Flight Physiology [AVS357] Group Project

Submitted to: Mrs. Laurie Earl

Musab Mohammad Salman Hyder Ali Suhail Zubair Salem Bin Sulayem 1005103 1004478 1003078 1012466

Executive Summary

Trauma after a stressful incident is very common and nearly every person goes through such as situation in their lifetime. These incidents tend to cause mental and physical problems which disrupt the normal functioning of a person as a part of a society. One of the most common psychological phenomenonss observed after a traumatic incident is the development of Post Traumatic Stress Disorder (PTSD) in a person. This report explains the occurrence of PTSD, the methods of treatment and how this disorder is related to the aviation industry.

Contents
Executive Summary................................................................................................................................... 1 Introduction: ............................................................................................................................................. 4 Research Methodology: ............................................................................................................................ 4 PTSD: Overview and History ..................................................................................................................... 5 Symptoms and Reactions:......................................................................................................................... 6 Who is at risk of PTSD? ............................................................................................................................. 7 Treatment of PTSD: ................................................................................................................................... 8 PTSD and the Aviation Industry: ............................................................................................................. 10 Conclusion: .............................................................................................................................................. 10 Works Cited ................................................................................................................................................. 11

Post Traumatic Stress Disorder (PTSD)

Introduction:
PTSD or Post Traumatic Stress Disorder can be defined as a psychiatric disorder that arises in a person after he/she faces or experiences an event or events that cause the threat of death or serious injuries and includes the intense feelings of fear, helplessness and horror (American Psychiatric Association, 1994). An average person will face a traumatic incident at least once in their lifetime and will develop PTSD due to the incident or will show some of the symptoms of the disorder. The research into PTSD is fairly recent and researches are still being done to determine the best course of treatment because although the disorder existed from long ago, the magnitude of the problem was not large and hence was not focused upon. With recent conflicts such as terrorist attacks, wars etc.; the disorder seems to be prevalent especially in war veterans. This research paper focuses on the disorder and its causes, the existing treatments and how it is related to the aviation industry.

Research Methodology:
This research is a brief insight on the topic of PTSD and the scope is limited to research done through review of literature and interview with a professional. The study is based mainly on the following articles: 1. The Epidemiology of Post-Traumatic Stress Disorder after Disasters by S. Galea, A. Nandi, and D. Vlahov (Galea, Nandi, & Vlahov, 2005). 2. Helping Airport and Air Carrier Employees Cope with Traumatic Events published by the Transportation Research Board of the National Academies (Kimberly, Rosanne, Higgins, Petros, Jensen, & Yurkovich, 2009). 3. Posttraumatic Stress Disorder following an Air Disaster: A Prospective Study by Richard S. Epstein, Carol S. Fullerton, and Robert J. Ursano (Epstein, Fullerton, & Ursano, 1998).
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The interview conducted was with Dr. Sreethi Nair, a cognitive psychologist and Head of Department of Psychology at Abu Dhabi University. Her insights were very useful in understanding the concepts and her explanations of the concepts are included in different parts of the report to give a better picture of PTSD.

PTSD: Overview and History

PTSD can be defined simply as reactions to stressful situations experienced by individuals who face trauma. Trauma usually creates physiological and psychological problems which include hormonal imbalance, depression, Alcohol and Drug abuse etc. It affects the normal functioning of a person and it can disturb a person to an extent that he/she can take their own life. The concept of PTSD is associated with the humankind since the very beginning of the human race although it was not given the name until the late 1980s. The first accounts of the symptoms of PTSD can be found in the narration of the Battle of Marathon by Herodotus, a Greek historian from over 3000 years ago. He narrates that a soldier not injured in war was blinded after he saw a friend die in front of his eyes. The blindness is one of the extreme side effects of PTSD (Moon, 2004). In one of Shakespeares plays, Henry IV; the lead character Henry the 4th portrays symptoms which can be classified as those of PTSD and hence the fact can be established that this disorder is not a new one (Friedman, 2007). The early accounts of PTSD are usually found in war scenarios and war veterans. The American Psychiatric Association maintains a Diagnostic and Statistical Manual of Mental Disorders (DSM) which classifies mental disorders and is constantly revised to accommodate changes in the pattern of a given mental disorder. PTSD was first listed in DSM in 1980 and has been continuously updated and the section for PTSD is now classified as DSM - IV - R where 4 is the edition and R stands for revised (American Psychiatric Association, 1994). The identification of PTSD in air crash survivors or the rescue workers was during the Kegworth disaster in 1989 when a Boeing 737 crashed into an embankment. The incident is the base of study for PTSD cases related to airline crashes (Galea, Nandi, & Vlahov, 2005).
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Symptoms and Reactions:

