Post-traumatic stress disorder (PTSD) is a type of psychiatric or mental health disorder that occurs in some people who experience a traumatic event, such as war or combat, a serious accident like a plane crash, a terrorist event, a natural disaster, rape, or abuse. The first instances of documented PTSD were called shell shock and involved the diagnosis of unusual behaviors in survivors and veterans of World War I. Since then, the clinical understanding of PTSD has changed, and now, an estimated one in 11 adults, or 3.5 percent of the US adult population, will develop this condition at some point in their lives.
Around 7.7 million Americans ages 18 and older have PTSD, according to the Anxiety and Depression Association of America (ADAA). People who have experienced previous trauma are at greater risk for developing PTSD. One in 10 men and two in 10 women will develop PTSD.
To understand whether a set of behavioral and mental changes qualifies as PTSD, the person must have been exposed to a traumatic event prior to the behaviors manifesting. Symptoms of PTSD include:
- Intrusive thoughts, including flashbacks, distressing dreams, and involuntary memories
- Avoiding reminders of the event, places associated with the trauma, or people associated with the event
- Negative thoughts and feelings, including distorted beliefs about oneself or others
- Reactive symptoms like angry outbursts, extreme irritability, or self-destructive behaviors, including substance abuse
To receive a diagnosis of PTSD, the person must experience all these symptoms at least once in a month. The symptoms are likely to disrupt daily life or enjoyment of life.
Symptoms most often begin within three months after the traumatic event occurs, but in some instances, they are delayed for years before appearing. Typically, people recover from these symptoms within six months, but treatment for any signs of PTSD is crucial. For some, PTSD becomes a chronic condition requiring ongoing management of the psychological symptoms and associated mental and behavioral problems like depression, panic attacks, and substance abuse.
Treatment for PTSD is important, and understanding the different approaches to treatment can inform decisions about available options. The foundation of PTSD treatment is psychotherapy, or talk therapy, although some people may benefit from medication and complementary treatments.
Many Approaches to Treating PTSD
Therapy to treat post-traumatic stress disorder has three main goals:
1. Improve symptoms
2. Teach coping skills
3. Restore self-esteem
A physician may perform a physical exam to rule out any other underlying causes that could lead to PTSD symptoms or make PTSD symptoms worse. Then, they will perform a psychological evaluation by discussing symptoms and the events that may have triggered them.
Psychotherapy: There are many approaches to talk therapy, but the most effective combinations for PTSD include the following:
Cognitive Behavioral Therapy (CBT): One of the most common and effective approaches to therapy for many mental and behavioral conditions, CBT works on uncovering cognitive patterns that lead to destructive behaviors, like fear about uncontrollable events that lead to negative self-talk and self-medication with drugs or alcohol. A counselor or therapist leads their client through a discussion of these patterns and then talks through new behavioral approaches when they appear. For PTSD treatment, CBT is often applied in conjunction with exposure therapy.
Exposure therapy: This therapeutic approach helps the person face traumatic and frightening memories in order to learn methods for coping with them. Exposure therapy has been shown to be very helpful for people who suffer flashbacks or nightmares due to their trauma. Methods for exposing the individual to the event include guided mental imagery, writing exercises, and visiting places or people associated with the trauma. Some researchers are examining the potential of virtual reality technology to help in PTSD treatment.
Cognitive restructuring: Sometimes part of exposure therapy or CBT but sometimes used on its own, this talk therapy helps the person make sense of bad memories and alleviate survivor’s guilt, addressing how the trauma was not the victim’s fault. People who have experienced a traumatic event often don’t remember the event as it occurred and have personal associations and a sense of failed responsibility at many points. Talking through the actual parts of the event can help the person understand that they did not have control over much of it, which can change the emotional association with the trauma.
Eye Movement Desensitization and Reprocessing (EMDR): A fairly new type of therapy, EMDR uses guided eye movements along with guided imagery to re-experience parts of the traumatic event and help the person reprocess these memories so they are less disturbing and stressful. While the person is talked through some part of the event, they are cued to move their eyes back and forth or listen to specific sounds; this process can change connections in the brain.
Stress Inoculation Training (SIT): Another approach to reducing anxiety and helping the individual develop coping skills, SIT involves breathing exercises, muscle relaxation techniques, assertiveness skills, and cognitive restructuring.
Medication: The most understood and prescribed medications used to treat PTSD are antidepressants because they alleviate sadness, anger, irritability, and anhedonia or emotional numbness. However, some medications may be used to treat more immediate PTSD symptoms. Some research suggests that a high blood pressure medication, Prazosin, may work for some PTSD symptoms. Anti-anxiety medications like Xanax or Valium may offer short-term benefits for panic associated with PTSD as well.
Present-Centered Therapy: Although this is a therapeutic approach involving a counselor, Present-Centered Therapy is not focused directly on the trauma that triggered the individual’s PTSD. Instead, it centers on problems caused by behaviors associated with PTSD and learning problem-solving and coping skills to better manage stress in daily life.
Complementary treatment: Exercise can improve mood, and a healthy diet can help to manage mental and physical health. Learning an approach to meditation, like mindfulness, yoga, deep breathing, and even chanting, can help to alleviate stress in daily life or during episodes of panic. Getting counseling to manage a regular sleep schedule is important, too. Finding ways to set goals, create a daily routine with self-support, and even finding community in a spiritual or religious group can help.
Emotional support: Encourage friends and family to access resources and educate themselves on the condition. Find a mutual support group for ongoing discussion about coping mechanisms and daily life challenges from others struggling with PTSD. If there are co-occurring conditions like substance abuse, seeking evidence-based treatment for those, too, will be very important. Interpersonal psychotherapy (IP) helps a person understand the impact of PTSD on their interpersonal relationships, which can lead to improved social support.
Other approaches: These treatments have less research behind them, but may work for some people suffering from PTSD:
- Brief Eclectic Psychotherapy involves reliving the event, reframing it, writing it out, and holding a farewell ceremony for it.
- Narrative Exposure Therapy involves talking through multiple events in a person’s life, including trauma, to frame everything in a narrative context.
- Written Narrative Exposure involves writing about trauma during therapy sessions based on a therapist-provided prompt.
Help to Manage PTSD
Even if PTSD symptoms have persisted for a long time, it is never too late to get help. Getting help after a traumatic event can reduce the impact of PTSD, but some people, like those who experience childhood abuse, domestic abuse, or conflict zones, may not have the time or personal understanding to seek treatment before PTSD symptoms become severe. It is not a sign of weakness to develop PTSD, and getting help will improve one’s resilience in life. A combination of the above approaches will likely work best, and the specific combination of therapies will be different for everyone.