Seeking Help for Posttraumatic Stress Disorder

A National Center for PTSD Fact Sheet

This fact sheet provides information about the resources that are available to individuals who suffer from PTSD and offers a guide for how one might seek help for treatment of PTSD.

Why seek help for PTSD?

Most people experience considerable distress and avoidance after being exposed to a severely traumatic experience. This is a normal and adaptive response and often includes reliving the event in thoughts, images, and dreams. This initial rumination of the event may in fact contribute to the healing process and provide a way of achieving mastery over the event. For most people, these symptoms usually become less severe and gradually disappear over time. For others, the symptoms persist and become chronic, leading to PTSD. About 8% of men and 20% of women develop PTSD after experiencing a traumatic event, and roughly 30% of these individuals develop a chronic form that persists throughout their lifetimes.

The symptoms and problems associated with PTSD can interfere with a person’s life and become difficult to manage. Turning to someone for help is the first step in addressing the impact of PTSD in your life. Psychologists and other appropriate mental-health providers help educate people about reactions to extreme stress and ways of processing the event and dealing with the emotional impact.

With children, continual and aggressive emotional outbursts, serious problems at school, preoccupation with the traumatic event, continued and extreme withdrawal, and other signs of intense anxiety or emotional difficulties all point to the need for professional assistance. A qualified mental-health professional can help such children and their parents understand and deal with thoughts, feelings, and behaviors that result from trauma. For information about how trauma affects children see "PTSD in children and adolescents" below.

Knowing what kind of help is available, where to look for help, and what kind of questions to ask might make the process of seeking help easier and lead to more successful outcomes.

How is PTSD assessed and treated?

In recent years, a great deal of attention has been aimed at developing reliable assessment tools to aid in the diagnosis of PTSD. Today, there is a range of available measures that clinicians can use to diagnose PTSD. For more on how PTSD is assessed see the fact sheet on "Assessment of PTSD" below.

PTSD is treated with a variety of forms of mental health treatment, including psychotherapy and medication. Today there are some promising treatments that include cognitive behavioral interventions such as cognitive restructuring and exposure. For more information on these treatments see the fact sheet on "Treatment options" below.

How do I get an evaluation?

While it may be tempting to identify PTSD for yourself or someone you know, the diagnosis generally is made by a mental-health professional. This will usually involve a formal evaluation by a psychiatrist, psychologist, or clinical social worker specifically trained to assess psychological problems.

What can I expect from an evaluation for PTSD?

The nature of an evaluation for PTSD can vary widely depending on how the evaluation will be used and the training of the professional evaluator. As part of a screening, an interviewer may take as little as 15 minutes to get a sense of your traumatic experiences and its effects. On the other hand, a specialized PTSD assessment can last several hours and involve detailed, structured interviews and questionnaires Whatever the particulars of your situation, you should always be able to find out in advance from the professional conducting the evaluation what the assessment will involve and what information they will be looking for to determine a diagnosis.

How is PTSD treated?

The many therapeutic approaches offered to PTSD patients are presented in Foa, Keane, and Friedman's (2000) comprehensive book on mental health treatment. The most successful interventions are cognitive-behavioral therapy (CBT) and medication. Excellent results have been obtained with some CBT combinations of exposure therapy and cognitive restructuring, especially with female victims of childhood or adult sexual trauma. Sertraline (Zoloft) and Paroxetine (Paxil) are selective serotonin reuptake inhibitors (SSRI) that are the first medications to have received FDA approval as indicated treatments for PTSD. Success has also been reported with Eye Movement Desensitization and Reprocessing (EMDR), although rigorous scientific data are lacking and it is unclear whether this approach is as effective as CBT.

What is psychotherapy and how can it help treat PTSD?

