Treatment of PTSD
Today, there are good treatments available for PTSD.
When you have PTSD, dealing with the past can be hard. Instead of telling
others how you feel, you may keep your feelings bottled up. But talking with a
therapist can help you get better.
Cognitive behavioral therapy (CBT) is one type of
counseling. It appears to be the most effective type of counseling for PTSD.
The VA is providing two forms of cognitive behavioral therapy to Veterans with
PTSD: Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) therapy.
To learn more about these types of therapy, see our fact sheets listed on the Treatment page.
There is also a similar kind of therapy called eye
movement desensitization and reprocessing (EMDR) that is used for PTSD.
Medications have also been shown to be effective. A type of drug known as a
selective serotonin reuptake inhibitor (SSRI), which is also used for
depression, is effective for PTSD.
Types of cognitive behavioral therapy
What is
cognitive therapy?
In cognitive therapy, your therapist helps you
understand and change how you think about your trauma and its aftermath. Your
goal is to understand how certain thoughts about your trauma cause you stress
and make your symptoms worse.
You will learn to identify thoughts about the world
and yourself that are making you feel afraid or upset. With the help of your
therapist, you will learn to replace these thoughts with more accurate and less
distressing thoughts. You will also learn ways to cope with feelings such as
anger, guilt, and fear.
After a traumatic event, you might blame yourself for
things you couldn't have changed. For example, a soldier may feel guilty about
decisions he or she had to make during war. Cognitive therapy, a type of CBT,
helps you understand that the traumatic event you lived through was not your
fault.
What is
exposure therapy?
In exposure therapy your goal is to have less fear
about your memories. It is based on the idea that people learn to fear
thoughts, feelings, and situations that remind them of a past traumatic event.
By talking about your trauma repeatedly with a
therapist, you'll learn to get control of your thoughts and feelings about the
trauma. You'll learn that you do not have to be afraid of your memories. This
may be hard at first. It might seem strange to think about stressful things on
purpose. But you'll feel less overwhelmed over time.
With the help of your therapist, you can change how
you react to the stressful memories. Talking in a place where you feel secure
makes this easier.
You may focus on memories that are less upsetting
before talking about worse ones. This is called "desensitization,"
and it allows you to deal with bad memories a little bit at a time. Your
therapist also may ask you to remember a lot of bad memories at once. This is
called "flooding," and it helps you learn not to feel overwhelmed.
You also may practice different ways to relax when
you're having a stressful memory. Breathing exercises are sometimes used for
this.
What is EMDR?
Eye movement desensitization and reprocessing (EMDR)
is another type of therapy for PTSD. Like other kinds of counseling, it can
help change how you react to memories of your trauma.
While thinking of or talking about your memories,
you'll focus on other stimuli like eye movements, hand taps, and sounds. For
example, your therapist will move his or her hand near your face, and you'll
follow this movement with your eyes.
Experts are still learning how EMDR works. Studies
have shown that it may help you have fewer PTSD symptoms. But research also
suggests that the eye movements are not a necessary part of the treatment.
Medication
Selective serotonin reuptake inhibitors (SSRIs) are a
type of antidepressant medicine. These can help you feel less sad and worried.
They appear to be helpful, and for some people they are very effective. SSRIs
include citalopram (Celexa), fluoxetine (such as Prozac), paroxetine (Paxil),
and sertraline (Zoloft).
Chemicals in your brain affect the way you feel. For
example, when you have depression you may not have enough of a chemical called
serotonin. SSRIs raise the level of serotonin in your brain.
There are other medications that have been used with
some success. Talk to your doctor about which medications are right for you.
Other types of
treatment
Some other kinds of counseling may be helpful in your
recovery. However, more evidence is needed to support these types of treatment
for PTSD.
Group therapy
Many people want to talk about their trauma with
others who have had similar experiences.
In group therapy, you talk with a group of people who
also have been through a trauma and who have PTSD. Sharing your story with
others may help you feel more comfortable talking about your trauma. This can help
you cope with your symptoms, memories, and other parts of your life.
Group therapy helps you build relationships with
others who understand what you've been through. You learn to deal with emotions
such as shame, guilt, anger, rage, and fear. Sharing with the group also can
help you build self-confidence and trust. You'll learn to focus on your present
life, rather than feeling overwhelmed by the past.
Brief
psychodynamic psychotherapy
In this type of therapy, you learn ways of dealing
with emotional conflicts caused by your trauma. This therapy helps you
understand how your past affects the way you feel now.
Your therapist can help you:
§ Identify what triggers your stressful memories and
other symptoms.
§ Find ways to cope with intense feelings about the past.
§ Become more aware of your thoughts and feelings, so
you can change
your reactions to them.
§ Raise your self-esteem.
Family therapy
PTSD can affect your whole family. Your kids or your
partner may not understand why you get angry sometimes, or why you're under so
much stress. They may feel scared, guilty, or even angry about your condition.
Family therapy is a type of counseling that involves
your whole family. A therapist helps you and your family to communicate,
maintain good relationships, and cope with tough emotions. Your family can
learn more about PTSD and how it is treated.
In family therapy, each person can express his or her
fears and concerns. It's important to be honest about your feelings and to
listen to others. You can talk about your PTSD symptoms and what triggers them.
You also can discuss the important parts of your treatment and recovery. By
doing this, your family will be better prepared to help you.
You may consider having individual therapy for your
PTSD symptoms and family therapy to help you with your relationships.
How long does
treatment last?
CBT treatment for PTSD often lasts for 3 to 6 months.
Other types of treatment for PTSD can last longer. If you have other mental
health problems as well as PTSD, treatment may last for 1 to 2 years or longer.
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 mental health problem. Depression, alcohol or drug abuse problems,
panic disorder, and other anxiety disorders often occur along with PTSD. In
many cases, the PTSD treatments described above will also help with the other
disorders. The best treatment results occur when both PTSD and the other
problems are treated together rather than one after the other.
What will we
work on in therapy?
When you begin therapy, 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 focused on reducing their symptoms.
Some people want to learn the best way to live with
their symptoms and how to cope with other problems associated with PTSD.
Perhaps you want to feel less guilt and sadness. Perhaps you would like to work
on improving your relationships at work, or communicating 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 discuss with you which
goals might take a long time to achieve.
What can I expect
from my therapist?
Your therapist should give you a good explanation for
the therapy. You should understand why your therapist is choosing a specific
treatment for you, how long they expect the therapy to last, and how they will
tell if it is working.
The two of you should agree at the beginning that this
plan makes sense for you. You should also agree on what you will do if it does
not seem to be working. If you have any questions about the treatment, your
therapist should be able to answer them.
You should feel comfortable with your therapist and
feel you are working as a team to tackle your problems. 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 scary 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.
If you do not like your therapist or feel that the
therapist is not helping you, it might be helpful to talk with another
professional. In most cases, you should tell your therapist that you are
seeking a second opinion.
Date Created: 01/01/2007 / Reviewed/Updated Date: April 25, 2012
The
National Center for PTSD does not provide direct clinical care or individual
referrals.
Please see: Where to Get Help for PTSD
Please see: Where to Get Help for PTSD
PTSD
Information Voice Mail: (802) 296-6300
Contact Us: ncptsd@va.gov
Also see: VA Mental Health
Contact Us: ncptsd@va.gov
Also see: VA Mental Health
