PTSD Research & Treatment

Thank you Guy. Thanks for having me. 

Yeah.  Ah, well, so I, um, did a Bachelor of Social Science Psychology, what feels like a millennium ago. Um, Mainly because I, I've always been interested in human behavior and, , the Bachelor of Social Science degree allowed me to do sociology and criminology and psychology.  But I really psychology really resonated with me.

So I actually went back and did a full bachelor of psychology because,  I really wanted to make sure I had a good grounding and really comprehensive training, and I started my work,  when I got my registration with a balance of work, rehab and private practice. And the more I did that, um, I just found that my work just so rewarding.

 But particularly when I was working with police or first responders and then I moved into a role where I was providing,  rehab and transition support to the military, and that's when I was like, yes, this is really what I want to do. And I just kept seeing more and more. Clients in private practice, particularly around police and, um, first responders, health workers,  who were presenting with P T S D.

 And then I guess my journey at Saint Johnna, God kind of started,  because I knew they had the gold standard of trauma programs and that's really where I wanted to put all of my focus in. And I knew that, um, working here would give me that exposure. And so, Since 2018, I've been at the organization in a few different roles, starting as a clinician on the P T S D ward,  , sort of moving up the ranks myself into the management role, which has given me, I guess, the scope to start developing and writing some programs, evaluating our programs, and really looking at how do we tailor care, particularly for our first responders.

Military, um, personnel, which is I guess where we are sort of getting to now.

Yeah, so P T S D or post-traumatic stress disorder is something that we've known about for a really, really long time. But psychology as a science hasn't fully committed to the research. Really until the return of the Vietnam Veterans, we used to have a lot of different terms for P T S D, like Shell Shock or Soldier's Heart in the early days.

Um, and I guess the most advances in our science has been since that time, since the, um Vietnam veterans, and now we continue to build and learn things and we now know about complex P T S D and moral injury and a lot of other really complicated facets in. So I guess what it is, um, PTSD is a, is a diagnosis for someone who's,  experienced a traumatic incident and has subsequently,  started to experience sort of four core, I guess, diagnostic criteria, flashbacks, avoidance, intrusions, sleep disturbances, things like that.

Um, But it's such a complex thing that it just seems that a few diagnostic criteria can't really explain it very well.  So. People can develop P ts D after one single incident trauma. It's not something that's solely reserved for first responders or military. There are no predisposing factors. Any human on this planet has an equal chance of developing P T S D.

But what we do know is that because there's no known predisposing factors, the only factor that contributes to this is the experience of trauma. And trauma is something that we all, as humans experience in varying. Across our lifespan. But if you look at these populations, police first responders, military emergency workers, their trauma load is significantly higher than what a civilian would be in their day-to-day lives.

So I do believe they're mo more predisposed simply because their work forces them into very traumatic incidents on a very regular and saturated basis compared to. What we as civilians are in our day-to-day life.

Yeah. So I mean, we very much look at PTSD as a injury here, and we very much treat it as an injury, particularly like when we are looking at workplace, um, incidents that caused. The injury, but P T S D very much, um, diminishes social and emotional resources in people. We, we find it very corrosive in multiple areas of life, and that emotional and social is a huge component of that, as well as their sense of safety in the world.

Um, for most, of our patients, I would say the majority of them, they also. Their job and sense of identity, meaning, and purpose in life as a result of acquiring this injury at work. Um, you know, and when you say avoidance, avoidance is a core sort of,, symptom of P T S D because the emotions become so difficult to manage on a day-to-day.

Um, We would definitely see them start to avoid a lot of things. And a lot of those things do end up being engagement with family, friends,  in society in general because it feels so overwhelming and they become so heightened, you know, to threat,  in the world. And this complete loss of sense of safety in the world is what drives a lot.

Oh, absolutely. And I mean, their training in these occupations is so effective that it gets them to basically go against what our natural human instinct is, which is generally run away. Um, you know, and that's very protective for them. And they're, you know, they're taught to. Seek out threat and be hypervigilant, and that makes them extraordinarily effective in their role.

