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How Do You Treat PTSD in Veterans?

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:1

  • War or combat.
  • A serious accident like a plane crash.
  • A terrorist event.
  • A natural disaster.
  • Rape.
  • Other violent abuse.

Treatment for PTSD is important. Understanding the different approaches to treatment can inform decisions about available options. The foundation of PTSD treatment for military veterans and civilians alike is talk therapy (psychotherapy), although some may benefit from medication and complementary treatments.2

A Closer Look at PTSD

The first documented instances of post-traumatic stress disorder (PTSD) were called “shell shock” and involved the diagnosis of unusual behaviors in survivors and veterans of World War I.3 Since then, the clinical understanding of PTSD has changed. Today in the U.S.:4

  • An estimated 7% of the U.S. will develop this condition at some point in their lives.
  • 8 million adults will have PTSD in a given year.
  • 4% of men will develop PTSD sometime in their lives, while the number is 10% for women.

Diagnosing PTSD

military veteran sitting on couchBefore you can treat someone for PTSD, they first need to get an accurate diagnosis.

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:5

  • 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 PTSD diagnosis, 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.5

Symptoms most often begin within 3 months after the traumatic event occurs, but in some instances, they are delayed for years before appearing. Typically, people recover from these symptoms within 6 months, but treatment for any signs of PTSD is crucial. 5

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.5

Talk Therapy (Psychotherapy) for PTSD

There are many approaches to talk therapy, but the most effective combinations for PTSD are detailed below.

Cognitive Behavioral Therapy

(CBT) is of the most common and effective approaches to therapy for many mental and behavioral conditions.6 When used with a patient with PTSD, the therapy centers around the trauma.7

Therapists help their patients uncover cognitive patterns that often lead to destructive behaviors, like fear about uncontrollable events that lead to negative self-talk and self-medication with drugs or alcohol.6

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.6

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 this specific approach to PTSD treatment.7

Cognitive Restructuring

Sometimes part of exposure therapy or CBT, but also 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.7

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.7

Eye Movement Desensitization and Reprocessing (EMDR)

A fairly new type of therapy, EMDR uses guided eye movements along with guided imagery to help a patient re-experience parts of the traumatic event and 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.7

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.7

Medication for PTSD

The most understood and prescribed medications used to treat PTSD are antidepressants because they can alleviate sadness, anger, irritability, and emotional numbness.2

Antidepressants can be SSRIs (selective serotonin reuptake inhibitors) or SNRIs (serotonin-norepinephrine reuptake inhibitors). These medications affect your brain cells and how much serotonin or norepinephrine they produce.2

The U.S. Department of Veteran Affairs (VA) recommends 4 antidepressant medications for PTSD: 2

  • Sertraline (Zoloft).
  • Paroxetine (Paxil).
  • Fluoxetine (Prozac).
  • Venlafaxine (Effexor).

Other Options for PTSD Treatment

military veteran with therapistPresent-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.2

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.

Help to Manage PTSD

Even if PTSD symptoms have persisted for a long time, it’s 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 can improve one’s resilience in life.

 

References:

  1. American Psychiatric Association. (2017). What is posttraumatic stress disorder?
  2. U.S. Department of Veterans Affairs. (2019). PTSD treatment basics.
  3. Crocq, M.A. & Crocq, L. (2000). From shell shock and war neurosis to posttraumatic stress disorder: a history of psychotraumatology. Dialogues in Clinical Neuroscience, 2(1), 47-55.
  4. U.S. Department of Veterans Affairs. (2018). How common is PTSD in adults?
  5. National Institute of Mental Health. (2019). Post-traumatic stress disorder.
  6. American Psychological Association. (2017). Cognitive behavioral therapy (CBT).
  7. Anxiety and Depression Association of America. (2018). Treatment for PTSD.
About The Contributor
Laura Close
Senior Web Content Editor, American Addiction Centers
Laura Close is a Senior Web Content Editor at American Addiction Centers and an addiction content expert at Recovery First Treatment Center. She has a bachelor’s degree in English and has nearly a decade in professional editing experience... Read More