Supporting Women to Heal from Trauma and Post-Traumatic Stress Disorder

Abstract

It is normal to feel anxious, terrified, and agitated after being involved in a potentially dangerous or traumatic incident. Most emotions disappear after a few weeks have passed. Some people continue to have these emotions for many months or even years following the traumatic event. This article looks at how post-traumatic stress disorder (PTSD) might manifest differently in men and women. It was discussed how PTSD develops, what causes it, how it affects women, and what treatments are available. PTSD is far more common in women than in males. PTSD can result in feelings of guilt and worry, as well as shame, hopelessness, depression, and frustration. When someone suffering from PTSD is treated with empathy, compassion, understanding, and acceptance, she feels safe and secure, which has been linked to the development and improvement of PTSD symptoms. With the aid of loved ones, it is possible to overcome feelings of helplessness, grief, and hopelessness. Patients suffering from PTSD may benefit from the encouragement and support of their friends and family. With the help of their loved ones, women may enhance their health and well-being.

Post-traumatic stress disorder (PTSD) is a condition that characterized by repetitive thinking, flashbacks of prior traumatic events, nightmares, avoiding memories of trauma, avoidance behaviors, irritability, emotional numbing, hypervigilance, and sleep disruptions. Several different forms of trauma contribute to PTSD (APA, 2013). According to Schiraldi (2000), this disorder is characterized by experiencing stress as a result of facing, observing, or hearing about traumatic events, such as events that harm anyone physically or threaten their lives; a person can develop PTSD even if he or she is not the person who experienced the trauma.

PTSD is more common in women as gender and sex influence PTSD in a variety of ways, including gender roles, genetic susceptibility, and hormonal factors (Christiansen & Berke, 2020). These factors combine to put women at a higher risk of developing PTSD. According to the National Center for PTSD (2022), five out of 10 women have experienced a traumatic event. Women experience traumas differently than males. While men and women describe the same PTSD symptoms (hyperarousal, reexperiencing, avoidance, and numbness), some symptoms are more prevalent in either gender.

The biopsychosocial model helps explain the several risk factors that render women more prone to suffering PTSD. A prominent biological idea is the sex differences in the HPA axis, a regulatory mechanism that governs the neurological, endocrine, and immunological systems through negative feedback inhibition since it appears that women have a more sensitive HPA axis than males (Dunlop & Wong, 2019; Olff, 2017). Moreover, from a psychological perspective, it is considered that both men’s and women’s coping techniques contribute to the development of PTSD. Research indicates that under stressful situations, women have an emotional "tend and befriend" reaction, whereas males have a more problem-focused response (Olff, 2017). The tend-and-befriend strategy entails caring for others and reaching out to others as a form of stress reduction; hence, women are more susceptible to developing PTSD if their support system is insufficient and they feel abandoned (Vernor, 2019). In addition, societal factors contribute to the frequency of PTSD in women. Boys and girls are required to conform to stereotypically feminine and male abilities and behaviors that influence the extent of expressing fear and emotions, resulting in a positive correlation between feminine qualities and greater levels of anxiety (Hu et al., 2017). Also, research indicates that in communities where conventional gender norms are imposed and males have more social authority and power, the rate of reported PTSD among women is significantly higher (Vernor, 2019).

Etiology of PTSD

Post-traumatic stress disorder (PTSD) is a condition caused by traumatic, frightening, or unsettling events. PTSD can occur whenever a person experiences great fear, terror, or helplessness. Schick et al. (2020) reported that women often utilize greater emotional avoidance methods in response to stressful situations, resulting in more severe PTSD symptoms than males.

Types of Traumatic Events

There are several forms of traumatic events, including those caused by humans, accidents, and natural disasters. It has been shown that women are more prone to avoid recalling or engaging in activities that remind them of a traumatic event, to experience depression or anxiety, or to feel stunned (Geoffrion et al., 2022, Hourani et al., 2015).