Psychotherapy is meant to help with a person’s emotional, behavioral, or mental distress. In practice, psychotherapy is the relationship between a professional psychotherapist and a client who work together to make changes in the client’s thoughts, feelings, and behaviors. How the psychotherapist goes about helping a client will depend upon the client’s goals and the therapist's training and theoretical orientation. Theoretical underpinnings can determine what techniques a therapists uses and the focus of therapy, and they can affect the psychotherapist’s style of interaction.

However, sometimes a person’s diagnosis will influence the decision about what type of therapeutic orientation the person should engage in. PTSD is a good example of this type of diagnosis because there are many psychotherapeutic treatments that have been designed specifically to treat PTSD. A client’s response to treatment will have a lot to do with the unique values, hopes, and personality factors of that individual, but there are some treatments that have been rigorously studied and shown to be helpful for PTSD

Who is available to provide psychotherapy?

There are many different types of professionals qualified to practice mental health treatments (psychotherapy), including psychiatrists, doctoral-level clinicians, masters level clinicians, clinical social workers, clinical nurse specialists, nurse practitioners, and marriage and family therapists. Below we describe some of the most common of these professionals.

Clinical Psychologists

Clinical Psychologists have doctoral degrees (Ph.D., Psy.D., Ed.D.) from graduate programs that specialize in the study of clinical, research, and educational psychology. Programs that are approved by the American Psychological Association (APA) must meet specific teaching and training requirements that adhere to ethical, academic, and clinical standards. In addition to 4 years of course work, clinical psychologists must complete 1 year of supervised clinical training. After the fifth year of training, clinical psychologists must have another 1 to 2 years of supervised clinical experience to be eligible for licensure. Licensure is granted after passing an examination given by the American Board of Professional Psychology. Licensure allows the psychologist to practice psychotherapy without formal supervision. Although psychologists are doctors, they cannot prescribe medications.

Clinical Social Workers

Certified social workers have a master’s degree or doctoral degree in social work (MSW, DSW, or Ph.D.). Graduate training for the master’s level requires at least 2 years of schooling beyond the 4 years necessary for the undergraduate degree. To be licensed, clinical social workers must pass an exam given by the Academy of Certified Social Workers (ACSW).

Masters Level Clinicians

Masters Level Clinicianss have a master’s degree in counseling or psychology (MA). Graduate training for the master’s level requires at least 2 years of schooling beyond the 4 years necessary for the undergraduate degree. To be licensed, masters level clinicians must pass an exam as well as other qualifications that vary by state.

Psychiatrists

Psychiatrists attend medical school and have a medical degree (MD). As with other medical specialties, psychiatrists participate in a 3- to 4-year residency training in psychiatry after they complete 4 years of medical school. Child psychiatrists must complete at least 1 year of concentrated clinical experience with children. Board certified psychiatrists have also passed a written and oral examination given by the American Board of Psychiatry and Neurology. Psychiatrists, like medical doctors, can prescribe medications and also provide psychotherapy.

Psychotherapeutic approaches commonly used to treat PTSD

As stated above, there are a number of different therapeutic approaches used to treat PTSD. We will briefly explain some of the more effective approaches.

Cognitive Behavioral Treatment (CBT)

Cognitive-behavioral strategies have been the most frequently studied and most effective form of psychotherapy treatment for PTSD. The essential feature in all cognitive therapies is an understanding of PTSD in terms of the workings of the mind. Implicit in this approach is the idea that PTSD is, in part, caused by the way we think. CBT helps people understand the connection between their thoughts and feelings. CBT can help change the way we think (“cognitive restructuring”) by exploring alternative explanations, and assessing the accuracy of our thoughts. Even if we are not able to change the situation, we can change the way we think about a situation.

CBT is based on the understanding that many of our emotional and behavioral reactions to situations are learned. The goal of therapy is to unlearn the unhelpful reactions to certain events and situations and learn new ways of responding. CBT relies on evaluating thoughts to see whether they are based on fact or on assumptions. Often we get upset because we think something is occurring when it is not. CBT encourages us to look at our thoughts as hypotheses to be questioned and tested. CBT for trauma includes strategies for processing thoughts about the event and challenging negative or unhelpful thinking patterns.

