How is PTSD Usually Treated?
PTSD is a complex mental issue and thus needs a professional who is an expert in treating PTSD. One of the major PTSD treatments includes short-term psychotherapies. Since each person suffering from PTSD may show different symptoms, a treatment that is the best fit for him needs to be worked out.
Accordingly, a treatment that may have worked for someone else may not work for you. Thus, the mental health professional specializing in PTSD treatment would look at the symptoms faced by you and then suggest the necessary treatment.
What is the Most Effective Treatment for PTSD?
The APA specifies various treatment interventions that clinicians adopt considering their practice. All of these are an evidence-based treatment for PTSD that clinicians use to help patients in decision-making.
The following section answers the question ‘What are the best practices for trauma treatment’. There are four interventions that are highly recommended for PTSD treatment and are nothing but variants of Cognitive Behavioral Therapy (CBT).
1. Cognitive Behavioral Therapy (CBT)
CBT is one of the best therapies that is used for PTSD treatment. This is considered to be the most effective short-term as well as the long-term treatment for treating PTSD. It is a therapy that concentrates on the link between thoughts, behaviors, and feelings and observes how alterations in one area can enhance the functioning in other areas.
It is cognitive psychotherapy that concentrates on solving the individual’s present problems. It is an approach that alters an individual’s dysfunctional behavior and thought process.
How CBT Helps People With PTSD?
There exist a host of theories related to trauma that explain how CBT helps people in improving PTSD symptoms.
- Emotional Processing Theory
As per this theory, people who experience a traumatic event build connections. They build such connections among the meaning, responses, and things that serve as reminders of the trauma.
For instance, they may relate certain people or instances with trauma (reminder), draw the meaning that the world is an unsafe place, and go through feelings of fear (response).
In CBT, the therapists help patients in identifying these connections. This is done to change such associations which result in impaired functioning of the patients.
- Social Cognitive Theory
As per this theory, there are people who attempt to integrate the traumatic experience into current beliefs about themselves, others, and the world. This is what leads them to misunderstand their experiences and their understanding of regulating themselves and the world around them.
For example, say someone believes in the fact that you are your karma and experiences sexual abuse. Such a person may think that it is due to one of her bad karma’s that she faced this traumatic event of sexual abuse. Whereas, she should instead understand this episode as a pure act of violence on the act of the person who did this to her.
How is CBT Used to Treat PTSD?
CBT therapists use a variety of techniques to enable patients to reduce PTSD symptoms and improve overall functioning. They help patients to re-think their thought patterns so as to recognize the unreasonable thoughts or distortions. These may include negative thoughts that kill the positive ones, over-exaggerated outcomes, over-generalizing bad outcomes, etc. The intention is to help patients develop a more effective thought pattern.
This helps individuals to re-understand their traumatic experiences together with their awareness about themselves and their potential to deal with PTSD.
Thus, CBT helps an individual to understand the way he or she construes his problem. Further, it also enables the individual to know how such perceptions would impact his/her emotions.
CBT involves a therapist and the patient working together. In the CBT session, the therapist helps the patient identify automatic thoughts that occur to the patient. These are thoughts that occur to the patient spontaneously and that take the patient away from reality.
Thus, such thoughts interfere with the patient’s routine functioning and that is why the therapist helps the patient to analyze in a conscious way.
Likewise, the CBT therapist helps the patient to:
- recognize his emotions
- differentiate between the negative thoughts and emotions
- label his emotions
- quantify the degree of emotions they are experiencing
- understand the degree of emotions he is currently facing
- analyzing his automatic thoughts
- identify how he will respond to the automatic thoughts
Therefore, the therapist exposes the patient to the trauma reminders, feelings, and the trauma account. This is to help the patient lessen the negative connections with the traumatic experience.
Now, all of this is undertaken slowly, in a regulated way where both the therapist and the patient work together.
The intention is to help the patient learn skills like self-control, self-confidence, and reducing maladaptive behaviors.
Thus, the skills learned during the CBT sessions are practiced repeatedly which helps in improving PTSD symptoms. Typically, the CBT treatments last for 12-16 weeks.
2. Cognitive Processing Therapy (CPT)
CPT is also a type of cognitive-behavioral therapy that has proven to be effective in lessening PTSD symptoms. These symptoms could be the result of traumatic events like child abuse, sexual or physical assault, natural disaster, military combat, etc.
