There are a host of people who go through self-esteem issues. They wonder what characterizes an individual a high self-esteem individual. They often confuse arrogance with having high self-esteem.

Well, if you are one of those, then you need to understand that there are certain experiences that give rise to high self-esteem and to low self-esteem. Further, such people fail to understand the importance of having high self-esteem.

In this article, we will clarify in detail what is self-esteem, what is high self-esteem and low self-esteem, and what causes low self-esteem? We will also discuss some of the ways in which individuals facing low self-esteem issues can get rid of it.

Define What is Self-Esteem?

There are three ways in which one can define the term self-esteem. These include global self-esteem, self-evaluations, and feelings of self-worth.

I. Global Self-Esteem

In generic terms, the term self-esteem refers to an individual’s personality attribute that represents the manner in which an individual generally feels about himself or herself. This form of self-esteem is called global self-esteem or trait self-esteem. Note that this type of self-esteem is endured in an individual across time as well as situations.

Thus, in simple words, self-esteem refers to the feelings of affection for oneself. Accordingly, an individual with high self-esteem has a general fondness or love for oneself. Whereas, an individual with low self-esteem is mildly positive or has confused feelings toward oneself. In extreme cases, low self-esteem people hate themselves. However, this kind of self-loathing occurs in people with clinical mental issues and not in normal people.

II. Self-Evaluations and Self-Esteem

Another way in which the term self-esteem is defined is the manner in which an individual evaluates his or her set of abilities. At times, the words self-confidence and self-efficacy are also used to refer to this type of self-esteem. This means in this case many people consider their level of confidence to be equivalent to self-esteem.

Thus, these beliefs are often referred to as self-evaluations or self-appraisals. This is because such beliefs refer to the manner in which people evaluate or appraise their abilities and personality characteristics. 

For instance, certain school students are often found doubting their learning abilities. This is sometimes referred to as low academic self-esteem. Likewise, many students consider themselves to be out of the famous lot and hence consider themselves to have high social self-esteem.

It might seem that self-evaluations and self-esteem are related. That’s why many people having high self-esteem consider that they have much more positive qualities as compared to people with low self-esteem. However, these are two separate beliefs.

For instance, a person who lacks confidence in school may like himself or herself on the whole. Likewise, a person who is beautiful or handsome may hate herself or himself respectively on the whole. 

But, you will find psychologists using the terms self-esteem and self-evaluation interchangeably. Note that such a causal relationship between self-esteem and self-evaluation is not clear.

Though, there are certain cognitive models in psychology that adopt a bottoms-up approach in defining the relationship between the two beliefs. As per this approach, positive self-evaluations in certain domains can give rise to high self-esteem. Such an approach demonstrates that global self-esteem is dependent on the kind of self-evaluations a person undertakes of oneself.

In addition to the cognitive models, there are effective models of self-esteem in psychology. These models adopt a top-down approach in defining the relationship between self-evaluation and self-esteem. Accordingly, high global self-esteem can give rise to positive self-evaluations in individuals.

III. Feelings of Self-Worth and Self-Esteem

Finally, the term self-esteem is also defined in terms of the feelings of self-worth that an individual has of oneself. Accordingly, the term self-esteem refers to the temporary emotional states, specifically the ones that occur due to either positive or negative outcomes.

Thus, when people say that their self-esteem is bolstered or threatened by the kind of experiences they have in life, this is what they refer to. For instance, an individual after losing his job may say that he is experiencing low self-esteem post losing the job. Or, an individual may say that he is experiencing high self-esteem after receiving a good project.

According to William James, these emotions are referred to as self-feelings or as feelings of self-worth. Thus, the feelings of self-worth refer to feeling proud on the positive end and feeling humiliated on the negative end.

Another characteristic of feelings of self-worth that you must make a note of this that humans have a basic need to feel good about themselves. This is referred to as a self-enhancement motive in psychology.

Self-enhancement motive refers to the fact that we humans are motivated to have high feelings of self-worth. What this means is that people always want to feel proud of themselves instead of being ashamed of themselves. 

As a result, they always make an effort to maximize and protect their feelings of self-worth. However, the manner in which individuals fulfill this need is different across times and cultures. The fact of the matter is that humans have a universal need of having high self-worth.

The anthropologist Ernest Becker demonstrated that “all organisms like to “feel good” about themselves. Thus in the briefest and direct manner, we have a law of human development.”

Why Are People Always Motivated To Have High Self-Worth?

Well, as per research, there is no one answer to this question. Some researchers believe that high self-worth feelings satisfy humans intrinsically. 

Others believe that positive feelings of self-worth are related to positive outcomes for humans. For instance, an individual achieving success in his or her job is a positive outcome and hence is responsible for feelings of high self-worth in an individual. 

In addition to this, there is another category of psychologists who believe that humans crave feelings of self-worth as these give meaning to their life. Perhaps, such feelings help them deal with the reality of death more comfortably. 

So the above connotations make one thing clear. And that we humans are motivated to promote, maintain, and protect positive feelings of self-worth, irrespective of the source of this need. 

How To Measure Self-Esteem?

People with low self-esteem say or do certain things that make you believe that such person has a low self-esteem. What this means is that the words and actions of an individual give a strong signal to your intuition that a person is low on self-esteem. 

But if you want a measure or a scale that gives you a reasonable approach to determining self-esteem, you can use Rosenberg Self-Esteem Scale. 

Methods of Measuring Self-Esteem

I. Rosenberg Self-Esteem Scale

One of the most widely used instruments for measuring self-esteem in the area of research is the Rosenberg Self-Esteem Scale. This scale measures the global self-esteem of an individual. That is, it focuses on an individual’s general feelings toward themselves and does not consider any specific quality or attribute. 

Note that the Rosenberg Self-Esteem Scale is in the form of positive and negative statements. Each of these statements has four options against them accompanied by a number that ranges from 0 to 3. 

These options include Strongly Disagree (0), Disagree (1), Agree (2),  and Strongly Agree (3). Also, fifty percent of the statements are worded in a positive direction and the other fifty percent are worded in a negative direction.

The following table showcases the Rosenberg Self-Esteem Scale.

S.No.	Statements	Strongly Disagree	Disagree	Agree	Strongly Agree
1.	At times I think I am no good at all.	0	1	2	3
2.	I take a positive view of myself.	0	1	2	3
3.	All in all, I am inclined to feel that I am a failure.	0	1	2	3
4.	I wish I could have more respect for myself.	0	1	2	3
5.	I certainly feel useless at times.	0	1	2	3
6.	I feel that I am a person of worth, at least on an equal plane with others.	0	1	2	3
7.	On the whole, I am satisfied with myself.	0	1	2	3
8.	I feel I do not have much to be proud of.	0	1	2	3
9.	I feel that I have a number of good qualities.	0	1	2	3
10.	I am able to do things as well as most other people.	0	1	2	3

To calculate the score, you first have to reverse the score of the five negatively worded statements. For instance, the negatively worded statements in the scale above include statements 1, 3, 4, 5, and 8. Reverse the score for each of these statements as below:

• Make 0 as 3
• Then, 1 as 2
• Make 2 as 1
• Then, make 3 as 0

Once this is done, then add up your scores across all the 10 items. Note that your total score must range between 0 and 30. The higher the score, the higher is your self-esteem. The lower the score, the lower is your self-esteem.

II. Texas Social Behavior Inventory

Texas Social Behavior Inventory is another important measure that researchers use to determine the self-esteem level of an individual. Again, this scale is used to measure the global self-esteem of an individual.

In addition to measuring an individual’s global self-esteem, the Texas Social Behavior Inventory also measures the level of comfort and competence an individual feels when exposed socially. 

Note that the scores of the Texas Social Behavior Inventory scale are related to the scores on the Rosenberg Self-Esteem Scale. However, both scales measure different outcomes.

For instance, an individual may like himself or herself but may not feel comfortable in social situations. Likewise, a person may feel relaxed and enjoy with other people socially. However, such a person may not like himself or herself on the whole. For this reason, the Rosenberg scale is the appropriate one to use for measuring global self-esteem.

The following table showcases the Texas Social Behavior Inventory Scale.

S.No.	Statements	A	B	C	D	E
1.	I am not likely to speak to people untilthey speak to me.	1	2	3	4	5
2.	I would describe myself as self-confident.	1	2	3	4	5
3.	I feel confident about my appearance.	1	2	3	4	5
4.	I am a good mixer.	1	2	3	4	5
5.	When in a group of people, I have trouble thinking of the right things to say.	1	2	3	4	5
6.	When in a group of people, I usually do what others want rather than make my own suggestions.	1	2	3	4	5
7.	When I’m in a disagreement with other people, my opinion usually prevails.	1	2	3	4	5
8.	I would describe myself as one who attempts to master situations.	1	2	3	4	5
9.	Other people look up to me.	1	2	3	4	5
10.	I enjoy social gatherings just to be with people.	1	2	3	4	5
11.	I make a point of looking other people in the eye.	1	2	3	4	5
12.	I cannot seem to get others to notice me.	1	2	3	4	5
13.	I would rather not have much responsibility for other people.	1	2	3	4	5
14.	I feel comfortable being approached by someone in a position of authority over me.	1	2	3	4	5
15.	I would describe myself as indecisive.	1	2	3	4	5
16.	I have no doubts about my social competence.	1	2	3	4	5

To calculate the score, you first have to reverse the score of the negatively worded statements. In this case, the negatively worded statements include statement numbers 1, 5, 6, 12, 13, and 15. Reverse the score for each of these statements as below:

• Make 1 as 5
• Then, make 2 as 4
• Make 3 as 3
• Then, make 4 as 2
• Finally, make 5 as 1

Once this is done, then add up your scores for all the 16 items. Doing so, your total score must fall between 0 and 80. The higher the score, the higher is the self-esteem.

In addition to the above self-reporting measures to determine self-esteem, there are other measures as well. These include a rating scale that H.W. March developed in the year 1990. 

This is an extensive measure that is used to assess the manner in which people evaluate themselves in various domains of life. These include items include physical abilities, appearance, problem-solving abilities, social skills, peer relationships, opposite-sex relationships, and emotional stability.

Another rating scale to measure self-esteem for adolescents and teens was suggested by Harter. This rating scale included subscales that helped in assessing the scholastic competence, athletic competence, social acceptance, physical appearance, and behavioral conduct of an adolescent. 

Note that this type of self-esteem rating scale focused on people having different self-esteem levels for different attributes, situations, and activities. Generally, these scales also include a separate subscale to measure global self-esteem.

Challenges With The Self-Reporting Measures of Self-Esteem

There is no doubt that these self-reporting measures of self-esteem predict a high level of valid outcomes. But these measures incorporate certain challenges.

For instance, as per Baumeister, Tice, and Hutton (1989), certain self-report measures give scores that incorporate self-presentational challenges. What this means is that there is a high probability that people may distort their responses instead of rating how they really feel about themselves. This is because they want to create a particular impression about themselves in the minds of other people. 

Note that a high self-esteem score represents a personality that is assertive and interpersonal. Accordingly, a person possessing such a personality is one who is willing to present oneself to others in a highly positive manner. Likewise, a low self-esteem score represents a personality that is modestly interpersonal. Accordingly, a person having such a personality is the one who is reluctant to present oneself in a highly positive matter. 

Thus, these self-presentational patterns showcase that they are somewhere correlated to how people feel about themselves personally.

In addition to how a person feels about himself or herself privately, he or she may also become defensive when undertaking self-evaluation with regard to self-esteem. 

Accordingly, people rating themselves high on self-report measures of self-esteem fool themselves. They defensively claim to feel better about themselves than they really do. But not all forms of self-deception are unhealthy. Some forms of self-deception are actually healthy. This is because it plays an important role in making psychological adjustments when required.

Thus, researchers like Greenwald and Banaji (1995) have suggested that one must adopt methods from cognitive psychology. Such methods can help to overcome the potential limitations of self-report measures of self-esteem. 

How? Well, as per researchers the cognitive measures of self-esteem such as response latencies, recognition thresholds, and the like are implicit in nature. These measures are less transparent relative to the self-report questionnaires. This means that while taking such tests people would be unaware that their self-esteem was being assessed. 

Theories of Self-Esteem

There are different theories of Self-Esteem that demonstrate how high self-esteem and low self-esteem get developed in an individual. These self-esteem models help us in understanding where self-esteem comes from in an individual. 

I. Affective Models of Self-Esteem

The Affective Models of Self-Esteem are the ones based on an assumption that self-esteem develops at an early age and is characterized by feelings of belongingness and mastery.

Components of Self-Esteem 

A. Feelings of Belonging

The feeling of belongingness is the one in which a person feels that he is loved and valued unconditionally socially. Such a person does not feel as if he is loved or valued for any particular quality or reason. In fact, he believes that he is loved or valued simply for who he is.

Note that a sense of belonging gives people a secure base in life. It gives them the feeling that they are valued and respected irrespective of whatever happens. 

It is important to note that there is a thin line difference between feelings of belonging and reflected appraisals. 

Reflected appraisals refer to the conscious perceptions that a person has about himself of how others view him. If other people believe that a person is funny, then such a person believes that he is witty. That is, reflected appraisals are more intuitive in nature. 

Whereas, the feelings of belonging represent that a person is loved by others and has a sense of security that such feelings bring.

B. Feelings of Mastery

Another important aspect of self-esteem is a sense of mastery. A sense of mastery refers to the perception a person has about himself that he is impacting the world in some way or the other. 

The kind of influence the person is having on the world may not necessarily be largescale in nature. Such an influence can be the one that a person may have in his day-to-day life.

It is important to note that the sense of mastery is not the same as perceived competence. For instance, there is no need for a pianist to think that he is a pianist. Likewise, there is no requirement for a top-rated student in the school to develop a sense of mastery. This is because the feeling of mastery is the one that an individual gets when he is immersed in an activity or is striving to overcome some obstacle.

