Post-traumatic stress

We hear a lot about post-traumatic stress, but what is it really? Can one suffer from post-traumatic stress even though one has not really experienced a traumatic event?

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1. WHAT IS POST-TRAUMATIC STRESS ?

As defined by INSERM (Institut Nationale de la Santé et de la Recherche Médicale), post-traumatic stress is classified as a psychiatric disorder that can occur after a traumatic event. PTSD (Post-Traumatic Stress Disorder) will have significant psychological consequences, long after the event.

Post-traumatic stress is present in around 5-12% of the population. However, like many other pathological conditions, it is likely to be underestimated, as some people are not diagnosed at all.

In other words, post-traumatic stress can be likened to a major emotional shock. This emotional shock will have a direct impact on the sufferer’s day-to-day life, in a variety of ways.

2. WHAT ARE THE SYMPTOMS OF POST-TRAUMATIC STRESS ?

Many symptoms accompany PTSD. The main symptoms include : 

Reliving

Reviviscence is the repeated “reliving” of the event. People can relive their trauma in different ways: Through repeated flashbacks that make the person relive the entire scene; intrusions of involuntary thoughts and images related to the traumatic event; recurring nightmares. Any external event can bring the memory of the traumatic event to the surface: a noise, a light, a person, a place… These various external signals will automatically trigger anxiety symptoms.

Avoidance

Avoidance is one of the main reasons for maintaining post-traumatic stress. People tend to avoid trauma sites, objects or people, for example.

There are different types of avoidance: emotional avoidance (e.g., never again experiencing the same type of emotion as those present during the trauma); cognitive avoidance (e.g., avoiding thinking about the trauma that took place) and behavioral avoidance (e.g., not returning to the scene of the accident). This avoidance will be worked on in therapy. In fact, it is necessary, little by little, to avoid avoidance.

This avoidance can have a major impact on people’s professional and personal lives. In particular, people can develop various phobias. We’ll come back to this in a moment.

  • Hypervigilance, concentration difficulties, sleep disorders… Various cognitive disorders may be linked to the trauma.
  • Mood disorders, such as emotional outbursts (anger, sadness) or emotional blunting (reduced affectivity).

3. WHAT EVENTS CAN LEAD TO PTSD ?

A variety of events can lead to post-traumatic stress disorder (PTSD). Among the most common are attacks, assaults, rapes, sudden deaths of loved ones, accidents of all kinds, natural disasters…

You don’t have to have experienced a traumatic event to suffer from it; witnessing these same events can also be a source of PTSD.

As you can see, PTSD can develop when a person is faced with the threat of imminent death, when his or her physical integrity may be compromised, or when a loved one is significantly affected by a serious event.

There are two types of post-traumatic stress disorder:

  • Type 1 “simple” PTSD

This type of trauma occurs after an isolated, single, brutal event. This type of trauma includes accidents, natural disasters, assaults, etc.

  • Complex” type 2 PTSD

This type of trauma occurs following prolonged and repeated exposure to a certain type of event. Here, we find traumas linked to repeated physical or psychological abuse, sexual violence, harassment…

There are different ways of being a victim of a traumatic event.

  • A person can be a direct victim, i.e. be directly exposed to the event.
  • A person can also be an indirect victim: for example, someone who witnessed an incident, or relatives of direct victims.
  • There is also a third category, that of secondary victims: in this category, we find people whose job it is to provide care, i.e. doctors, firemen, ambulance drivers…


Television viewers are also indirect victims of post-traumatic stress. Indeed, several studies have examined the impact of the media on the development of post-traumatic stress in people who did not witness the event. For example, we all remember that complicated period of regular terrorist attacks. These were omnipresent in the media. For example, a study was carried out on the mediation of the November 2015 attacks in Paris (Enguerrand du Roscoät et al.,).

This study shows that people who have had high or very high exposure to media images (from 2 to more than 4 hours a day) are likely to develop symptoms of post-traumatic stress. Thus, over-mediatization of images of the attacks is associated with an increase in post-traumatic stress symptoms in the general population.

4. WHAT IMPACT CAN POST-TRAUMATIC STRESS HAVE ?

Post-traumatic stress can have a major impact on the sufferer’s daily life. Gradually, various phobias and psychiatric disorders may develop as a result of the trauma.

Associated disorders include phobias associated with public places, such as generalized anxiety, agoraphobia and social phobia.

Comorbidities often include alcohol addiction and depression.

As mentioned above, trauma can lead to significant psychological distress, impacting on different spheres of a person’s life, whether personal or professional. The person will avoid certain situations. For example, a person who has been in a car accident may no longer be able to drive, as it causes them anxiety. Not being able to use the car will prevent them from taking part in certain activities with their loved ones. A person who develops agoraphobia as a result of post-traumatic stress will no longer be able to leave the house to go to work…

Post-traumatic stress can occur immediately after the event, but it can also occur several months or even years after the event. Disorders disappear within 3 months, or become chronic in 20% of cases. There is also a 20% risk of relapse in patients who receive treatment.

