Understanding PTSD Treatment

National Center for PTSD, US Department of Veterans Affairs
Understanding PTSD Treatment

Do you or a loved one have PTSD?

There is no need to suffer.

Treatment works.

If you have PTSD — posttraumatic stress disorder — you don’t have to suffer. There are good treatments that can help. This booklet describes therapies and medications that are proven to help people with PTSD. You’ll hear from experts about what treatment is like, and how it can help you.

Don’t let PTSD get in the way of your enjoyment of life, hurt your relationships, or cause problems for you at work or school.

PTSD treatment works.

Treatment That Works

What is PTSD?

Posttraumatic stress disorder, or PTSD, can occur after someone goes through or sees a traumatic event like:

  • Combat exposure
  • Child sexual or physical abuse
  • Terrorist attack
  • Sexual/physical assault
  • Serious accident
  • Natural disaster

Most people have some stress-related reactions after a traumatic event. Fear, sadness, guilt, anger, and sleep problems are common. You may have bad memories of the event. If your reactions don’t go away over time and they disrupt your life, you may have PTSD.

Symptoms of PTSD

PTSD has four types of symptoms:

  • Reliving the event (also called re-experiencing): Memories of the trauma can come back at any time. You may have nightmares or feel like you are going through it again. This is called a flashback.
  • Avoiding situations that remind you of the event: You may try to avoid situations or people that bring back memories of the event.
  • Feeling numb: You may find it hard to express your feelings. It also may be hard to remember or talk  about parts of the trauma.
  • Feeling keyed up (also called hyperarousal): You may be jittery and on the lookout for danger. You might suddenly become angry or irritable. This is known as hyperarousal.

Available Treatments

There are good treatments available for PTSD. The two main types are psychotherapy, sometimes called “counseling,” and medication. Sometimes people combine psychotherapy and medication. The following treatments for PTSD work:

  • Cognitive Behavioral Therapy (CBT), such as
    • Cognitive Processing Therapy (CPT)
    • Prolonged Exposure Therapy (PE)
  • Eye Movement Desensitization and Reprocessing (EMDR)
  • Medications called Selective Serotonin Reuptake Inhibitors (SSRIs)

Getting Better

CBT, EMDR, and SSRIs have the best evidence for treating PTSD. Researchers around the world have examined them. They have found better outcomes for people who get these treatments than for people who receive other treatments, or no treatment at all.

All three treatments can cause positive and meaningful changes in symptoms and quality of life for the people who use them. “Getting better” means different things for different people, and not everyone who gets one of these treatments will be “cured.” But they will likely do better than people with PTSD who were not treated, or who received other kinds of treatment.

Psychotherapy (Counseling)

Cognitive behavioral therapy (CBT) is the most effective treatment for PTSD. CBT usually involves meeting with your therapist once a week for up to four months. There are different types of cognitive behavioral therapy. The two most-researched types of CBT for PTSD are Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE).

Cognitive Processing Therapy (CPT)

Why it works:

Trauma often causes people to struggle with memories and thoughts of the event. You may get “stuck” on these thoughts and feel unable to make sense of the trauma.

CPT can give you skills to handle these distressing thoughts. It helps you understand what you went through and how the trauma changed the way you look at the world, yourself, and others. In CPT, you will focus on examining and challenging thoughtsabout the trauma. By changing your thoughts, you can change the way you feel.

CPT has four main parts:

  • Learning about your PTSD symptoms and how treatment can help
  • Becoming aware of your thoughts and feelings
  • Learning skills to challenge your thoughts and feelings (cognitive restructuring)
  • Understanding the common changes in beliefs that occur after going through trauma

In addition to regular meetings with your therapist, you will get practice assignments to help you use your new skills outside of therapy.

Prolonged Exposure Therapy (PE)

Why it works:

Repeated exposure to thoughts, feelings, and situations that you have been avoiding helps you learn that reminders of the trauma do not have to be avoided. In PE, you and your therapist will identify the situations you have been avoiding. You will repeatedly confront those situations until your distress decreases.

PE has four parts:

  • Education: to learn about your symptoms and how treatment can help
  • Breathing retraining: to help you relax and manage distress
  • Real world practice (in vivoexposure): to reduce your distress in safe situations you have been avoiding
  • Talking through the trauma (imaginal exposure): to get control of your thoughts and feelings about the trauma PE usually involves 8–15 sessions with a therapist, plus practice assignments you will do on your own. With time and practice, you learn to manage your reactions to stressful memories.

