PTSD Fact Sheet: Treatment for PTSD

National Center for Posttraumatic Stress Disorder, US Department of Veterans Affairs
PTSD Fact Sheet: Treatment for PTSD

Today, there are good treatments available for PTSD. When you have PTSD dealing with the past can be hard. Instead of telling others how you feel, you may keep your feelings bottled up. But talking with a therapist can help you get better.

Cognitive-behavioral therapy (CBT) is one type of counseling. It appears to be the most effective type of counseling for PTSD. There are different types of cognitive behavioral therapies such as cognitive therapy and exposure therapy. There is also a similar kind of therapy called eye movement desensitization and reprocessing (EMDR) that is used for PTSD. Medications have also been shown to be effective. A type of drug known as a selective serotonin reuptake inhibitor (SSRI), which is also used for depression, is effective for PTSD.

Cognitive Behavioral Therapy

What is cognitive therapy?

In cognitive therapy, your therapist helps you understand and change how you think about your trauma and its aftermath. Your goal is to understand how certain thoughts about your trauma cause you stress and make your symptoms worse.

You will learn to identify thoughts about the world and yourself that are making you feel afraid or upset. With the help of your therapist, you will learn to replace these thoughts with more accurate and less distressing thoughts. You also learn ways to cope with feelings such as anger, guilt, and fear.

After a traumatic event, you might blame yourself for things you couldn't have changed. For example, a soldier may feel guilty about decisions he or she had to make during war. Cognitive therapy, a type of CBT, helps you understand that the traumatic event you lived through was not your fault.

What is exposure therapy?

In exposure therapy your goal is to have less fear about your memories. It is based on the idea that people learn to fear thoughts, feelings, and situations that remind them of a past traumatic event.

By talking about your trauma repeatedly with a therapist, you'll learn to get control of your thoughts and feelings about the trauma. You'll learn that you do not have to be afraid of your memories. This may be hard at first. It might seem strange to think about stressful things on purpose. But you'll feel less overwhelmed over time.

With the help of your therapist, you can change how you react to the stressful memories. Talking in a place where you feel secure makes this easier.

You may focus on memories that are less upsetting before talking about worse ones. This is called "desensitization," and it allows you to deal with bad memories a little bit at a time. Your therapist also may ask you to remember a lot of bad memories at once. This is called "flooding," and it helps you learn not to feel overwhelmed.

You also may practice different ways to relax when you're having a stressful memory. Breathing exercises are sometimes used for this.

What is EMDR?

Eye movement desensitization and reprocessing (EMDR) is a fairly new therapy for PTSD. Like other kinds of counseling, it can help change how you react to memories of your trauma.

While talking about your memories, you'll focus on distractions like eye movements, hand taps, and sounds. For example, your therapist will move his or her hand near your face, and you'll follow this movement with your eyes.

Experts are still learning how EMDR works. Studies have shown that it may help you have fewer PTSD symptoms. But research also suggests that the eye movements are not a necessary part of the treatment.

Medication

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant medicine. These can help you feel less sad and worried. They appear to be helpful, and for some people they are very effective. SSRIs include citalopram (Celexa), fluoxetine (such as Prozac), paroxetine (Paxil), and sertraline (Zoloft).

Chemicals in your brain affect the way you feel. When you have or depression you may not have enough of a chemical called serotonin. SSRIs raise the level of serotonin in your brain.

There are other medications that have been used with some success. Talk to your doctor about which medications are right for you.

Other types of treatment

In addition to CBT and SSRIs, some other kinds of counseling may be helpful in your recovery from PTSD.

Group therapy

Many people want to talk about their trauma with others who have had similar experiences.

In group therapy, you talk with a group of people who also have been through a trauma and who have PTSD. Sharing your story with others may help you feel more comfortable talking about your trauma. This can help you cope with your symptoms, memories, and other parts of your life.

Group therapy helps you build relationships with others who understand what you've been through. You learn to deal with emotions such as shame, guilt, anger, rage, and fear. Sharing with the group also can help you build self-confidence and trust. You'll learn to focus on your present life, rather than feeling overwhelmed by the past.

Brief psychodynamic psychotherapy

In this type of therapy, you learn ways of dealing with emotional conflicts caused by your trauma. This therapy helps you understand how your past affects the way you feel now.

Your therapist can help you:

  • Identify what triggers your stressful memories and other symptoms.
  • Find ways to cope with intense feelings about the past.
  • Become more aware of your thoughts and feelings, so you can change your reactions to them.
  • Raise your self-esteem.

Family therapy

PTSD can impact your whole family. Your kids or your partner may not understand why you get angry sometimes, or why you're under so much stress. They may feel scared, guilty, or even angry about your condition.

Family therapy is a type of counseling that involves your whole family. A therapist helps you and your family communicate, maintain good relationships, and cope with tough emotions. Your family can learn more about PTSD and how it is treated.