The process of the symptoms to show up in a person can be different due to certain factors as explained by Dr. Nair. She said that the level that affects differs on two factors which are: whether the trauma causing incident was natural or man-made. A man-made incident such as a terrorist attack or a an accident has more impact and the trauma faced is much more than in natural incidents because people tend to accept that there was nothing that could be done to save the situation. The most common symptoms showed by PTSD patients are: Re-living the traumatic event: The victims in this case tend to recall the traumatic incidents and most probably try to find alternatives to the situation or make up scenarios of how they could have avoided the situation. They re-experience it usually through memories, flashbacks, nightmares etc. Avoiding people and being numb: The patients start avoiding places that remind them of trauma and this gradually evolves to such a situation that they do not leave their house altogether. They tend to lose interest in their daily life and usually detach themselves from others. Heightened anxiety and emotional uncontrollability: The patients tend to have difficulty to fall asleep as it is common in most stress cases. They also become irritable and tend to lose their cool very fast and are usually very jumpy or in state of high alertness. The most common symptom of PTSD is that the patient starts getting suicidal thoughts and starts contemplating about taking their own lives. It is due to the fact that they start feeling worthless and hopeless and want to get out of the situation by ending their lives. The typical reaction of PTSD patients is that they turn to substance abuse. They start binge drinking and use drugs that numb their thoughts. This occurs because the patients are trying their level best that they forget the whole traumatic incident. (Smith & Segal, 2011) These are certain symptoms common in PTSD patients and a person portraying such symptoms must be given immediate care as the chance of recovery on their own is very less.
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Who is at risk of PTSD?

It is nearly impossible to determine which person in the population is going to develop PTSD after a traumatic incident. There are certain factors that determine the vulnerabilities in a person which might indicate that he/she is going to develop PTSD. The longer the time period a person undergoes a traumatic incident, the greater probability that he/she is going to develop PTSD. There are certain factors that determine whether a person is vulnerable to PTSD. These factors are: If the person has already experienced a traumatic event during the early stages of life, even if he/she is not subjected to another event; the person tends to develop PTSD. Hence, children molested at an early age tend to low self esteem and are usually introvert due to the trauma caused by the incident. A person who has already faced a mental illness such as depression, anxiety etc is also prone to develop PTSD. According to Dr. Nair, this is due to the already imbalance of hormones in the body which is one of the physiological reasons that cause the disorder. Having a family history of mental illness can also be a contributing factor. Another factor can be due to the lifestyle a person chooses. Having a high stress lifestyle makes the person more susceptible to PTSD as he/she is not able to cope with the stress. Also having inadequate support after a traumatic incident can cause the disorder. A person having a history of substance abuse, he/she are prone to develop PTSD after an incident because they are not able to cope because their brain function is reduced from the usage of these substances. (Smith & Segal, 2011) According to the literature reviewed, the article Posttraumatic Stress Disorder following an Air Disaster: A Prospective Study concludes that lack of education can also be one of the contributing factors. Dr. Nair argued that it cannot be generalized although it might be a factor in that case. It is because old people substitute lack of education with experience and

knowledge. When Capt. Sullenberger was interviewed, he said that what helped him cope with the symptoms of PTSD he had developed was his experience. PTSD can be mainly seen in war veterans, emergency services workers, accident survivors etc. or any other incident or occupation which involves facing trauma.

Treatment of PTSD:
The study of PTSD has advanced recently as more and more cases are being reported all around the world. The treatment of the disorder is possible only when the person is willing to remember the incident and relive the experience in order to free all the suppressed emotions which are a direct cause of stress. The treatment for PTSD helps in clearing the memory of traumatic event which holds a strong influence on the persons memory. The treatment of the disorder is done through different methods psychological counseling and usage of medical drugs to help in stabilizing the condition of the brain. Relying only on psychological counseling for PTSD is ineffective and it makes matters worse. Dr. Nair explains that it can be only effective if the victim is given such counseling before facing trauma as is in the case of soldiers before they leave for war. This method is only effective when the victim knows that there is a probability that he/she might face a traumatic incident. There are various other methods of treatment for PTSD. They are: Cognitive Behavioral Therapy: According to Dr. Nair, the thinking of a person during PTSD changes from positive to negative. The focus of this therapy is to change those thoughts to positive again. It is done by gradually exposing the events of the trauma and replacing the distressing picture that is set in your mind to a more balanced view. Family Therapy: The best way to treat PTSD is through family therapy because having a good support after the trauma can effectively help remove the symptoms of PTSD. The patient is able to communicate better with their families and helps in better understanding by the family member about what the person is going through. Family can help change the mindset of the person once he/she sees hope.