5. CAN WE REDUCE THE RISK OF DEVELOPING POST-TRAUMATIC STRESS ? HOW TO TREAT POST-TRAUMATIC STRESS ?

It is, of course, possible to reduce the risk of developing chronic post-traumatic stress, but psychotherapy is essential. These therapies will help you to better understand the event, the emotions felt afterwards, and the factors that led to the painful memories.

Among the therapies with the best results for post-traumatic stress are EMDR and CBT.

EMDR is a therapy that involves alternating bilateral (left/right) stimulation.  This stimulation can take the form of eye movements, tapping or sound.

CBT stands for Cognitive Behavioral Therapy. These therapies have proved their worth in the treatment of post-traumatic stress. In particular, they enable progressive exposure to anxiety-provoking situations or situations reminiscent of the trauma. CBT works on the cognitive (modifying thoughts), behavioral (modifying maladaptive behaviors, avoiding avoidance) and emotional (learning to manage anxiety) levels. In the case of post-traumatic stress, the person will associate a place, a sound, a smell, an image… that recalls the event, with a danger. CBT enables the person to modify these associations.

CBTs use imaginative exposure and in vivo exposure. However, for several years now, exposure through virtual reality has also been proving its worth. In particular, virtual reality makes it possible to expose the patient in a much more progressive way, and to fully control the environment while keeping the person in a safe environment.

Numerous studies are underway to better understand the development of this type of disorder.

For example, a study by Butler et al. looked at the use of the game Tetris to limit the development of post-traumatic stress. In particular, they used it in conjunction with EMDR therapy. The results showed an increase in the hippocampus in people who had played Tetris in addition to EMDR therapy. This increase in hippocampus volume was associated with a reduction in PTSD symptoms, and a decrease in depressive and anxiety symptoms. In particular, the increase in hippocampal volume was associated with better maintenance of learning during EMDR therapy.

In all cases, as you’ve probably guessed, psychotherapy is necessary to limit the avoidance that prevents traumatic memories from being processed like other memories.

Do you need further information or have any specific questions ?