Eye Movement Desensitization and Reprocessing (EMDR)

Why it works:

In EMDR, you focus on hand movements or tapping while you talk about the traumatic event. The idea is that the rapid eye movements make it easier for our brains to work through the traumatic memories. Focusing on hand movements or sounds while you talk about the traumatic event may help change how you react to memories of your trauma over time. You also learn skills to help you relax and handle emotional distress.

EMDR has four main parts:

  • Identification of a target memory, image, and belief about the trauma
  • Desensitization and reprocessing: focusing on mental images while doing eye movements that the therapist has taught you
  • Installing positive thoughts and images, once the negative images are no longer distressing
  • Body scan: focusing on tension or unusual sensations in the body, to identify additional issues you may need to address in later sessions

Over time, EMDR can change how your react to memories of your trauma. A course of four to twelve sessions is common.

Medication

Selective Serotonin Reuptake Inibitors (SSRIs)

Why they work: SSRIscan raise the level of serotonin in your brain, which can make you feel better. The two SSRIs that are currently approved by the FDA for the treatment of PTSD are sertraline (Zoloft) and paroxetine (Paxil).

Possible side effects that may occur in fewer than one out of three people who take SSRIs include:

  • Nausea (feeling sick to your stomach)
  • Decreased interest in sex
  • Feeling drowsy, tired, or sleeping too much

PTSD medications may interact with other medications you are taking. You should check with your doctor about all medications you are taking.

Warning:

Sometimes, doctors prescribe medicines called “benzodiazepines” for people with PTSD. These medicines are often given to people who have problems with anxiety. While they may be of some help at first, they do not treat the core PTSD symptoms. They also may lead to addiction, especially for people who have had problems with alcohol or drugs. So, benzodiazepines are not recommended for long-term PTSD treatment.

Myths About Treatment

Myth: Therapists just nod their heads and listen.
Fact: CPT, PE, and EMDR are active treatments where the patient and therapist work together. Therapists are very engaged. Sessions are goal-oriented. Elements of treatment are skills-based.

Myth: Therapy goes on for years and years.
Fact: CPT, PE, and EMDR are all time-limited treatments

Myth: Therapists “get inside your head” to change who you are.
Fact: Therapists help you understand your thoughts and feelings so that you have more control over them.

Myth:I can get better on my own.
Fact: If you have had PTSD for a year or more, the chance of getting better without counseling or medication is quite small.

Myth:  If I have to talk about trauma, I’ll “lose it.
Fact:  Therapy takes place in a safe, controlled environment, and you work with the therapist to go only as far as you feel safe. You learn coping skills to help you manage your anxiety.

Myth: Only a therapist who’s been through what I’ve been through understands this well enough to help me.
Fact: Providers with and without their own trauma histories can effectively deliver PTSD treatments. What’s important is that the provider has good training and experience, and can help you develop the skills you need to get better.

Myth: All I need to get better is the support of other people who’ve been through what I’ve been through.
Fact: Support groups can provide social support and interpersonal connection, but there’s little evidence that they help the PTSD symptoms themselves.

Success Stories

Maria

Maria used to enjoy socializing, but after she was mugged, she couldn’t even go on simple outings with her family. Driving was difficult. Going to a movie theater was impossible. When she did manage to go out to dinner, she was so focused on what was going on around her that she couldn’t enjoy her meal or join the conversation.

After treatment, things changed. Now, she can sit down with her family and enjoy a meal at a restaurant. She can even spend a day at an amusement park, where there are crowds “I still have some things that bug everywhere, and not be anxious. me,” she says, “but my life has improved so much that the things that bother me are just small.”

George

George is a Vietnam Veteran who’d been a medic. A Vietnamese mother brought her badly injured child to his field hospital. He was unable to save the child, who died in his arms.

Back home, he never held his own children. “I never held my kids, never changed their diapers. I didn’t want to have that reminder.” But with the birth of his first grandchild he decided to get help. His therapy was a success. At the end of his treatment he showed his therapist a picture of himself with his grandson in his arms. He said, “I love holding my grandson. And you know what? I couldn’t hold my kids then, but I’m holding them now.’

Resources

Treatment Resources

These links are accessible online at www.ptsd.va.gov/public/where-to-get-help.asp:

More About PTSD Treatment

View the multimedia companion to this booklet and other resources at www.ptsd.va.gov/public/.

Posted on BrainLine May 31, 2013.

This guide was created by the National Center for PTSD, U.S. Department of Veterans Affairs. The Center conducts research and education on trauma and PTSD. Our website offers extensive information, educational materials, and multimedia presentations for a variety of audiences, including Veterans and their families, providers, and researchers. www.ptsd.va.gov.