In the last post, I explored the criteria for Posttraumatic Stress Disorder (PTSD). Next, let’s look at the types of treatments that are available to treat PTSD.
Cognitive therapies focus on how a person thinks about and approaches the trauma. These therapies focus on identifying and shifting the distorted beliefs that arise from trauma (e.g., taking responsibility for the trauma) and looking at the connections of thoughts, emotions, and behaviors that contribute to stressful symptoms after a trauma. In cognitive therapies for treating PTSD, a therapist and client may focus on identifying what increases distress and replacing those thoughts and feelings with more adaptive ones.
Many types of cognitive therapies are used in treating PTSD. For example, Cognitive Processing for PTSD (CPT) focuses on challenging overgeneralized beliefs and assumptions through a Socratic method. In Cognitive Restructuring, the goal is to reinterpret beliefs and narratives about the trauma such that one can have a more balanced and adaptive response. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) focuses on understanding the trauma responses through psychoeducation and then developing relaxation and coping skills, improving emotional regulation, and processing the traumatic material.
Prolonged Exposure (PE) Therapy for PTSD involves steps of psychoeducation and understanding of trauma symptoms, imaginal exposure to the memory of the traumatic event, and then exposure to the triggers of the trauma. PE is effective in that it can help a client to get out of the avoidance and reactive symptoms of PTSD in an incremental, non-overwhelming way. It is important in exposure therapy that the nervous system gets the message “I am okay now” or “I can handle this” because this leads to a decrease in PTSD symptoms.
Eye Movement Desensitization and Reprocessing (EMDR) is a therapy designed to move through and reprocess stuck traumatic memories. EMDR is based on the Adaptive Information Processing Model, which states that maladaptive neural networks can develop after traumas. These maladaptive networks leave the client separated from more adaptive beliefs, feelings, memories, and sensations. In EMDR therapy, the therapist works with the client to take a history and prepare for EMDR. Then, the traumatic material and its associated feeling state are targeted. The client is guided through bilateral stimulation (BLS). BLS can be in the form of eye movements from side-to-side or other methods such as alternating taps or music that shifts back and forth between the two headphones. Through EMDR, the client works through the maladaptive network until the distress around the memory clears out and clients are left with new meaning about their traumatic experience.
Somatic Therapies such as Somatic Experiencing focus on how trauma is stored in the body, on the sensation level. The therapist and client work to learn more about how patterns of stress are being held in the body and focus on resetting or lowering these patterns. The process both brings up the feelings associated with reactions to trauma and is meant to be gentle enough not to overwhelm the nervous system.
People with PTSD may experience a sense of isolation and a loss of connection, often because the traumatic experience involved betrayal by others or resulted in feeling separate from friends and family. In group therapy for survivors of PTSD, one can get support from others who understand the experiences of PTSD and feel connected to a larger group. Group therapy provides a peer setting (facilitated by a therapist) to work through the shame, guilt, and fear of PTSD and to learn skills that help relationships outside of the group.
Additional Types of Treatments:
A general practitioner or psychiatrist can prescribe medication to lower the intensity of fear and anxiety that accompanies PTSD.
Yoga helps those dealing with PTSD to reconnect to their body and become familiar with their sensations, moods, and rhythms. Yoga connects across the body, mind, and spirit, and so it aids survivors in increasing embodied awareness and in releasing tension and stress. Yoga is being more commonly recommended for survivors of PTSD including veterans.
Acupuncture, Body Work
Acupuncture and other types of body work can help in shifting a survivor’s internal energy, lowering stress, and improving mood and physical pain.
In deciding on PTSD treatment, I recommend working with providers with knowledge, skills, and professional experience in working with trauma. It may be helpful to ask providers about their experience and training and how they think about working with trauma to see if it resonates for you.
Most importantly, survivors of trauma should feel that they can connect with and trust their providers. While this post is focused on some of the types of therapy and treatments for PTSD, there is evidence to support the idea that the therapeutic relationship is just as or more valuable than the type of technique used in treatment.