Healing trauma: Overcoming PTSD and claustrophobia - a case study

Complex trauma and PTSD, particularly when accompanied by specific phobias such as claustrophobia, present significant challenges in therapeutic settings.

This case study explores the successful treatment of a 35-year-old female patient, referred to as Jane, who suffered from severe PTSD and claustrophobia. By sharing Jane's journey, I aim to provide hope and insights for others dealing with similar conditions.

Background

Jane had a history of childhood sexual abuse and multiple traumatic events in adulthood. These experiences led to severe PTSD symptoms, including persistent nightmares, flashbacks, hypervigilance, and avoidance behaviours. Her claustrophobia manifested as intense fear and panic attacks in enclosed spaces, significantly impairing her daily life and social interactions.

Initial assessment and diagnosis

During the initial assessment, Jane exhibited high levels of anxiety and distress. Diagnostic tools, including the PTSD Checklist for DSM-5 (PCL-5) and the Claustrophobia Questionnaire, were used to evaluate her condition. These tools confirmed the severity of her symptoms and guided the development of a personalised treatment plan.

Treatment plan

Phase one: Case formulation and psychoeducation

The first phase of treatment involved detailed case formulation and psychoeducation to help Jane understand her condition and the therapeutic process. Establishing a strong therapeutic rapport was crucial, providing Jane with a safe and supportive environment to share her experiences.

Case formulation: A comprehensive case formulation was developed, outlining Jane's trauma history, current symptoms, and contributing factors. This formulation helped in identifying the specific triggers and maintaining factors for her PTSD and claustrophobia.

Psychoeducation: Psychoeducation sessions were conducted to help Jane understand PTSD, complex trauma, and claustrophobia. This included information on the physiological and psychological responses to trauma, normalising her experiences, and reducing self-blame. Jane was introduced to the therapeutic modalities, that would be used in her treatment, setting clear expectations and goals.

Phase two: Stabilisation work

The second phase focused on stabilisation techniques to prepare Jane for trauma memory processing. These techniques helped Jane manage her anxiety and build resilience.

Grounding techniques: Grounding techniques were introduced to help Jane stay present and manage her anxiety. These techniques included sensory grounding exercises, such as focusing on physical sensations and mindful breathing, which helped her feel more connected to the present moment.

Resourcing and tapping: Resourcing involved identifying and reinforcing Jane's internal and external resources. Techniques like tapping and visualising positive figures were used to enhance her sense of safety and stability. This process helped Jane develop a reservoir of positive emotions and coping strategies to draw upon during difficult times.

Phase three: Trauma-focused therapy

After establishing a foundation of understanding and stabilisation, the focus shifted to trauma-focused therapies aimed at processing and reducing the emotional impact of Jane's traumatic memories.

Eye movement desensitisation and reprocessing (EMDR): EMDR was employed to help Jane process her traumatic memories. By working through these memories in a controlled therapeutic setting, Jane began to integrate them into a coherent narrative, alleviating her PTSD symptoms and enhancing her emotional resilience.

Cognitive-behavioural therapy (CBT): CBT complemented EMDR by helping Jane identify and challenge maladaptive thought patterns that contributed to her anxiety and fear. This therapy involved developing healthier coping strategies and improving her emotional regulation skills.

Phase four: Exposure therapy

With significant progress made in processing trauma memories, the next phase focused on addressing Jane's claustrophobia through exposure therapy.

Gradual exposure therapy: Exposure therapy was introduced gradually, starting with less threatening situations, such as imagining enclosed spaces, and progressively moving towards real-life exposure. This approach allowed Jane to build confidence and reduce her fear responses over time.

Phase five: Relapse prevention

To ensure lasting recovery, relapse prevention strategies were implemented. This phase involved creating a "therapy blueprint" for Jane to follow, helping her maintain the gains made during therapy and manage potential setbacks.

Relapse prevention (therapy blueprint): A comprehensive relapse prevention plan was developed, including:

• Identifying triggers - recognising potential triggers for PTSD and claustrophobia.
• Coping strategies - reinforcing effective coping mechanisms learned during therapy.
• Support networks - encouraging the use of social support systems.
• Continued practice - emphasising the importance of ongoing practice of exposure and CBT techniques.
• Follow-up sessions - scheduling regular follow-up sessions to monitor progress and address any emerging issues.

Outcome

Symptom reduction

Jane's treatment resulted in a significant reduction in both PTSD and claustrophobia symptoms. Her PCL-5 scores showed marked improvement, and the frequency of her panic attacks decreased substantially. Jane reported feeling more in control of her emotions and less overwhelmed by her traumatic memories.

Functional improvement

With the reduction in symptoms, Jane experienced notable improvements in her daily functioning. She could engage in activities she had previously avoided, such as using elevators and attending social gatherings. Her increased mobility and participation in everyday life greatly enhanced her overall quality of life.

Follow-up

Regular follow-up sessions were essential in monitoring Jane's progress and preventing relapse. These sessions focused on reinforcing the coping strategies she had learned and addressing any new challenges that arose. At three-month and six-month follow-ups, Jane continued to show sustained improvement and stability.

Discussion

Integrated therapeutic approach

Jane's case highlights the effectiveness of an integrated therapeutic approach in treating complex trauma, PTSD, and claustrophobia. The combination of case formulation, psychoeducation, stabilisation work, EMDR, CBT, and exposure therapy provided a comprehensive treatment framework that addressed the multifaceted nature of her conditions.

Challenges and solutions

One of the main challenges in Jane's treatment was her initial resistance to exposure therapy. This was managed through a gradual and supportive approach, ensuring that each step was manageable and that Jane felt safe throughout the process. Flexibility in the treatment plan allowed for adjustments based on Jane's responses and progress.

Clinical implications

This case underscores the importance of personalised, multidisciplinary treatment plans for individuals with co-occurring disorders. The success of Jane's treatment provides valuable insights for clinicians and offers hope to patients facing similar challenges.

The successful treatment of Jane's complex trauma, PTSD, and claustrophobia through an integrated therapeutic approach demonstrates the potential for significant recovery and improved quality of life. By sharing this case study, I aim to inspire hope and provide a roadmap for others on their journey to healing.