Post-Traumatic Stress Disorder (PTSD) Therapy

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Post-Traumatic Stress Disorder (PTSD) is a trauma and stress-related disorder that can develop after witnessing or experiencing an incident or ordeal in which death or serious physical harm happened or was threatened. Military personnel, rescue workers, and survivors of shootings, bombings, violence, and rape are among those affected by the disorder. Through vicarious trauma, family members of victims can develop the disorder as well.

According to the National Institute of Mental Health, approximately 6.8 percent of American adults develop PTSD during their lifetime. PTSD can occur to anyone at any age, even children. Women are more likely than men to develop the disorder, and there is some indication that it runs in families. Depression, substance use disorder, and anxiety disorders are usually associated with PTSD. The likelihood of successful treatment increases when additional illnesses are correctly detected and addressed.

Acute stress disorder is a condition in which symptoms develop soon after exposure and last for up to a month. When the stress symptoms caused by the exposure linger for more than a month, PTSD is diagnosed. Delayed PTSD symptoms can occur six months or more after the beginning of trauma.

In the military, PTSD is well-documented: For example, over 30% of Vietnam veterans suffered PTSD. The disorder has also been found in up to 10% of Gulf War (Desert Storm) veterans, around 6% to 11% of Afghanistan war veterans, and approximately 12% to 20% of Iraq war veterans. Combat-related factors may raise the risk of PTSD and other mental health disorders among veterans. These include the veteran’s position in the battle, the politics surrounding the war, the location of the fighting, and the sort of adversary encountered. Military sexual trauma (MST), or sexual harassment or assault in the military, is another cause of PTSD in the military. MST affects both men and women and can occur during times of peace, training, or war. Approximately 23% of women who used VA health care reported sexual assault while in the military, while 55% of women and 38% of men reported sexual harassment while in the military.

Aside from military combat, a variety of traumatic experiences, such as physical assaults, sexual assaults, vehicle attacks, terrorist attacks, and natural catastrophes, can lead to the development of PTSD.

Panic attacks are severe and fleeting. They cause physical sensations such as difficulty breathing, rapid heart rate, tense muscles, and chest tightening. They last between 20 and 30 minutes. One or two such attacks are common in a person’s lifetime. However, if these attacks are recurring or the individual experiences continuing fear of another attack, they may be suffering from panic disorder.

Complex PTSD (CPTSD) is defined as severe and repeated trauma, commonly experienced as a child, which refers to additional obstacles such as emotional regulation, interpersonal difficulties, and a negative self-concept. It is a diagnosis in the World Health Organization’s most recent revision of the International Classification of Diseases.

PTSD does not develop in every trauma survivor; the disorder appears in only 10 to 30 percent of trauma patients. Distressing symptoms usually go away after a month of support and care.

Treatment for PTSD typically begins with a thorough evaluation and the formulation of a treatment plan tailored to the survivor’s specific needs. Psychotherapy, medications, or combination are the most common treatments for people suffering from PTSD. Treatment varies and is adapted to the individual’s symptoms and needs due to differences in experience and the consequences of the trauma. Treatment by a PTSD-experienced mental health care specialist assists people to live more balanced and functional lives. Some people suffering from PTSD may need to try multiple treatments to see what works best for their symptoms.

If a person with PTSD is dealing with ongoing trauma, such as being in an abusive relationship, treatment may entail assisting them in finding safety. Only until the survivor has been safely evacuated from the crisis situation can PTSD-specific treatment begin. Individuals who have other symptoms of panic disorder, depression, substance use disorder, or who are suicidal may require treatment to address these issues as well.

Other treatment options include:

  • Educating trauma survivors and their families on the risks of PTSD, how PTSD affects survivors and their loved ones, and other issues that are typically associated with PTSD symptoms. It is critical to understand that PTSD is a medically recognized disorder in order to receive successful treatment.
  • Exposure to the event through visuals allows the survivor to relive the event in a safe, controlled context. A expert can thoroughly investigate people’s reactions and beliefs in regard to the event.
  • Examining and resolving intense feelings such as shame, wrath, or guilt, which are frequent among trauma survivors.
  • Teaching the survivor how to deal with post-traumatic memories, reminders, reactions, and feelings without becoming overwhelmed or emotionally numb. Trauma memories seldom disappear completely as a result of therapy, but new coping skills might help make them more manageable.

Medications

The FDA has approved two medications to treat people with PTSD: sertraline (Zoloft) and paroxetine (Paxil), both of which are selective serotonin reuptake inhibitors (SSRIs). These medications are both antidepressants, which are used to treat depression. They may aid in the management of PTSD symptoms such as melancholy, worry, wrath, and numbness. Using medications in conjunction with therapy or prior to starting therapy may improve treatment efficacy. If an antidepressant is recommended, it may take several days or weeks for considerable improvement to occur. It is important not to become disheartened and quit taking medications before they have had a chance to work. A dosage change or switching to another SSRI may help address these concerns. It is important to work with your doctor.

