The main treatments for people with PTSD are psychotherapy, medication, or a combination of the two. Everyone is different, so a treatment that works for one person may not work for another. Some people may need to try different treatments to find what works best for their symptoms. Regardless of what treatment option you chose, it is important for anyone with PTSD to be treated by a mental health professional who is experienced with PTSD.
Cognitive Behavior Therapy (CBT):
CBT is a type of psychotherapy that has consistently been found to be the most effective treatment of PTSD both in the short term and the long term. CBT for PTSD is trauma-focused, meaning the trauma event(s) are the center of the treatment. It focuses on identifying, understanding, and changing thinking and behavior patterns. CBT is an active treatment involved the patient to engage in and outside of weekly appointments and learn skills to be applied to their symptoms. The skills learned during therapy sessions are practiced repeatedly and help support symptom improvement. CBT treatments traditionally occur over 12 to 16 weeks.
Main Components of CBT:
While different CBTs have different amounts of both exposure and cognitive interventions, they are the main components of the larger category of CBTs that have been repeatedly found to result in symptom reduction.
- Exposure therapy. This type of intervention helps people face and control their fears by exposing them to the trauma memory they experiences in the context of a safe environment. Exposure can use mental imagery, writing, or visits to places or people that remind them of their trauma. Virtual reality (creating a virtual environment to resemble the traumatic event) can also be used to expose the person to the environment that contains the feared situation. Virtual reality, like other exposure techniques can assist in exposures for treatment for PTSD when the technology is available. Regardless of the method of exposure, a person is often gradually exposed to the trauma to help them become less sensitive over time.
- Cognitive Restructuring. This type of intervention helps people make sense of bad memories. Oftentimes people remember their trauma differently than how it happened (e.g., not remembering certain parts of the trauma, remembering it is a disjointed way). It is common for people to feel guilt of shame about aspects of their trauma that were not actually their fault. Cognitive restructuring helps people look at what happened with fact to get a realistic perspective on the trauma.
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It is important for anyone with PTSD to be treated by a mental health care professional who is experienced with PTSD. Some people will need to try different treatments to find what works for their symptoms.
Description of Specific CBTs for PTSD:
- Cognitive Processing Therapy (CPT) is a form of CBT that utilizes cognitive therapy to evaluate and change trauma related thoughts. CPT focuses on the way people view themselves, others, and the world after experiencing a trauma. Often times inaccurate thoughts after a trauma keep you stuck and prevent recovery from trauma. In CPT you look at why the trauma occurred and the impact it has had on the persons beliefs. CPT focuses on learning skills to evaluate whether you thoughts are supported by facts and if there are more helpful ways to think about your trauma. There is strong research support showing CPTs effectiveness across a wide range of traumas.
- Prolonged Exposure (PE) is another form of CBT that relies more heavily on behavioral therapy techniques to help individuals gradually approach trauma related memories, situations, and emotions. PE focuses on exposures to help people with PTSD stop avoiding trauma reminders. Avoiding these reminders may help in the short term, but in the long term it prevents recovery from PTSD. PE uses imaginal exposures, which involve recounting the details of the trauma experience, as well as in vivo exposures, which involve repeatedly confronting trauma-related situations or people in their life that they have been avoiding. There is strong research support showing PEs effectiveness across a wide range of traumas.
- Eye Movement Desensitization and Reprocessing (EMDR) is a form of psychotherapy that involves processing upsetting trauma-related memories, thoughts and feelings. EMDR asks people to pay attention to either a sound or a back and forth movement while thinking about the trauma memory. This treatment has been found to be effective for treating PTSD, but some research has shown that the back and forth movement is not the active treatment component but rather the exposure alone is.
- Stress Inoculation Training (SIT) is another type of CBT that aims to reduce anxiety by teaching coping skills to deal with stress that may accompany PTSD. SIT can be used as a standalone treatment or may be used with another types of CBTs. The main goal is to teach people to react differently to react differently to their symptoms. This is done through teaching different types of coping skills including, but is not limited to, breathing retraining, muscle relaxation, cognitive restructuring, and assertiveness skills. There is modest research support showing PEs effectiveness across a wide range of traumas.
Other PTSD Treatments:
There are other types of PTSD interventions that are not considered CBTs.
Present Centered Therapy (PCT) is a type of non-trauma focused treatment that centers around current issues rather than directly processing the trauma. PCT provides psychoeducation about the impact of trauma on one’s life as well as teaching problem solving strategies to deal with current life stressors.
Medication commonly used to treat PTSD are selective serotonin reuptake inhibitors (SSRIs)