In family therapy, each person can express his or her fears and concerns. It's important to be honest about your feelings and to listen to others. You can talk about your PTSD symptoms and what triggers them. You also can discuss the important parts of your treatment and recovery. By doing this, your family will be better prepared to help you.

You may consider having individual therapy for your PTSD symptoms and family therapy to help you with your relationships.

How long does treatment last?

For some people, treatment for PTSD can last 3 to 6 months. If you have other mental health problems as well as PTSD, treatment for PTSD may last for 1 to 2 years or longer.

What if someone has PTSD and another disorder? Is the treatment different?

It is very common to have PTSD at that same time as another mental health problem. Depression, alcohol or substance abuse problems, panic disorder, and other anxiety disorders often occur along with PTSD. In many cases, the PTSD treatments described above will also help with the other disorders. The best treatment results occur when both PTSD and the other problems are treated together rather than one after the other.

What will we work on in therapy?

When you begin therapy, 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 focused on reducing their symptoms.

Some people want to learn the best way to live with their symptoms and how to cope with other problems associated with PTSD. Perhaps you want to feel less guilt and sadness? Perhaps you would like to work on improving 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.

What can I expect from my therapist?

Your therapist should give you a good explanation for the therapy. You should understand why your therapist is choosing a specific treatment for you, how long they expect the therapy to last, and how they see if it is working.

The two of you should agree at the beginning 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.

You should feel comfortable with your therapist and feel you are working as a team to tackle your problems. 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 scary 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 do not like your therapist or feel that the therapist is not helping you, it might be helpful to talk with another professional. In most cases, you should tell your therapist that you are seeking a second opinion.

Posted on BrainLine July 25, 2008

From the National Center for Posttraumatic Stress Disorder, US Department of Veterans Affairs. www.mentalhealth.va.gov.

Comments

Veterans are all different. some of them you can talk to them but it is not a good idea to scream at them or try to fight them because they are having flash backs and in this time they are remembering there overseas fighting and they are fighting for there life you have to try to talk to him/her calmly. I know its hard at first but you also might need to try to get them a ptsd service dog that is trained to stop them from getting to that point. you shouldn't have to fear your loved ones because of what they went through. they need someone who will be strong for them in their time of need. a lot of them feel like they are alone and they need you to let them know you are there for them. my fiance was in the marine corps. he was jn Afghanistan twice and he has ptsd. at night when we are sleeping I can feel that hes having a bad dream or I wake up and can see he is and sometimes it helps to put my head on his chest and put my hand over his heart and I just hold him and let him know that he isn't alone im there for him and he will calm down. but if your husband/wife whoever is physical with their ptsd you need to call the va if you cant get them to snap back from it easy because they can hurt you. they are not trying to. to them at that time you are not you you are someone they had to fight for there life overseas and so they are fighting for their life but getting them to talk about it helps when they are fully awake and all. if you cant handle knowing what they did or what they went through dont ask them to tell you. ask them to talk to the va drs or another veteran. just let them know you love them and are going to be with them through their hard time

I have been through a series of dysfunctional experiences beginning in my childhood and moving into adulthood.  While I am on several medications, and have fought hard to heal through PTDS therapy, group therapy, and psychiatric consultation.  As well I try to make each day as  positive as I can.  I have lived an interesting and courageous life although I am burdened with horrific panic as I awake each day. Things like exercise, taking on challenges I fear, and working on my interpersonal relationships provide some relief.

  In the past I have always worked hard and my performance has been positively acknowledged. Is there anything more I can do, because I presently find it hard to hold down a job. I'm not sure if its my medication or my mental illness that is causing this problem.

I would be nice to hear from others who are going through the same thing, so that I don't feel alone. I would be very happy to hear about your experiences.

A small number of persons (not everyone) benefit from a med which works for ADHD (central nervous system stimulant/alerting agent) or a med for epilepsy. Also, good nutrition is an important factor for overall health (for everyone, not only those with brain injuries).
Neurofeedback is a drug-free brain training regimen with profound effects on PTSD. Find a provider at EEGInfo.com. The training is provided free of charge for all military personnel through hc4v.org. John Mekrut The Balanced Brain Studio City, CA
Please try not to become angry yourself, even if he is feeling violent towards you. Whenever someone is feeling very depressed or very scared, the normal reaction is to become angry or violent. He needs reassurance that he is still loved and cared about. He probably feels guilty after he's had an 'episode', so explain to him that it's not his fault, and that he's going to come through the pain eventually, with help. Learn Transactional Analysis, it will help you to understand what his mind is going through, and how to best proceed. CBT counselling is a good therapy for some people, but others don't get on with it. Transactional Analysis is a great tool - use it! My best wishes to you both.
If he is a veteran even if not check out militaryministry.org hope this helps take care and God Bless
How do you handle a person during an episode?My husband has frequent ones and,I do not know how to handle it. I do not know what to expect or if I CAN talk him out of it or not. I get very scared especially late at night.Can someone give me some advise,please?

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