The first category is a deliberate human event, which refers to man-made catastrophes. Abuse is one of the intentional human events: sexual abuse, such as rape, inappropriate touching, and physical abuse, such as beating, threatening with a gun or any weapon, choking, or adults abusing their children; and emotional abuse, such as locking someone up, controlling someone, or destroying property. Sexual abuse combines physical and psychological pain. There are other types of intentional human events like civil war, kidnaping, and bombs. The second category is the kind of events that happen by accident like car, plane, or train accidents, falling and collapsing of buildings, or fire that is caused by human accidental actions. Acts of nature or natural catastrophes, such as volcanoes, earthquakes, floods, lightning-caused fires, and animal assaults comprise the third group of traumas (Schiraldi, 2000).

According to Bucciol and Zarri (2020), as a result of sexual assault, physical violence, and rape, women appear to have a greater prevalence of PTSD than men, which impacts their life satisfaction. Also, for women, the trauma induced by intimate partner abuse is far more detrimental than trauma caused by strangers or accidents. According to another survey, 51% of women experienced at least one traumatic incident that led to PTSD, and 9% of these women had PTSD due to rape (Kessler et al., 1995). Since rape is one of the greatest predictors of PTSD in women, McConnell et al. (2020) investigated the relationship between distinct forms of rape (force-only rape, impaired rape, mixed rape, and incapacitated rape) and the severity of PTSD symptoms. They determined that combination type rapes, including both force/threat of force and substance-related impairment, were much more likely to result in severe PTSD symptoms than force-only type rapes and impaired type rapes.

Living with an abusive relationship has long been connected to the development of PTSD, which is an indication of the physical and mental health issues that can result from such events; hence, women experience PTSD at a higher rate than men (Mertin et al., 2021).

Symptoms of PTSD

Everyone may have experienced at least one traumatic incident or terrible adversity in their lives, however, not everyone suffers from PTSD as a result (Young, 2017). Since women are more likely to be raped and sexually abused, they experience depression, anxiety, eating disorders, and insomnia (Hyland et al., 2020; Price et al., 2019; Scharff et al., 2019). Moreover, women with a history of trauma exposure and substance use disorder (SUD) are more likely to display co-occurring PTSD symptoms than the general population (Arnaudova & Amaro, 2020). In addition to these comorbidities, women are prone to endure chronic pain and physical PTSD symptoms such as back pain, stomachache, headaches, exhaustion, and fatigue (Kind & Otis, 2019). Women’s symptoms are more chronic than men’s symptoms, and they are at a greater risk of developing PTSD than males, even when rape and sexual assault cases are excluded. Also, young girls who endure trauma or maltreatment in childhood, such as sexual assault or domestic violence, have a much-increased chance of having PTSD as adults (Gobin et al., 2013, Kessler et al., 1995). According to the study by Ashraf et al. (2019), females scored higher on PTSD symptoms than males, and this was connected with childhood maltreatment.

The long-term psychological effects of child maltreatment, including sexual abuse, were explored in a case study that followed the same group of children throughout time. It was demonstrated that the vast majority of children had PTSD as a primary result of the event (Tsang et al., 2021). Symptoms in young girls or children, in general, are more difficult to detect than in adults since they do not recognize them. Furthermore, their symptoms, such as dizziness, trouble breathing, or diarrhea, may fluctuate somewhat, and there are additional symptoms related to their academic performance, such as difficulties conversing with others. However, the most typical symptom in children is repeating images of the trauma or engaging in chaotic behavior related to the traumatic incident (Hoeboer et al., 2021). Furthermore, there is a correlation between difficulty regulating one’s emotions and PTSD. PTSD patients have a more difficult time keeping emotional control than people who do not have the disorder (ElBarazi, 2022).

Effects of PTSD on Women

These symptoms impact women in a variety of ways, with the majority of them blaming themselves for the trauma or having second thoughts about themselves to the point of suicide ideation or attempt. Furthermore, the symptoms affect not only the women suffering from PTSD but also their families and inner circle. Military women who have children left at home, for example, will be influenced by their moms’ shifts in attitude and emotions (Gewirtz et al., 2014). According to McNamara (2010), a study was conducted on 70 women who had PTSD, and it was discovered that each of these women had an average of 2.5 children, indicating that having this disorder may harm their children, since they may also have depression. As per Young (2017), extensive research has demonstrated that women who have had a traumatic incident during their pregnancy will alter the development of their child, and in many circumstances, this will have lasting consequences throughout the child’s life.