Exposure therapy

Exposure is one form of CBT. Exposure uses careful, repeated, detailed imagining of the trauma (exposure) in a safe, controlled context to help the survivor face and gain control of the fear and distress that was overwhelming during the trauma. In some cases, trauma memories or reminders can be confronted all at once ("flooding"). For other individuals or traumas, it is preferable to work up to the most severe trauma gradually by using relaxation techniques and by starting with less upsetting life stresses or by taking the trauma one piece at a time ("desensitization"). When exposure is conducted by having the person imagine the trauma (such as a rape) it is called “imaginal exposure.” When it is done in real life, such as having the person go into a feared situation such as a crowded place, it is called “in vivo exposure.” In most cases, both forms of exposure are used.

CBT often involves reading assignments and homework so that clients can practice on their own the techniques they have learned in therapy.

Pharmacotherapy (medication)

Medications can reduce the anxiety, depression, and insomnia often experienced with PTSD, and in some cases, they may help relieve the distress and emotional numbness caused by trauma memories. Several kinds of antidepressant drugs have contributed to patient improvement in most (but not all) clinical trials, and some other classes of drugs have shown promise. The FDA has approved two medications, Paroxetine and Sertraline, for use in the treatment of PTSD. Although no medication has been proven to cure PTSD, medications are clearly useful for symptom relief, which makes it possible for survivors to participate in psychotherapy.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is a relatively new treatment for traumatic memories that involves elements of exposure therapy and CBT combined with techniques (eye movements, hand taps, sounds) that create an alternation of attention back and forth across the person's midline. While the theory and research are still evolving for this form of treatment, evidence suggests that it is the exposure and cognitive components of EMDR that make it effective, rather than the attentional alternation.

Group treatment

Group therapy is often an ideal therapeutic setting because trauma survivors are able to share traumatic material within the safety, cohesion, and empathy of other survivors. In such a setting, the PTSD patient can discuss traumatic memories, PTSD symptoms, and functional deficits with others who have had similar experiences. As group members achieve greater understanding and resolution of their individual traumas, they often feel more confident and able to trust. As they discuss and share how they cope with trauma-related shame, guilt, rage, fear, doubt, and self-condemnation, they prepare themselves to focus on the present rather than the past. Telling one's story (the "trauma narrative") and directly facing the grief, anxiety, and guilt related to trauma enables many survivors to cope with their symptoms, memories, and other aspects of their lives.

How can I tell if therapy is working well?

When you begin psychotherapy, you and your therapist should decide together what goals you hope to reach in therapy. Not every person with PTSD will have the same treatment goals. For instance, not all people with PTSD are concerned with lessening their symptoms. Some people want to learn instead the best way to live with existing symptoms and how to cope with other problems associated with PTSD. Perhaps you want to lessen your feelings of guilt and sadness? Perhaps you would like to work on more tangible aspects of your distress, like your relationships at work, or communication issues with your friends and family. Your therapist should help you decide which of these goals seems most important to you, and he or she should discuss with you which goals might take a long time to achieve.

Your therapist should also provide you with a good rationale for the therapy. That is, you should understand why your therapist is choosing a specific treatment for you, how long they expect the therapy to last, and how they will evaluate its effectiveness. The two of you should agree at the outset that this plan makes sense for you and what you will do if it does not seem to be working. If you have any questions about the treatment your therapist should be able to answer them.

Another aspect important to the course of good therapy, is the relationship you have with your therapist. If you feel comfortable with your therapist and feel you are working as a team to tackle your problems, it is likely that the therapy will go well. If you have concerns about your therapist, or concerns about the therapy, you should speak with your therapist about them. Therapy is not easy. It can be difficult to talk about painful situations in your life, or about traumatic experiences that you have had. Feelings that emerge during therapy can be frightening and challenging. Talking with your therapist about the process of therapy, and about your hopes and fears in regards to therapy, will help make therapy successful.