Let us explain the difference between mastery and perceived competence using a simple example. Say a writer is writing a book. While writing the book, he feels the words or thoughts that come to his mind. He gets numerous joys in researching a topic and creating a story out of it. 

Thus, the joy that comes from that experience creates feelings of mastery. These feelings promote high self-esteem. But such feelings are not the same as believing that one is a “good writer.”

Writing a book involves a process. It involves numerous joys in creating and manipulating the story for a writer. 

On the other hand, perceived competence or evaluation is based on the outcomes that one achieves in life. Thus, it is a judgment an individual makes about himself of whether he is good or bad at something. 

So, the effective models of self-esteem maintain that the feeling of mastery is relevant to the origin of self-esteem and not the perceived competence.

Development of Self-Esteem 

The Affective Models of Self-Esteem claim that the feelings of belonging and mastery develop early in an individual’s life. Erik Erikson, the Danish-German-American developmental psychologist, developed the stages of development in humans

As per the stage development theory, there are eight different stages of personality development in an individual. 

The first stage is the Basic Trust Vs Mistrust stage. As per this stage of psychosocial development,  the first developmental task that infants face is establishing feelings of trust with their caregivers. These feelings of trust are assumed to develop during the first year of life. Further, such feelings correspond to the feelings of belonging that are important for an individual to have a sense of high self-esteem.

The second stage of Erikson’s Psychosocial Development theory is the  “Autonomy versus Shame and Doubt” stage. During this stage, children develop feelings of mastery. They develop such feelings only when they are encouraged to explore, create, and modify their world.

However, children may fail to develop such feelings when their parents subvert, ridicule, or are overly critical of their efforts. So what encourages children to explore, create, and modify their world? It is the healthy caregiver-child relationship that leads to developing attachment bonds and hence high self-esteem.

Attachment Bonds and Self-Esteem

In Erik Erikson’s theory of psychosocial development, the caregiver-child relationship plays an important role. In fact, this relationship plays a key role in other theories of self-esteem development as well including Baumeister & Leary, Bowlby, Epstein, and Sullivan. 

But the theory that is most relevant to the caregiver-child relationship with the perspective of the development of attachment bonds is Bowlby’s Attachment Theory. 

Bowlby was keen to know the foundations and primary functions of attachment bonds between a child and his caregiver. He observed that infants bond with their caregivers, particularly with their mothers, both in humans and other animals. 

The reason why this happened was the fact that the mother-child attachment relationship served a paradoxical function. 

What this means is that a child feels safe to leave the mother and explore the surrounding environment when it becomes securely attached to the mother. As per Bowlby, the secure attachment of the child with the mother developed the feeling of belonging within the child. Further, such a feeling led to a willingness within the child to explore the surrounding environment, a feeling called a sense of mastery. 

This means that individuals of any age are likely to explore the environment away from their attachment figure (mother in this case) when they feel secure. However, such individuals feel an urge toward proximity or staying close to their attachment figure when they feel alarmed, anxious, tired, or unwell.  

Thus, there exists a typical pattern of interaction between the child and the parent. This pattern is called “exploration from a secure base”. This pattern exists in healthy children who believe that their parents are accessible and will be responsive when called upon. This is because they feel secure enough to explore the environment away from their parent.

A series of studies (Ainsworth, Blehar, Waters, & Wall, 1978) were conducted using a procedure called the strange situation to understand such typical patterns. As a part of such studies, a young child, around 14 months of age, visits a psychological laboratory with his or her mother. Bot the child and the mother are made to sit in a room having a number of interesting toys and objects. 

The first variable that the researchers are keen on studying is the degree to which the child explores the objects initially in the room. 

Then, the second variable that the researchers want to study is the manner in which the child reacts to the separation from the mother.

As a part of the study, the mother leaves the child alone with a stranger unexpectedly after staying together with the child for a few minutes. The researchers note the child’s emotional reaction to the mother’s departure. 

Several minutes later, the mother returns and the researcher notes the child’s emotional and behavioral reaction to the mother’s return. In this way, the researchers measure the degree to which a child uses the mother as a secure base from which to explore the environment. In addition to this, they also note down the extent to which such a child considers the mother as a source of comfort in times of stress.

Different Attachment Styles

These studies led to the recognition of three different attachment styles.

• The first one is secure attachment. In this attachment style, the infants showcase a healthy balance between closeness to the mother and independence. Such infants readily separate from their mothers to explore the surrounding environment during the first phase of the strange situation procedure. Although they may be distressed when their mother leaves, such children are curious to see her when she returns. Furthermore, such children enjoy engaging her as well in their play and share their discoveries with her.
• The second attachment style is the anxious/ambivalent attachment style. The children with such an attachment style face difficulty separating during the first phase of the procedure. That is, they are not willing or are afraid to explore the environment. Thus, such children become very distressed and upset when their mother leaves. Although they feel comforted to a certain extent when their mother returns. But, they cling to her and show other signs of insecure dependence.
• The third attachment style is the avoidant attachment style. These children tend to avoid or ignore their mothers altogether. They appear to have little difficulty separating during the first phase of the procedure, and they outwardly exhibit few signs of distress when their mother leaves. Furthermore, they show little interest in her when she returns, preferring instead to play alone rather than interact with her. Importantly, the indifference these infants display toward their mothers is contradicted by an inner sense of anxiety and distress. Rather than being secure and independent, avoidant children are evading intimacy and closeness with their mothers.

Thus, these attachment styles may display the essence of self-esteem. For instance, avoidant infants may develop feelings of mastery. That’s because such infants explore the

Environment willingly. However, they lack a sense of belonging. In other words, such infants fail to develop a strong emotional bond with their mothers.

Likewise, infants who are anxious or insecure may have a sense of belonging. But, they do not develop feelings of mastery. They get distressed easily and are not willing to meet people face-to-face.

However, infants attached to their mothers in a secure way showcase a strong sense of belonging as well as mastery. These children have everything that is necessary to build high self-esteem. This conclusion is supported by research. 

Bowlby developed the concept of the “internal working model” to prove why the early attachment of an infant to the mother has an enduring effect. As per this model, Bowlby explains that as children grow older, they develop a working model of the attachment relationship between themselves and their mothers.

Therefore, a child having a secure attachment with the mother believes that she is good and is worth loving. Whereas, a child having an insecure attachment with the mother believes that she is bad and is not worth loving. 

Also, infants having the above-mentioned attachment styles with their mothers tend to generalize such beliefs to other people and situations as well. Such beliefs form the foundation for the development of self-esteem.

What this means is that a child who believes that he or she is unwanted by his parents also believes that he is unwanted by anyone. On the other hand, a child who believes that he or she is much-loved by his or her parents may have confidence in his parents’ affection.  Also, such children have confidence in other people and believed they are loved by them.

II. Cognitive Models of Self-Esteem

The nature and origin of self-esteem are explained differently under the Cognitive Models of Self-Esteem. These models consider self-esteem as a conscious decision that people make with regard to their worth as an individual.

For instance, you will have high self-esteem if you believe that you possess many socially desirable qualities. Thus, cognitive models signify how an individual evaluates himself or herself in different aspects of life is what determines the self-esteem of an individual.

Cognitive Models of Self-Esteem Formation

The first cognitive model of self-esteem is called the Add-Em-Up Model. This is the simplest of all the three cognitive models and assumes that an individual’s self-esteem is the aggregate of the way such an individual evaluates his or her specific qualities and

attributes. 

The following tables explain the three cognitive approaches to self-esteem. These tables showcase the responses of individuals who rank themselves in terms of 4 attributes using seven-point scales. The attributes include attractiveness, intelligence, likeness, and athleticism. Further, the 7-point scales are as follows: 1= not at all attractive; 7= very attractive. 

For instance, Person A believes he is quite attractive, not terribly intelligent, reasonably well-liked, and very athletic. Likewise, Person B believes he is not terribly attractive, very intelligent, moderately well-liked, and not very athletic.

 Add-Em-Up Model

The table below showcases the individual responses in the case of the Add-Em-Up model. As mentioned earlier, this model of self-esteem assumes that global self-esteem represents the sum of the way individuals evaluate their more specific qualities. 

Thus, we simply need to add up the four self-evaluation scores to determine each person’s self-esteem score. Using this approach, one can anticipate that Person A has higher self-esteem relative to Person B.

	Add-em-up Model
	Attractive	Intelligent	Well-Liked	Athletic	Self-Esteem
Person A	5	2	5	7	19
Person B	3	7	4	3	17

This is because Person A evaluates himself more positively than does Person B. However, there is one limitation of using this method to evaluate an individual’s self-esteem level. This method overlooks the fact that different things are important to different people.

For instance, if sports are more important for person A and academics are more important to person B, then B may feel better about himself relative to A.

Thus, the above example promotes the idea that self-esteem depends on what a person thinks about himself or herself in the areas of high personal importance. What this means is that the outcomes in the areas of high personal importance have a greater impact on the self-esteem of a person than do the outcomes in the areas of low personal importance. 

In addition to this, a person may also feel good about himself or herself when he or she is able to achieve outcomes that exceed his or her personal standards. Likewise, a person may feel bad about himself or herself when he or she achieves outcomes that fall short of his or her personal standards. 

However, of the two, more importance is given to the ‘significance of different attributes’ as a determinant of the self-esteem of a person. Thus, if someone respects himself in certain aspects, then he respects himself in general. For example, if he thinks he is smart, attractive, likable, moral, interesting, and so on, then he thinks well of himself in general. 

But it is clear that a person’s global self-esteem is based not only on the assessment of his qualities but on an assessment of the qualities that matter to him. Thus, the differential importance of self-concept components is thus critically significant for self-esteem.

Weight-Em By Importance Model

This model assumes that self-esteem depends on how individuals evaluate themselves in specific aspects as well as on how important they think it is to be good in those domains. 

The following table showcases the responses of Persons A and B. These responses showcase the order in which each of the four attributes is important for both persons. For instance, point 1 is for least important and point 4 is for most important.

	Weight-Em By Importance Model
	Attractive	Intelligent	Well-Liked	Athletic	Self-Esteem
Person A	5 * (2)	2 * (3)	5 * (4)	7 * (1)	43
Person B	3 * (1)	7 * (4)	4 * (3)	3 * (2)	49

Then, the individuals need to multiply each of the self-evaluation scores by its corresponding importance rating. This rating is mentioned within the brackets. Finally, individuals need to add the products.

As you can see, the individuals are able to anticipate that Person B has higher self-esteem as compared to Person A using the Weight-Em By Importance Model. Person B has higher self-esteem than Person A because Person B values what he thinks he is good at more than Person A does.

Self-Ideal Model

The self-ideal model of self-esteem assumes that self-esteem depends on the difference between who the individuals think they are at present and who they would ideally like to be. 

The following table showcases the responses of Persons A and B in terms of how attractive, intelligent, well-liked, and athletic they would like to be. 

	Self-Ideal Model
	Attractive	Intelligent	Well-Liked	Athletic	Self-Esteem
Person A	5 – (7)	2 – (6)	5 – (7)	7 – (6)	-7
Person B	3 – (3)	7 – (4)	4 – (7)	3 – (2)	+1

For this, they use 7 rating scales where 1 means ‘not at all and 7 means ‘very’. Then, the individuals subtract these ideal self-ratings, mentioned in brackets, from their corresponding self-evaluation scores. Finally, they sum up the differences. 

Thus, using this approach, they are able to predict that Person B has higher self-esteem as compared to Person A. 

III. Sociological Models of Self-Esteem

The basic assumption of the Sociological Models of Self-Esteem is that the societal factors influence the self-esteem of an individual. Accordingly, individuals have high self-esteem if they believe that society at large values them and regards them highly. Taking this into consideration, sociological variables like occupational prestige, income, education, and social status are assumed to impact the self-esteem of individuals. 

However, there is weak evidence that supports such an association. It has been found that the successful, the affluent, the well educated, and the socially privileged do not have higher self-esteem relative to the people who are less advantaged in these areas. 

In fact, people belonging to the stigmatized and minority groups were observed to report higher levels of self-esteem at times relative to those more privileged. One of the reasons of higher self-esteem in disadvantaged groups can be group pride. 

Note that the minority groups are currently encouraged to view their minority status as a badge of honor rather than a stigma. Take, for instance, the Gay pride movement and other similar social movements. In the case of such movements, the group pride impacts the self-esteem of the members of the respective social movements.

This means that as per the social identity theory, self-esteem depends, in part, on the group memberships or social identities of people. People who view their social groups positively enjoy greater self-esteem as compared to those who see their social groups negatively. 

As per research, self-esteem was observed to be positively correlated with a measure of collective self-esteem. Here, collective self-esteem means the extent to which people view or evaluate their social groups in favorable terms. 

Note that such a correlation does not prove that positive group evaluations result in high self-esteem. However, it does establish that personal self-esteem and collective self-esteem are related. 

In addition to the above, research suggested another reason for why members of socially disadvantaged groups do not have low self-esteem. Accordingly, socially disadvantaged groups do not have a low self-esteem as they are able to protect themselves from prejudice and discrimination by:

• regarding negative feedback to prejudice against their group rather than to themselves; 
• selectively comparing their own outcomes with other members of the group rather than with members of the majority group; 
• devaluing attributes on which their group is weak and magnifying the importance of attributes on which their group excels

Puberty is marked by sudden physical, psychological, social, and emotional changes a child goes through as he/she steps into adolescence. It is the time when both boys and girls mature sexually.

There are a lot of uneasy changes happening when children step into adolescence. And not all of them are physical. They are growing physically, psychologically, socially, and emotionally. And this is when puberty can become challenging for them. 

According to G. Stanley Hall, a psychologist who is known as the founder of child and educational psychology, called Adolescence is the period of ‘Storm and Stress’. Where ‘Storm’ meant reduced self-control,  ‘Stress’ referred to the increased levels of sensitivity. 