PTSD has long-term physiological consequences that can be severe. Studies link PTSD to obesity in women. A study found that PTSD increases women’s BMI and obesity rates after childhood trauma (Dedert et al., 2010). A physical injury combined with a traumatic event increases the risk of developing post-traumatic stress disorder, which affects the subjective impression of physical health, such as somatoform and psychosomatic diseases and post-concussion syndrome (Auxéméry, 2018). Recent research links PTSD to cardiovascular disease vulnerability (Krantz et al., 2021). Alcoholism is a common coping technique for women with PTSD. Women with trauma histories and PTSD consume more alcohol and are more prone to alcohol-related risks and repercussions, according to research (Stappenbeck et al., 2013). PTSD affects the brain’s structure and function, like other mental disorders. PTSD sufferers have a reduction in cortical thickness and grey matter volume in brain regions that govern memory, emotions, and fear, according to research using structural neuroimaging (Crombie et al., 2021).

Variations in estradiol and progesterone levels during the female menstrual cycle have been demonstrated to affect several neurotransmitter systems and the HPA axis response to stress (Christiansen & Berke, 2020; Kimerling et al., 2018).

Treatment of PTSD

Recovering from a traumatic experience or PTSD requires a great deal of work on the part of the sufferer and the therapist (Bufka et al., 2020). According to the Clinical Practice Guideline for the Treatment of PTSD in adults published by the American Psychological Association (2017), recovery requires the completion of several phases; however, this varies from person to person (Lynn et al., 2020).

The first step in recovering from PTSD is feeling secure again. It is of the utmost importance to assist the individual with PTSD in experiencing feelings of safety and security. They should avoid things that annoy them and make them feel worse since this might cause their symptoms and side consequences of the trauma to get worse. A person with PTSD should be kept safe to prevent the symptoms and side effects of the trauma from becoming worse. The second step in recovering from PTSD is to rebuild the distressing experience related to the traumatic event. Importantly, PTSD victims should attempt to recover and reestablish their link with the community; most persons with PTSD, particularly youngsters, have great difficulties speaking with others (Bryant-Davis, 2019).

Improving the client’s PTSD symptoms, giving the client skills to deal with the traumatic event, and restoring the client’s self-esteem are the three primary objectives of PTSD therapy.

The vast majority of treatments for PTSD are classified as forms of cognitive-behavioral therapy (CBT) (Smith et al., 2010). The client’s problematic thoughts are the focus of this plan to improve their quality of life. This might take place through the client’s discussion of the traumatic event or by the practitioner’s concentration on the origins of the client’s worries (Bisson et al., 2020, Bisson & Olff, 2021).

Treatment guidelines for post-traumatic stress disorder (PTSD) were developed by the American Psychological Association (APA). The guidelines are a compendium of recommendations for therapists who work with clients who are suffering from PTSD. Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy (PE) have been recommended as first-line treatments for PTSD by both the American Psychological Association and the VA/DoD Clinical Practice Guideline Working Group (American Psychological Association, 2017; VA/DoD Clinical Practice Guideline Working Group, 2017).

CPT is a 12-week course of treatment that comprises 60–90-min weekly sessions (Resick et al., 2016). The client and therapist initially address the traumatic event that happened and how the client’s thoughts about the event have affected her life. The client will next compose a thorough report of what transpired. The client is directed through a process that assists them in analyzing how they perceive their traumatic event and discovering new coping mechanisms (Resick et al., 2016). According to randomized clinical trials, the (CPT) is effective in the treatment of PTSD, having the high impact and effect size of PTSD therapy (Bohus et al., 2020; Lewis et al., 2020).