People who take these medications may experience side effects. The side effects can be annoying, but they normally go away. Medication, on the other hand, affects everyone differently. Any side effects or odd reactions should be reported to a doctor right once. The following are the most prevalent side effects of antidepressants such as sertraline and paroxetine:

  • Headaches that normally go away after a few days.
  • Nausea, which normally subsides after a few days.
  • Sleeplessness or drowsiness that may occur in the first few weeks but gradually subsides. To help reduce these side effects, the medication dose may need to be reduced or the time of day taken modified.
    Feeling agitated or anxious.
  • Sexual problems that can affect both men and women, such as reduced sex drive and problems having and enjoying sex.

Other sorts of medications that doctors may give include the following: Benzodiazepines may be prescribed to help people relax and sleep more easily, but there is a risk of addiction developing. Antipsychotic medications may be provided to people who have severe agitation, suspicion, or paranoia. Other antidepressants, such as fluoxetine (Prozac) and citalopram (Celexa), can help people suffering from PTSD in feeling less tense or melancholy. Antidepressants may be effective in lowering symptoms of co-occurring illnesses in people with PTSD who also have other anxiety disorders or depression. The potential side effects of these medications necessitate a discussion with your practitioner.

Similarly, antidepressant medications known as tricyclics are started at low doses and progressively raised. Tricyclics have been around longer than SSRIs and have been investigated more extensively for treating anxiety disorders. They are just as effective as SSRIs, but many doctors and patients prefer newer drugs because tricyclics can cause dizziness, dry mouth, sleepiness, and weight gain. Mood stabilizers like lamotrigine and divalproex sodium may also help with symptoms.

Psychotherapy

In the treatment of PTSD, therapy is widely used. It entails speaking with a mental health expert to work through the experience and its impact on the individual. Psychotherapy can occur place one-on-one or in groups. PTSD therapy typically lasts until the individual has learnt to control and cope with their experience and is able to function more normally.

People suffering from PTSD can help from a variety of types of psychotherapy. Some types are specifically designed to treat PTSD symptoms. Other therapies focus on social, family, or work-related problems. Depending on the needs of the individual, the doctor or therapist may mix various therapies.

CBT, or cognitive-behavioral therapy, has been shown to be quite successful in treating PTSD. CBT consists of numerous components, including:

  • Exposure therapy: This therapy assists people in being more conscious of their surroundings. It may be a safe approach for them to be exposed to the memories of the trauma they experienced. It uses mental imagery, writing, or visits to the location where the event happened. These strategies are used by the therapist to assist people suffering from PTSD in coping with their emotions.
  • Cognitive restructuring is a type of therapy that helps people in making sense of their memories and experiences. People’s memories of an event can differ from how it actually happened. They may feel guilty or ashamed for something that is not their fault. The therapist helps people suffering from PTSD in looking at what happened in a realistic light.
  • Stress inoculation training: This therapy tries to reduce PTSD symptoms by teaching a person how to reduce anxiety when confronted with anxiety-provoking situations. This treatment, like cognitive restructuring, helps people in viewing their experiences in a healthy manner.

Other types of treatment can also help people with PTSD, and a client may want to discuss therapy alternatives and treatment focus with their therapist, which may include:

  • Understanding trauma and its effects
  • Practicing relaxation and anger control skills
  • Improving sleep, dietary, and physical activity habits
  • Identifying and dealing with feelings of guilt, humiliation, and other negative emotions related to the event
  • Focusing on our reactions to PTSD symptoms—for example, therapy might assist people in visiting locations and people that serve as memories of the trauma.

Eye movement desensitization and reprocessing (EMDR) is a treatment for traumatic memories that combines aspects of exposure therapy and cognitive behavioral therapy with procedures that shift attention (sounds, eye movements, hand taps). There is some evidence that the EMDR-helpful therapy aspect, attentional alteration, may aid in accessing and processing traumatic material.

The emotional tensions created by the traumatic event are the focus of brief psychodynamic psychotherapy. This therapy helps a person in understanding how their past influences how they feel now. The survivor gains a greater sense of self-esteem, learns effective ways of thinking and coping, and more successfully handles with the intense emotions that emerge during therapy by reliving the traumatic event to a calm and sympathetic counselor. The therapist helps the survivor in identifying current life conditions that trigger traumatic memories and exacerbate PTSD symptoms.