Where it becomes, um, where the impairment comes is when they're no longer in the role, but they can't switch that off.  And for the most part, you know,  I work really closely with Professor Zachary Steele, who's an expert in this area. And he says P T S D travels with what he calls the four horsemen, and that is insomnia, depression, anxiety, um, substance use.

Um, like alcohol or other drugs to self-medicate and chronic pain, because often in these occupations, they're very physically taxing as well, and that physical pain and chronic pain element will often trigger the trauma element, and it ends up being this horrible. Cycle. And when you said before around emotional numbing, a lot of people try and self-medicate, particularly in the early days when they don't understand what's really happening and they're still at work and the P T S D functions in the workplace, but the wheels start to fall off at home.

And so they'll often go back to those old, um, Old culture things of you just go to the pub after work and do a bit of a debrief over a couple of beers, and then a couple of beers turns into a couple more, couple more, and it, it just becomes a, well, if I numb it, it becomes easier to manage on a day today till ultimately it doesn't.

Yeah,  none that come to mind that I could specifically reference, but I definitely, um, think that's true. I mean, it was covered pretty comprehensively recently in the Frontline Mental Health Conference where it was discussed, and it's primarily in the context of the load of trauma that these occupations see.

As I said, there's no,, you know, predisposing factors, so people, you know, civilians that aren't in these occupations definitely would be at risk of developing PTs d but I would definitely say that it's a higher risk just because of the higher. Traumatic load. I mean, particularly things like paramedics, they're never called out to pleasant jobs.

Everything's quite urgent, traumatic, and they have to be quite hypervigilant around that. And they see all of those things that we don't normally see around how dangerous certain things can be. And they've seen the worst of of that. So it would make sense to me that they would be more, you know, more prevalence to ptsd.

Yeah, it's a really nice point you make. You know, ignoring problems, don't make them go away. We know that true, that's true of sort of most of life's problems, but particularly mental health.  You know, some really recent researchers sort of said to us that a early marker for P T S D is sleep disturbance.

 And that can be a little bit difficult to identify in these occupations cause they work in shift work, which means that their sleep is disrupted anyway. But, uh, you know, what we talk about is. You know, for workers to be mindful of when it starts to become more difficult to go to sleep, when they're starting to notice that they're waking up more frequently or starting to experience the nightmares.

 The other things that we sort of see is. You know, because of that corrosive nature of ptsd, T S D, what they'll start to do is have a bit of a shorter fuse, be a bit more aggressive, um, more angry because they're more tired.  The people who develop PTSD at work are often some of my most hardest working.

Um, first responders, they're the ones that when they start to see the problems leak at home, we'll often work longer hours, refuse to take, leave, you know, spend more time at work, do overtime go in on their days off. They're usually the symptoms where we go. What's that about? Um, and why do you feel like it's getting really difficult to manage at?

Oh, this is such a. You know, I guess topical thing really, because, I mean, what that is is around mental health stigmas, right? Um, and. I think the conversation is happening. We definitely have a long way to go, but there is an impact. I mean, there's an impact to, um, police in that if they say that their firearms are removed and they're put on desk duty, you know, and so it's sort of like everyone knows in the same way, military, they, they get delivered a medical downgrade and they have all of these restrictions placed on them.

And the same with health workers. I mean,, if a doctor puts their hand up and says they're struggling, then there's things on their registration. You know, limitations and things like that. So it can be really difficult for people to put their hand up, , and say, I'm struggling when they really enjoy what they do and try and avoid the impacts.

Of Seeking Health. I think there's more awareness of mental health in the workplace, and definitely, you know, where we have these forums like Frontline Mental Health, where we have commissioners of these large organizations like Ambulance New South Wales or police coming together to go, we understand that this job puts people's mental health at risk and how we work towards that and how do we start to remove these stigmas and offer help on site.