Exposure treatment is one of the most beneficial therapies for PTSD. Exposure therapy is the approach to treating patients by having them focus on recounting the horrific incident in detail and doing it again until their anxiety is reduced (Brown et al., 2019). It is difficult for them to recall every detail of the traumatic experience because they attempt to avoid everything that reminds them of it, and it is much more difficult for them to find the words to convey what happened. Numerous tests have demonstrated that it is safe to treat PTSD with this type of therapy. Exposure therapy may also involve exposing patients to the site or location where the traumatic event occurred. Recent data support the efficacy of exposure treatment using virtual reality, which would allow the patient to confront the fearful circumstance while remaining in a normal setting (Deng et al., 2019; Eshuis et al., 2021; Finn, 2007).

In addition, cognitive trauma therapy for battered women (CCT-BW) is effective in several clinical trials for the treatment of PTSD in abused women (Zemestani et al., 2022). This treatment combines cognitive-behavioral therapy with relaxation techniques and psychoeducation. As it only takes three to six months to heal someone, it has proven to be highly effective in treating PTSD (Stapleton et al., 2007). In addition, the research looked at the association between gender and PTSD symptoms in cognitive processing treatment and extended exposure and found that women reported fewer symptoms when administered CPT than males (Khan et al., 2020).

One of the most helpful treatments for post-traumatic stress disorder is called eye movement desensitization and reprocessing (EMDR). It is well recognized that the method helps ease the reprocessing of dysfunctional memories, which are believed to play a fundamental role in this disorder. Eye movement desensitization and reprocessing (EMDR) is a sort of exposure therapy involving evaluation and preparation, imaginal flooding, and cognitive restructuring for the treatment of traumatic memories. Rapid, rhythmic eye movements and other bilateral stimulation are utilized to treat individuals who have suffered traumatic stress (Scelles & Bulnes, 2021).

Also, Dialectical behavioral therapy (DBT) can be used to treat post-traumatic stress disorder symptoms (PTSD). DBT for PTSD often includes skill training, such as mindfulness and distress tolerance, to assist patients in managing and coping with emotional discomfort. DBT for PTSD often includes improving social skills and acceptance of self and others. DBT also assists clients in recognizing and replacing dysfunctional behaviors (Bohus et al., 2013; Steil et al., 2011). A study compared CPT to DBT, and the results showed that they were both effective in treating PTSD symptoms of childhood abuse survivors, but the DBT group was more effective because they demonstrated more consistent recovery and improvement and had a lower dropout rate (Bohus et al., 2020).

Moreover, seeking Safety is a cognitive-behavioral group treatment that explicitly tackles the unique difficulties that arise as a result of persons battling substance abuse and alcoholism in addition to PTSD (Najavits et al., 1998).

It has been shown via studies that exposure therapy and relaxation therapy is very effective treatment for PTSD. After three months of exposure therapy treatment, the patients no longer had PTSD, and the treatment also had a significant impact on abused women (Stapleton et al., 2007). On the other hand, other treatments involve combining several interventions that have been shown effective in lowering PTSD symptoms and are favored by patients and therapists (Brynhildsvoll Auren et al., 2021).

Supporting Women with PTSD

Women suffering from PTSD frequently withdraw from family and friends. They may feel humiliated, as if they don’t want to bother others, or as if others won’t comprehend what they’re going through. Support, on the other hand, can help individuals overcome emotions of helplessness, sadness, and despair. The most crucial aspect of PTSD rehabilitation is the support from others. Family and friends can help women suffering from PTSD restore a sense of safety. Loved ones can also play an important role in assisting women on their journey toward health and wellbeing. Teaching a woman’s support system, as well as the patient herself, is critical since stigma and a lack of awareness at home will have an impact on her health and treatment. In the rehabilitation from trauma and PTSD, a well-educated support system might be a woman’s most valuable asset. Because of their knowledge of the brain and body, as well as their experience expressing compassion, clinicians should prepare a patient’s family and friends to come alongside her while she heals. Friends and/or family members of the PTSD patient should attend supporting appointments to better appreciate how PTSD impacts her everyday functioning.

