Hello mister Dombeck. Recently I had a farm accident. My girlfriend was riding in the back of a tractor I was driving when she slipped and fell. I had just the time to step on the brake before she would have been crushed to death by the concrete counterweight she was standing on. She only got a sprained ankle but I keep having horrific visions of what could have happened and I just don’t know what to do. I have lost sleep and eating capability. I can’t even work because I burst to tears every fifteen minutes. What could I do to kill my imagination for a while? thank you for reading.
- Dr. Dombeck responds to questions about psychotherapy and mental health problems, from the perspective of his training in clinical psychology.
- Dr. Dombeck intends his responses to provide general educational information to the readership of this website; answers should not be understood to be specific advice intended for any particular individual(s).
- Questions submitted to this column are not guaranteed to receive responses.
- No correspondence takes place.
- No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Dombeck to people submitting questions.
- Dr. Dombeck, Mental Help Net and CenterSite, LLC make no warranties, express or implied, about the information presented in this column. Dr. Dombeck and Mental Help Net disclaim any and all merchantability or warranty of fitness for a particular purpose or liability in connection with the use or misuse of this service.
- Always consult with your psychotherapist, physician, or psychiatrist first before changing any aspect of your treatment regimen. Do not stop your medication or change the dose of your medication without first consulting with your physician.
The reaction you describe in the wake of such a potentially serious accident leads me to think that you may be dealing with something on the order of Acute Stress Disorder, which is classified as an anxiety disorder, and a close relative of the more commonly known Post Traumatic Stress Disorder or PTSD. ASD and PTSD both occur in the wake of exposure to trauma, which is commonly defined for this psychological purpose as a violent and potentially lethal event that is out of the ordinary circumstance. Exposure to combat and the aftermath of combat, murder or rape are the commonly used examples of potentially psychologically traumatic events, but other events qualify as well, including vehicle accidents that involve fatality or near-fatality.
The symptoms associated with ASD and PTSD are similar. What separates these two disorders from one another is time. In ASD, significant symptoms occur within a month of the traumatic event and last for a month’s duration or less. In PTSD, onset of symptoms may occur at any time after the traumatic event and must last for at least one month’s duration. Because of the way these definitions have been created, it is impossible to diagnose PTSD during the first month after a traumatic event. If you have immediate symptoms, it is ASD, and if they last for more than a month, the diagnosis turns into PTSD.
<p>Both conditions are reactions to a very stressful traumatic event. Three types of reactions are common and may be present. Affected people find that they experience increased arousal. They become restless and irritable, cannot relax and may have difficulty sleeping. They may also display hypervigilance; a sort of scanning behavior where they are constantly on the lookout for threats, even though those threats are not likely to be there. Affected people also commonly will become avoidant of things that remind them of the trauma they have experienced. Finally, affected people will commonly experience unwanted and intrusive memories and replays of the traumatic event. Such replays of the trauma may occur at any time; in dreams and during waking hours. They may be experienced as simple memories, or may occur more vividly as immersive daydreams and flashbacks. Needless to say, since most people experiencing ASD or PTSD are motivated to avoid reminders of their traumatic exposure, these intrusive memories are unwelcome and anxiety provoking, sometimes in the extreme.</p> <p>There is no good way to "kill your imagination" in general, and no good way to do so if you do have one of these conditions I've described above. However, in many cases, this sort of thing fades with time on its own. For those cases where the problem hangs around (say beyond a month or so) , there is help available for this sort of thing, and if you catch it early enough, the results tend to be good.</p> <p>My advice is for you to see a psychiatrist and to explain what has occurred to this specialist doctor. He or she will be able to make a diagnosis and to prescribe some medication if that is appropriate. Typical medications prescribed for post-trauma conditions tend to be anxiolytics (e.g., anti-anxiety medications) and hypnotics. These help to keep people's arousal and stress levels to manageable levels and may promote sleep. Some of them (e.g., benzodaizapines like Valium and Xanax) are addictive, so caution is advised. However, "when you need 'em; you need em", is also the case.</p> <p>Medications have their effect by reducing symptoms. They won't necessarily help you come to terms with the memories that are causing this problem in the first place. Psychotherapy can help with that part (and as well with stress reduction). In my experience, most effective psychotherapy for PTSD ends up being a graduated variety of exposure therapy. Classically, this meant that the therapist would encourage you to talk about what you have experienced and help you to manage the anxiety that would come up while talking. The basic idea is that anxiety is sustained by avoidance and that if you can be helped to overcome your avoidance, in short order you will learn that there is little to actually fear from the memories themselves. There are a lot of nuances to pulling this sort of therapy off in practice (such as the need to overcome a client's tendency to become dissociated (mentally spaced out), and to not provoke too much fear at any given time (so that the therapy is never quite overwhelming). So – to boil it down – talking generally helps, but only talking that feels safe on your terms and is combined with settings and interventions that help you feel safer. Stress reduction, relaxation and self-soothing techniques are also very helpful things to learn about in therapy for this sort of problem.</p> <p>In the last decade or so, a newer therapy known as EMDR has become prominent for treatment of PTSD. EMDR (eye movement desensitization and reprocessing) is based on the idea of exposure therapy, but goes about it differently than the classical approach. In EMDR the therapist encourages you to talk about your trauma, but then distracts you while you are talking in a particular way that helps take the vinegar out of the trauma memory. There is some secrecy surrounding the EMDR methodology that I don't know (not being trained in the method myself), but therapists I trust have spoken well about it so you might look into it.</p>