If you have concerns about your therapy or concerns about your therapist that have not been successfully worked out with your therapist, it might be helpful to consult another professional. It is recommended, however, that you let your therapist know you are seeking a second opinion.

How do I find a qualified therapist?

Selecting a therapist is a highly personal matter. A professional who works very well with one individual may not be a good choice for another person. There are several ways to get referrals to qualified therapists such as licensed psychologists.

Listed below are some ways to find help. When you call, tell whomever you speak to that you are trying to find a mental-health provider who specializes in helping people who have been through traumatic events. Check this website regularly for updated information on how to get help. We will be listing more ways to get help as they become available.

For veterans

VA medical centers and Vet Centers provide veterans with mental-health services that health insurance will cover or that costs little or nothing, according to a veteran's ability to pay. VA medical centers and Vet Centers are listed in the phone book in the blue Government pages. Under "United States Government Offices," look in the section for "Veterans Affairs, Dept of." In that section look for VA Medical Centers and Clinics listed under "Medical Care" and for "Vet Centers - Counseling and Guidance," and call the one nearest to where you live. On the Internet, go to http://www.va.gov/ and look for the VHA Facilities Locator link under "Health Benefits and Services," or go to www.va.gov/rcs.

For more information see Specialized PTSD Treatment Programs in the U.S. Department of Veterans Affairs

For non-veterans

Some local mental-health services are listed in the phone book in the blue Government pages. In the "County Government Offices" section for the county where you live, look for a "Health Services (Dept. of)" or "Department of Health Services" section. In that section, look for listings under "Mental Health." In the yellow pages, services and mental-health professionals are listed under "counseling," "psychologists," "social workers," "psychotherapists," "social and human services," or "mental health." Health insurance may pay for mental-health services and some are available at low cost according to your ability to pay.

For anyone

Call your doctor's office or ask friends if they can recommend any mental-health providers.

If you work for a large company or organization, call the human resources or personnel office to find out if they provide mental-health services or make referrals.

If you are a member of a Health Maintenance Organization (HMO), call to find out if mental-health services are available.

Call the National Center for Victims of Crime's toll-free information and referral service at 1-800-FYI-CALL. This is a comprehensive database of more than 6,700 community service agencies throughout the country that directly support victims of crime.

Contact your local mental-health agencies or family physician. To learn more about discussing PTSD with your physician, see the fact sheet "Discussing PTSD with your doctor" below.

Online Resources:

The Anxiety Disorders Association of America offers a referral network of professional therapists, as well as a self-help group network.

The Associate for Advancement of Behavior Therapy (AABT) is a professional organization that maintains a database of CBT therapist at https://aabt.org/members/Directory/Clinical_Directory.cfm

The National Institute of Mental Health Anxiety Disorders has published an extensive list of mental health organizations to help the consumer find more information about anxiety disorders and related issues, as well as to obtain referrals for specialists in different geographical areas.

Sidran offers a referral list of professional therapists, as well as a fact sheet on how to choose a therapist for PTSD and dissociative disorders.

The National Alliance for Mental Illness (NAMI) has a website with information on advocacy for those with mental illness, including affiliates who provide family support groups in different states.

About.com's trauma resource page offers a comprehensive listing of information, resources, links, and support groups on a wide array of topics related to trauma, particularly incest and child abuse.

Facts for health offers a referral database for clinicians based on clinicians who have completed a continuing education course on PTSD or clinicians who have been identified by the directors of the Madison Institute of Medicine as being specialists in PTSD.

The holistic health yellow pages offer a referral network of holistic practitioners.

Related Fact Sheets

Assessment of PTSD

Provides brief information about how PTSD is assessed

Discussing PTSD with your doctor

A useful checklist to help discuss traumatic stress symptoms with primary care physicians

PTSD in children and adolescents

An overview of the effects of trauma on children and adolescents