Responding with compassion at the moment aids in the restoration of a sense of safety in the world. Inquire with the PTSD patient about what makes her feel safe in different situations. Friends and/or family members of the PTSD patient should intervene compassionately to interrupt the cycle of childhood trauma and neglect. Friends and/or family members can do routine things with PTSD patients, such as going out with friends, pursuing hobbies that they enjoy, and engaging in rhythmic activity, such as walking, jogging, swimming, or mountain climbing. Join a fitness class, go dancing, or make a regular lunch meeting with friends and family.

Friends and/or family members should strive to listen without making assumptions or passing judgment. Friends and/or family members should make it evident that they are interested and concerned. It is the act of attentive listening, not what they say, that is beneficial to PTSD patients. Friends and/or family members should refrain from offering advice. Friends and family members should accept and anticipate the varied, mixed, and painful emotions of a PTSD patient.

Alongside support from family/friends, some ways can be incorporated nationwide that help women who experienced any trauma. Trauma researchers, practitioners, and survivors have acknowledged that knowing trauma and trauma-specific therapies are insufficient to improve outcomes for trauma survivors or impact how care systems operate.

The setting in which trauma is handled or therapies are implemented influences the results for trauma survivors, individuals receiving services, and those working in the systems. The framework is known as “trauma-informed care” or “trauma-informed approach,” and is seen as critical to the context of care. The trauma-informed approach idea developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) is based on four assumptions and six important concepts. The key assumptions are referred to as the 4 R’s, which include realize, recognize, respond, and resist re-traumatization. First, everyone at every level of the organization or system understands what trauma is and how it impacts families, groups, organizations, communities, and individuals. People’s experiences and behaviors are understood in the context of coping strategies that are used to survive adversity and overwhelming circumstances, whether they occurred in the past, are manifesting now, or are related to the emotional distress caused by hearing about another person’s experiences (SAMHSA, 2014). People in the organization or system can also detect symptoms of trauma. Individuals seeking or giving assistance in various situations may exhibit these signs, which may be gender, age, or setting-specific. Trauma screening and assessment, as well as workforce development, employee support, and supervisory techniques, aid in the detection of trauma (SAMHSA, 2014). Also, the program, organization, or system responds by applying trauma-informed concepts to all aspects of functioning.

There is an agreement that traumatic events influence everyone involved, whether directly or indirectly. Staff at all levels of the organization have changed their language, behaviors, and policies to reflect the trauma experiences of women who use the services, as well as the staff who provide the services (SAMHA, 2014). This is achieved via staff training, a continuing training budget, and leadership that recognizes the impact of trauma in the lives of their employees and the people they serve. Lastly, a trauma-informed approach attempts to avoid re-traumatization of both clients and staff; Organizations frequently unknowingly generate stressful or toxic environments that impede client rehabilitation, employee well-being, and organizational purpose fulfillment (SAMHSA, 2014). Staff that works in a trauma-informed workplace are educated to notice how organizational practices might elicit unpleasant memories and re-traumatize clients who have experienced trauma. Furthermore, the trauma-informed approach is defined by six basic principles rather than a collection of methods or processes. Those principles can be generalizable across different sorts of situations. They include Safety, Trustworthiness and Transparency, Peer Support, Collaboration and Mutuality, Empowerment, Voice and Choice, and Cultural, Historical, and Gender Issues. Safety ensures that the physical environment is safe, and the people’s interactions promote a sense of safety. Then, all decisions are made with transparency to build trust. Peer support and reciprocal self-help are important vehicles for establishing safety and hope, developing trust, boosting cooperation, and promoting recovery and healing via their tales and lived experiences (SAMHA, 2014). Also, the place recognizes that the approach is built upon the collaboration utilized by each individual. Which also supports the idea that the organization should empower individuals and utilize their strengths. The organization fosters the belief in the resilience and ability to heal from or promote trauma recovery. Lastly, it is important to move past stereotypes and biases to incorporate protocols or policies that are responsive to the racial-ethnic, and cultural needs of the individuals (SAMHA, 2014). This program has offered better ways to accommodate trauma survivors in recent days. Given that sexual assault and interpersonal violence affect women at a higher rate than males and are coercive, interpersonal attacks caused by power imbalances, survivors’ rehabilitation path must address these concerns. Clinicians may get a full grasp of the impact of trauma on women’s general health and how to best assist them to deal with the aftermath by adopting SAMSHA’s trauma-informed care framework and feminist theory (Pemberton & Loeb, 2020).