Further, Storm and Stress are divided into the following three categories:

• Parent-Child Conflict

Adolescents have the tendency to fight or go against authority for they go behind freedom and liberty.

• Disruption of Mood

Biological changes like changes in hormones and cognitive stress during adolescence results in emotional changes. These are responsible for fluctuation in moods. 

• Risky Behavior 

Both emotional immaturity and the neurological need for excitement compel adolescents to take up risky behaviors during this time.  

Now, according to Stanley, these sudden and multiple changes during puberty become challenging to manage for adolescents. And that is why they go through Storm and Stress. 

And in many cases, these pubertal complexities can result in adolescents showing signs of teenage depression. 

Why Does Depression Increase During Puberty? 

As per research studies, the rate of occurrence of depression is equal both in both girls and boys before puberty. However, girls are close to two times more likely than boys to experience depression after the onset of puberty. 

Puberty is a phase where adolescents experience various complexities. These complexities become difficult to handle or manage since they happen early on in life. And that is why these may result in teenage depression and other psychological disorders in adolescents.  

Let’s have a look at the various factors that increase depression during puberty. 

The Sudden and Multiple Pubertal Changes 

Puberty is a phase that is marked by sudden, massive changes responsible for unstable behaviors, attitudes, and mood swings in children turning into adolescents. 

It is typical for parents to take the normal changes due to puberty as a mental illness in teens. This is because it is challenging to tell when these changes are normal and when they take the shape of a mental illness. 

Let’s first have a look at some of the important changes children go through during puberty. 

1. Physical Changes 

These are the most visible changes and are thus easy to spot. Both girls and boys go through various bodily changes during puberty. These are as follows: 

Girls go through bodily changes like: 

• hair growth under armpits and in the pubic region
• developing of breasts
• the onset of the menstrual cycle with an increase in height

On the other hand, boys witness physical changes like: 

• hair growth under armpits and in the pubic area
• the growing size of the testicles and penis 
• deepening of the voice, facial hair growth, and muscle growth with an increase in height  (in boys) gets difficult to accept. 

Now, when the children develop physically, there’s a change in the way they think about themselves and how people connect with them socially. In many cases, children find it difficult to accept sudden bodily changes. They feel uneasy and awkward. This increases the chances of exposing them to teenage depression. 

2. Changes in Social Outlook

Likewise, puberty is also the time when a transition from childhood to adolescence is marked by a changing social outlook. Early adolescence is a tough time where focus shifts from parental relationships to peer relationships. 

Adolescents give more importance to their relationships with peers or friends and how well are they accepted by others. They seek independence from their parents and increasingly depend on close friendships.  

They start valuing social relationships more and show increased dependence on friends and romantic partners. Initially, friends and parents are equally important. However, friends and romantic partners become more important than parents eventually as they reach the end of puberty. And this is where fear of rejection, peer conflict, social pressure, and relationship issues come in. 

Teens seek acceptance, popularity, and are conscious of their social status. Not being able to meet these needs can cause issues of self-esteem, worthlessness, excessive guilt, and in extreme cases self-harm. Thus, it is important to keep track of changes in moods, behaviors, and attitudes which are unavoidable due to the changing social landscape. 

3. Hormonal Changes 

Much like the physical changes, there is a sudden spike in hormone production in teens. The pituitary gland releases hormones that guide the body to increase the production of sex hormones like progesterone and estrogen in the case of girls and testosterone in the case of boys. 

This increased production of hormones during puberty is responsible for developing secondary sex characteristics in both boys and girls. It is responsible for mood fluctuations that can, in some cases, result in symptoms of depression. 

There are studies that reveal that gonadal steroids progesterone and estrogen impact the brain regions that regulate mood and behavior.  

Further, social pressures, early maturing in the case of girls, and the fear of fitting in hold the potential for causing depression during puberty.  

4. Neurological Changes 

These refer to the neurological needs that adolescents have of excitement or stimulation. Neurological connections speedily come together that compel adolescents to indulge in risky behaviors. 

This may prove devastating both for the child and the people around. 

Additionally, there are a lot of other factors apart from these physical, emotional, and biological changes that increase complexities during puberty. These may further increase the likelihood of teenage depression. 

Pubertal Status and Pubertal Timing

Both Pubertal Status and Pubertal Timing are the two most researched factors that are said to affect the psychological adjustments of adolescents. 

Pubertal Status

Pubertal Status is the existing level of development that the adolescent goes through against the total overall pubertal change that typically takes place. That is to what degree is the adolescent currently experiencing the change as compared to the overall changes that take place during puberty. 

Therefore, Pubertal Status lets you know at what stage of physical development is the adolescent at present or at a given point in time. 

Now, Pubertal Status is critical as it involves a comparison of signs of physical maturation. For example, one is able to define the degree of physical growth via the development of physical aspects like:

• breast growth 
• facial hair
• deepening of voice
• hair growth in the pubic region and armpits
• increased size of male sex organ 
• increased height and weight 

These physical changes not only invite responses from parents, friends, and others. They also lead to responses from the adolescent experiencing such changes himself. 

For example, increased weight results in advanced pubertal status in the case of girls. This may lead to body image issues that can trigger depression symptoms and self-esteem issues in them. 

However, mature Pubertal Status is a good predictor of depression in the case of girls relative to boys. 

Pubertal Timing 

Pubertal timing refers to the level of an adolescent’s development as compared to his/her peers. Therefore, early, on-time or late development of an adolescent relative to his/her peers can also lead to maladjustment issues in adolescents. 

In fact, pubertal timing contributes much more to the pubertal maladjustment issues in contrast to the pubertal status in the case of both girls and boys. It results in sad moods in both males and females. Also, the timing of menarche (or period) in the case of females always contributes to depressive symptoms in them when compared to pubertal status.  

Further, when we talk about pubertal timing, we refer to both the physical and psychological development involved in puberty. This is because it includes an adolescent comparing his/her physical development with both social and regular standards. Thus, pubertal timing is actually one of the important factors that indicate whether an adolescent will face adjustment issues or not. That is why it is an important predictor of an adolescent’s overall welfare as compared to the pubertal status. 

There are studies that indicate that before time or late development puts the adolescents at the risk of mental issues like anxiety, depression, aggression, and criminality. 

However, there are other studies that only hold that before time or early maturation only results in problem behaviors in adolescents. For instance, early maturing girls were found to indulge in increased smoking and sexual activities. 

Menarche in the Case of Girls 

Apart from the degree of development and pubertal timing, one of the important factors to take into account is menarche. Menarche, or the onset of menstruation, is the last phase in puberty. Thus, the age at which the girl experiences the first occurrence of menstruation also influences the development of depression symptoms in girls. 

Thus, puberty is an extremely tight time for both males and females as it leads to a bunch of changes. The changing social relationships defining deeper bonds with peers over authority figures and increased consciousness of social status expose adolescents to social stressors that may result in depression symtoms. 

As peer acceptance becomes extremely important, adolescents fear peer rejection and interpersonal issues. Interpersonal issues with peers result in the development of internalizing symptoms in females. These include anxiety, sadness, loneliness, etc. 

Also, rejection sensitivity or an expectation of being rejected by peers is also responsible for increased mental issues in the case of adolescents. 

Accordingly, females who are sensitive to rejection are more likely to have peer conflict and issues with their relationships. Therefore, the increased probability of being liked by peers makes adolescents less sensitive to rejection. 

Signs of Depression

As mentioned earlier, puberty is a difficult time for both males and females. Various physical, biological, and emotional changes may result in a sad mood, rumination, and even self-harm. 

Therefore, it is important for parents, caregivers, and other authority figures to know various signs of depression in teenagers. This will help them to identify the depression symtoms and seek the right help for the children at the right time. 

• irritable mood
• losing interest in activities that earlier interested the adolescent
• significant weight loss or gain
• excessive sleep or difficulty in sleeping 
• feelings of excessive worthlessness or guilt
• loss of energy 
• difficulty in focusing or concentrating
• the threat of losing a loved one (mostly parents)
• self-esteem issues
• avoiding school
• poor performance in academics 
• risky behaviors like drug abuse
• thoughts of self-harming oneself

Depression Treatment: What Helps in Overcoming Teenage Depression?

Depression in teenagers can be treated by anti-depressants, psychotherapeutic intervention, or a combination of both. 

Anti-depressants 

Anti-depressants are recommended by mental health professionals as an initial treatment for mild, moderate, and severe cases of depression. Various anti-depressants are suggested considering the person’s inquisition and various side-effects linked with the medication. Selective Serotonin Reuptake Inhibitors (SSRIs) are the first-line anti-depressants commonly used to treat depression. 

Psychotherapeutic Interventions 

Apart from anti-depressants, mental health professionals also recommend various psychotherapeutic interventions for treating depression in teenagers. Some of the commonly used psychotherapies include: 

• Cognitive Behavioral Therapy (CBT)
• Interpersonal Therapy (IT)
• Family Therapy, etc

You may experience Posttraumatic Stress Disorder (PTSD) if you have been through a trauma. Trauma includes dangerous events that you have been through which may include combat, assault, physical or sexual abuse, natural disasters, or serious accidents. If your reaction to these shocking events does not fade away with time, chances are you have PTSD.

As per the Anxiety and Depression Association of America (ADAA), more than 8 million Americans between the ages of 18 years and above suffer from PTSD. In some cases, PTSD complicates as the impact of the traumatic event may leave you anxious for years. As a result, you may have questions like is PTSD hard to treat or how to treat PTSD?

Now, it is common for people to go through traumatic events and have intrusive memories of the event for years. And the trauma survivors who suffer from PTSD face issues like difficulty in trusting others, problems in communication, and problem-solving. These issues impact theory relationships with family and friends. 

Further, women are two times more likely to suffer from PTSD than men. Likewise, children, too, are at the risk of experiencing PTSD post a traumatic event. 

In this article, we will discuss what is PTSD, is PTSD a mental illness or disorder, PTSD symptoms, and treatment. 

What is PTSD?

PTSD is a mental disorder that you may suffer after going through a traumatic or life-threatening event. These events could include combat, assault, physical and sexual abuse, a natural disaster, or a car accident. It is marked by emotional reactions to such life-threatening events that do not go away with time. The emotional reactions may include fear, hopelessness, and horror. 

As a result, you may have intrusive memories of the traumatic event or flashbacks. Or lose interest in things that earlier used to give you pleasure. Similarly, you would find yourself feeling detached from your mind and body or you may feel the world around as unreal. 

Is PTSD a Mental Illness or Disorder?

Yes, PTSD is a serious mental illness that makes you weak and occurs if you have experienced trauma.  It is quite common to have memories that upset you post experiencing a traumatic event. Initially, you may find it challenging to carry out your routine chores like going to work, being with loved ones, having issues with sleeping, etc. 

Many people start feeling better a few months after the traumatic episode. However, if these issues continue to show longer than a few months, there are higher chances that you may have PTSD. For instance, you may find yourself dealing with the memories of the traumatic event by trying hard to avoid it. Likewise, the anniversary of the traumatic event may make you upset or show severe stigma of mental issues. 

Also, you may feel irritated, show anger, feel helpless, and upset as a result of the combat you had years before if you served during wartime. 

But the good thing is that PTSD diagnosis and necessary treatment can treat this mental health issue.

What are PTSD Symptoms?

The mental health professionals check for symptoms for PTSD diagnosis. As per DSM-5 criteria, the following are the PTSD symptoms that medical professionals check for in children younger than 6 years, children older than 6 years, adolescents, and adults. 

The following PTSD symptoms apply to children older than 6 years, adolescents, and adults.

1. Trauma

Going through a traumatic event. This may include:

• experiencing the trauma directly

• seeing others experiencing a trauma

• knowing about the traumatic event occurring to a loved one

• exposing to the traumatic event details repeatedly 

2. Intrusive Symptoms Related to Trauma

• Showing one or more of the following intrusive symptoms related to the traumatic event

• repeated, intrusive memories of trauma

• repeated dreams whose content relates to trauma

• dissociative reactions such as flashbacks

• excessive psychological distress when exposed to internal or external triggers that remind of trauma

• physiological changes when exposed to internal or external triggers that remind of the traumatic event

3. Avoiding Triggers

Avoiding the triggers continuously to get rid of distressing memories or people, places, etc that give rise to distressing feelings. 

• Negative changes in thought process and mood 

• Changes in the reaction linked to the traumatic event

The above-mentioned disturbances last for more than a month which impairs important areas of functioning. 

In addition to the above symptoms for PTSD, the individual also suffers from either depersonalization or derealization in response to stressors. Depersonalization refers to continuous experiences of feeling detached from one’s body, feeling as if you’re in a dream. Likewise, derealization refers to continuous experiences of the unreality of the surrounding environment. 

Further, you can even self-screen or your family member for PTSD. If you have been feeling worried about a host of events in your routine life, take our PTSD online self-assessment. This will help you understand your PTSD symptoms and see if you need professional help. 

Is PTSD Curable?

PTSD is a  complex and difficult psychophysiological and psychosocial disorder to treat. There may not be any specific cure for PTSD,  but there are treatments that help in reducing the PTSD symptoms. 

These include therapies and medications that help the individuals in reducing or even getting rid of the PTSD symptoms.  

Why is PTSD Hard to Treat?

There are a number of factors that make PTSD complex and hard to treat. 

• People suffering from PTSD experience a host of posttraumatic reactions which persist long after the happening of the traumatic event. 
• They experience intrusive and repeated memories of trauma, avoid trauma-related stimuli, go through negative changes in cognitions and moods linked to trauma, and changes in reactivity. This makes things challenging for them. 
• Further, PTSD may be mild in nature or extremely devastating. In fact, it can even expose individuals to retraumatization or revictimization. 
• Apart from this, some people suffering from PTSD also have the risk of comorbidities. These may include anxiety, depression, substance abuse, personality and dissociative disorders, higher risk of suicide or self-injury. 
• Such factors may result in psychosocial consequences like poverty or homelessness. 

