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Posted June 08, 2021
Listen to this episode of the Healthy Vitals Podcast.
Dr. Adam Ripley discusses trauma exposure and options for treatment, not limited to combat trauma.
Scott Webb: Trauma exposure is common for many of us, and that can lead to PTSD, even for those of us who haven't been in combat. And joining me today to help us understand trauma and how treatable PTSD is for most is Dr. Adam Ripley. He's a psychology postdoctoral fellow at Summa Health System's Traumatic Stress Center.
This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. So doctor, thanks so much for your time today. We're talking about trauma and I wanted to start things off today by asking you is trauma exposure common and, if so, is it limited to just combat trauma?
Dr. Adam Ripley: Yes, trauma exposure is incredibly common and we do tend to attribute that to veterans. We tend to think about trauma and PTSD as being combat-specific or war-specific partially because the initial identification of PTSD occurred within Vietnam veteran populations. But trauma exposure takes a variety of different forms and it is incredibly common in the general population.
So depending on the study, depending on which statistic you're looking at, the exposure rate is anywhere from 50% to 60% of say the average American population. So on average, say one and two Americans will experience a traumatic event during their lifetime that meets our normal criteria for trauma related to PTSD. A lot of folks who experienced those traumas won't go on to develop post traumatic stress disorder, but the kinds of things that we experienced include things like motor vehicle accidents, natural disasters, sexual and physical assaults. Sometimes sudden and traumatic medical events can take the form of a trauma have some of the same characteristics there. So it's incredibly common and definitely not limited to veterans or combat-exposed persons.
Scott Webb: Yeah, I see what you mean. The origins of PTSD, sort of our understanding of PTSD, does originate with Vietnam and combat trauma. But as you say, so many Americans suffer trauma and many may not even realize it, may not even realize where their PTSD is coming from or where it originates from. And when we talk about PTSD and whether it's common or not, I'm assuming that it tends to naturally follows some sort of traumatic exposure. And I think the followup to that is does it tend to resolve itself?
Dr. Adam Ripley: Yes and no. So most of the things that we experience as post-traumatic stress disorder are common reactions following a traumatic event. For a wide variety of people, many of them don't go on to have life impairment and ongoing distress related to PTSD symptoms. So we think about things like intrusive memories, so an unwanted memory of the traumatic event or being somewhat jumpy or nervous about similar situations in the future, that is pretty common, especially in the first say six months after trauma exposure. And a lot of these tend to resolve themselves, but for some folks, this does become a more chronic condition. And so if we're looking at population estimates, again, the number will vary depending on the study you're looking at, but somewhere between 4% and 6% of the United States population will probably meet criteria for PTSD at any given time.
Scott Webb: Okay. Yeah. So you were saying earlier, it's like one in two Americans will have suffered some sort of trauma. And then when we talk about PTSD, you're saying 4% to 6%, depending on the study, of course. So I'm assuming those of us who have been exposed to trauma, those of us who've suffered from PTSD, we go through cycles. And I want you to talk a little bit about those cycles of anxiety and avoidance.
Dr. Adam Ripley: Yeah, absolutely. So one of the things I always emphasize to patients I'm working with or people I'm speaking with about PTSD is that what is happening for a person experiencing this disorder is a lot of the brain and body circuitry that is designed to keep us safe and to protect us that normally works well is somewhat malfunctioning essentially. So we kind of get stuck in, as you say, these cycles or these loops. And so our brains are really good at pairing information and that helps us learn stuff. It helps us navigate the world effectively, but when those things become paired with a traumatic memory, then it starts to cause us some problems.
So earlier I mentioned intrusive memories, oftentimes what triggers those things are reminders that are similar to our traumatic event. So say for somebody who's suffered a sexual assault, lots of physical touch that's even non-sexual can trigger that memory for them. So somebody placing a friendly hand on a shoulder might not feel safe because it reminds them of the time they were assaulted and then their memory comes up related to that.
What we think sort of perpetuates the PTSD as a disorder is that cycle where we avoid the memory because it's so uncomfortable because we tend to feel a lot of the same emotions we felt in the moment of the trauma in the present moment. So we try to avoid that through "I don't think about it. I don't experience those reminders. I avoid places where I might remind myself." Oftentimes it takes the form of substance use and abuse where "I'm trying to avoid this thing that lives inside my brain. So I can change my brain chemistry. So I don't have to think about it through a substance."
And unfortunately, that doesn't allow us to learn that these reminders, while uncomfortable and while maybe never going to be a happy memory of a time in our past, that the things that are happening now are not necessarily unsafe, not necessarily dangerous. So the circuit that normally keeps us safe by telling us to avoid danger is now telling us to avoid these reminders. And that perpetuates that cycle because we don't get to learn that the trauma's over and we're no longer in that dangerous position.
