A combination of medication and psychotherapy is often the foundation of PTSD treatment, but treatment doesn’t have to stop there.
Once associated only with post-war veterans, post-traumatic stress disorder (PTSD) is a mental health condition that can occur after experiencing or witnesses any traumatic event.
Everyone has experienced some type of trauma. From near-miss accidents to emergency room scares, we’ve all had those fear-inducing moments that make our hearts pound and our pulses race.
For some of us, once the danger passes and the scare subsides, we can move on. But for others, that feeling of panic and fear can persist for days, weeks, or even years. Many times, these feelings occur with other symptoms, such as unpleasant memories, flashbacks, or distressing dreams.
These unpleasant symptoms can make the day-to-day life of someone living with PTSD challenging. Fortunately, PTSD is treatable.
If you have PTSD, there are a variety of treatment methods available to help you manage your symptoms.
PTSD is primarily diagnosed by a mental health specialist — such as a psychologist, psychiatrist, or clinical social worker. If you think you may have PTSD, consider reaching out to your family doctor or other healthcare professional, if available.
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), certain criteria must be met for an accurate diagnosis of PTSD:
- You were exposed to or witnessed death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence.
- You experience one or more intrusion symptoms, avoidance symptoms, reactivity symptoms, and mood and cognition symptoms.
- Your symptoms have been present for at least 1 month.
- Your symptoms cause difficulty in social or occupational settings.
- Your symptoms are not related to medication, substance use, or illness.
These criteria can either be determined through completing a questionnaire or through a conversation with your healthcare professional.
During your assessment, a physical exam or psychological evaluation may also be performed.
Physical exams can rule out other illnesses that often resemble PTSD, including:
- low blood cell count
- micronutrient deficiencies
Physical exams can consist of lab tests, examinations of your medical history, and assessments of your lifestyle.
If other physical conditions are ruled out, a psychological evaluation may be conducted.
A psychological evaluation often begins with a conversation about signs and symptoms you may be experiencing, as well as the traumatic event or events that may be causing them.
It also may include talking about active stressors currently in your life, such as your relationship or work.
Psychological evaluations aim to rule out other mental health conditions that resemble PTSD, like anxiety or depression.
Research shows that various forms of therapy can be effective in treating PTSD.
Cognitive behavioral therapy (CBT)
Trauma-based CBT is shown to be an
The principle behind CBT is that since emotions and behaviors can be learned, they can also be unlearned.
For PTSD, the goal of this therapy is to teach you methods to recognize disruptive thoughts as they are — false and damaging — to help you combat them when they arise. The role of a CBT therapist, essentially, is to teach you how to cope with your PTSD symptoms by changing your thoughts and behaviors related to the trauma you’ve experienced.
It often involves directly revisiting the trauma by either discussing it with your therapist or writing your thoughts down in a journal.
Also, part of CBT is to encourage more positive beliefs and thoughts through setting goals and practicing gratitude.
Cognitive processing therapy (CPT)
Cognitive processing therapy (CPT) is a type of CBT that has been
It usually begins with a therapist teaching you about the relationship between thoughts and emotions. Typically, it consists of 12 weekly sessions done either one-on-one or in a group session.
One of the goals of this therapy is to teach you that your thoughts can be automatic.
If you have PTSD, some automatic thoughts can exaggerate symptoms. Therefore, identifying automatic negative thoughts to reduce their prevalence is a core element of CPT.
A major, unique part of CPT involves writing down your trauma in great detail, reading it aloud to yourself, and then reading it to your therapist. Through this exercise, your therapist can help you combat negative thinking about trauma through dialogue and questioning.
Cognitive therapy (CT)
Like cognitive processing therapy, cognitive therapy (CT) is a type of CBT.
A possible symptom of PTSD is interpreting memories of trauma in a negative way. The goal of cognitive therapy is to interrupt and challenge the thoughts and beliefs characterized by these interpretations.
Cognitive therapists help you work through harmful coping mechanisms, such as ruminating about your trauma or suppressing negative thoughts, which can oftentimes exaggerate PTSD symptoms.
Your therapist may ask probing or investigative questions — known as Socratic questioning — about your thoughts related to the trauma to help you recognize them.
They will help you analyze and understand your trauma by revisiting the trauma through dialogue, thinking, and writing, and attempting to reinterpret the trauma in a more positive and compelling way.
Prolonged exposure (PE)
Prolonged exposure (PE) is a form of therapy that teaches you how to slowly and systematically confront trauma-related stimuli or situations.
A symptom of PTSD is the suppression of trauma-related memories and the avoidance of places, people, or things that might be causing your symptoms. The primary goal of prolonged exposure is to help you gradually engage with these memories and situations.
In small and safe increments, a therapist will guide you to voluntarily expose yourself to stimuli associated with trauma and situations that can elicit negative symptoms.
