When providing care to a patient with anxiety, which intervention would be the highest priority?

Trauma and post-traumatic stress disorder (PTSD) are alarmingly common. In the U.S., about 60% of men and 50% of women experience at least one trauma in their lives, according to the U.S. Department of Veterans Affairs (VA). Although most people who experience trauma do not develop PTSD, occurrences of the disorder are still numerous: VA data shows that 7% to 8% of the population will have PTSD at some point in their lives, and as many as 8 million adults have PTSD during a given year. Nurses who are interested in treating patients with PTSD may benefit from specialized training, even if they already have Master of Science in Nursing (MSN) degrees. Advanced training such as an online post-master’s certificate in psychiatric mental health (PMHNP) can help nurses build the skills they need to help people who suffer from PTSD.

PTSD at a Glance

PTSD stems from events that cause moderate to severe stress reactions that may be experienced as a sense of horror, helplessness, serious injury, or threat of serious injury or death. Common precipitating events include combat, natural and man-made disasters, the sudden or unexpected death of a loved one, terrorist attacks, serious accidents or illnesses, sexual or physical assault, and various forms of abuse.

People with PTSD experience disturbing thoughts or feelings related to a traumatic event long after the event has occurred. The traumatic event may be experienced or witnessed directly, but knowledge of a traumatic event that was experienced by a family member or close friend can also trigger PTSD. The disorder may be triggered by a single event or repeated exposure to unpleasant or disturbing episodes. For example, emergency responders may experience PTSD as a result of regularly witnessing scenes of injury and death. Factors that put individuals at greater risk for developing PTSD include proximity to a traumatic event, exposure to multiple traumas, prior experience with trauma, and chronic illness.

The wide range of symptoms associated with PTSD include cognitive (poor concentration, confusion), emotional (shock, depression), physical (nausea, sleeplessness), and behavioral (suspicion, irritability) reactions. However, the disorder is characterized by three primary types of symptoms, according to the Anxiety and Depression Association of America:

• Re-experiencing a traumatic event through intrusive recollections, flashbacks, and nightmares
• Emotional numbness and avoidance of people, places, and activities that are associated with a trauma
• Increased arousal such as difficulty sleeping and concentrating, feeling jumpy, and being easily irritated and angered

More specifically, people suffering from PTSD may experience persistent or exaggerated negative thoughts, including fear, horror, anger, guilt, or shame. Significant diminishment of interest in activities, feelings of detachment or estrangement from others, and the inability to experience positive emotions are also common symptoms, as are reckless or self-destructive behaviors, hypervigilance, and an exaggerated startle response. People with PTSD are sometimes unable to remember an important aspect of a traumatic event.

PTSD is diagnosed after a person experiences symptoms for at least a month following a traumatic event. Most often, symptoms occur within three months of the event, but they can take years to emerge. Some people recover within six months; for others, the symptoms become chronic.

Teenagers and young children may manifest slightly different symptoms. In addition to conditions common in adults, teens may become disruptive, disrespectful, or destructive. They are also prone to experiencing feelings of guilt for not preventing the incident that caused the trauma. Young children may wet the bed, forget how to talk, act out a traumatic event during playtime, or become clingy with a parent or other adult.

How Nursing Interventions Can Help

With proper training, health care professionals in multiple disciplines — including psychologists and psychiatrists, advanced social workers, licensed professional counselors, and psychiatric mental health nurse practitioners (PMHNPs) — can conduct PTSD interventions. Advanced practice nurses with mental health expertise can administer or assist in the administration of primary PTSD therapies and treatments:

• Cognitive therapy. A type of talk therapy, cognitive therapy helps patients recognize and modify potentially harmful thinking patterns, such as fears that traumatic events will recur.
• Exposure therapy (ET). Used to help PTSD patients reduce flashbacks and nightmares, ET lets patients safely face frightening situations and memories until they are better able to cope with them. Exposures can be real or imagined. Virtual reality technology can also be used for ET.
• Eye movement desensitization and reprocessing (EMDR). Used in conjunction with exposure therapy, EMDR therapy involves a series of guided eye movements that help patients process traumatic memories and manage their reactions.
• Psychopharmacology. PTSD symptoms can be treated with any of multiple types of medications, including antidepressants and anti-anxiety drugs. Prazosin has been identified as a possible aid in reducing or suppressing nightmares in some people with PTSD, but its efficacy is still being studied.

Strategies for treating PTSD vary from person to person, and determining the optimal intervention strategy for a given patient requires careful assessment. Training in psychopharmacology and psychotherapies is essential, but advanced communication skills are also crucial.

The Skills Needed for Successful Interventions

Training to become a psychiatric mental health nurse practitioner (PMHNP) builds on core nursing competencies, teaching nurses to provide mental health diagnostic evaluations, treatment planning, psychotropic medication management, and therapy. It also cultivates the advanced communication skills necessary for PTSD interventions and other advanced mental health treatments.

Essential to all nursing practices, active listening skills help nurses collect vital data about patients’ trauma history and gauge their current mental state and anxiety levels. By demonstrating empathy and compassion, validating emotional reactions, and de-emphasizing language that is overly clinical or pathological, nurses can create a dynamic that is person-to-person rather than expert-to-victim. Maintaining calm, demonstrating patience, and explaining that symptoms are normal can also help patients who may be experiencing high levels of anxiety.

Once trust has been established and a nurse and patient have built rapport, coping techniques — maintaining routines, identifying ways to relax, recognizing triggers — can be explored. Encouraging patients to talk only when they are ready, nurses can also help those with PTSD express emotions (orally or in writing) and identify additional resources and supportive family and friends.

Preparing to Provide Nursing Interventions for PTSD

For both MSN nurses and active nurse practitioners, additional training can expand skills and career opportunities. A Psychiatric Mental Health Nurse Practitioner (PMHNP) certificate program includes courses in psychotherapies and psychopharmacology, essential preparation for treating patients with PTSD. Learn more about Regis College’s online post-master’s certificate in psychiatric mental health to explore mental health training and other options for advancing nursing careers.

Recommended Readings

Integrative Health Education for PTSD: The Ultimate Guide

Post-Traumatic Stress Disorder: A Comprehensive Guide

Special Roles in Nursing: What Does a VA Nurse Do?

Sources:

American Psychological Association, PTSD Treatments

Anxiety and Depression Association of America, Symptoms of PTSD

Centers for Disease Control and Prevention, Helping Patients Cope with a Traumatic Event

The Journal of Child Psychology and Psychiatry, “Practitioner Review: Posttraumatic Stress Disorder and Its Treatment in Children and Adolescents”

Mayo Clinic, Post-Traumatic Stress Disorder

National Institute of Mental Health, What Is Post-Traumatic Stress Disorder, or PTSD?

Psych Central, “PTSD & Relationships”

Regis College, Online Post-Master’s Certificates — MSN to NP

U.S. Department of Veterans Affairs, How Common Is PTSD in Adults?

U.S. Department of Veterans Affairs, PTSD: National Center for PTSD

Verywell Mind, Virtual Reality Exposure Therapy Can Help PTSD

WebMD, What Are PTSD Triggers?

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Clinical manifestations of anxiety disorders according to ICD-10 (4)