Scott Webb: Yeah, I see what you mean. That sort of ironically that things people will do to try not to deal with those memories, it makes it difficult for us to ever really deal with that trauma head on and really treat the PTSD because we never really take the time to understand why these reminders are happening and what they're actually reminding us of. And it's interesting and complex, right?
Dr. Adam Ripley: Yeah. Absolutely. And that's a big part of our treatment approaches to PTSD, which frankly sound counterintuitive because honestly, if avoiding the trauma memories or trauma reminders worked for people. I wouldn't say like, "Let's think about this traumatic event" in a therapy session, because why would I purposely subject you to pain and memory of this horrible thing that happened to you or that you witnessed or whatever, if I could just have you not think about it ever again, and you feel fine, but this does cause impairment in people's lives. And yeah, it is ironic that these things normally keep us safe, they keep us protected and now, making our lives harder to live.
So say if I avoid a major intersection because I had a motor vehicle accident there and I add 20 minutes to my commute, that might not be a horrible thing, but if it's lots of these intersections, lots of these places where I can't go now and I am working really hard and feeling very anxious all the time because I have to avoid all these things, then that really starts to interfere with my life. And so our treatment approaches tend to involve looking at the memory, looking at the thoughts that we have about it and what they mean and facing that thing so that we can learn now that things don't always go that badly and things aren't always that dangerous essentially.
Scott Webb: Yeah. In the example you were giving there, you know, those intersections that we avoid, literal ones and the figurative ones, you know, just because we had an accident in a particular intersection, doesn't mean we're going to have an accident every time, right? And as you say, that avoidance can really affect our quality of life because we're going 20 minutes out of the way every day to avoid something. So, really fascinating.
Let's talk about the stigmas about trauma survivors. I know they're still around. So maybe talk about them a little bit and also are they changing?
Dr. Adam Ripley: They are changing somewhat. I think PTSD and trauma are becoming more of a cultural topic. There's something that appear in movies. There's something that appeared in TV shows and something that we talk about in our sort of national dialogue. I don't think that the stigma is gone, so I can talk about some of the original stigma and maybe some of where we are now.
But even before Vietnam, this was something that was noticed in veterans and armed services personnel, and has been given names like shell shock, battle fatigue. There's even some records from the Civil War of something that sounds kind of PTSD like, and it was seen as this moral failing, it's a weakness. It means that these guys just couldn't cut it, but these other guys don't seem to be as bothered. It's some sort of cowardice note there in the stigma originally. Now it does tend to be less cowardice now specifically, but some of the same idea of they couldn't handle it, lots of people experienced trauma and feel fine. So this person, the reason they're having the reactions that they are is because they are in some way broken or screwed up or they have an inability to face their concerns or they just need to get over it. That sort of continues as well.
There are some, you know, specific stigma related to specific kinds of events, so particularly sexual assault or any kind of domestic violence. There's a lot of victim blaming that goes on of "Why didn't they just leave?" or "She shouldn't have been wearing that if she didn't want to experience the sexual event or things like that are untrue and unfair, but that do tend to cause people who have survived trauma to not want to disclose what happened to them out of fear that they will be received poorly. And that actually feeds a lot of that avoidance cycle, where if "I'm worried about what will happen to me and my relationships, if I tell them that I experienced this horrible thing, I'm probably going to withdraw from social relationships and not feel as safe there." And that isolation can really feed the PTSD as well. And again, I do think some of that's getting better, especially around sexual assault, although that remains a stigma. But some of that sense of people just can't handle life, I think remains as a major component of the stigma for PTSD now.
Scott Webb: Yeah, it does seem like during this period of time of Time's Up and Me Too, it's encouraging, I think, that we are talking about these things more. It is more mainstream, it is on social media, good, bad or otherwise. But it does seem like it has brought some of the at least the sexual assault trauma and PTSD to the forefront.
Dr. Adam Ripley: And I will say that despite the presence and prevalence of things like Time's Up and Me Too, a lot of those stigma-related statements will still show up related to say, when somebody gives testimony, why didn't they report it to the police earlier, or why didn't that person just leave this clearly abusive situation with their partner and what's wrong with them that they didn't use the resources they had to escape and oftentimes one that's just unhelpful because it's too late to go back and change any behavior now. But that tends to show up, especially when someone's reporting a sexual assault against somebody famous or somebody prominent that like, why didn't they talk about it earlier? That sort of stigma remains when they're trying to receive justice from what happened to them.