This therapy helps patients to question and change the illogical thoughts associated with the traumatic event. CPT generally undertakes over 12 sessions which help the patient to challenge his thought pattern and develop a new and improved understanding of the traumatic episode.
Such a change helps in reducing the impairment caused due to unreasonable thoughts in respect of trauma in routine functioning.
How is CPT Used to Treat PTSD?
The first thing that the therapist undertakes is that of psychoeducation in respect of PTSD, its symptoms, and associated thoughts, and emotions. In this, the patient becomes increasingly aware of the thoughts and emotions and the connection between them. This helps him to identify the automatic thoughts that are responsible for sustaining the PTSD symptoms.
2. Writing the Traumatic Event
In addition to this, the patient is asked to pen down a statement that reveals the impact the traumatic event had on him/her. This statement details the patient’s present understanding of the trauma, why it took place, and the influence it had on the beliefs about oneself, others, and the world around.
3. Socratic Questioning for Challenging Illogical Thoughts
Socratic questioning involves the therapist asking questions that help the patients to direct their thoughts and behavior towards goals that help them alter their thinking. These questions are not instructional in nature. Instead, they are such that they help the patients build new perspectives.
These questions enable the patients to challenge their negative thoughts about the traumatic event. Lately, once the patients learn these skills of recognizing and questioning unreasonable thoughts, they use these skills repeatedly. This enables them to analyze and alter their unreasonable beliefs in respect of the traumatic event.
At this stage, the therapists attempt to help the patients learn and practice these skills outside therapy sessions. And this is what helps in improving the overall functioning of the individuals.
In addition to this, CPT can be undertaken both through individual and group sessions. Also, therapists give practice assignments that are to be done outside the session.
4. Cognitive Therapy (CT)
Cognitive Therapy is a technique that is acquired from CBT. As per this theory, an individual is bound to show PTSD symptoms if he processes the traumatic event in a manner that results in he/she feeling severe threat.
This is the result of excessive negative analysis of the traumatic event or some issues in one’s memory of the traumatic event. In this, the individual tends to relive some part of trauma in an unregulated way. This results in unreasonable behavior and cognitive coping responses.
How is CT Used to Treat PTSD?
CT too focuses on changing the negative analysis and memories linked to trauma. The intent is to break the thought patterns that impair the individual’s routine functioning.
CT, much like CBT, is offered in weekly sessions over a period of three months in the form of individual or group sessions.
1. Identifying Negative Triggers
The first step involves the therapist recognizing negative memories, analyses, and triggers linked to trauma. This is because it is these negative associations that result in sustaining PTSD symptoms.
Once the negative evaluations are identified, the therapist helps the patient to understand the meaning of his/her traumatic memories. In addition to this, the therapist also explains how the patient is understanding them at present. He also explains that negative evaluations of trauma may result in increasing the feelings of threat.
Here too, the therapist uses Socratic questioning to help the patient alter his evaluation of trauma.
2. Incorporating Modified Evaluation With Trauma
The altered evaluation is now incorporated with trauma memories. This is achieved through patient writing and thinking about the new, improved evaluation as he thinks about the trauma memory.
Alternatively, the new analysis is incorporated by the patient reliving the trauma in his imagination with this new evaluation in mind.
Similarly, the therapist guides the patient to develop a new, meaningful account of the traumatic experience. This is achieved through various means. For instance, the patient can either write the account of the traumatic experience, relive the trauma in his imagination, or visit the same location again where the traumatic event took place.
No doubt the patient here is exposed to the aspects of trauma. However, the aim here is to see particular trauma-related memories that trigger certain responses.
This is done so that the therapist can use cognitive restructuring to help the patients to question the unreasonable thinking connected to trauma.
3. Alter Behaviors to Reduce PTSD Symptoms
Lastly, the therapist helps the patient to prevent behaviors and thought processes that may reduce the current threat. However, it may let the PTSD symptoms persist in the long run.
Thus, both the patient and the therapist work together on issues like suppressing thoughts, rumination, and behaviors that seek safety. Thus, the therapist makes the patient realize that these are unhelpful strategies and avoid these to reduce PTSD symptoms.
