traumatic Stress Disorder (PTSD) has had quite a lot of media coverage in the last decade, especially with the events that occurred on September 11 and the other events happening throughout the world. There is a lot of interest into the basic understanding of the impairing effects of PTSD, assessment tools, and treatment options. More and more research and funding are being committed to this topic. PTSD is defined as a potentially debilitating psychiatric condition that can occur after experiencing, witnessing, or being confronted with events involving actual or threatened death or serious injury (Shin et al 2004). But not everyone who experiences or witnesses events that are serious develops the pathology of this disorder. The aetiology of PTSD is multi-faceted.  The only central aetiological factor in the development of PTSD is that there was an external traumatic event that had occurred (Mezey and Robbins 2001).  The other possible traumatic factors contributing to the pathogenesis of PTSD are many and can vary from individual to individual. Symptoms may have delayed onset or follow a latency period. The factors that contribute to the severity of symptomatic expression have not been exactly pinpointed, since there is a wide range of possibilities. There is a range of pre-trauma variables like whether a person is male or female, lack of post-trauma social support, and post-trauma life stress that can contribute and effect to the outcome of the disease (Shear 2002) (Kroll 2003). Since a stressor can be defined as any “perceived threatâ€, and that the perceived part is ambiguous, the threshold level may be different in each person according to cultural norms of how individuals are expected to respond to threat, injury, and loss (Kroll 2003). These variables can alter one’s perception of the situation. It has also been shown that the development and severity of PTSD symptoms are not directly related to proximity of exposure or severity of the trauma (Kroll 2003).
In relation to an impacting stressor, people move through Selyes’ General Adaptation Syndrome (GAS). This reaction can be short lived or longer in length, depending on the intensity and duration of the stressor. We move first into the Alarm Phase, then to Resistance Phase, and finally to Exhaustion (Tortora and Grabowski 2000). When in the Resistance Phase our body-mind organism readjusts itself to combat or resist a stressor. This stage can last a short time or be stretched longer in period until the body can no longer keep it up and we move into exhaustion or the stressor itself is removed. The resistance phase has a few physical markers that it involves mostly through arousal of the stress hormones (Schafer 2000). Some of the hormones involved such as the corticotrophin releasing hormone, which triggers the anterior pituitary to release adrenocorticotropic hormone which in turns triggers the adrenal cortex to release glucocorticoids also play a role in PTSD as well (Tortora and Grabowski 2000). Impaired feed back regulation of the stress responses from the insufficient glucocorticoid signalling can cause the stress response to become chronic as well as the fact that the stressor is still present.
In the usual stress physiology of the resistance phase of the GAS, the sympathetic nervous system is involved as well as the hormones. The sympathetic nervous system is one of major parts of the first Alarm Phase and the continued presence of the stressor in the resistance phase can cause the brain to continue with the sympathetic arousal. This cascade creates many stress responses such as increased heart rate, sweating, decrease in digestions as well as others (Tortora and Grabowski 2000). The onset of symptoms from the PTSD is characterized by re-experiencing symptoms such as intrusive recollections of trauma, avoidance of trauma-related stimuli and/or emotional numbing, and heightened arousal (Shin et all 2002).  Both PTSD and the resistance phase involve arousal and some of the symptoms that go with it. It is during these PTSD reactions, that the amygdala thinks it is under attack again and the system acts accordingly. Studies have also shown that the symptoms such as anxiety, irritability – which can also manifest in the Resistance Phase, and flashback imagery usually follow an acute stress reaction (Green 2003). So not only is the person’s body-mind mechanism trying to deal with an acute stressor, it also is then many times thrown back to the trauma that preceded it. The body is receiving a double whammy and has to try to cope with two stressors where there was only one, and therefore may also have an intense level of symptomology, since the body thinks it is under a greater attack and has to hold itself together. Â
Another common pathway between the resistance phase and PTSD is that they both share the same degree of chronic activation of the hypothalamic-pituitary-adrenal (HPA) axis. In this persistent activation the glucocorticoids are the final effectors (Stratakis and Chrousos 1995). This relentless activation can also cause adrenal exhaustion from enhanced negative feedback inhibition of the HPA axis as well as many other pathophysiological changes such as shrinking of the hippocampus (Yehuda 2001). Studies have also shown that both subjects with chronic stress and PTSD have decreased urinary and plasma cortisol concentrations and that the low cortisol levels have repeatedly been reported despite high central nervous system corticotropin-releasing hormone (CHR) activity (Raison and Miller 2003) (Kellner et al 2002). This state of lower cortisol can be attributed to chronic adrenal exhaustion from inhibition of the HPA axis by persistent stress or anxiety. One study also inquires into the theory that the HPA axis and the sympathetic nervous system are disassociated in persons who develop PTSD. These two systems create a situation which may allow for an uncontrolled catecholamine release that affects formation of memories during the trauma and perhaps exacerbates symptoms when that person is exposed to cues after the trauma (Grinage 2003).