Thus, all these factors make PTSD difficult to treat. That’s why the American Psychological Association has come up with certain guidelines in respect of treatments that are effective for PTSD. 

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. However, each PTSD patient undergoes different treatment. This is becasue each patient may show different PTSD symptoms.  

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. Such interventions are evidence-based that help patients in decision-making. 

The following section answers the question ‘What are the best practices for trauma treatment’. Typically, clinicians recommend four interventions to treat PTSD. Further, the interventions are 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. 

Cognitive psychotherapy 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. 

I. 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. 

II. 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. 

How Therapist Helps the Patient?

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? 

1. Psychoeducation 

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. 

8. NET

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. 

9. Medications 

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. 

Can PTSD Be Cured Without Medication?

As stated earlier, therapies like EMDR can help people reduce PTSD symptoms without medication. PTSD treatment medication comes under conditional treatment for PTSD.  

This means that the psychotherapies and medications that come under conditional treatment may show favorable results. However, there isn’t enough strong proof for their success in reducing PTSD symptoms as the highly recommended methods like EMDR, CBT, etc. 

Further, these medications also come with side effects and they aren’t able to maintain the balance between benefits offered and adverse effects. 

Apart from the highly recommended psychotherapies, people are able to deal with PTSD symptoms with other treatments. These include neurofeedback, vagus nerve stimulation, gratitude journal, and others.   

Complex PTSD Treatment

Complex PTSD is a mental condition closely associated with PTSD. It is a mental disorder that occurs as a result of traumatic events being faced repeatedly over days or months. This is unlike PTSD which results from a single traumatic event being faced by an individual. 

The common symptoms of PTSD include:

• patient not being able to control his feelings
• negative view about self
• finding difficulty in managing relationships
• thinking about the abuser and having feelings of revenge 
• dissociating with one’s emotions or forgetting the traumatic event 
• losing faith in things you once believed and having a negative view of the world

Accordingly, complex PTSD is treated using a mix of psychotherapy and medications. CBT and EMDR are the commonly used psychotherapies to treat PTSD. 

Similarly, commonly used SSRIs or antidepressants for treating PTSD include sertraline, paroxetine, and fluoxetine. 

Posttraumatic Stress Disorder (PTSD) is a disabling mental health issue for which a victim must consult a mental health professional. A traumatic life event such as military combat or losing a loved one may result in PTSD. Hence, a victim must get this treated. Different mental health professionals use various treatments like EMDR, PE, CBT, etc to cure PTSD. However, one of the major challenges that an individual faces is how to find a good therapist for PTSD?

Well, several credible sources help you find a good PTSD therapist or a mental health care provider. These sources help you find the best fit type of mental health professional.

The first few steps that you can take is to ask your family doctor for a referral. Similarly, you can even ask your friends or people close to your family for recommendations. And if you have a health insurance cover like Medicare or Medicaid, you should ask for a recommendation from your insurance provider.

This is because your insurance provider would give you a list of therapists to whom your insurance coverage may apply.

In this article, we will help you with several sources that you can refer to for locating a good PTSD therapist. Further, we’ll also help you with things that you should consider when looking for a PTSD therapist.

Note: Finding a PTSD therapist might take some time. This is because you need to think and evaluate how to locate the best fit therapist. But if you are experiencing a crisis and need immediate help, here are some hotline numbers that you can dial to seek help.

National Youth Crisis Hotline: 800-442-HOPE

The National Suicide Prevention Lifeline: 1-800-273-8255

National Domestic Violence/Child Abuse/Sexual Abuse: 1-800-799-SAFE

How Do I Find a Therapist for PTSD?

There are a host of ways through which you can locate a therapist for PTSD. Good PTSD therapists hail from different disciplines, have experience working in different settings, use a variety of treatment techniques, and have sound experience.

However, there are certain things that you must keep in mind while searching for a PTSD therapist.

Things to Remember

1. Medical Professional’s Education and Years of Experience

Since there are different types of mental health professionals, they have different areas of expertise, credentials, and experience. Thus, you must check their educational background, years of experience, credentials, and area of expertise before choosing a PTSD therapist.

2. Treatments Used for PTSD

Make sure you look for a mental therapist who concentrates on using evidence-based treatments for PTSD. These may include psychotherapies like Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), Eye Movement Desensitization and Reprocessing (EMDR), and PTSD medications that include antidepressants like SSRIs and SNRIs.

3. Insurance and Fees

You should also consider the type of insurance your mental health care provider accepts. This will help you understand whether your mental health care provider will accept insurance cover and to what extent. Also, it will help you know the amount you have to pay out of your pocket (in part or in full) and the overall cost of the treatment.

4. Different Types of Therapists

Many of us do not understand which mental health professional to consult, especially if we are first-timers. There are a variety of mental health care professionals who hold different credentials, licenses, educational degrees, and training. They can also offer different services based on their area of expertise. You can consider visiting one of the mental health care providers based on your need mentioned in the section below.

5. Validation of Feelings

The first step towards successful treatment is to open up about your issues, feelings, and experiences with the mental health professional. Therefore, seeking PTSD treatment would be of no use if you do not share comfort with your therapist. Now, there are several things you can consider here. For instance, whether you would want to meet the therapist in person or whether online therapy is more convenient for you. Similarly, you may consider the gender of the mental health professional as per your comfort.

Also, one-on-one therapy is one thing that works best for most individuals. This is because they feel safe disclosing trauma-related feelings. As a result, they share a trusting relationship with their therapist.

Thus, observe closely your therapist’s personal capabilities. These may include his intuition, perceptions, and the extent to which he can understand your unsaid things. You need to see if the therapist is really interested to hear your story and the issues you are facing. Check if you feel validated.

6. Check for Collaboration Between You and Your Therapist

Another important criterion for choosing a therapist is to see if he empowers you in place of forcing his treatment on you.

Thus, you and your therapist need to work together as partners. This involves sharing responsibility, expertise, as well as trauma-related perspective. The most important part of PTSD treatment is that both parties need to work together and participate actively. This is because the therapist may be an expert in his field. However, it is you, the PTSD survivor, who will tell him about what you feel and go through. Thus, check whether the therapist offers you things like respect, hope, connection, and information, which are the pillars of your healing relationship.

Once you are clear with the above things, the next step is to refer to the right sources that help you locate credible mental health care providers.

Finding a PTSD Therapist

You can adopt various means to locate a suitable mental health care provider.

1. Searching for PTSD Therapist Online

There are several credible online platforms that can help you find a mental health professional for PTSD treatment.

a) Anxiety and Depression Association of America (ADAA)

ADAA is an international non-profit organization that is a credible online resource for treating, preventing, and educating about mental health disorders. These include anxiety, depression, obsessive-compulsive, traumatic disorders.

ADAA has its own therapist directory that has listed licensed mental health care professionals. The mental health care providers include counselors, psychologists, psychiatrists, clinical social workers, and other professionals. These are specialists of mental disorders like anxiety, depression, PTSD, OCD, and other linked mental health issues. Further, all the specialists listed in the directory are professional members of ADAA. ADAA selects these specialists.

Note that ADDA itself is only an online platform that educates, lists mental health care providers, and provides mental health research. That is, it serves you with information that helps you reach credible mental health professionals and make informed decisions. It does not provide clinical treatment, advice, or care of its own.

b) American Psychological Association (APA)

APA is one of the principal scientific and professional organizations that represents psychology in the United States of America. Its members include doctoral-level psychologists who contribute in various sectors. These include research academics, schools, hospitals, prisons, and practitioners.

The APA psychologist locator helps you to find a licensed psychologist. All you need to do is simply fill in the name or the expertise of the health care professional and your city/state zip code.

These professionals specialize in treating various mental health issues. You can search for a mental health care provider based on several criteria. These include telemental health, treatments provided, languages spoken, insurance accepted, etc

c) EMDR International Association (EMDRIA)

EMDRIA is a professional organization that has professionals trained in EMDR therapy as its members. Apart from listing profiles of the EMDR specialists, EMDRIA provides clinical information on EMDR therapy and numerous other resources for the professionals.

Much like other platforms mentioned above, EMDRIA has an EMDR therapist directory. This contains a list of EMDR specialists registered on the platform with their details like name, specialty, language, contact details, etc.

Accordingly, you can search for an EMDR specialist based on parameters like name, location, specialty, language, insurance, population served, etc.

d) Substance Abuse and Mental Health Services Administration (SAMHSA)

SAMHSA is an association that comes under the US Department of Health and Human Services. This agency makes information, research, and services associated with substance abuse and mental disorders more easily available to people.

SAMHSA has its own therapist locator called Behavioral Health Treatment Services Locator. You can use various filters to narrow your search and find a therapist that is the best fit for your mental health issue. For instance, you can sort by city, zip code, facility name, facility address, phone number, state, county, distance, services provided, etc. The locator provides you with complete details of the mental care provider like name, address, contact details, website, services offered, etc.

e) International Society for Traumatic Stress Studies (ISTSS) Clinician Directory

ISTSS is a society that is devoted to providing information about the impact of trauma. It is a platform that shares research about policies and programs that help in reducing stressors that result in trauma. In addition to this, ISTSS provides a forum where researchers can share their research, strategies, and policy in respect of trauma. This platform brings psychologists, psychiatrists, counselors, nurses, social workers, etc together from around the world.

ISTSS has its own clinician directory which lists licensed mental health care providers. You can choose from various types of mental health care providers by applying various filters. These include zip or postal code, state, city, last name, specialty, gender, languages spoken, etc.

f) Sidran Institute Help Desk

Sidran Institute is a non-profit organization that enables people to understand, treat, and recover from traumatic stress including PTSD. It also helps people to know and deal with dissociative disorders and co-occurring issues like suicidality, addictions, self-injury, etc.

It is a community of people who are impacted by the effects of trauma. Accordingly, it includes adolescents, adults, mental health, crisis, public professionals, schools, support networks, and others.

Sidran Institute offers a Help Desk that helps you locate a mental health care professional near you, mental health care centers across the country, and organizations devoted to survivor groups.

g) Psychology Today

Psychology Today is one of the leading mental health online resources across the world. It has a ‘Find a Therapist’ locator that helps you to find a mental health professional that fits your needs. You can fill in the zip code, city, or name of the therapist in the search bar and apply various filters. These include teletherapy, treatment centers, support groups, etc.

2. Finding a PTSD Therapist Via Phone

Apart from these online platforms, you can also approach a mental care provider by phone. You can contact the professionals through the hotline numbers mentioned above.

Some of the other hotline numbers include:

• SAMHSA’s National Helpline Number – 1-800-662-HELP (4357)
• SAMHSA’s Disaster Distress Helpline Number – 1-800-985-5990

In addition to these, you can check mental health services in the phone book. Similarly, you can look in the ‘County Government Offices’ section in the Government pages and search ‘Health Services (Dept. of)’ or ‘Department of Health Services. You’ll see ‘Behavioral Health’ or ‘Mental Health’ listed there.

Likewise, you also have mental health care providers in the yellow pages. These are listed under ‘behavioral health’ ‘psychologists’, ‘mental health’, etc.

3. Locating PTSD Therapist for Veterans

The mental health care needs of veterans including PTSD treatment are different from others. That’s why there are different sets of treatment choices available for them.

For instance, there are VA Medical Centers and various VA clinics that offer PTSD treatment and are under the U.S. Department of Veterans Affairs. This VA locator helps you find out mental health professionals for veterans using various criteria. These include your location, facility type, and service type.

Similarly, there are some special programs offered by VA centers for PTSD. You can go for the VA PTSD Program Locator to search for a VA PTSD program.

Then, there are VET centers that offer to counsel veterans and their families post-war. You can look for a VET center near you to seek such counseling.

To know more about treatment and programs available for veterans, check Help for Veterans.

What kind of Therapist Should I See for PTSD?

Typically, the terms ‘counselors’ or ‘therapists’ are terms that are generic and do not fall under any regulation. Therefore, these terms are typically used to refer to any kind of mental health care provider.

In fact, these terms can be used by anyone who is offering mental health treatment with no need for some specialized training.

Therefore, it is important to check the educational backgrounds of mental health care providers you get associated with. The following are the types of mental health care professionals you can approach for PTSD treatment.

1. Psychologists

We consider people who are Ph.D.’s as psychologists. But this is certainly not the case. People who complete a minimum of four years of post-graduation are Doctors of Education Ed.D, Psychology (Psy.D.), and Philosophy (Ph.D.). However, only those who are given licenses can be called psychologists.

The licensed clinical psychologists have special training in evaluating the client to work out the mental health issue the person is going through and provide necessary treatment.

That’s why one should not assume all Ph.D. holders as psychologists. It may be the case that some of them may have degrees in academics that are not related to therapy in any way. However, they may still decide to practice therapy without any license or professional training.

2. Marriage and Family Therapists and Professional Counselors (LMFT)

LMFTs and professional counselors (LPCs) typically attend two years of graduate school and have at least a master’s degree out of the following:

• Master of Science (M.S.)
• The Master of Arts (M.A.)
• Master of Education (M.Ed.)

Apart from this, LMFTs have special training in family therapy. Also, professional counselors have a wide range of general training in counseling and psychology. The professional counselors typically include Certified Addiction Counselors (i.e. C.A.C. I, II, and III ). Further, it is not necessary that a counselor will have a master’s degree.

They are mental health professionals who offer supportive therapy and concentrate on behavioral challenges that are not categorized as mental illness. Also, counseling is not as rigorous as psychotherapy.