Also, there is rising worry about suicide among female veterans, who have seen an increase in suicide rates that has surpassed that seen in other adult demographics in the United States. A recent study has improved our understanding of the risk factors for suicide among female veterans. However, the majority of existing suicide prevention strategies are gender-neutral rather than gender-sensitive (Monteith et al., 2022). So, by implementing the trauma-informed approach, the suicide interventions will be tailored to the needs, preferences, and experiences of women veterans. Furthermore, this approach can be used just by any individual who wants to be supportive of women who have PTSD as it helps them be more mindful and understanding of the trauma and the emotions it elicits.

Our Clinical Practice

During my work in the field of psychotherapy with survivors of war trauma among Syrian refugees, I have seen that escape and avoidance are the core symptoms of PTSD. If a person is experiencing intense conditioned emotional responses, they are prone to avoid reminders of the trauma that have been generalized to non-threatening circumstances.

I have found during my clinical practice with refugees that PTSD is accompanied with complicated emotions of guilt, worry, dread, depression, and frustration. The trauma survivors suffer from learned helplessness due to the unpredictability and lack of control of the victimization experience (Seligman, 1971). Paykel (1974) suggested that depression results from bad interpersonal experiences, threatening situations, or self-esteem injuries. Obviously, victims of war face all of these.

The initial sessions of CPT focus on PTSD patients’ understanding of the traumatic event’s origins, meaning and its significance. When the trauma survivors recollect the traumatic events, we can determine where the client’s thinking evolved and if they emotionally processed the experience at the time. Based on CPT, I believe that individuals who were unable to heal had remained "stuck" in their thinking from the time of the traumatic occurrences. Resick et al. (2016) refer to these clients’ thoughts as “Stuck Points.”

For example, one woman who survived from war and lost her family told me, "I know I survived from the explosion, but I still believe it was my fault; I must have done something bad, therefore God is punishing me; why would God take my entire family except for me?!" I am so ashamed and repulsed by myself". As a consequence, I work with her to identify all of the variables outside of her control and help her comprehend and embrace the reality that the traumatic events were not her fault. She was able to go on with her life after recognizing she was not to blame. I used the Socratic technique to analyze the woman’s beliefs and feelings of shame and guilt based on the CPT. It became easier for her to modify the idea that God hates her or punishes her for faults. Her PTSD symptoms lessened once she stopped blaming herself for the traumatic events.

The latter stages of CPT involve working with the PTSD patient on the five schemas (mental structures and needs) likely to be altered by trauma. These schemas pertain to safety, trust, power/control, self-respect, and intimacy. These constructions may be either self-directed or other-directed.

My experience working with people who had survived the trauma of war showed me that the schema associated with safety is the one that is most disrupted by trauma. As a result, when I treat a patient with post-traumatic stress disorder (PTSD) with empathy, compassion, understanding, and acceptance, the patient’s condition significantly improves, and she acquires a sense of safety and security.

Even discussing the PTSD patient’s thoughts and stuck points with compassion utilizing the Socratic approach has been connected to the development and improvement of post-traumatic stress disorder (PTSD) symptoms (ElBarazi et al., 2022).

Conclusion

The neurological system of PTSD patients is "locked or stuck" in a state of permanent attention, making them feel constantly vulnerable and dangerous, or having to repeat the terrible experience again and over. This can result in PTSD symptoms such as aggression, impatience, depression, distrust, and others that the patient cannot just switch off. Women are more likely to get PTSD than males. Exposure Therapy, Eye Movement Desensitization & Reprocessing (EMDR), and CPT are considered the best therapies for PTSD. The patient’s loved ones, including family and friends, can significantly improve her prognosis by providing increased assistance and support.