But absolutely there's a long way to go because I don't think anyone's come up with this perfect answer of what, what would we need to do to make people feel comfortable and confident enough to put their hand up and minimize, the risk to themselves or the community if they're not traveling well. So it's a really difficult one to answer cuz I wish I had this perfect answer or solution to how we fix this problem.

And I don't, which is unfortunate. Um, but I. We're getting there. We are making positive steps and I'm seeing the conversations shift and change.  But I can definitely appreciate why there's a reluctance and I hear that so much from our clients. Like, I knew something was wrong, but I just kept pushing cause I just thought maybe I'm tired.

Maybe it's not that bad till it really was, you know.

Yeah, great question. And I think, , for us here at St. Johnna, God, what we really move to is trying to do a more tailored approach to. To care,  which is why we introduced all of these additional programs to try and meet those needs of the complexity. I think when we are looking at P T S D and we're talking about a civilian who might have encountered a traumatic incident and has developed P T S D, um, as a result of that, we could do something like 12 sessions of prolonged exposure and we would.

They're subclinical of completely regained sort of quality of life back and it's a very short term treatment. I think where it becomes more difficult to define the treatment guidelines is when we have things like complex P T S D or people who've carried this for years before treatment and when they carry with them other, those other things, chronic pain, insomnia, anxiety, depression, particularly substance use.

And then we need to look at which one do we deal. First, and what's the correct treatment pathway for that person at this time? And I think we need to consider what else is happening. Like you said, a really important part is, you know, this doesn't just affect the person with P T S D, it affects their family system as well.

And we often see a lot of family breakdown happen as a result of this. And so, You know, it's hard to say, you know, every person's gonna have this rehab, you know, like we would with a broken arm or a broken leg to say, we've got these really tight guidelines around that. I think people with the right treatment at the right time can get a wonderful quality of life back.

And I know that because we've seen it just at our service and there's so many places that provide these amazing programs or individual counseling and get people with great quality of life back. I think in terms of what it is, I hate using the word cure because it just doesn't seem to fit. But you know, we see people completely regain control of their emotions or process those traumas and no longer have those active P T S D symptoms and then just manage their emotions on a day-to-day thereafter.

And we have people that, you know, never have to reengage our service again after this course of treatment. And some people who come in when. They've experienced another loss and they feel like the depressive symptoms are coming back and they come for a three week stabilization, then they're off again for years.

So I know it's not a tight answer that gives people a really clear boundary, but I think it does look different for everyone depending on that, that level of complexity. But I think where we can tailor that approach. To each individual to meet those needs. Like, you know, um, if it is, you know, the primary thing is around those memories and flashbacks and intrusions, you know, and targeting that.

Um, or is it more around, you know, trying to,  teach people the skills to manage their emotions effectively, to build those connections again? Is that the primary thing? Is it around the chronic depression first and it's about working with that to get the best outcome for each individual.

Yeah, so. Triggers for the PTSDs, for those intrusions and flashbacks are very personal to that person and that trauma, as avoidance grows, those triggers seem to expand. And external life stresses become quite difficult because we know part of having PTSD is the inability to regulate emotions effectively.

So, you know, we call it the window of tolerance. You know, for, for people without P T S D that have normal life stresses, our windows. Broad in terms of where we feel like we're abso at our absolute limit. So we were able to tolerate daily stressors, getting stuck in traffic, running late for an appointment, and then we sort of feel okay once everything's settled.

But where that window is really sort of shortened with P T S D, there's not much room to send people into that complete overwhelm state. Sometimes what sends them into is just daily stresses. You know, an example yesterday when I ran a group was people really struggling with their working memory. You know, these people who were in these high functioning, often high ranked positions within these organizations.

Say I was in charge of a thousand people and I had this really stressful job, and everything felt really easy, and now I can't remember five things on my shopping list to get to the shops. And I get to the shops and I can't remember. So infuriating and I get so stressed and talking about it makes me feel stressed.