3. Social Workers

These are clinical social workers (CSW) who have attended two years of graduate school and hold at least a master’s degree. Some may even earn doctoral degrees and have varied credentials. A few of the common ones include:

• Bachelor’s of Social Work (B.SW.)
• Master’s of Social Work (M.SW.)
• Academy of Certified Social Workers (A.C.SW.)
• Diplomate of Clinical Social Work (D.C.S.W)

One thing that you must remember here is that all social workers, except a few, have an ‘L’ in front of their degree. For example, L.B.S.W.

4. Other Types of Professionals

There are other mental health care providers who extend mental health care services to people. These include:

(a) Psychiatrists

Psychiatrists, like any other physician, are medical doctors (M.D.s). They earn their medical degree and undertake a specialty course in psychiatry that lasts for four years. Since they are medical doctors, they charge the highest fee among all the mental health care professionals.

They prescribe medication and do not use talk therapy frequently. Further, it is not necessary for you to refer to a psychiatrist for PTSD or any other trauma-related disorder. However, you may do so if you experience complicated or co-occurring medical conditions.

Typically, psychiatrists work with other non-medical mental health professionals for treating and prescribing medication to people with trauma disorders.

(b) Psychiatric Nurses and Nurse Practitioners

These are mental health care providers who have the following credentials.

• Registered Nurse (R.N.)
• Registered nurse Practitioner (R.N.P.)
• Master’s of Science in Nursing (M.S.N.)

(c) Hypnotherapists

Hypnotherapists are skilled professionals who put trauma survivors in a state of trance. This is done to help survivors use their subconscious minds and alter their behavior or thought processes.

Hypnotherapists, while guiding survivors to undertake some exercises, enable them to reach their subconscious state. This is to encourage the survivors to change their negative thoughts and do away with unwanted habits or addictions.

(d) Pastoral Counselors

They are clergymen and women who have credentials like Master of Divinity (M.Div.) and Doctor of Theology (Th.D.). In addition to this, they also have supplementary training in therapy along with a degree from a seminary.

Can Therapy Make PTSD Worse?

Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) are two of the most exhaustively researched and evidence-based CBT treatments for PTSD. That’s why these are the most commonly used treatments for PTSD across various settings and facilities.

Despite being effective, these cognitive-behavioral treatments remain underutilized. This is in part because of the worries of both the researchers and clinicians in respect of using these treatments. The concerns that treatments like PE and CPT result in intensifying or making PTSD symptoms worse or increased dropouts have long been in the discussion.

Now, there have been various studies on whether treatments like PE and CPT result in increased patient dropouts or make PTSD symptoms worse. A few studies suggest that worsening PTSD symptoms or increased dropout as a result of PE and CPT are myths. And this is what is preventing clinicians from using these treatments for PTSD.

However, there are studies that suggest either way. For instance, research undertaken by Kilpatrick and Best claimed that repeated exposure to a traumatic event may result in increased anxiety and dropouts. This specifically applies to people who have experienced sexual assault.

Similarly, victims of childhood sexual abuse may find difficulties with exposure therapy leading to dropout.

In addition to this, a study by Pitman et al. came out with case studies that revealed that EMDR could be better accepted and tolerated by patients and therapists. However, there was no solid reasoning behind it.

Accordingly, it is important to know in what cases does exposure to past trauma lead to intensifying PTSD symptoms and increased dropouts.

When Exposure Therapy May Not Be Ideal?

Revisiting, writing, or talking about past trauma has proved effective with many PTSD patients. In fact, Prolonged Exposure (PE) and CPT are the most commonly used psychotherapies to treat PTSD.

This is because these make the survivor revisit trauma and encounter or feel the process. Such an exposure results in:

• awareness and expressing one’s feelings which helps in healing
• building of trust and faith with the therapist that helps survivors overcome shame or guilt. This is because they feel comfortable coming out with their feelings.
• such opening up results in increased positive thinking and helps overcome anxiety and depression
• survivors understanding and becoming conscious of what happened and why which reduces distress.
• survivor talking his feelings out that helps in healing

However, this may not work in each case.

Revisiting the Past Trauma Can Be a Problem

Despite exposure therapies like PE and CPT having been proved effective in treating PTSD symptoms, these may not be useful in some cases. In fact, these may result in even increasing or worsening PTSD symptoms.

In some cases, the past traumatic event may be too negative or difficult to deal with. That’s why revisiting the trauma may add to the problem. One may feel impaired despite the therapy.

Therefore, it is important to know that avoiding re-exposure to trauma can in some cases prove effective. There are PTSD survivors who chose to focus on other well-balanced, healthy actions instead of going back in time and re-experiencing trauma.

They take up activities like painting, exercising, etc that prove therapeutic for them. Let’s consider the claims made by veteran David J. Morris who is a trauma survivor in his article. He holds that exposure therapy can make things worse, as was the case with him. And that’s what made him drop out of the therapy before completing the sessions.

Likewise, he mentions the study undertaken by a Harvard Medical School psychiatry professor Roger K. Pitman. This was a study on Vietnam veterans who faced some complications post the PE therapy. These included experiencing suicidal thoughts, panic attacks, or depressive moods.

How Do You Get Diagnosed With PTSD Online?

You can take our PTSD online test to know about the PTSD symptoms that may be going through. You can then share these PTSD symptoms with your mental health care provider so that he can undertake a proper diagnosis.

To locate a therapist who can undertake proper diagnosis, you can visit online-therapy.com and register yourself for receiving online treatment.

How Long Does Therapy Take for PTSD?

One of the other typical questions asked with respect to PTSD therapy is ‘How many therapy sessions are needed for PTSD?’ Well, the time period for therapy would vary from case to case, given varying degrees of symptom severity. It is important to note here that both the type and length of therapy must be aligned with the person’s nature and severity of symptoms he’s going through.

For instance, intense PTSD symptoms require more time for treatment than mild symptoms. Likewise, what therapy is your mental health care provider using for treatment also decides the time duration? Similarly, Let’s have a look at the usual time it takes for each of the different therapies used for PTSD.

1. Cognitive Behavioral Therapy (CBT)

CBT is one of the commonly used psychotherapies for treating CBT. As a PTSD survivor, whatever skills you learn during CBT sessions must be practiced repeatedly for symptom improvement. As your therapist focuses on the traumatic event, the idea is to make you identify, understand and alter your thinking and behavior patterns.

Although it may vary from case to case, the CBT usually takes place over 12 to 16 weeks.

2. Prolonged Exposure Therapy (PE)

In Prolonged Exposure, you are asked to revisit the traumatic event. The aim is to face the feelings and trauma memory in a safe, controlled environment repeatedly. This is to help the PTSD survivor overcome trauma-related fear.

PE stretches over 3 months where the sessions are conducted on a weekly basis. Further, each session lasts between 60-120 minutes.

3. Cognitive Processing Therapy (CPT)

In CPT, again the focus is to help the PTSD survivor challenge the current negative thoughts related to trauma. The aim is to enable the survivor to develop a new understanding of the traumatic event. This is to enable the survivor to reduce the negative impact of trauma on his routine functioning.

CPT typically lasts for 12 sessions.

4. Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is unlike the other psychotherapies where changing the emotions related to the trauma is the focus. In this, the trauma-related memory of the PTSD survivors is the focus. The mental health care providers aim to change the trauma-related memory that is understood and stored in the survivor’s brain. Further, survivors are also asked to simultaneously face bilateral stimulations like eye movement. This helps in reducing the emotions related to trauma.

EMDR is provided once or twice a week and typically contains 6-12 sessions.

Why Do Clients Smile When Talking About Trauma?

It is a common practice amongst PTSD survivors to smile when talking about their trauma in the therapy sessions. Smiling certainly is not a gesture they should be showing while narrating the painful, horrifying, abusive childhood experiences.

Yet, you would find trauma survivors laughing and smiling as they come out with those humiliating experiences they had. This mismatch between emotions and their painful stories can actually provide insights about so much about the survivors.

1. It May be a Strategy To Reduce the Trauma Impact

Traumatic events like childhood abuse or losing a loved one bring feelings of humiliation, hate, disgust, and sadness. Thus, to not go into the zone of these feelings, many survivors laugh or smile as they narrate their painful traumatic experiences.

This helps them to keep such feelings at bay. And this is what helps them to reduce the pain associated with revisiting the traumatic memory.

2. Smiling While Narrating Traumatic Experience Can Be a Sign of Feelings of Shame and Disgust

Trauma survivors smiling as they share their painful stories can also be a sign of them feeling shameful or disgusted. It requires a brave heart to come out with experiences that are marked by shame and humiliation.

So smiling may be a way to tell the therapist the shame and embarrassment the survivors are going through. Also, it helps the survivors to not go into the deeper analysis of the traumatic memory.

3. It May Be Used as a Defense Strategy to Avoid Pain

Another thing can be that laughter may help the survivors avoid trauma-related pain. Survivors have the understanding that once the feelings like shame, disgust, anger, hate, etc are processed, they will be possessed by these emotions.

And when such emotions would overpower them, they feel they have no control over their pain. So laughing while narrating their traumatic experience can help them to avoid pain.

4. Laughter Can Indicate Towards Issues With Expressing Certain Feelings Since Childhood

Laughing can also be a sign that there were certain feelings that the survivor was not allowed to express during childhood. For example, many families prevent children from expressing feelings of anger and frustration. In fact, they are looked down upon by elders in the family if children express these feelings.

So laughing or smiling as they express their painful stories can also be an indicator of feelings that they were not permitted to express.

5. It May Reveal Self-Esteem Issues

Laughing while sharing their painful experience may also show a lack of self-worth in survivors. Since the survivor may think he or she is not worthy enough, he may smile to express that he/she is not that important that his painful issue must be discussed.

6. Smiling is a Sign That the Survivor Does Not Know How to Emote Negative Feelings

Finally, it may be an indicator that the survivor is not equipped to express his negative feelings. Many trauma survivors are scared to bring out their negative feelings. This is because they fear how they will react and deal with these negative feelings. Therefore, smiling is a way to deal with such a situation.

This is where the therapists need to understand that the survivors first need to be equipped with emoting negative feelings. Only then can they go ahead with therapy.

Can PTSD Be Cured?

PTSD is no doubt a complex mental health issue. As such, there is no particular cure for PTSD. Yet, there are various treatments available that help in reducing PTSD symptoms.

Mental health care providers use both psychotherapy and medication to treat PTSD. But there is no doubt that it is challenging to treat PTSD.

This is because PTSD survivors repeatedly experience intrusive, trauma-related memories long after the traumatic event. They experience negative alterations in their cognitive abilities and in many cases even witness revictimization.

Not only this, many are at the risk of suffering comorbidities like substance abuse, anxiety, depression, etc.

But, psychotherapies like CBT, CPT, PE, EMDR, etc, and antidepressants have been proved useful in treating PTSD symptoms.

What Therapy is Best for Trauma?

There exist a few therapies that are highly recommended for treating PTSD. All of these therapies are different forms of CBT. These therapies are some of the most widely used and are considered best for trauma. Further, the following section will also help you to understand what happens in therapy for PTSD.

1. Cognitive Behavioral Therapy (CBT)

CBT is a type of psychotherapy where the therapist and the trauma survivor come together to identify and alter unhelpful thought patterns. CBT works by the therapist motivating the survivors to re-analyze their thought patterns and assumptions.

This is to help them recognize unpleasant thought patterns and shift towards more positive and balanced thoughts. Unpleasant thoughts, also called distortions, typically include negative thinking, always thinking of disastrous outcomes, etc which impair routine functioning.

In this, the survivor is exposed to the past traumatic event and reminded of the feelings or emotions associated with it. The aim is to help the trauma survivor reduce avoidance behavior and maladaptive associations with the traumatic event.

Accordingly, some of the important CBT principles involve focusing on the present problem and setting goals, educating the survivor to be his own therapist, and being structured and time-bound.

2. Prolonged Exposure (PE)

This is a type of CBT where the trauma survivors are taught to slowly approach their memories, events, and feelings related to trauma. The aim is to enable the survivors to learn that memories and events related to trauma involve no danger. Hence, there is no need for the trauma survivors to escape from them.

It is typical with trauma survivors to avoid trauma-related memories, feelings, and events. However, running away from anything that reminds them of trauma only adds to their fear.

PE is based on the idea that by repeatedly facing the trauma narrative and dreadful feelings associated with it, one can reduce PTSD symptoms. That is, facing the fear instead of escaping from it can actually help in reducing the PTSD symptoms.

PE involves the therapist giving the trauma survivor a briefing of the treatment and hearing out the survivor’s past trauma. Then, after psychoeducation, the survivor is exposed to the traumatic event. This involves asking the survivor to either re-imagine or relive the trauma. Or it involves identifying places, people, and vents outside the therapy session that remind the survivor of the trauma. The survivor is then asked to face these people, places, etc as a home assignment to get rid of the fear attached to them.

3. Cognitive Processing Therapy (CPT)

This is a type of CBT where the trauma survivor is educated about symptoms of PTSD and the relationship between trauma-related thoughts and feelings. The survivor is made to understand how this association and the automatic thoughts maintain the PTSD symptoms. Here techniques like Socratic Questioning are used by the therapist to help the survivor identify unhelpful thoughts related to trauma. The idea is to help the survivor to identify and alter the maladaptive thoughts.

4. Cognitive Therapy (CT)

CT is also psychotherapy that comes from CBT. The aim of this therapy is to help the trauma survivor alter the negative evaluations and memories associated with trauma. The aim is to interfere with the unhelpful behavior and thought patterns that impair day-to-day functioning.

Here, the mental health care provider enables the survivor to understand the meaning of the trauma-related memories. Not only this, but the professional also helps the survivor to understand how the survivor currently understands them. He also enables the survivor to become aware of the negative evaluations that the survivor has done of the trauma. And that such evaluations will only add to the problem.

The typical strategy used by professionals here is Socratic Questioning, This involves asking questions that help the survivor to evaluate the trauma differently. Not only this, but the therapist also enables the survivor to combine this new, meaningful evaluation with the traumatic memory.