For example, suppose your PTSD resulted from an event that occurred in a specific place. In that case, your therapist might begin with having you look at pictures of that place. Then, when you adapt to looking at those pictures, your therapist will continue to gradually expose you to that place until you’re able to physically revisit it.
The goal of prolonged exposure is to revisit such places, but no longer see them through the lens of negative emotion.
This type of PTSD therapy is typically completed in 8 to 15 sessions and might include an education element and breathing exercises. There are three types of exposure:
- In vivo: visiting the places that remind you of the trauma
- Imaginal: imagining the trauma and writing about it to reduce symptoms
- Virtual: facing the trauma using computer stimulation
Each type of exposure is done in a safe and controlled way.
Research shows that
Eye movement desensitization and reprocessing (EMDR)
The basic principle behind EMDR is that the brain naturally moves toward healing after a traumatic event. The impact of the event can block this healing and the negative emotions are left to fester. This can result in intense and unpleasant thoughts, memories, and feelings.
The goal of EMDR is to remove the block so that emotional healing can begin.
EMDR is typically in eight phases in which eye movement is used. During therapy, you’ll be instructed to focus on traumatic memories while at the same time focusing on another external stimulus, such as flashing lights, a moving finger, or a beeping tone.
The belief is that stimulating rapid eye movement — as done in a deep sleep — can help the brain begin to process, rather than suppress, the traumatic memory and unpleasant feelings, which leads to healing and recovery.
Medications can be used to successfully treat PTSD. The APA’s recommendation for using medication to treat PTSD is “conditional,” meaning there might be clinical evidence that the medication works to reduce symptoms of PTSD, but the research is not strong enough to recommend as a first-line choice.
While the APA doesn’t refer to medication as a “second-line” treatment, it also doesn’t recommend it as strongly as it does therapy.
Nevertheless, medication may be an option to help some symptoms of PTSD.
Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), may be used to help reduce depression or symptoms of anxiety in people with PTSD.
SSRIs work by increasing the levels of serotonin — a neurotransmitter responsible for mood — in the brain.
The only SSRIs currently approved by the Food and Drug Administration (FDA) to treat PTSD are sertraline (Zoloft) and paroxetine (Paxil).
Other antidepressants that may be used include:
- selective norepinephrine reuptake inhibitors (SNRIs)
- monoamine oxidase inhibitors (MAOIs)
A 2020 literature review suggests that the SSRI fluoxetine (Prozac) and the SNRI venlafaxine (Effexor) may be helpful for treating PTSD, although they are not approved for this use by the FDA.
Your doctor will work with you to determine which medication best fits you and your symptoms.
Other medications for PTSD
There has been recent interest in using topiramate (Topamax), an anti-seizure medication, to treat PTSD. However, according to the APA, there’s not enough evidence to recommend topiramate for PTSD.
In addition, topiramate has a higher chance of causing serious side effects than SSRIs.
Benzodiazepines are among the most common anti-anxiety medications. However, they’re not recommended for PTSD due to a lack of evidence supporting their ability to treat PTSD and evidence suggesting they might make symptoms worse.
MDMA, while currently a schedule I illegal drug, is now in phase 3 trials in the United States for PTSD. MDMA-assisted therapy is slated to be approved as a treatment for PTSD by the FDA within the next few years.
In addition to therapy and medication, there’s evidence suggesting that some self-care methods can also help treat PTSD.
Exercise can include anything from lifting weights and running to playing a sport or taking a walk.
Exercise improves physical health, but there’s also growing evidence suggesting that exercise may help reduce symptoms associated with PTSD.
Likewise, physical activity may also help improve conditions that may co-occur with PTSD, such as anxiety, depression, sleep disturbances, and heart disease.
Nutrition and diet
What we eat can play a role in determining our feelings, thoughts, and behavior.
You can help improve your PTSD symptoms by eating a balanced diet consisting of nutrient-dense foods like fruits, vegetables, and lean protein.
Meditation and mindfulness
Activities such as running and lifting weights are often referred to as “physical training.” It’s helpful to think of meditation and mindfulness similarly; only instead of training the body, you’re training your mind.
Mindfulness in particular focuses on centering your thoughts in the present and accepting how you’re feeling in that moment. Doing this can help you begin to lessen those intrusive feelings and thoughts as they arise.
Mindfulness techniques can include:
Living with PTSD can be frustrating and overwhelming at times. But your PTSD doesn’t have to last forever.
There are plenty of resources available to help treat your PTSD.
If you or a loved one is experiencing symptoms of PTSD, consider speaking with friends or family members for support. If your symptoms are more serious and you need additional help, consider talking with your primary care physician, if you have one.
They may be able to recommend a mental health professional who specializes in PTSD to help with diagnosis and treatment if needed. If you prefer virtual therapy, there are many options for you to consider.
Remember that you’re not alone. There are others like you who live with PTSD every day. Sometimes connecting with others like you can be helpful. You can find a list of support groups and other resources here.