Most people experience
considerable distress and avoidance after being exposed to a severely traumatic experience. This is a normal and adaptive
response and often includes reliving the event in thoughts, images, and dreams. This
initial reliving of the event may in fact contribute to the healing process and provide a way of achieving mastery over the
event. For most people, these symptoms usually become less severe and gradually disappear over time. For others, the symptoms
persist and become chronic, leading to PTSD.
What treatments have been shown to be effective for PTSD?
PTSD is treated by
a variety of forms of psychotherapy (talk therapy) and pharmacotherapy (medication).
There is no single best treatment, but some treatments are quite promising, especially cognitive-behavioral therapy which
includes a number of techniques such as cognitive restructuring and exposure therapy.
Cognitive therapy is based on the idea that thoughts and feelings are connected. The goal in cognitive therapy is therefore to help
people identify and challenge problematic thinking patterns to reduce distress. For example, a soldier who fired on and killed civilians at a checkpoint might feel guilty because he believed “it is my fault.”
Through cognitive restructuring he would challenge the belief that it was his fault and replace it with a more accurate one,
such as “Firing my weapon was a last resort.”
Exposure therapy is another form of CBT and is based on the idea that during the traumatic event people learn to be afraid of thoughts,
feelings, and situations that remind them of the traumatic event. Exposure therapy involves careful, repeated, detailed imagining
of the trauma (exposure) in a safe, controlled context to help the survivor face and gain control of the fear and distress
that was overwhelming during the trauma. For example, a sexual assault survivor may be asked to describe what happened to
her over and over again in the session until she “learns” not to be afraid of the memory of her assault. In some
cases, trauma memories or reminders can be confronted all at once ("flooding"). For other individuals or traumas, it is preferable
to work up to the most severe trauma gradually by using relaxation techniques and by starting with less upsetting life stresses
or by confronting the trauma one piece at a time ("desensitization").
Medication. Studies have also shown that medications help ease associated symptoms of
depression and anxiety and help with sleep. The most widely used drug treatments for PTSD are the selective serotonin reuptake
inhibitors (SSRIs), such as Prozac and Zoloft, which are approved by the Food and Drug Administration as treatments for PTSD.
Are there any other PTSD treatments?
Group Treatment. Trauma survivors are able to share traumatic material
within the safety, closeness, and understanding of other survivors. As group members achieve greater understanding and resolution
of their trauma, they often feel more confident and able to trust. As they discuss and share how they cope with trauma-related
shame, guilt, rage, fear, doubt, and being down on themselves, they begin to focus on the
present rather than the past. Telling one's story (the "trauma narrative") and directly facing the feelings related
to trauma allows many survivors to cope with their symptoms, memories, and other aspects
of their lives.
What if someone has PTSD and another disorder? Is the treatment different?
It is very common to
have PTSD at that same time as another disorder. Psychiatric disorders that commonly
co-occur with PTSD include depression, alcohol/substance abuse, panic disorder, and other anxiety disorders. In many cases,
the PTSD treatments described above will also help with the other disorders.
What can I expect from my therapist?
When you begin psychotherapy,
you and your therapist should decide together what goals you hope to reach in therapy. Not every person with PTSD will have
the same treatment goals. For instance, not all people with PTSD are concerned with lessening their symptoms. Some people
want to learn instead the best way to live with existing symptoms and how to cope with other problems associated with PTSD.
Perhaps you want to lessen your feelings of guilt and sadness? Perhaps you would like to work on more tangible aspects of
your distress, like your relationships at work, or communication issues with your friends and family. Your therapist should help you decide
which of these goals seems most important to you, and he or she should let you know which goals might take a long time to
achieve. If you have any questions about the treatment your therapist should
be able to answer them.
Another aspect important
to the course of good therapy is the relationship you have with your therapist. If you feel comfortable with your therapist
and feel you are working as a team to tackle your problems, it is likely that the therapy will go well. If you have concerns
about your therapist, or concerns about the therapy, you should speak with your therapist about them. Therapy is not easy.
It can be difficult to talk about painful situations in your life, or about traumatic experiences that you have had. Feelings that emerge during therapy can be frightening and challenging. Talking with
your therapist about the process of therapy, and about your hopes and fears in regards to therapy, will help make therapy
successful.