The therapist also directs the survivor to write a meaningful account of trauma by reliving it or revising the places, people, etc who were part of the event. The aim of such exposure is to identify the triggers that evoke strong responses and use cognitive restructuring at that moment.

This helps in getting rid of those unhelpful thoughts related to trauma. Lastly, the mental health care provider also helps the survivor do away with behaviors that may maintain PTSD symptoms in the future. These may include suppression of thoughts, rumination, etc.

People suffering from anxiety issues often go through the uneasiness caused by excessive fear and threat. However, it is actually the avoidance behaviors that they display that are the main reason for their impairment. This is because avoidance behaviors stop them from carrying out routine functions like socializing, dealing with their feelings, etc.

Take the case of a person with OCD. While behaving obsessively can be the cause of concern for him, it is the avoidance behaviors that stop him from normal functioning. For instance, he may perform certain compulsive behaviors like tapping, or checking repeatedly if the doors are closed to avoid any threat or harm.

Thus, what you need to understand here is that fear is a natural response to and is not generally dangerous. It is a natural, automatic response to the threat which is necessary for survival. It results in identifying danger, putting us in fight or flight mode, and taking actions that help us survive. For instance, we may either fight back or run away from the danger. Whereas anxiety is more related to muscle tension, avoidance behaviors, and being vigilant so as to be prepared for the upcoming danger.

Now, what can prove to be harmful is the avoidance behavior seen in people with anxiety. For instance, the fear of talking to people may make them avoid meeting people for work. This may deny them some good work opportunities.

Similarly, people may resort to heavy drinking or drug abuse to avoid painful thoughts.

Let’s have a look at what avoidance behavior is, is avoidance a form of anxiety, how does avoidance prevent anxiety, and how can we reduce avoidance behavior.

What is Avoidance Behavior?

The American Psychological Association (APA) defines avoidance behavior as a single act of a string of actions that help a person to avoid or predict painful events, situations, and stimuli. This also includes conditioned aversive stimuli.

Typically, avoidance behaviors are taken as maladaptive as a response to anxiety or fear. This is because they add to or maintain anxiety disorders. That’s why psychotherapies like Prolonged Exposure or CBT expose people with anxiety to situations, events, or people that trigger anxiety. The idea is to reduce or discourage such people from displaying avoidance behaviors which include escaping or behaviors that induce safety.

Well, there are circumstances where avoidance behaviors can be therapeutic and effective coping strategies for people with anxiety disorders. This is because such behaviors may improve a person’s sense of control over the possible threat as well as the surrounding environment.

So, Is Avoidance a Form of Anxiety?

The question that you may be asking yourself right now could be “Is avoidance a mental disorder” or “Is avoidance a form of anxiety?”

Well, avoidance is not a form of anxiety or mental disorder. Instead, avoidance behaviors are one of the typical characteristics of some anxiety disorders. In fact, the fear and anxiety resulting from an anxiety disorder are closely linked to avoidance behaviors. Though in some cases, avoidance may be adaptive in nature in place of being maladaptive. That is, these avoidance strategies may serve as adaptive coping strategies to deal with anxiety disorders.

Let’s first discuss why avoidance results in maintaining anxiety disorders.

Why Does Avoidance Make Anxiety Worse?

There are various theories of avoidance learning that explain why avoidance makes anxiety worse. These will help us to understand how avoidance leads to maintaining anxiety disorders.

1. Fear, Anxiety, Fear Generalization, and Avoidance

The theory that explains fear and anxiety leading to avoidance behaviors and fear generalization is the Pavlovian Fear Conditioning. As per this theory, avoidance is a consequence of fear and anxiety. Further, one develops fear or anxiety because of Pavlovian Conditioning.

One of the most famous psychological cases where Pavlovian conditioning was first applied is the Little Albert Experiment. In this experiment, an 11-month olds child named Little Albert was exposed to a white rate (Conditioned Stimulus (CS)) to which he showed no fear.

But, the psychologist John B. Watson and his student Rosalie Rayner combined the white rat with the loud noise of a hammer striking the metal bar (Unconditioned Stimulus (UCS)).

When the boy was exposed to such a pairing, Little Albert showed fear and avoidance behaviors, even when he was exposed to the white rat alone. Not only this, the little boy also showed fear and avoidance behaviors towards objects that were similar to the white rat. This indicated words fear generalization. That is, once conditioned to fear an object, one also fears and avoids objects that are similar to the fear object.

Thus, fear and avoidance behaviors towards safe stimuli (CS) and novel stimuli which are similar to the fear object increase instances where people are reminded of the feared object. Therefore, each time they come across the feared object or something similar to it, they experience more fear and anxiety.

For instance, a woman lost her first job because she was not used to checking and replying to emails. Now, whenever she receives any email or a message from a colleague, it triggers fear and anxiety. Even though the email may be an appreciation from a senior or a simple work request. She gets extra vigilant in checking her inbox and delivering work as requested.

2. Avoidance to Protect Oneself From Threat Results in Anxiety

One of the typical things that a person does when he anticipates a threat or is anxious is to display defensive behavior. Now, such a behavior may include avoiding the feared situation or threat to reduce anxiety. Such a behavior may help the person temporarily or in the short-term. However, he may keep feeling fear and anxiety in the long-term.

The following explains how fear and anxiety result in avoidance behaviors and avoidance adds to more anxiety with the help of avoidance theories.

(a) Avoidance Used as a Defense for Perceived Threat

The theory that explains this is the Perceptual-Defensive-Recuperative model. This involves three stages. In the first stage, a person perceives threat.

In the second stage, the person adopts defensive behavior like avoiding people, places, thoughts, or events that remind him of the pain. Or doing activities that save you from the threat . These are called Safety Behaviors which are also a kind of avoidance behavior. Such behaviors help the person to reduce the pain sensitivity.

Finally, he enters the recuperative stage where the behaviors linked to pain return after the threat has passed. Thus, avoidance here may help the person in reducing anxiety in the short-run. However, he may continue to experience fear and anxiety in the long run.

For example, say you perceive the threat of being judged by people for your looks. Now, in order to not feel the pain associated with your looks, you avoid meeting certain people (avoidance behavior) or only step out with makeup on (safety behavior, also a type of avoidance) .

Such defensive behaviors may help you to reduce anxiety associated with perceived threat in the short-run. However, the fear and anxiety will certainly resume once the threat has passed. In this case, people whom you were supposed to meet or the need to step out of home.

In other words, your concerns with regards to your looks will keep appearing in the long-run.

(b) Avoidance Learned Through Negative Reinforcement

B.F. Skinner’s Operant Conditioning also explains how fear and anxiety results in learning of avoidance behavior. Operant Conditioning states that learning depends upon action and its outcome. That is, a behavior is likely to be repeated in the future if such a behavior results in positive or favorable outcomes. However, a behavior is less likely to be repeated in the future if it results in negative or unfavorable outcomes.

Say a person fears talking to people and chooses an action of not taking phone calls which results in reduced anxiety. The chances of avoiding the phone calls in the future increase as this results in reduced anxiety. Thus, the person learns the behavior of avoiding phone calls through negative reinforcement. This is because avoiding the phone results in no anxiety or reduced anxiety for the person.

Now, this too may be helpful temporarily. But, the person may continue to be unwilling to take calls and face such anxiety in the long-run. He continues to believe that taking calls is a threat and should be avoided no matter what.

Further, he does not challenge his devastating thoughts about what may happen if he attends the phone calls. Similarly, he also continues to be extra vigilant of the danger and safety cues which adds to his anxiety.

How Can I Break the Avoidance Cycle?

The main characteristic of anxiety is constant and excessive worry about the anticipated threat. You try to deal with a potential or future occurrence that you think would be devastating. This typically takes place by you being extra vigilant and focusing on cues of such a future occurrence. You also pay attention to yourself and see if you can deal with such a threat.

However, when you see your anxiety symptoms occurring, you get an understanding that you won’t be able to deal with the event. This is what makes you more anxious and initiates the vicious anxiety cycle.

The Vicious Cycle of Anxiety

(1) Being Extra Vigilant

As mentioned earlier, the vicious cycle of anxiety begins with you increasingly inspecting the environment for threat. This leads to increased physical symptoms of anxiety like headache, shortness of breath, stomach pain, etc

(2) Escape or Avoidance Behaviors

Now increased physical symptoms result in restricting your focus only on yourself. This is when you take actions that will keep you away from feeling anxiety. That is, you will either escape or avoid the situation, people, places, conversations, etc.

(3) Short-term Relief From Anxiety

Such avoidance behaviors certainly help in providing relief from anxiety in the short-run. This is because you longer have to face the feared stimuli like socializing, receiving a phone call, going to a shopping center, etc.

(4)Anxiety and Fear Exist in the Long Run

Avoidance may certainly be helpful in reducing anxiety temporarily. However, you will continue to face fear or anxiety from the feared stimuli in the long-run. That is, there will be increased physical symptoms of anxiety, excessive worry, loss of confidence in dealing with anxiety, increased avoidance and safety behaviors.

This will add to more fear and anxiety and that’s how the vicious cycle of anxiety will continue. This is because you are not disconfirming your excessive worry about the anticipated threat. Further, you are continuously scanning the environment for signals of the upcoming danger and what you can do to avoid, escape, or save yourself from such a threat.

This results in more anxiety and generalizing of fear or threat to other situations.

As discussed, vicious cycles play a critical role in sustaining your anxiety disorder. However, you can adopt certain strategies to break this vicious cycle.

How Can We Reduce Avoidance Behavior?

The next question that may come to your mind is how can we reduce avoidance behavior. Well, here are some strategies that you can adopt to reduce avoidance behavior.

(1) Understand the Vicious Cycle of Avoidance

People with anxiety disorders do not purposely allow anxiety and avoidance behaviors to show up. If you are facing anxiety issues, you do not choose to bring in anxiety or show avoidance behaviors in fearful situations. However, the issue is that once the avoidance behavior shows up, it consumes your thoughts and takes control over your emotions and behaviors. As discussed earlier, escape and avoidance behaviors only provide temporary relief from anxiety. But, you must understand that it doesn’t resolve the anxiety issues permanently.

This is because instead of disapproving of your catastrophic predictions, you are getting into learning behaviors. You continue to believe in the fact that the feared stimuli is dangerous and must be avoided no matter what. This intensifies your avoidance and safety behaviors and makes you extra vigilant for signals of danger and safety.

This turns vicious and self-limiting in nature. Therefore, the first step should be to understand this vicious avoidance cycle which helps you to know how you behave, what you worry about, your physical symptoms, etc so that you can know how to break it.

(2) Identifying and Changing Your Behaviors

Identifying what you do in situations that prompt anxiety will come from understanding the vicious cycle. Only then would you be able to change those behaviors. But, why is there a need to identify and change avoidance and safety behaviors?

Let’s take an example here to understand what kind of behaviors you may exhibit and why you need to alter them. Say, you have issues with attending phone calls and hence choose to avoid them. This is because you think taking phone calls may end up consuming your precious work time and leave you exhausted.

Now, you may exhibit the following types of behaviors to reduce your anxiety.

(1) You May Overtly Avoid the Feared Stimuli

Over avoidance is when you dont’ attend the phone calls. This is because you believe that your anticipated fear of you being left with less time or exhausted would come true. Thus, in overt avoidance, you don’t get into the situation where someone would take up your valuable time and leave you exhausted.

(2) You May Covertly Avoid the Feared Stimuli

This is when you take the phone calls but have a conversation with yourself. This is hidden avoidance where you are physically there in the anxiety provoking situation. But, you may not indulge in it.

This may include you saying repeatedly that you shouldn’t have received the call and that you are losing out on precious time. You may not show much interest in having a detailed conversation with the person on the other side. But, this ultimately leaves you sad. Thus, in covert avoidance,

Further, each time you avoid or escape from the feared situation, you are validating that the situation is threatening as you anticipated it to be. So, if you’re taking the phone calls that you were earlier avoiding, you are validating that it is not as bad as you predicted it to be.

Thus, it simply goes like this. The more times you prove your catastrophic predictions, the more evidence you have that the anticipated event was not dangerous.

(3) Alter Your Expectations About Upcoming Threat

Here’s what your original expectation would sound like:

” That person will consume all my time and leave me exhausted. Then, the guilt of offending that person and the pressure of not being able to do my work will leave me sad.”

Here’s what your new expectations can sound like:

” The person I’m talking to may take my time. But, I don’t need to talk for hours. I can talk for sometime, discuss things that add value to the conversation, learn from the other person’s perspective, make them feel good, and get to know him/her better.

(4) Gradually Expose Yourself to Fearful Events

Instead of facing your fear all at once, it’s better to start small and then lead your way towards the intensely feared situations. This will enhance your confidence, reduce your anxiety, and will help you encounter situations that are critical to be dealt with in your case.

Thus, slowly approaching your intensely feared situations is called Graded Exposure. This involves you beginning with facing events that are easier for you to deal with. As you get comfortable and used to such situations, you then shift to more challenging situations. This way, you build up on your confidence, utilize what you have learnt, and face the most challenging situations in a step-by-step way.

Thus, doing this repeatedly over time helps you reduce your anxiety and fear with regards to those situations.

How Does Avoidance Prevent Anxiety?

Until now, we discussed how avoidance behavior can be self-limiting, add to more anxiety, and provide only a temporary fix to your anxiety issues. But in this section, we will discuss Adaptive Avoidance.

Adaptive avoidance is when avoidance behaviors are actually helpful in coping with anxiety disorders. Coping as a concept is a little challenging to understand. This is because coping occurs in a variety of ways.

What are Avoidance Coping Strategies?

(1) Problem-focused Coping

(2) Emotion-focused Coping

(3) Approach Coping

(4) Avoidance Coping

Also Read:

What are the Top 5 Causes of Depression?

