War-related post-traumatic stress disorder: preventing the effects of traumatic experiences

Post-traumatic stress disorder (PTSD) affects about 10% of people involved in traffic accidents and up to half of war survivors and victims of rape or violence. PTSD has a negative impact on quality of life; it is also associated with high health care costs.

That’s why it’s so important to stop the effects of traumatic experiences early, and if PTSD or other mental health problems do occur, to treat victims using evidence-based methods, say researchers from SWPS University and Warsaw University.

Refugees are particularly vulnerable to PTSD. Three years ago, on Feb. 24, 2022, Russia invaded Ukraine. Millions of people fled their home country to save their lives. Many of those forced to escape had experienced war trauma related to violence or direct threat to life.

Refugees are a group at particular risk of mental health problems, including post-traumatic stress disorder (PTSD). Despite a number of studies identifying the most effective treatments, few receive adequate help, especially in the area of psychotherapy. Yet many refugees may need it, as research shows that each war doubles the incidence of PTSD in its victims, who continue to struggle with its effects long after the war has ended.

PTSD: recurrent memories, flashbacks, and chronic agitation

Agnieszka Popiel, Ewa Praglowska and Bogdan Zawadski, authors of the article “(Why?) evidence-based treatments for war-related PTSD” published in the journal Migration Studies – Review of Polish Diaspora, emphasize that PTSD symptoms are not related to the type of trauma experienced. These symptoms include: recurrent memories, flashbacks of the event (e.g. bombing or direct threat of death), a state of chronic agitation (which is why PTSD is a stress disorder), outbursts of anger, sleep problems, avoidance of situations that can be related to the trauma (unwillingness to talk about it, avoidance of shelters and people who were present in this or that situation).

All of these symptoms have a negative impact on quality of life and lead to impairment of a person’s functioning in many areas of life. Unfortunately, PTSD can be difficult to diagnose, as patients often avoid all bad memories and refuse to talk about them – which is why in many cases the problem remains undiagnosed.

While in the case of some people, “time heals wounds” and they regain their composure after a few months, others deteriorate over time.

If there is no improvement, a professional diagnosis should be made and the patient should be given appropriate treatment based on scientific evidence. This concept assumes that decisions regarding therapy should be supported by evidence and not, for example, based on intuition or traditional beliefs.

The goal is to provide patients with the most effective care based on the current state of scientific knowledge, explains Agnieszka Popiel, PhD, professor at SWPS University and head of the Center for Advanced Clinical Research and Excellence in Therapy at the Institute of Psychology at SWPS University.

Proper treatment — what does that mean?

Treatment of mental disorders includes pharmacotherapy and/or psychotherapy. The first may be recommended by physicians, including primary care physicians. In more complex cases, consultation with a psychiatrist may be required to recommend appropriate therapy for the individual patient. Psychotherapy for PTSD should be provided by psychotherapists (psychologists, physicians, or other health care professionals) who, in addition to general psychotherapy education, are trained in proven and recommended treatments for PTSD.

The treatment method chosen should be appropriate for the type of disorder. Over the past 50 years, many studies of psychotherapy methods have been conducted, identifying both the most effective ones and those that are ineffective or even harmful. However, some methods are still completely unexplored. This is why it is important for mental health professionals to consider scientific evidence when choosing a treatment method.

Among the organizations that provide guidance on this topic are the UK’s National Institute for Clinical Excellence (NICE), the American Psychological Association, the American Psychiatric Association (APA), and the International Society for Traumatic Stress Studies (ISTSS). These organizations recommend psychotherapy for the treatment of PTSD, primarily incorporating techniques known as trauma-focused cognitive-behavioral therapy. Pharmacotherapy may also be considered if psychotherapy is not currently available or is not possible due to other factors, such as cultural factors.

PTSD also applies to military and medical personnel

The authors of the article also emphasize that special attention should be paid to the prevention of PTSD in people who, due to their profession or service, cannot avoid traumatic events. Despite the obvious statement “prevention is better than cure”, there is relatively little research on the effectiveness of PTSD prevention measures. One of the few sources of data on the effectiveness of such interventions is the Polish PTSD prevention program for people at risk of occupational trauma, Effective Work under Stress.

Untreated post-traumatic stress disorder, affecting millions of people, can have a negative impact on both individuals and society as a whole, and resources for help will always be limited. This is why the authors of this article emphasize the need for careful planning in the post-trauma period to enable victims of conflict to return to their pre-trauma lives.

Adhering to guidelines and choosing evidence-based treatments allows for an assessment of the timing and risks associated with any psychological and medical intervention.