Treatment of PTSD
A National Center for PTSD Fact Sheet
This fact sheet describes elements common to many treatment modalities for
PTSD, including education, exposure, exploration of feelings and beliefs, and
coping-skills training. Additionally, the most common treatment modalities are
discussed, including cognitive-behavioral therapy, pharmacotherapy, EMDR, group
treatment, and psychodynamic treatment.
Common Components of PTSD Treatment
Treatment for PTSD typically begins with a detailed evaluation and the
development of a treatment plan that meets the unique needs of the survivor.
Generally, PTSD-specific treatment is begun only after the survivor has been
safely removed from a crisis situation. If a survivor is still being exposed to
trauma (such as ongoing domestic or community violence, abuse, or
homelessness), is severely depressed or suicidal, is experiencing extreme panic
or disorganized thinking, or is in need of drug or alcohol detoxification, it
is important to address these crisis problems as a part of the first phase of
treatment.
- It is important that the
first phase of treatment include educating trauma survivors and their
families about how persons get PTSD, how PTSD affects survivors and their
loved ones, and other problems that commonly come along with PTSD
symptoms. Understanding that PTSD is a medically recognized anxiety
disorder that occurs in normal individuals under extremely stressful
conditions is essential for effective treatment.
- Exposure to the event via
imagery allows the survivor to re-experience the event in a safe,
controlled environment, while also carefully examining his or her
reactions and beliefs in relation to that event.
- One aspect of the first
treatment phase is to have the survivor examine and resolve strong feelings
such as anger, shame, or guilt, which are common among survivors of
trauma.
- Another step in the first
phase is to teach the survivor to cope with posttraumatic memories,
reminders, reactions, and feelings without becoming overwhelmed or
emotionally numb. Trauma memories usually do not go away entirely as a
result of therapy but become manageable with the mastery of new coping
skills.
Therapeutic Approaches Commonly Used to Treat PTSD:
Cognitive-behavioral therapy (CBT) involves working with cognitions
to change emotions, thoughts, and behaviors. Exposure therapy is one form of CBT that is unique to trauma
treatment. It 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").
Along with exposure, CBT for trauma includes:
·
learning skills for coping with anxiety (such as
breathing retraining or biofeedback) and negative thoughts ("cognitive
restructuring"),
·
managing anger,
·
preparing for stress reactions ("stress
inoculation"),
·
handling future trauma symptoms,
·
addressing urges to use alcohol or drugs when trauma
symptoms occur ("relapse prevention"), and
·
communicating and relating effectively with people
(social skills or marital therapy).
Pharmacotherapy
(medication) can reduce the anxiety, depression, and insomnia often experienced
with PTSD, and in some cases, it 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. At this time, no particular
drug has emerged as a definitive treatment for PTSD. However, medication is clearly useful for symptom relief, which
makes it possible for survivors to participate in psychotherapy.
Eye Movement
Desensitization and Reprocessing (EMDR) is a relatively new treatment for
traumatic memories that involves elements of exposure therapy and
cognitive-behavioral therapy 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, there is some evidence that the therapeutic element unique
to EMDR, attentional alternation, may facilitate the accessing and processing
of traumatic material.
Group treatment
is often an ideal therapeutic setting because trauma survivors are able to
share traumatic material within the safety, cohesion, and empathy provided by
other survivors. As group members achieve greater understanding and resolution
of their trauma, 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.
Brief
psychodynamic psychotherapy focuses on the emotional conflicts caused by
the traumatic event, particularly as they relate to early life experiences.
Through the retelling of the traumatic event to a calm, empathic,
compassionate, and nonjudgmental therapist, the survivor achieves a greater
sense of self-esteem, develops effective ways of thinking and coping, and
learns to deal more successfully with intense emotions. The therapist helps the
survivor identify current life situations that set off traumatic memories and
worsen PTSD symptoms.
Psychiatric disorders that commonly
co-occur with PTSD
Psychiatric disorders that commonly
co-occur with PTSD include depression, alcohol/substance abuse, panic disorder,
and other anxiety disorders. Although crises that threaten the safety of the
survivor or others must be addressed first, the best treatment results are
achieved when both PTSD and the other disorder(s) are treated together rather
than one after the other. This is especially true for PTSD and
alcohol/substance abuse.
Complex PTSD
Complex PTSD (sometimes called
"Disorder of Extreme Stress") is found among individuals who have
been exposed to prolonged traumatic circumstances, especially during childhood,
such as childhood sexual abuse. Developmental research is revealing that many
brain and hormonal changes may occur as a result of early, prolonged trauma,
and these changes contribute to difficulties with memory, learning, and
regulating impulses and emotions. Combined with a disruptive, abusive home
environment that does not foster healthy interaction, these brain and hormonal
changes may contribute to severe behavioral difficulties (such as impulsivity,
aggression, sexual acting out, eating disorders, alcohol/drug abuse, and
self-destructive actions), emotional regulation difficulties (such as intense
rage, depression, or panic), and mental difficulties (such as extremely
scattered thoughts, dissociation, and amnesia). As adults, these individuals
often are diagnosed with depressive disorders, personality disorders, or
dissociative disorders. Treatment often takes much longer than with regular
PTSD, may progress at a much slower rate, and requires a sensitive and
structured treatment program delivered by a trauma specialist.
Related Links
VA/DoD Clinical Practice Guidelines for PTSD
Here you will find the VA/DoD Clinical Practice Guidelines for PTSD.
Related Fact Sheets
Associated
problems
Problems that commonly co-occur with PTSD
Cognitive-Behavioral
Therapy
Answers questions about the effectiveness
of Cognitive-Behavioral Therapy as a technique for early intervention
Complex
PTSD
Describes the differences between
reactions to acute trauma and reactions to prolonged, chronic trauma
Medication
for PTSD
A discussion of who should receive pharmacological
treatment for PTSD and what pharmacological agents clinicians might prescribe