10 Tips for Living With Depression

Should I See a Psychologist or Psychiatrist for Depression?

Is PTSD a Mental Illness or Disorder?

How is PTSD Usually Treated?

Can PTSD Be Cured Without Medication?

How Can We Reduce Avoidance Behavior?

How to Find a Good PTSD Therapist?

As per the Anxiety and Depression Association of America (ADAA), 264 million people across the world suffered from depression in 2017. Depression is one of the common mental health issues faced by people and typically occurs more in women as compared to men.

Various life stressors like losing a loved one, financial crisis, losing a job, divorce, etc may make you feel depressed and all alone. This is a natural response to such events. However, the low mood, sadness, and lack of interest in routine activities persist for a longer time if you have been diagnosed with depression.

Depression May Not Occur the Same Way Across People

It is important to know that depression occurs to different people in different ways. For instance, where men may show symptoms like anger, irritability, fatigue, and behavior of substance abuse. Women may, on the other hand, be marked by feelings of guilt, sadness, and worthlessness.

Likewise, depression in teenagers makes them irritable and typically gets such children into trouble in school. They also suffer from comorbid eating disorders, anxiety, and substance abuse.

In addition to this, there are different types of depressive disorders that people are diagnosed with.

The most common out of all is Major Depressive Disorder (MDD). MDD symptoms include :

• sad mood
• a lack of interest in routine activities
• fatigue, weight gain, or loss
• insomnia or hypersomnia
• psychomotor agitation or retardation
• excessive feelings of guilt and worthlessness
• cognitive challenges like reduced concentration, and
• repeated suicidal thoughts

Likewise, another type of depression includes Persistent Depressive Disorder or Dysthymia. One of the critical features of this type of depression is a sad mood for the majority of the days for a minimum of two years.

In addition to this, you may experience Seasonal Affective Disorder (SAD) which is typically a result of lack of sunlight and shorter days during winters. Similarly, you may experience a depressive disorder due to some other medical condition like a terminal illness.

Now, whatever may be the type of depression, it interferes with your routine functioning and impacts your physical and mental health. Thus, it is very important to understand depression and adopt effective strategies to cope with depression.

In this article, we answer some of the typical questions you may have in case you or your loved ones are living with depression.

What Should I Do During Depression?

You may be depressed and wondering what is the most effective way to treat depression? The following are some important tips for living with depression. The following section will help you answer the question “How do I stop overthinking and getting depressed?”

1. Understand Your Depression

One of the important things that can help you deal with depression is understanding your depression symptoms. As mentioned earlier, depression impacts people in different ways. And it may be a possibility that you may be attributing depression symptoms to other life stressors.

For instance, you may be relating fatigue or a sudden weight gain or loss with work pressure. Or you may be considering sadness to be a symptom of depression and as a result, overlooking other symptoms. These may include lack of focus or loss of interest in activities you love doing previously.

Therefore, it is very important to know more about your illness. This is because learning more about your depression type may make you aware of your symptoms. And this may further help in getting a sense of control.

Consulting a mental health professional and joining a self-help group are very good sources of learning more about your illness.

2. Connect With People

Another thing that you can do is to open up and connect with family, friends, or partners. When you are depressed, it is typical for you to isolate yourself from people. Depressed people even keep their problems secret from their loved ones who care about them.

This happens because depressed people have a pattern of going alone and dealing with issues all by themselves. They may not tell how they feel to others and as a result suffer from various issues.

(a) Use “I” Statements to Express Yourself

One way to get rid of this is to list down the names of people with whom you would want to express your feelings. Further, use “I” statements like :

• “I feel (label your feeling) because (say why you feel that )”.
• “I really want (say what you want)”.
• ” I would like it if you would (do what you want the person to do)”.
• ” I hope you understand that (say what you want the person to understand)”.

(b) Try Not to Be Alone

In addition to this, if you are depressed, try not to be alone. Remember, we humans are social beings and always look for opportunities to be with people. No doubt people have their own capacity to socialize. Where some people can”t stay without people for long hours, there are others who prefer being alone for as much time as possible.

But social interaction can be a major concern, especially when you are emotionally depressed. You should always have some people whom you”re close to or a group of friends whom you can be with. It”s important to go out and be with them whenever you feel all alone.

Thus, it”s very important to have the support of such people. This is because it becomes easy to deal with your illness issues when you have these pillars with you.

(c) Be Clear About The Kind of Support You Need From Others

Many people who are depressed keep to themselves because they feel that they will not get the kind of support they need from others. Well, if that”s what stops you too, first be clear about what you want and don”t want from others yourself. Then, share clearly with your loved ones the kind of support you”re expecting from them.

For instance, you can tell them things that you don”t want. These may include:

• Someone asking me to “liven up”
• Others blame me for something I can”t do much about
• They asking me to “overcome the issue”, etc

Similarly, you can also tell others what you want from them. This may include:

• Motivation
• People hearing you out
• Kindness
• Patience, etc

3. Challenge Negative Thoughts

One of the most important things you can do is to change the way you think. This can be done by accepting your negative thoughts and feelings and adopting a solution-oriented approach. Being optimistic about life and having a positive approach to finding solutions can go a long way in challenging negative thoughts.

a) Write Down Statements That Help You to be Optimistic

For this, you can pen down statements like below to get a positive view of life.

• This is tough, but this too shall pass for it is momentary.
• I can”t change my past.
• Being in the past prevents me from living the good in the present.
• I”m not going to overthink and go insane with things that I can”t change.
• I can live through this illness.
• I can learn from my past to find solutions to my current and future problems.

b) Identify Automatic and Illogical Thoughts

Likewise, there are certain illogical thoughts that come to you automatically. These are the thoughts that compel you to have a negative view of the world. Always remember that these thoughts are baseless for they are not founded on any facts. Yet, you consider them to be true.

Thus, identify your irrational and automatic thoughts and then substitute them with logical/positive ones. Sit with yourself and write down these automatic triggers. For instance:

• You magnify the negative outcomes of a situation that are disproportionate to the given situation. (Magnifying)
• You randomly forecast that life will turn out to be bad for you. (Predicting)
• You consider your mistakes to be things that define you and end up saying statements like “I”m foolish” or “I”m worthless.” (Labeling)
• You force yourself on the thought that your positive qualities don”t matter. (Discounting)

c) Reason Out With Illogical Thoughts

Once you identify your negative thoughts, try to sort them out with them each time they strike you. Since you now know your negative, unreasonable thoughts, catching them each time they occur would not be a challenge.

So, take the negative thought once it’s there. Then analyze how much this thought is true on a scale of 1-100. Then, evaluate what type of negative response is this, as discussed in the above point. For instance, whether it’s labeling, discounting, magnifying, etc.

Next, think of the positive response that you can substitute this unreasonable thought with. And finally, rate this new positive thought in terms of the degree to which you think sits true on a scale of 1 – 100.

Thus, such an evaluation will help you question your negative thoughts each time they occur.

(d) Getting Rid Of Negative Thoughts About Others

There may be times when you may find it challenging to understand others without judging them. Also, many times there are people who are over-critical about others to an extent that they don”t think that others have any good traits.

As a result, such people put all their energies into thinking about the negative side others have according to them. And this is what leaves them alone, sad, and irritated most of the time.

Such negative judgments about others make them unhappy and leave them discontented. Therefore, make note of these negative judgments and let them go whenever they strike you.

(e) Have a Solution-Oriented Approach

One of the major reasons why people are depressed is that they are always concentrating on their problems. Instead of spending time finding solutions to their problems, all their energy is consumed in worrying about the problems.

Thinking over and resolving your problems creates opportunities. Start small, with one problem at a time. People who are depressed get wired for thinking that they have a lot of problems and they are unsolvable. But, they need to understand that problems can be worked out, provided they set reasonable targets and take required actions to meet these goals.

(f) Have an Inner Voice That Heals

You may have that inner voice that constantly criticizes you and challenges your self-worth. This voice develops over the years as a result of someone of authority who has been over-critical about you.

This is where you have to bring a change. You don”t have to listen to it anymore and instead develop a voice that heals you when you are not in your best mood.

4. Do Activities That Make You Feel Good

This is another important strategy to deal with your depression. Take up activities that will help you relax and rejuvenate. These could be activities that help you deal with stress, adopt a healthy way of living, and include activities in your schedule that have an element of fun.

How can this be achieved? Well, by having a wellness toolbox that helps you deal with depression.

Now, some of the things that can come in this wellness box could be:

• Reading a good book
• Having a video call with friends/family
• Watching funny content like a movie or a sitcom
• Having a long hot bath
• Listening to music, etc.

How this actually works is that these relaxing activities help you break the cycle of stressful feelings. Now, we know that some amount of stress is good for it gives us that push needed to meet our goals. However, even mild stress for longer periods turns into chronic stress and results in increasing the stress hormone called cortisol.

Thus, with time, cortisol makes your immune system weak and impacts your mental health. And taking up activities such as recreational, social, planning, self-care, and creativity can help you fight depressed feelings.

5. Exercise, Exercise, Exercise

One of the costs that we are paying for modern-day life is the sedentary lifestyle. Given the time pressure and the nature of work becoming digital, there is less physical activity. In fact, not many of us are not able to plan physical work-out in our schedule.

Since we are sitting for most of the day, it is resulting in issues like obesity. Now as per studies, physical activity helps in reducing depressive symptoms. Thus, reduced physical activity increases the risk of developing depressive symptoms in people.

Similarly, exercising too helps in uplifting one”s mood. It not only proves to be beneficial for the neuroendocrine systems. But, also for improving one”s self-esteem and efficiency which are the major issues with depressed people. Likewise, it gives one the opportunity to socialize, improve body image, and reduce comorbid mental disorders.

In addition to this, exercise is known to regulate cortisol levels and increase the circulation of beta-endorphins. This helps in relaxation and reducing depressive symptoms.

Much like exercise, yoga has proved to provide physiological advantages. In addition to this, yoga also has the element of mindfulness to it. This helps in enhancing concentration and getting rid of rumination, which is a characteristic of depression.

6. Eat a Healthy Diet

Many of us take this for granted and are not very particular about what we eat. But it is important to note what you eat directly impacts both your physical and psychological wellness.

Well, that is not to say that you have to go way too far managing your diet. All you have to do is be careful with what you are eating and look for approaches that can help you bring about marked changes.

Here”s a list of things that add to your depression. Therefore, it is suggested to limit the consumption of these things.

1. Alcohol and Nicotine

Both alcohol and nicotine make you dependent on them as they are addictive in nature. Where alcohol serves as a depressant, nicotine acts like a stimulant. And both alcohol and nicotine do nothing good but add to your anxiety levels.

2. Caffeine

Caffeine, much like nicotine, serves as a stimulant. Caffeine is present in items like coffee, tea, chocolates, etc. So, if you are a heavy tea or a coffee drinker or have chocolates to get out of a bad mood, you”re actually adding to it. Caffeine does give you that energy kick. But this is momentary in nature. In fact, this momentary energy booster may make you feel all consumed and tensed.

In fact, a high caffeine intake is associated with many other issues like anxiety attacks, irritation, palpitations, heartburn, insomnia, high blood pressure, etc.

3. Sugar and Salt

People who have a high sugar-intake certainly suffer from issues like diabetes. However, foods high on sugar also carry the risk of depression in people who include these foods in their diet.

Similarly, too much salt consumption is associated with issues like high blood pressure and affects your weight. This may put you in a bad mood.

4. Preservatives

Processed foods contain preservatives which are not good for the human body. In fact, there have been endless debates on preservatives and their probable side-effects. Therefore, it is important to substitute foods that contain preservatives with organic food items.

7. Go For Mindfulness Meditation

Meditation also contributes towards uplifting mood and reducing the chances of depressive incidents. Meditation leads to mindfulness which is increased awareness. This happens when you try to focus in a specific way as you meditate.

You concentrate on your objective in the current moment without any judgments. Thus, when you are mindful, you are aware of both your inner experiences and the things happening around you.

As a result, you don”t end up reacting to these experiences or categorizing them as good or bad. And that is the reason why practicing mindfulness by undertaking meditative practices have proven to be effective for dealing with depression.

Also, there are a number of benefits associated with increased mindfulness practice on a routine basis. These include increased concentration levels, a good immune system and memory.

Now, mindfulness is of two types. The first one is mindfulness where you keep some dedicated time to practice the same.

The other is mindfulness where you are mindful of routine activities. These may include talking, working, eating, etc. As you become mindful, you try to understand your emotions and feelings as you take up these activities. This is done without judging any of them.

8. Have a Good Night”s Sleep

Disturbed sleep is one of the critical symptoms of depression. There is a strong connection between insomnia and depression. Thus, having proper sleep is very important both for one”s physical and mental health.

Also, insomnia can be a predictor of depression, much like depression being a predictor of insomnia. As per research studies, people who suffer from chronic insomnia have a higher risk of depressive disorder.

Similarly, as per another study, people who currently suffer from anxiety or a depressive disorder had a strong connection with disturbed sleep.

Also, 40% of the insomniacs experienced comorbid disorders. Further, disturbed sleep is also associated with bad mood, stroke, diabetes, obesity, and coronary artery disease.

Lack of sleep is linked to disturbance in the circadian rhythm. Therefore, it is important that one seeks ways to improve sleep issues. Most commonly used treatment involves sleep hygiene techniques and CBT, that includes hypnotic and antidepressant medication.

Lifestyle changes also help in improving sleep. This may be done by shifting from a sedentary to an active lifestyle, having a healthy diet, reducing caffeine and alcohol use.

9. Managing Recreational Substances

Recreational substances include consuming alcohol, smoking cigarettes, and increased caffeine intake. Where alcohol acts as a depressant, cigarettes and caffeine serve as stimulants.

