Therapy has been shown to be effective in the treatment of PTSD. However, since trauma symptoms are very specific, not all types of therapy are appropriate. SAMHSA has a list of every evidenced based therapeutic program by the National Registry of Programs and Practices, 17 of which list PTSD relief as an outcome.
There are several ways in which these treatments overlap:
- Many of them help the trauma survivor develop new coping skills related to their symptoms. These involve things like emotion regulation, cognitive restructuring, relaxation and mindfulness techniques and psychoeducation about symptoms and issues related to the type of trauma the individual experienced.
- Many of them require an individual to revisit the event in order to heal. These can involve repeatedly retelling the story, reprocessing in a new way, or allowing the body to discharge any held energy.
- Most of them can be delivered in individual or group settings.
- In order to safely and fully explore one’s trauma, an individual needs to have some stability. Homelessness, uncontrolled addiction, severe emotional distress showing up as recurring panic attacks or suicidal ideation can interfere with someone’s ability to explore trauma. Life doesn’t have to be perfect, but the therapy should help with an individual see some improvement prior to exploring the trauma.
There is a three phase treatment protocol that is recommended by expert bodies on trauma:
- Phase 1: Achieving patient safety, reducing symptoms and increasing competencies. This is the skills building phase and clinicians can use any evidence based therapy that has outcomes of improving emotion regulation, increasing distress tolerance, mindfulness, interpersonal effectiveness, cognitive restructuring, behavioral changes, and relaxation. This phase can also help move someone out of crisis to prepare for the next phase.
- Phase 2: Review and reappraisal of trauma memories. There are different techniques for doing this, and they are described below, but the success of this phase hinges on someone’s ability to tolerate the discomfort of reviewing the memories. People with single incident trauma may be ready to withstand exposure with minimal distress tolerance training, while people with complex trauma may need months of skills building support in order to be ready to process their trauma.
- Phase 3: Consolidating the gains. The therapist is helping the client apply new skills and adaptive understanding of themselves and their trauma experience. This phase can also include “booster” sessions to reinforce skills, increase professional and informal support systems, and create an ongoing care plan.
There are several different ways to explore one’s trauma:
The military has used Prolonged Exposure therapy for years to have the individual talk through the traumatic event over and over until the event is no longer activating. An evidence-based practice for children and adolescents is Trauma-Focused Cognitive Behavioral Therapy, which uses a trauma narrative to expose the individual to their trauma for the same result. Also, Cognitive Processing Therapy can sometimes include a trauma narrative.
- Exposure can be done all at once, called “flooding,” or gradually to build up tolerance, called “desensitization.”
- Trauma narratives can be done verbally, or with images or other forms of art.
- These therapies are most recommended for individuals who have experienced a single incident, or perhaps experienced several incidents but don’t have any other mental health complications.
Cognitive processing therapies are fairly readily available to veterans through the VA.
On SAMHSA’s National Registry of Evidence-Based Programs and Practices, Eye Movement Desensitization and Reprocessing (EMDR) is the only intervention that allows an individual to reprocess memories and events. Reprocessing means that an individual accesses the relevant memory and uses dual awareness with bilateral stimulation and images, thoughts, emotions and body sensations to move through the traumatic experiences that aren’t resolved. If storing memories is like putting away groceries, a traumatic event was stored by shoving a bunch of stuff in a cabinet and then any time it gets opened all the stuff falls on your head. EMDR allows you to pull everything out in a controlled manner and then put it away in the organized way that non-traumatic memories are stored.
- EMDR is highly recommended for individuals who have developmental or complex trauma, but also has evidence-based protocols for single incident trauma.
- EMDR has 8 phases of treatment, the first three of which don’t involve any bilateral stimulation, and are more about skills-building and resourcing in preparation for the processing phases.
While EMDR is fairly effective in the treatment of this condition, it is generally not as readily as available for veterans through the VA (cognitive processing therapies are more readily available). EMDR treatment is more readily available in private and group practices.
Therapies that use the body to process trauma are cutting edge and so far none of them are considered evidence based due to lack of research. Probably the most popular is Somatic Experiencing, based on Peter Levine’s observations of animals’ recovery from traumatic events. Another model is Sensorimotor Psychotherapy, which also uses the body to work through trauma.
While all of the above treatments are designed to be used individually, most of them can be delivered in a group setting as well. Group therapy can be helpful for many people who have experienced trauma, since simply having experienced the type of event that can produce trauma symptoms can be isolating. Group members can help normalize a lot of the reactions and feelings that someone has.
As with any therapy, finding a therapist that you feel comfortable with and can trust is the most important thing. They should be clear with you about what your treatment plan is, and address any concerns that you have about your symptoms and your recovery. With the right therapist, you will be able to work with them on your trauma and they should be flexible enough to shift your treatment plan if things aren’t working. Talk with your therapist about the treatment approaches they use for trauma, and seek a referral if you feel like the therapist or the treatment model is not the right fit for you.
Psychotherapy takes time and patience to work. Most types of psychotherapy take at least 2-3 months in order to begin working. Many people will benefit from continuing therapy beyond that point as well, continuing on for 6 months to a year.
Most types of psychotherapy involve some amount of temporary discomfort when thinking or talking about the trauma. A person needs to able to handle and cope with such discomfort; most therapists are aware of this and will help the person while conducting treatment.
References & For Further Information