5. Prolonged Exposure (PE)
This is a strategy that is used by therapists to help patients face their fears. PE is a type of CBT that guides patients to approach memories, emotions, and circumstances related to trauma slowly.
Typically, people try to avoid everything that triggers them to remember the traumatic experience they have gone through. However, preventing these cues only adds to fear. However, if the patient faces what he’s trying to avoid, it increases the chances of reducing PTSD symptoms. This is because facing what they have been avoiding helps them to learn that trauma-related triggers are not risky.
How is PE Used to Treat PTSD?
In this, the therapist begins by giving the patient an outline of the treatment and knowing the patient’s prior experiences. They then continue educating the patient about PTSD and its treatment and teach breathing exercises to the patients to deal with anxiety.
The therapist then initiates the exposure after making an assessment and taking the first session. Now, many patients get anxiety-ridden going through the process. That’s why the therapist makes sure that the patients find this therapy relationship to be safe. This is to allow the patients to face even the scariest of the stimuli during the therapy session.
The following types of exposures are used with the speed of the exposure adjusted as per the comfort of the patient.
1. Imaginal Exposure
In this, the patient describes the traumatic event during the therapy session. Thus, both the therapist and the patient come together to understand the emotions that come out as a result of describing the event in detail.
Further, the session is even recorded. This is to make the patient listen to the audio for processing the emotions and practicing breathing techniques.
2. In vivo Exposure
These are therapy sessions where the patient is asked to face the traumatic triggers outside the session. Typically, the therapist and the patient together work on recognizing the events, places, persons that act as triggers.
Then, both the patient and the therapist work out the triggers that the patient needs to face. These are typically experienced by the patient in between the therapy sessions. Thus, the therapist motivates the patient to face these triggers gradually. This enables the patient to experience some success in facing these triggers and helps him to deal with them.
Apart from the above treatments that are highly recommended, there are treatments that are recommended on the basis of certain conditions. These include:
6. Brief Eclectic Psychotherapy (BEP)
BEP is a technique that combines some components of CBT with the psychodynamic approach. Here, the focus is on altering the feelings of shame and guilt and the relationship shared by the patient and the therapist.
This is a 16-session approach where the patient is asked to narrate the traumatic event. They are then taught breathing techniques for relaxation that help them to concentrate Further, the patient is also asked to write a letter to the person whom he blames to be responsible for the event.
Next, the therapist and the patient together review the progress made during the therapy and make changes accordingly. The patient is guided on how the event has impacted him and what things he can learn from the same.
In the last session, the therapist devises a relapse plan and the patient identifies that trauma once ruled over him. He understands that PTSD and its symptoms are now things of the past.
7. EMDR Therapy
Eye Movement Desensitization and Reprocessing Therapy (EMDR) is a technique that is divided into various stages. In this, the patient is motivated to focus on the trauma memory and at the same time made to experience eye movements.
The various stages of this therapy include:
- knowing the trauma history
- preparing the client
- evaluating the trauma memory
- desensitizing where the client focuses on the memory with eye movements. The therapist then reports these eye movements to the patient.
- helping clients understand the physical symptoms they go through as they think over trauma
- reevaluating in which the therapist looks at the current psychological position of the client and sees how therapy sessions have helped the patient. The therapist also identifies aspects that still need improvements.
Narrative Exposure Therapy (NET) is a type of treatment that focuses on the patient narrating his traumatic experience. This includes describing in detail his emotions, thoughts, sensory information, and physical responses.
This way, NET helps the patient in creating a complete biography or account of what happened to him. NET is based on the understanding that a person’s narrative of the trauma that he describes or tells himself impacts the way he thinks about his experiences and overall well being. The patient receives the documented autobiography towards the end of the session which is created by the therapist.
This narrative helps the patient to appreciate his human rights and regain his self-respect.
One of the typical questions in respect of PTSD treatment is “what is the best medication for PTSD? Well, SSRIs and SNRIs are commonly recommended PTSD treatment medications by doctors.
- Selective Serotonin Reuptake Inhibitors (SSRIs)
Sertraline, paroxetine, and fluoxetine are the commonly recommended SSRIs for treating PTSD. These are the first class of medication used in PTSD treatment. Further, only sertraline and paroxetine are the SSRIs approved by the FDA.
- Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
Venlafaxine is the SNRI that is recommended conditionally for treating PTSD.