In fact studies conducted revealed that two to three times increased lifetime risk of anxiety and depressive disorders in people who engaged in alcohol abuse or depended on it.

Likewise, adolescents and young adults engaging in heavy alcohol consumption had a higher risk of depressive disorders in later life.

Much like alcohol, smoking cigarettes also increases the risk of anxiety and affective disorders. It also carries the risk of developing de-novo depression. Likewise, adolescents smoking cigarettes have the higher risk of developing depression in later life.

People with depression often get into the habit of smoking. In fact, people who suffer from unipolar depression and bipolar disorder and engage in smoking experience much more. Smoking not only results in severe symptoms in these people. It also negatively impacts their response to the treatment.

Smoking also increases inflammation and oxidative stress, both of which are components of depression.

Finally, a high caffeine intake can also add to depressive symptoms. No doubt caffeine helps in improving concentration, attention, cognition, and mood. However, high caffeine intake adds to insomnia which increases the chances of depressive mood.

10. Get Your Share of Daily Sunlight

Sunlight helps in pushing serotonin levels and enhances your mood. Therefore, it is important for you to have your daily share of sunlight. Whenever you get time, sit for 15-20 minutes in the sun every day with your sunscreen on.

This could include a small stroll between the work hours, having a cup of tea or coffee outside, or picking up an activity like gardening.

You can also exercise during the early hours of the morning, when you have a mild sunlight.

Also Read:

What are the Top 5 Causes of Depression?

10 Tips for Living With Depression

Should I See a Psychologist or Psychiatrist for Depression?

Is PTSD a Mental Illness or Disorder?

How is PTSD Usually Treated?

Can PTSD Be Cured Without Medication?

How Can We Reduce Avoidance Behavior?

How to Find a Good PTSD Therapist?

There is no one particular cause of depression. You can experience depression for a host of reasons. Depression occurs differently in different people and thus there are various stimuli that can act as triggers.

For instance, there may be people who experience depression due to a stressful event. This could be losing a loved one, experiencing divorce, terminal illness, etc.

Also, there can be a combination of events that can act as triggers for depression. For instance, you may experience an illness and at the same time lose a loved one.

Many people also go into depression with age. This is mostly due to the financial crisis they are into or their social life which makes them depressed.

People who feel depressed also mention the downward spiral of events. For instance, one may see a financial crunch which may make them withdraw from social life, lose interest in routine activities, and get into alcohol consumption.

Let’s see what are the top 4 causes of depression.

1. Environmental Factors

One of the top reasons for depression is unfavorable childhood experiences. Different types of unpleasant childhood experiences are one of the critical predictors of depression later in life. These majorly include stressful events like seeing the separation of one’s parents, child abuse, losing a loved one, etc.

Events like these make one withdraw from family and friends and deal with things on their own.

2. One’s Temperament

Personality or one’s nature also plays a significant role in making one vulnerable to depression. For instance, you may be facing low self-esteem issues or could be excessively critical about yourself.

This could result from your childhood experiences, your genes, or both.

3. Genetic and Physiological Factors

It is quite likely to inherit depression from someone in your first blood. In fact, iaf you have someone in the first-degree family who suffered from depression, the chances of you having depression increase by two – four times.

4. Course Modifying Disorders

As per DSM-5, all the non-mood disorders increase the risk of depression in an individual. Some of the common non-mood disorders include anxiety, substance use, and BPD.

A serious illness may also result in one showing depressive symptoms. These illnesses could be diabetes, cardiovascular disease, or morbid obesity.

5. Loneliness

You may experience loneliness which may be an outcome of withdrawing from family and friends. Similarly, those who decide to stay alone or do not seek partnerships suffer from loneliness which has the higher possibility of leading to depression. on-mood disorders increase the risk of depression in an individual.

What Should You Avoid if You Have Depression?

As discussed in the earlier sections, there are a number of things that you should avoid if you are depressed.

1. Do not lose connection with people. Withdrawing from family and friends or being lonely adds to your depression.

2. It’s difficult to move out of bed. But, don’t stay in bed for days as this makes you feel more depressed. Instead, exercise and get going.

3. Don’t consume alcohol and indulge in smoking cigarettes. Where alcohol acts as a depressant, smoking tobacco works like a stimulant. These add to your depressive mood, despite giving you temporary relief.

4. Listening to negative news also acts as a trigger and adds to the depressive mood. It makes one more pessimistic about life as its various aspects.

5. Avoid processed foods, foods high on sugar and salt, caffeine intake though tea, coffees, and chocolates.

6. Avoid negative thoughts that make you pessimistic and severely impact your mood.

7. Don’t work till late nights and make sure you are having a good night’s sleep.

How Can I Stop Being Sad Anymore?

The strategies mentioned above can help you to stop being sad anymore. For instance:

• Connecting with your family and friends and letting them know the kind of support you want from them
• Taking up mindful meditation to become aware of the current situation without being judgemental
• Taking up activities that make you feel good. These could include painting, reading, exercising, having a hot bath
• Creating a gratitude journal which involves writing things that you are grateful for appreciate, or are thankful for
• Having a good night’s sleep
• Avoiding consumption of recreational substances like alcohol, cigarettes, and caffeine
• Managing your diet and making sure that you consume healthy foods
• Increasing positive feelings
• Visualizing a positive future that can help uplift your mood
• Identifying and practicing your core strengths like love for learning, perseverance, honesty, kindness as a trigger and adds to

What is The First Line Treatment for Depression?

Antidepressants serve as the first-line agents for treating depression. The commonly used antidepressants for treating depression and approved by the FDA are as follows:

SSRIs: These are the antidepressants that are highly prescribed by the mental health professionals for treating depression. These include citalopram, escitalopram, sertraline, fluoxetine, paroxetine, and fluvoxamine.

What Happens in the Brain During Depression?

The depression symptoms like lack of interest and self-worth, poor concentration, etc are the result of dysfunctional neural networks.

Likewise, there are other processes that take place in depression. These include biological processes that involve changes in neurotransmitters, hormonal homeostasis of stress, metabolic dysfunction, increased inflammation leading to impaired metabolism, etc.

Also Read:

What are the Top 5 Causes of Depression?

10 Tips for Living With Depression

Should I See a Psychologist or Psychiatrist for Depression?

Is PTSD a Mental Illness or Disorder?

How is PTSD Usually Treated?

Can PTSD Be Cured Without Medication?

How Can We Reduce Avoidance Behavior?

How to Find a Good PTSD Therapist?

As stated earlier, therapies like EMDR can help people reduce PTSD symptoms without medication. PTSD treatment medication comes under conditional treatment for PTSD.  

This means that the psychotherapies and medications that come under conditional treatment may show favorable results. However, there isn’t enough strong proof for their success in reducing PTSD symptoms as the highly recommended methods like EMDR, CBT, etc. 

Further, these medications also come with side effects and they aren’t able to maintain the balance between benefits offered and adverse effects. 

Apart from the highly recommended psychotherapies, people are able to deal with PTSD symptoms with other treatments. These include neurofeedback, vagus nerve stimulation, gratitude journal, and others.   

You may experience Posttraumatic Stress Disorder (PTSD) if you have been through a trauma. Trauma includes dangerous events that you have been through which may include combat, assault, physical or sexual abuse, natural disasters, or serious accidents. If your reaction to these shocking events does not fade away with time, chances are you have PTSD. As per the Anxiety and Depression Association of America (ADAA), more than 8 million Americans between the ages of 18 years and above suffer from PTSD. Since the impact of the traumatic event may leave you anxious for years, it gets complicated in some cases. That is why you may have questions like ‘Why is PTSD hard to treat?’ or ‘How is PTSD usually treated?’

Now, it is common for people to go through traumatic events and have intrusive memories of the event for years. And the trauma survivors who suffer from PTSD face issues like difficulty in trusting others, problems in communication, and problem-solving. These issues impact theory relationships with family and friends. 

Further, women are two times more likely to suffer from PTSD than men. Likewise, children, too, are at the risk of experiencing PTSD post a traumatic event. 

In this article, we will discuss what is PTSD, is PTSD a mental illness or disorder, PTSD symptoms, and treatment. 

What is PTSD?

PTSD is a mental disorder that you may suffer after going through a traumatic or life-threatening event. These events could include combat, assault, physical and sexual abuse, a natural disaster, or a car accident. It is marked by emotional reactions to such life-threatening events that do not go away with time. The emotional reactions may include fear, hopelessness, and horror. 

As a result, you may have intrusive memories of the traumatic event or flashbacks. Or lose interest in things that earlier used to give you pleasure. Similarly, you would find yourself feeling detached from your mind and body or you may feel the world around as unreal. 

Complex PTSD Treatment

Complex PTSD is a mental condition closely associated with PTSD. It is a mental disorder that occurs as a result of traumatic events being faced repeatedly over days or months. This is unlike PTSD which results from a single traumatic event being faced by an individual. 

The common symptoms of PTSD include:

• patient not being able to control his feelings
• negative view about self
• finding difficulty in managing relationships
• thinking about the abuser and having feelings of revenge 
• dissociating with one’s emotions or forgetting the traumatic event 
• losing faith in things you once believed and having a negative view of the world

Accordingly, complex PTSD is treated using a mix of psychotherapy and medications. CBT and EMDR are the commonly used psychotherapies to treat PTSD. 

Similarly, commonly used SSRIs or antidepressants for treating PTSD include sertraline, paroxetine, and fluoxetine.

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How to Find a Good PTSD Therapist?

Yes, PTSD is a serious mental illness that makes you weak and occurs if you have experienced trauma.  It is quite common to have memories that upset you post experiencing a traumatic event. Initially, you may find it challenging to carry out your routine chores like going to work, being with loved ones, having issues with sleeping, etc. 

Many people start feeling better a few months after the traumatic episode. However, if these issues continue to show longer than a few months, there are higher chances that you may have PTSD. For instance, you may find yourself dealing with the memories of the traumatic event by trying hard to avoid it. Likewise, the anniversary of the traumatic event may make you upset or show severe stigma of mental issues. 

Also, you may feel irritated, show anger and feel helpless and may still be left upset by the combat that you had years before if you served during wartime. 

But the good thing is that PTSD is a mental health issue that can be treated with PTSD diagnosis and necessary treatment by professionals. 

What are PTSD Symptoms?

The mental health professionals check for symptoms for PTSD diagnosis. As per DSM-5 criteria, the following are the PTSD symptoms that medical professionals check for in children younger than 6 years, children older than 6 years, adolescents, and adults. 

The following PTSD symptoms apply to children older than 6 years, adolescents, and adults.

• Going through a traumatic event. This may include:
  • experiencing the trauma directly
  • seeing others experiencing a trauma
  • knowing about the traumatic event occurring to a loved one
  • repeatedly getting exposed to the unpleasant details of the traumatic event 
• Showing one or more of the following intrusive symptoms related to the traumatic event
  • repeated, intrusive memories of trauma
  • repeated dreams whose content relates to trauma
  • dissociative reactions such as flashbacks
  • excessive psychological distress when exposed to internal or external triggers that remind of trauma
  • physiological changes when exposed to internal or external triggers that remind of the traumatic event
• Avoiding the triggers continuously to get rid of distressing memories or or people, places, etc that give rise to distressing feelings. 
• Negative changes in thought process and mood 
• Changes in the reaction linked to the traumatic event
• The above mentioned disturbances last for more than a month which impairs important areas of functioning. 
• In addition to the above symptoms for PTSD, the individual also suffers from either depersonalization or derealization in response to stressors. Depersonalization refers to continuous experiences of feeling detached from one’s body, feeling as if you’re in a dream. Likewise, derealization refers to continuous experiences of unreality of the surrounding environment. 

Further, you can even self-screen or your family member for PTSD. If you have been feeling worried about a host of events in your routine life, take our PTSD online self-assessment. This will help you understand your PTSD symptoms and see if you need professional help. 

Is PTSD Curable?

PTSD is a  complex and difficult psychophysiological and psychosocial disorder to treat. There may not be any specific cure for PTSD,  but there are treatments that help in reducing the PTSD symptoms. 

These include therapies and medications that help the individuals in reducing or even getting rid of the PTSD symptoms.  

Why is PTSD Hard to Treat?

There are a number of factors that make PTSD complex and hard to treat. 

• People suffering from PTSD experience a host of posttraumatic reactions which persist long after the happening of the traumatic event. 
• They experience intrusive and repeated memories of trauma, avoid trauma-related stimuli, go through negative changes in cognitions and moods linked to trauma, and changes in reactivity. This makes things challenging for them. 
• Further, PTSD may be mild in nature or extremely devastating. In fact, it can even expose individuals to retraumatization or revictimization. 
• Apart from this, some people suffering from PTSD also have the risk of comorbidities. These may include anxiety, depression, substance abuse, personality and dissociative disorders, higher risk of suicide or self-injury. 
• Such factors may result in psychosocial consequences like poverty or homelessness. 

Thus, all these factors make PTSD difficult to treat. That’s why the American Psychological Association has come up with certain guidelines in respect of treatments that are effective for PTSD.

Also Read:

What are the Top 5 Causes of Depression?

10 Tips for Living With Depression

Should I See a Psychologist or Psychiatrist for Depression?

Is PTSD a Mental Illness or Disorder?

How is PTSD Usually Treated?

Can PTSD Be Cured Without Medication?

How Can We Reduce Avoidance Behavior?

How to Find a Good PTSD Therapist?

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? 

1. Psychoeducation 

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. 

8. NET

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. 

9. Medications 

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. 

Also Read:

What are the Top 5 Causes of Depression?

10 Tips for Living With Depression

Should I See a Psychologist or Psychiatrist for Depression?

Is PTSD a Mental Illness or Disorder?

How is PTSD Usually Treated?

Can PTSD Be Cured Without Medication?

How Can We Reduce Avoidance Behavior?

How to Find a Good PTSD Therapist?