Group treatment is an excellent therapeutic setting because trauma survivors can seek help and support while sharing traumatic material in a safe context. As group members gain a greater knowledge and resolution of their trauma, they frequently feel more confident and capable of trusting themselves and others. They learn to focus on the present rather than the past as they discuss and express trauma-related shame, guilt, fear, fury, doubt, and self-condemnation. Many survivors can cope with their symptoms, memories, and lifestyles by telling their experience and confronting the pain, guilt, and anxiety associated with the trauma.

Because PTSD can affect the entire family, family therapy is a type of psychotherapy that involves the entire family. One’s children or partner may not understand why the person becomes angry at times or why they are under so much stress. They may be terrified, guilty, or even enraged by the condition. In family therapy, a therapist assists the patient and family in communicating, maintaining positive connections, and coping with difficult emotions. Each person is free to share his or her anxieties and concerns. It’s important to be open about your feelings and to listen to others. The patient can discuss PTSD symptoms, triggers, and important aspects of treatment and recovery. The person’s family will be more prepared to help them as a result of this.

Many people suffering from PTSD tend to relive portions of the traumatic event, especially when they are exposed to situations or items that remind them of the trauma. The anniversary of the event, as well as similarities in person, place, or circumstance, can trigger off symptoms. Intrusive memories or flashbacks, emotional numbness, sleep disturbances, anxiety, severe guilt, melancholy, impatience, outbursts of wrath, and dissociative experiences are all symptoms of PTSD. Many people suffering from PTSD may try to avoid circumstances that remind them of their ordeal. When symptoms linger for longer than a month, a PTSD diagnosis may be appropriate.

Symptoms of remembering the traumatic event include:

  • Having bad dreams, or distressing memories about the event
  • Behaving or feeling as if the event were actually happening all over again (known as flashbacks)
  • Dissociative reactions or loss of awareness of present surroundings
  • Experiencing intense emotions when reminded of the event
  • Having intense physical sensations when reminded of the event (heart pounds or misses a beat, sweating, difficulty breathing, feeling faint, feeling a loss of control)

Symptoms associated with avoiding reminders of the traumatic event:

  • Avoiding thoughts, conversations, or feelings about the event
  • Avoiding people, activities, or places associated with the event

Symptoms of negative thought or mood changes:

  • Having difficulty remembering an important part of the original trauma
  • Feeling numb or detached from things
  • Lack of interest in social activities
  • Inability to experience positive moods
  • Pessimism about the future

Symptoms of arousal and reactivity:

  • Sleeping difficulties including trouble falling or staying asleep
  • Irritability and outbursts of anger
  • Difficulty concentrating
  • Feeling easily startled
  • Excess awareness (hypervigilance)

Other symptoms such as depersonalization (feeling like an observer of one’s body and thoughts/feelings) or derealization (experience of the unreality of surroundings) may also exist in some people.

PTSD’s cause is unknown, but psychological, genetic, physical, and social factors all play a role. PTSD alters the body’s response to stress. It has an effect on the stress hormones and molecules that transport information between nerves. People who have experienced childhood abuse or other traumatic experiences are more likely to develop the disorder, which might occur months or years after the trauma. Externalizing behaviors or other anxiety difficulties, for example, may potentially raise the risk. Other risk factors in the environment include family dysfunction, childhood hardship, cultural factors, and a family history of psychiatric disease. The greater the degree of the trauma, the greater the risk for PTSD—witnessing atrocities, sustaining a severe physical injury, or enacting violence. Inadequate coping methods, a lack of social support, family instability, or financial stress may exacerbate the situation.

Other factors, known as resilience factors, can help reduce the disorder’s risk. Some of these resilience factors exist prior to the trauma, while others become important during and after the trauma. Seeking support from others, such as mental health professionals, friends, and family, finding a support group after a traumatic event, feeling good about one’s own actions in the face of danger, having a coping strategy, and being able to act and respond effectively despite feeling fear are all resilience factors that may reduce the risk of PTSD.

The amygdala, which regulates emotion and processes fear; the hippocampus, which stores and retrieves memories; and the prefrontal cortex, which governs planning and decision making, are key brain regions involved with PTSD. A traumatic event can disrupt communication between these three regions, causing the brain to fail to properly process and control memories of the trauma.

Psychedelics such as MDMA and ketamine show tremendous potential in the treatment of PTSD. Psychedelics, when administered in a therapeutic setting, have been shown in studies to reduce PTSD symptoms. They can help survivors in processing and re-framing their memories, deriving meaning from their experiences, and beginning to heal.

The transformation also tends to occur faster than with other types of therapy. “Those of us who have tried to understand trauma have been looking for a window to help people,” one psychedelic researcher explained. This could be a floor-to-ceiling window or a door.

What is the next step?

If you or someone you love is considering individual therapy or counseling, please contact Through The Forest Counseling. We are a team of professionals who have the expertise to help.

Call us at our office to schedule an appointment with one of our highly skilled clinicians at Through The Forest Counseling.