From a biologic perspective, the body's failure to return to its pretraumatic state differentiates PTSD from a simple fear response. From all the activation and arousal of the system to maintain under duress, with both the resistance phase and PTSD, this in long run can take its toll on the body. Another such damaging area is that of the immune system. One study stated that PSTD patients had lower glucocorticoid receptor (GCR) expression in lymphocytes as compared with healthy volunteers (Immunology Weekly 2003). The body’s line of defence is compromised by the constant arousal of the system in these two phases and by the glucocorticoids, which play a major role in the suppression of the immune/inflammatory reaction (Stratakis and Chrousos 1995).Â
PTSD once called battle fatigue or shell shock can be helped by various forms of relaxation training. Because PTSD is an anxiety disorder in which the victim is left tense and jittery, the practice of any exercise or relaxation technique is extremely valuable. Such protocols for treatment should identify what is best for each individual and treatments geared for each individual personality and exclusive for their situation. In most studies, the therapy of choice seems to be the cognitive-behavioural treatments. Cognitive-behavioural therapy focuses on changing specific actions and thoughts with the help of relaxation training and breathing techniques. Studies have shown that this therapy yielded the most permanent gains relative to pharmacological and combination treatments (Gauthier 1999). These therapies focus on ways for patients to confront fear and develop anxiety-management tools (Grinage 2003).  It is in this realm that the stress management protocols can help the PTSD patient’s health outcomes by helping the client to learn techniques that help the body-mind organism to relax and in doing so start the parasympathetic response, and quiet their system which in turn decreases the stress response. Meditation techniques and the effects of it, besides relaxing the individual, also have a role in boosting the immune system (Solberg, Halvorsen, and Holen 2000). Coping is another strategy that has been looked at in studies (Ager 2002) (Clohessey and Ehlers 1999). Seeing that there is such a high frequency in today’s society of PTSD, because of the violent events and stress that is happening at this time on the planet, this strategy can be a useful tool. Coping techniques can be an affective economical way of helping people by allowing them a healthier response to deal with the acute stress that may bring on a PTSD episode as well as helping them to deal with the original trauma. Of the many different coping mechanisms, mental disengagement and wishful thinking were two of the most common coping mechanisms used by subjects in a study (Clohessey and Ehlers 1999). Social support, situational self-talk skills, communication skills, and community services would be an asset to have as a tool to help manage PTSD.
Persistent symptoms of increased arousal: Difficulty falling or staying asleep; unusually alert and easily startled; difficulty concentrating; increased irritability and anger, that a PTSD patient may experience, can be facilitated by stress management techniques (Brock and Cowan 2004). Sleep complaints and disorders are common in posttraumatic stress disorder (PTSD) (Fagan 2004). In this area there are many preventative measures that can be taken such as establishing a regular sleep routine, using relaxation methods, and maintain realistic self- talk about sleep (Schafer 2000). Just making one’s environment more quiet and peaceful in the evening could be a way for someone to relax and prepare for bed.
The client could also learn to monitor their early warning signs and when they feel like they are being triggered they can use a technique to quite themselves down. Another very simple technique is turning one's attention to one's breath. This moves us naturally toward relaxation and meditation, putting one in conscious touch with one's vital, non-physical essence. Breathing exercises can increase in productivity empowering the person with a strong grounding ability enabling them to control the onset of panic, which is important in the PTSD patient.
One of the best and most helpful ways would be for the patient to develop and initiate health buffers. Things like getting regular exercise, eating well, resting, and developing healthy pleasures would be assets rather than destructive habits of drowning oneself in alcohol and numbing with drugs. This healthier lifestyle would support the patient in their time with PTSD and beyond.
So-called alternative or complementary therapies are approaching PTSD differently to effect a release of stored emotions and resolution of them, by working with the body, rather than merely talking through the experience. One specific psychotherapeutic approach is Somatic Experiencing (SE), developed by Dr. Peter Levine. SE is a short-term, biological, body-oriented approach to PTSD, or other trauma. This approach heals the person by emphasizing physiological and emotional responses, without retraumatizing the person, without placing the person on medication, and without the long hours of conventional therapy (Levine 1997). The therapy involves allowing that trapped energy created by the "immobility response" (or paralysis of fight or flight) to be released, while avoiding the cathartic reliving of the immobility which can be re-traumatizing.
Conclusion
In conclusion, the present study shows the effects on the system from the stress related sequelae. Glucocorticoids play the biggest part by being the effectors to the body accounting for many of the pathophysiology with occurs with PTSD and the Resistance Phase. The studies have shown that the alterations and reactions to the hippocampus and the immune system, which occur via glucocorticoids, have a marked effect on the individuals with PTSD. In relation to treatment and PTSD, many of the symptoms can be lessened with stress management techniques to help the individual come back to a more relaxed and centred internal environment.
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Source: ACS Distance Education Library