Scott Webb: Yeah, I see what you mean. And of course, there is no real roadmap or blueprint for this. And everybody's different and deals with things in their own time. And so I guess, it's a little bit encouraging that things are changing, but we still have a long way to go. No doubt.
Dr. Adam Ripley: Yeah, agreed.
Scott Webb: So I want to have you talk about the traumatic stress center at Summa Health and specifically the scalability of services.
Dr. Adam Ripley: Yeah, absolutely. So the Traumatic Stress Center at Summa Health is an outpatient mental health clinic located in Akron. We provide, as you say, some degree of scalability of services and we also work with other providers in the community to link patients and clients here with other resources that'll be beneficial.
So we have individual psychotherapy that tends to be not the lowest level of services in the sense of not least effective, but in the sense of least number of contact hours per week, right? So maybe one, maybe two therapy hours a week with somebody. The approaches we tend to use in there are what we call cognitive processing therapy and prolonged exposure or our trauma-focused interventions, as well as other therapy interventions, depending on the individual patient needs.
We also have a variety of groups. So we have groups related to specific areas that often show up in trauma survivors and their recovery journey. So things like dual diagnosis, which is a trauma and related psychological disorders, along with substance use and addiction history. We have a grief and loss group because oftentimes that mourning process occurs as well in our trauma survivors that we work with here, dialectical behavioral therapy, skill building, just general coping skill building groups.
And so sometimes folks will have to do one or two of those groups a week in addition to individual therapy. And we also have what's called an intensive outpatient program, which is three sessions per week or three hours a piece for 18 sessions. So it's a six-week program where it's for folks who are not in need of inpatient hospitalization or some sort of partial hospitalization program, which we also have through Summa Health, but tend to be more for folks who are acutely suicidal or at high risk.
Once that risk is sort of stepped down, an IOP is often a good fit where you get basically a high dose of therapy. I kind of liken it with my patients to doing an antibiotic treatment where you have this high dose of medication for a few weeks, and then you're going to step back to deal with residual ongoing things afterwards. And usually have individual therapy support as well, while folks are going through that, just to help internalize some of the skills and lessons they're getting out of that group. Obviously, group size has been limited due to COVID and some of our space restrictions here, but that’s, one of our really important interventions or treatment options we have here through the clinic.
Scott Webb: Doctor, as we wrap up today, this has been really educational for me, and I'm sure it has been for listeners as well. Any final thoughts or takeaways on trauma, what folks can do for themselves and ultimately what Summa can do to help them?
Dr. Adam Ripley: One thing I do want to clarify before I get into those final thoughts is that the partial hospitalization and inpatient programs are not through the TSC specifically, but they are in the general Summa Health system. But in terms of takeaways, I think the chief takeaway I would have for folks is that PTSD is not a life sentence. This isn't a disorder where you're going to have it forever. This isn't a diabetes type of a situation where this is probably going to be a part of your story for the rest of your life. I think it's highly treatable. The interventions we use for PTSD are among the most well-researched psychological interventions we have. And so there's a lot of hope for this to get better, you to no longer hopefully meet criteria for PTSD when you're done with treatment. And there are a lot of great programs that we have and other people have to help you all along that journey. And this isn't something that there is no hope for.
And in terms of advice, if some of the things we've been talking about here have resonated with folks who are listening, I encourage them to talk to their primary care providers and ask specifically about PTSD and psychotherapy services. If they live outside of the Akron area, obviously there's places to search online to find local psychotherapy services. And to consider the possibility that things could be better and it doesn't have to be this way for all time I think the chief takeaways there. And again, I think the traumatic stress center is a great resource through Summa Health. I know we also have outpatient providers outside of here that do trauma-specific work in a more traditional outpatient setting.
I definitely think that the thing to remember is that this is conquerable and the way I phrase it to patients a lot is my goal in treatment for them is that the worst day of their life doesn't have to control the rest of the days that they're going to live. Just want to emphasize that that's possible and that there's a lot of hope out there.
Scott Webb: Yeah, that's really well said. And that those are going to be my takeaways today is that PTSD is highly treatable. There are many, many decades of informed knowledge and care available to people. As you say, it's sort of originated with Vietnam, but here we are in 2021. And there's every reason to be hopeful, which is always a good thing when we finish these things up.
So doctor, thanks so much for your time today and you stay well.
Dr. Adam Ripley: You too.
Scott Webb: The Traumatic Stress Center at Summa Health is dedicated to the treatment and investigation of traumatic stress and its consequences. For more information, call (330) 379-5094. And if you found this podcast helpful and informative, please share it on your social channels and be sure to check out the entire podcast library for additional topics of interest.
This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.