I said, yeah, I know because we know that your memory's impaired with this condition. Let's put in some strategies to manage that. So in terms of those triggers, you know, outside of the workplace, they can really be anything, um, inside the workplace. You know, again, it's very personal. Is it just more and more traumas and then it's at one point where the brain just goes.

It's sort of like, I always use that analogy of a cup. You know, we can have a small cup and it'll fit its amount of water, but there's an endless, you know, there's not an endless amount of water that can fit in. At some point it's gonna leak out, and it's the same way that this does. Um, you know, the tipping point is different for everyone.

You know, it might be just that one trauma that was just too much. It might be an element in that trauma that. Was complete overwhelming. It might be an organizational thing where they didn't feel supported in that situation, that that is the trigger point. So many, many factors in this complex diagnosis.

Yeah,  I guess in to clarify, is that particularly in the workplaces or are we talking outside in terms of treatment protocols or both? Probably both. So I think in the workplaces, um, I know each organization manages this slightly different and again, They're always looking at ways to better that. You know, some people ha, some organizations have incorporated pastoral services or peer workers or lived experiences or allow external agencies to come in and provide the support.

Or they talk about is it better that we provide that psychological support in the workplace? Um But I think around the, what I've seen at least in the last three years, if I look at the first few years I attended Frontline, it was really about the stigma of mental health, you know, and that how prevalent that still is in these organizations.

And now we're already moving to where we know that this causes an impact to people's mental health. So how do we change it? And I can see the conversation shifting, but like I said earlier, does have a long way to go before people, I think, in these organizations, feel confident. You know, everything's in place and it's a little bit of trial and error, I guess.

Um, broadly in the community, I think it's more awareness of this condition and having clinicians out there who were trained specifically for this complex condition, you know? Um, Because there are so many treatment protocols and the condition is so complex and, um, things like that, you know, just having awareness and knowing all of those things, , in terms of treatment protocols or knowing what services to engage for these clients, I think that's where the biggest shift is, that there's just, you know, people are talking about it more than before.

But again, it could, could always be better.

Oh yeah, we're, I mean, we're always looking at it. They've been looking at this, um, you know, even gender differences and seeing do men or women, you know, is there a predisposition there? Um, And you know, I remember sitting through this seminar where they were saying they're looking at hormone changes and things like that time of month for females and still all that they can find is females generally carry the diagnosis of P T S D more simply because, and this is not in the first responder sort of context if we're just talking globally.

Um, but females carry it more simply because we are more predisposed to, uh, partner and interpersonal sexual violence. Males. But in these industries, like policing a military, males carry a higher PTSD diagnosis simply. The ratio of male to female in those industries is not 50 50. It's a  highly male dominated area.

Um, all we know up until now is the more trauma you experience, the higher the percentage of developing P T S D, but you still have a higher risk of developing clinical depression as a result of encountering traumatic incidences than P T S D. So we still don't really know why one person develops it and someone else doesn't.

What. What we know about PTSD t at the moment is we think it's just a memory reconsolidation issue. So if we've experienced this traumatic incident and we have these natural brain resources that kick into effect, you know, our fight flight free system, and all of these systems come on board, which are protective to us in those moments, um, and for some reason that memory doesn't consolidate where all the other memories are and they, they remain what we call a hot memory.

It doesn't, you know, it ends up being very intrusive. We get a lot of flashbacks and it doesn't behave in the same way our other memories do.  And again, all of those PTSD symptoms in the aftermath of a traumatic incident or a natural disaster are all normal. Responses. It's only after a period of time that we ac that it, that system doesn't shut down that we say it is P T S D.

So even if we were to go in after a natural event, you know, we talked about the flooding in the Hawkesbury a little bit earlier. Most people there would probably have symptoms, but we would expect after a month that all of that would sort of come offline and they would resume normality. You know, it's after that where it doesn't that we say it is P T S D.

So we still really don't know because we know it's not a personality thing. We know it's got nothing to do with how resilient or not resilient someone is. You know, they do all the screening, people have the adequate training. Um, we still don't have that answer.