Eye Movement Desensitization and Reprocessing (EMDR): This method involves stimulating the brain to unblock the information process through senses of touch, feel and sight. The therapy involves desensitizing the patient about the traumatic event by repeatedly exposing him to the events of the trauma.

Medical drugs such as Antidepressants are used to treat PTSD patients. They are used to decrease the feeling of sadness, worry etc in the patient but is not a treatment for PTSD unless and until it is not coupled with psychological counseling. (Smith & Segal, 2011)

An important factor to remember is that if the person forgets the events of the trauma it becomes more difficult to cure because the doctors have to go through the process of hypnotizing the patient in order to collect information from the sub-conscious of the person. It is possible that a person might not need therapy to recover from PTSD but there are great chances that the memory settles in the sub-conscious mind and later in life come up again and create problems. An unusual method of coping with PTSD was recently introduced by the Veterans Affairs Department of the United States Army. It involves training dogs to become partners with veterans affected by PTSD. The purpose of this canine-human bonding is that it will help the veterans develop the emotional sustenance they had lost due to PTSD (Allen, 2010).

PTSD and the Aviation Industry:

The focus of the aviation industry shifted on study of PTSD in the industry after the Kegworth disaster. It was never considered before but as PTSD was recognized by the American Psychiatry Association as a mental disorder due to trauma, the industry had to focus on it. In case of an air disaster, the people who are most susceptible to PTSD are the survivors, their families and the rescue workers. The emotional stress after these events is so great that even the emotionally strongest person will have trouble coping with it. Hence, it is mandatory for airlines to provide counseling and psychological support for the people affected by the trauma (Kimberly, Rosanne, Higgins, Petros, Jensen, & Yurkovich, 2009). It has been observed that even in cases where there were positive outcomes in air disasters, people involved have faced trauma and have showed signs of PTSD. This was the case of the passengers and crew of US Airways Flight 1549 which had to ditch in the Hudson River shortly after takeoff due to loss of power in both engines after a bird strike. The crew operated efficiently without any margin of error and was able to save the lives of all those on board. Even after such a positive outcome, it was reported the Capt. Sullenberger, his crew and the passengers were all facing specific symptoms of PTSD. The captain said in an interview that he regularly kept re-experiencing the event and searching for alternative solutions. This reexperiencing is a tell-tale sign of PTSD. Captain Sullenberger, his co-pilot and a survivor from the crash got together on the flight in which the captain returned to active duty. It was sort of therapeutic for them to recover from the PTSD after the incident (Anonymous, 2009).

Conclusion:
In conclusion, PTSD differentiates itself from normal shock after a traumatic instead because in a normal shock, the trauma wears off in a couple of days whereas in PTSD the mind remains in a constant state of psychological shock. Help must be sought if a person has symptoms because if the problem escalates, it can lead to loss of life.

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Works Cited
Allen, A. (2010, November 8). The Washington Post. Retrieved May 6, 2012, from washingtonpost.com: http://www.washingtonpost.com/wp-dyn/content/article/2010/11/08/AR2010110803376.html American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th Edition ed.). Washingnton D.C.: American Psychiatric Publishing, Inc. Anonymous. (2009, 10 2). Brace for impact. Retrieved May 5, 2012, from HCI Books: http://braceforimpact.hcibooks.com/2009/10/02/miracle-on-the-hudson-plane-crash-survivors-joinpilots-sully-sullenberger-and-jeff-skiles-on-second-chance-flight-for-ptsd-healing/ Epstein, R., Fullerton, C., & Ursano, R. (1998). Posttraumatic Stress Disorder following an Air Disaster: A Prospective Study. Am J Psychiatry. Friedman, M. (2007, 1 31). NATIONAL CENTER for PTSD. Retrieved May 7, 2012, from U.S. Department of Veterans Affairs : http://www.ptsd.va.gov/professional/pages/ptsd-overview.asp Galea, S., Nandi, A., & Vlahov, D. (2005). The Epidemiology of Post-Traumatic Stress Disorder after Disasters. Epidemiologic Reviews , 78-91. Kimberly, A., Rosanne, B., Higgins, J., Petros, T., Jensen, W., & Yurkovich, E. (2009). Helping Airport and Air Carrier Employees Cope with Traumatic Events . Washington: Transportation Research Board of the National Academies. Moon, P. (2004). Sand Play Therapy With U.S. Soldiers Diagnosed With PTSD and their Families. American Counseling Association , 63-66. Smith, M., & Segal, J. (2011, 10). Helpguide.org . Retrieved 5 8, 2012, from A HelpGuide.org website: http://www.helpguide.org/mental/post_traumatic_stress_disorder_symptoms_treatment.htm

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