The Frustrated and Helpless Healer: Pathways Approaches to Posttraumatic Stress Disorders.

Posttraumatic stress disorder is a psychophysiological disorder, characterized by the following: chronic sympathetic nervous activation; persisting perceptual/sensory vigilance for threats; recurrent distressing memories of the event, including intrusive memories, flashbacks lived as if in the present moment, and nightmares; and a persisting negative emotional state including fear and shame. The psychophysiological basis for this disorder calls for psychophysiologically based interventions. This article presents the case narrative of a 29-year-old national guardsman, exposed to combat trauma and later to civilian trauma in public safety work. His treatment followed the Pathways model, comprised of multimodal interventions, beginning with self-directed behavioral changes, then the acquisition of skills (including self-hypnosis), and finally professional treatment including clinical hypnosis and EMDR.