Psychotherapy is an effective treatment for post-traumatic stress disorder (PTSD) and survivors of trauma. There are a variety of psychotherapies available, but they all share a number of common attributes:
- Therapy always is individualized to meet the specific concerns and needs of each unique trauma survivor, based upon careful interview and questionnaire assessments at the beginning of (and during) treatment.
- Trauma therapy is done only when the patient is not currently in crisis. If a patient is severely depressed or suicidal, experiencing extreme panic or disorganized thinking, in need of drug or alcohol detoxification, or currently exposed to trauma (such as by ongoing domestic or community violence, abuse, or homelessness), these crisis problems must be handled first.
- When a shared plan of therapy has been developed within an atmosphere of trust and open discussion by the patient and therapist, a detailed exploration of trauma memories is done to enable the survivor to cope with post-traumatic memories, reminders, and feelings without feeling overwhelmed or emotionally numb.
- The goal of “trauma focused” exploration is to enable the survivor to gain a realistic sense of self-esteem and self-confidence in dealing with bad memories and upsetting feelings caused by trauma; trauma memories usually do not go away entirely as a result of therapy, but become manageable with new coping skills.
- Trauma exploration can be done in several ways, depending upon the type of post-traumatic problems a survivor is experiencing. (See “Types of PTSD” for more information.)
Uncomplicated PTSD involves persistent reexperiencing of the traumatic event, avoidance of stimuli associated with the trauma, emotional numbing, and symptoms of increased arousal. It may respond to group, psychodynamic, cognitive-behavioral, pharmacological or combination approaches.
Group psychotherapy is likely the most beneficial psychotherapy method for PTSD, especially for military personnel and veterans. Group treatment is practiced in VA PTSD Clinics and Vet Centers for military veterans and in mental health and crisis clinics for victims of assault and abuse.
A group of peers provides an ideal therapeutic setting because trauma survivors are able to risk sharing traumatic material with the safety, cohesion, and empathy provided by other survivors. It is often much easier to accept confrontation from a fellow sufferer who has impeccable credentials as a trauma survivor than from a professional therapist who never went through those experiences first-hand.
As group members achieve greater understanding and resolution of traumatic themes, they often feel more confident and able to trust. As they work through trauma-related shame, guilt, rage, fear, doubt, and self-condemnation, they prepare themselves to focus on the present rather than the past. Telling one’s story (the “trauma narrative”) and directly facing the grief, anxiety, and guilt related to trauma enables many survivors to go on with their lives rather than getting stuck in unspoken despair and helplessness.
Of the various types of psychotherapy, the one most widely accepted as useful for PTSD is cognitive-behavioral psychotherapy (CBT). CBT is a relatively structured kind of psychotherapy. It involves teaching the patient specific techniques within a limited number of sessions (with “homework exercises” between sessions). The therapist and patient clearly agree on the goals of the therapy.
Specific techniques in therapy for PTSD include exposure and cognitive restructuring. Other techniques, such as relaxation, self-talk and assertiveness training may also be used. Exposure therapy involves gradually facing the thoughts and memories of the traumatic event or situations (places where the event occurred) that make one anxious. This can be done by using imaging techniques or by actually returning to the place where one had an accident. Exposure should be gradual and done with the help of an experienced clinician.
Exposure therapy is intended to help the patient face and gain control of the fear and distress that was overwhelming in the trauma, and must be done very carefully in order not to re-traumatize the patient. In some cases, trauma memories or reminders can be confronted all at once (“flooding”), while for other individuals or traumas it is preferable to work gradually up to the most severe trauma by using relaxation techniques and either starting with less upsetting life stressors or by taking the trauma one piece at a time (“desensitization”).
Cognitive restructuring involves identifying irrational (but understandable) patterns of thought, feeling and behavior that emerge after a traumatic event. The person gradually learns to substitute new thoughts (for example, a raped women who sees all men as untrustworthy may revise perceptions of some men), and so to develop new emotional and behavioral patterns (for example, learning to date again or discovering how to enjoy sex again).
Additional cognitive-behavioral techniques may involve learning skills for coping with anxiety (such as breathing retraining or biofeedback) and negative thoughts (“cognitive restructuring”), managing anger, preparing for stress reactions (“stress inoculation”), handling future trauma symptoms and urges to use alcohol or drugs when they occur (“relapse prevention”), and communicating and relating effectively with people (“social skills” or marital therapy).
Eye movement desensitization and reprocessing (EMDR)
EMDR is another psychological treatment for PTSD, in which a mental health professional will help you to look at your memories of the trauma (including all of the negative thoughts, feelings and sensations experienced at the time of the event). EMDR aims to change how you feel about these memories and helps you to have more positive emotions, behavior and thoughts.
During EMDR, you will be asked to concentrate on an image connected to the traumatic event and the related negative emotions, sensations and thoughts, while paying attention to something else, usually the therapist’s fingers moving from side to side in front of your eyes. After each set of eye movements (about 20 seconds), you should be encouraged to let go of the memories and discuss the images and emotions you experienced during the eye movements. This process is repeated, this time with a focus on any difficult, persisting memories. Once you feel less distressed about the image, you should be asked to concentrate on it while having a positive thought relating to it. It is hoped that through EMDR you can have more positive emotions, thoughts and behavior in the future.
Brief psychodynamic psychotherapy has less empirical support for help people with PTSD and focuses on the emotional conflicts caused by the traumatic event. Through the retelling of the traumatic event to a calm, empathic, compassionate and non-judgemental therapist, the patient achieves a greater sense of self-esteem, develops effective ways of thinking and coping, and more successfully deals with the intense emotions that emerge during therapy. The therapist helps the patient identify current life situations that set off traumatic memories and worsen PTSD symptoms.
Techniques known as Emotional Freedom Technique (often referred to as “tapping”) or Thought Field Therapy have no empirical evidence supporting their use in PTSD treatment. Despite the lack of scientific evidence, however, some clinicians use these techniques with reported success.
Hypnosis or hypnotherapy is also sometimes suggested for people with PTSD and does have some empirical support for its use. Hypnotherapy is a legitimate therapeutic technique and if traditional psychotherapy techniques appear ineffective, can be tried. Not everyone can be hypnotized, so its effectiveness will vary.
Choosing the Treatment Right For You
If you have developed PTSD within 3 months of a traumatic event you should be offered cognitive-behavioral therapy. Depending on how you are feeling, a course of treatment is likely to be 12-14 sessions lasting for 60–90 minutes each. If your symptoms are severe, treatment may be started in the first month after the trauma and may take only 4 or 5 sessions. A delay in beginning treatment should not affect the success of the treatment. CBT should normally be provided on an individual outpatient basis, which means that you will go to a hospital or clinic for your appointments but will not have to stay overnight.
If you have had PTSD for more than 3 months you should be offered a course of trauma focused psychological treatment (CBT or EMDR). These treatments should normally be provided on an individual outpatient basis. If you have experienced a single trauma, a course of treatment is likely to be 12-24 sessions, usually lasting for 60–90 minutes each. It may be necessary to have more than 12 sessions of treatment if you have experienced the traumatic death of a relative or friend, if the trauma has resulted in a long-term problem or disability, or if you have lived through a series of traumatic events.
This article used material adapted from the National Center for PTSD and the National Institute for Health and Clinical Excellence.
Cohen, H. (2006). Psychotherapy Treatment for PTSD. Psych Central. Retrieved on May 23, 2013, from http://psychcentral.com/lib/2006/treatment-of-ptsd/
Last reviewed: By John M. Grohol, Psy.D. on 30 Jan 2013
Published on PsychCentral.com. All rights reserved.