FAQ

Virtual reality (VR) is an innovative technology that enables patients to be exposed to immersive and controlled environments, facilitating the management of numerous psychological and psychiatric disorders. Its use in mental health offers several advantages:
  • Gradual and Controlled Exposure: VR allows patients to confront anxiety-inducing situations in a secure environment, gradually adjusting the intensity of stimuli to promote habituation and emotional regulation.
  • Realistic and Reproducible Environments: Unlike traditional techniques, VR provides immersive scenarios that can be consistently reproduced, ensuring a coherent and effective approach.
  • Increased Patient Engagement: The interactive and immersive nature of VR enhances treatment adherence and motivates patients to continue their therapy.
  • Personalized Treatment: Virtual environments can be adapted to meet the specific needs of each patient.
  • Versatile Applications: VR is used to treat anxiety disorders (phobias, post-traumatic stress disorder, obsessive-compulsive disorders), addictions, mood disorders, and even cognitive remediation.
The use of virtual reality in healthcare is not new! It has been studied and utilized for over 30 years in the medical and psychological fields. As early as the 1990s, researchers began exploring its potential for treating anxiety disorders, particularly phobias and post-traumatic stress disorder. Since then, numerous scientific studies have confirmed its effectiveness in addressing various psychiatric, neurological, and cognitive disorders.
Today, VR is widely integrated into therapeutic and medical practices, with clinically validated protocols. It is used in hospitals, clinics, and psychologists' offices worldwide to provide patients with innovative, effective, and safe treatments.
To use virtual reality, one must immerse themselves in a virtual environment. There are several ways to achieve this.
In the past, the CAVE system (Cave Automatic Virtual Environment), a 3D setup consisting of multiple screen walls, was the primary method used. This system allowed users to be fully immersed in the virtual world, with their movements detected in real-time. However, this technology was expensive and not widely accessible.
Since around 2016, with the introduction of virtual reality headsets like the Oculus Rift and HTC Vive, VR has become much more accessible. These headsets immerse users in virtual reality through an enclosed screen that projects digital images. The user's head movements are tracked, enabling them to look around and interact with the environment as they would in the real world.
Today, VR headsets are wireless and standalone, providing maximum comfort and ease of use without requiring external sensors or cables.
A virtual environment is an immersive digital simulation created through virtual reality. It allows users to navigate in a 3D space that accurately replicates everyday situations or specific contexts.
In mental health, these environments are designed to help individuals gradually face certain situations, manage their emotions, or enhance cognitive skills. By interacting with these virtual spaces, patients can engage in meaningful experiences tailored to their needs.
You need to equip yourself with a virtual reality headset. Our software is compatible with Meta Quest 2, 3, and 3S. 
You will then only need an internet connection. 
Numerous studies confirm that virtual reality is safe to use. However, some restrictions are in place to protect users from potential adverse effects.
For instance, individuals with epilepsy and pregnant women should avoid this type of therapy.
As with any immersive technology, prolonged use may cause visual fatigue or mild discomfort, particularly for those sensitive to motion sickness. Therefore, it is recommended to take regular breaks and adjust session durations according to individual needs.
Virtual environments are designed to be gradual and controlled, minimizing the risk of excessive anxiety. Most users quickly adapt to immersion and experience the benefits of this innovative approach from the first sessions.
Anxiety disorders and phobias can be effectively treated using virtual reality. Patients are gradually and progressively exposed to anxiety-inducing situations in various environments while remaining in a safe space. This process helps develop a sense of habituation, ultimately reducing or even eliminating anxiety over time.
Behavioral and substance addictions can also be addressed through virtual reality. By incorporating synthetic stimuli into the environments that trigger craving responses, patients struggling with addiction can work on their cravings to diminish the urge to consume.
Additionally, multiple environments—such as bars, casinos, and social settings—enable cognitive work on dysfunctional beliefs associated with specific temptation scenarios.
Regarding eating disorders, virtual reality software helps target key etiological factors, such as body dysmorphia, allocentric lock (a tendency to focus on others rather than oneself), and food cravings.
Currently, our TERV (Virtual Reality Exposure Therapy) solutions include multiple software programs designed to address critical psychiatric, psychological, and neuropsychological determinants such as relaxation, cognitive stimulation, behavioral activation, and social skills training.
Reminiscence therapy is also a major therapeutic tool in treating depression. By allowing patients to relive sensations linked to past pleasurable activities (such as sports, driving, or traveling), virtual reality stimulates hypoactive brain areas, enhancing therapeutic success. VR serves as an excellent mediator for reigniting engagement in enjoyable activities.
Moreover, cognitive stimulation for elderly individuals is another area where virtual reality proves beneficial. By leveraging technology to make stimulation activities more engaging and accessible, patients and nursing home residents can improve executive functions and memory through specially designed applications.
Today, virtual reality in mental health care is advancing rapidly. Researchers, clinicians, and developers continue to explore new therapeutic targets to offer innovative and effective treatment solutions in the near future.
VR can be used by all healthcare professionals assisting patients with anxiety, phobias, post-traumatic stress disorders, addictions, or other psychological challenges.
It is particularly beneficial for psychologists, psychiatrists, neuropsychologists, specialized nurses, as well as psychomotor therapists, physiotherapists, dietitians, sophrologists, and hypnotherapists. With a wide range of immersive environments, VR enhances therapeutic approaches and provides innovative tools to improve patient care.
Healthcare providers incorporating virtual reality exposure therapy (VRET) expand their range of treatment options. VRET is a well-established therapeutic technique with scientific validation from cognitive-behavioral therapy research.
  • Professional Differentiation: Integrating VR into practice allows therapists to stand out from traditional treatment options.
  • Scientific Validation: VRET is backed by extensive research, reinforcing its credibility as an effective treatment method.
  • Improved Patient Engagement: The interactive nature of VR fosters greater patient involvement in therapy.
  • Time-Saving: VR provides direct access to various exposure environments without needing external logistics.

One of the considerable advantages of virtual reality is that it is effective on a wide spectrum of populations. Existing data from the literature on the subject shows us that it is entirely possible to expose a wide age group to virtual reality, with real therapeutic benefits.

The studies attest, in fact, to excellent feasibility and significant results; particularly in adults, in the treatment of anxiety disorders (including school phobia), autism, addictions, eating disorders, neuropsychological disorders, psychotic disorders and mood disorders.

The results are identical for adolescents with a significant added value concerning therapeutic engagement where virtual reality promotes adolescents' interest in their therapy.

Among elderly subjects, study results encourage the use of virtual reality with the aim of working on cognitive stimulation, on behavioral disorders but also on anxiety.

One of the major advantages of virtual reality is its effectiveness across a broad spectrum of the population. Existing literature on the subject shows that virtual reality can be used with individuals of various age groups, providing significant therapeutic benefits.
Studies confirm excellent feasibility and significant results, particularly among adults in the treatment of anxiety disorders (including school phobia), autism, addictions, eating disorders, neuropsychological disorders, psychotic disorders, and mood disorders.
The results are equally promising for adolescents, with a notable advantage in terms of therapeutic engagement, as virtual reality enhances their interest and participation in treatment.
For older adults, research supports the use of virtual reality to improve cognitive stimulation, behavioral disorders, and anxiety management.
However, people with epilepsy and pregnant individuals are not advised to undergo this type of therapy.
Yes, all our environments are grouped within a single application.
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