Yeah, I love this because, um, I hear it so much.  It's almost the most common theme that runs across every client I see at the hospital. And,  every family member that engages, we run family sessions to try and break down some of those barriers, just to educate them. What is P T S D. You know, and give them a voice around how difficult it is and how do we break down some of those barriers.

You know, what we encourage people if they do have a supportive loved one or family, is try and include them in your therapy in that, you know, if you are working on communication styles with your therapist or in group, or managing your emotion, or you are learning new skills, for example, um, You know, anger outbursts we know are part of P T S D, and part of your skill is to remove yourself when you are starting to feel your emotions become overwhelming.

So people don't think that you're just tapping out of the conversation. We, we need you to communicate that. That's a skill. I'm gonna practice, skill, I'm gonna come back. You know, we try and get them to include them in there so the family can support them. You are overwhelmed. What skill can you use? We use this beautiful thing called the SUDS Scales, um, subjective units of distress scale.

And it, and it's a zero to 10. We now provide it in a magnet and we, um, ask everyone to put it on your fridge. And it just allows patients to communicate where they're at to their family. But the other side is they also have to communicate what they're doing at that time. Um, and it's a small communication skill, but it's enough just to let everyone know where everyone's at at the moment.

So, you know, we say zero is calm, relaxed, you know, no distress. And 10 is as worse as it can be. Like, I'm so angry and I'm at rage, I'm so anxious. I'm at, you know, panic attack, or I'm so depressed, you know, I'm feeling suicidal. And if people can rate zero to 10, that seems a lot easier than trying to. Or name those emotions to families.

Like you said, you know, if someone goes, I'm a little bit anxious, but I'm very fearful. I can't explain the fear. That's very overwhelming for a family member to hear. But if I came to you and said, um, I'm an eight, and we know that's in their red zone, we would know, you know, let's not talk about Christmas planning right now.

Let's not give them a list of 40 things to get at the supermarket. All of those things like we would know. Now's not the time to have those conversations and you know, how do we sort of start those things with the family? Um, sometimes, you know, I love that. Are you okay? Movement. That's a beautiful movement.

Cuz that's a really simple way just to say, are you okay? Um, and they have fabulous resources already around, you know, little decision trees. If someone answers yes, what can you do? Whether you are prepared to sit there or not. Um, But mostly if, if the client is willing to, it's really to, um, maybe invite them to a few, either family seminars run by organizations information sessions, um, or a couple of their treatment sessions where the therapists can help break down some of those barriers around like, what is P T S D?

What, what are those normal symptoms we expect to hear? Um, you know, and what are those small strateg. In family sessions. I always give one question cuz it's, I mean, it's a huge topic and we can't solve all the problems, but most of the time family just wanna know, how can I help them cope? What can I do that's gonna be helpful?

Cause I feel like I'm walking on eggshells all the time and everything I say seems to be the wrong thing. And so we ask the clients to think of something that someone else can do that might be helpful. And even if that is to leave me alone, but check on me in 20. Or just put a hand on my shoulder, but please don't say anything.

You know, or you know, whatever that is. They know the answer. And then how do you communicate that to the person that you live with so that everyone still feels connected and it's still that little family tribe and unit, but you're trying to navigate this journey together.

Yeah, so our, our website, the St. Donna God website definitely has a lot of resources. We run these sessions regularly for our clients or people engaged in our service for family and for the clients. Um, but there's a lot of great, um, resources. Online, so you know, are you okay or. You know, Fordham Australia do a lot of work with police.

They have a lot of great information on their website. There's a charity called Emergency, which, um, looks at supporting, , you know, current transitioning or ex-serving police and their family. There's a whole host of these beautiful ex-service organization. The military have almost unlimited resources and things like that.

Um, so just encourage them to either speak to. Their clinician who can guide them into things that are more specific and tailored to them. But online has a lot of contacts that can guide people into the right areas.

Thank you for having me.