What are the Best Treatments for PTSD?

PTSD (Post Traumatic Stress Disorder) is a condition that can develop after exposure to an extremely threatening or horrific event or series of events.

Many people associate PTSD with combat situations and the experiences of military veterans. However, many people suffer from PTSD due to a range of events, so it’s important to understand more about PTSD and – crucially – how to treat it.

 

What causes PTSD?

The association between PTSD and military combat is an important one, and it’s not surprising it’s the first thing that springs to mind when thinking about PTSD.

Clearly, military combat fits the description of an extremely threatening or horrific event or a series of events. 2,700,000 American men and women served in Vietnam, and four out of five Vietnam veterans reported recent symptoms of PTSD when interviewed 20-25 years after returning from active duty^[1]. This is likely to have cemented the association between PTSD and military combat in the public consciousness.

But there are many other types of events that can cause PTSD. These include:

• Sexual assault
• Traffic collisions
• Plane crash
• Child abuse
• Physical abuse
• Physical assault
• Kidnapping
• Robbery
• Mugging
• Domestic violence
• Death of a loved one
• Fire
• Natural disaster
• Life-threatening illness

Interestingly, PTSD does not just develop in those who have experienced a traumatic event directly, but also in those who witnessed it, heard about it (for example, family or friends of the victim), or whose work means they come into contact with the event or its aftermath (for example, first responders or medics).

 

How common is PTSD?

According to the National Center for PTSD, about six out of every 10 men (or 60%) and five out of every 10 women (or 50%) experience at least one trauma in their lives.

Women are more likely to experience sexual assault and child sexual abuse. Men are more likely to experience accidents, physical assault, combat, disaster, or to witness death or injury.

Interestingly, not all of these individuals will go on to develop PTSD. In fact, most people who experience a traumatic event do not.

The National Center for PTSD suggests that:

• About six out of every 100 people (or 6% of the population) will have PTSD at some point in their lives.
• About 12 million adults in the U.S. have PTSD during a given year. This is only a small portion of those who have gone through a trauma.
• About eight of every 100 women (or 8%) develop PTSD sometime in their lives compared with about four of every 100 men (or 4%).

The research^[2] does tell us that PTSD is more likely to develop when the traumatic event is one involving interpersonal violence (for example, sexual assault, kidnap, stalking, physical assault) than non-assault trauma such as car accidents or natural disasters.

 

What are the symptoms of PTSD?

To be diagnosed with PTSD, individuals must have experienced a traumatic event, and be suffering the following symptoms for at least four weeks (note that these apply to adults, as symptoms in children and young people are different):

1. Reliving the event (also called re-experiencing symptoms). Memories of the traumatic event can come back at any time. They can feel very real and scary. For example:

• You may have nightmares.
• You may feel like you are going through the event again. This is called a flashback.
• You may see, hear, or smell something that causes you to relive the event. This is called a trigger. News reports, seeing an accident, or hearing fireworks are examples of triggers.

2. Avoiding things that remind you of the event. You may try to avoid situations or people remind you of the trauma event. You may even avoid talking or thinking about the event. For example:

• You may avoid crowds, because they feel dangerous.
• You may avoid driving if you were in a car accident or if your military convoy was bombed.
• If you were in an earthquake, you may avoid watching movies about earthquakes.
• You may keep very busy or avoid getting help so you don’t have to think or talk about the event.

3. Having more negative thoughts and feelings than before the event. The way you think about yourself and others may become more negative because of the trauma. For example:

• You may feel numb – unable to have positive or loving feelings toward other people – and lost interest in things you used to enjoy.
• You may forget about parts of the traumatic event or not be able to talk about them.
• You may think the world is completely dangerous, and no one can be trusted.
• You may feel guilt or shame about the event, wishing you had done more to keep it from happening.

4. Feeling on edge or keyed up (also called hyperarousal). You may be jittery, or always alert and on the lookout for danger. You might suddenly become angry or irritable. For example:

• You may have a hard time sleeping.
• You may find it hard to concentrate.
• You may be startled by a loud noise or surprise.
• You might act in unhealthy ways, like smoking, abusing drugs or alcohol, or driving aggressively.

Adapted from the National Center for PTSD guidance

PTSD symptoms do not necessarily begin immediately after a traumatic event. They can surface months or even years afterwards, and they may come and go over time.

 

What are the best treatments for PTSD?

It’s important to seek treatment for PTSD for many reasons. PTSD is treatable, so there’s no need to suffer. Early intervention can mean recovery is quicker. Also, those with PTSD are at higher risk of suicide^[3] and intentional self-harm, so by treating PTSD you reduce the overall risk of harm.

The two main types of treatment for PTSD are psychotherapy (also known as talking therapy) and medication. Studies^[4] suggest that the benefits of therapy are greater than those of medication, but many patients combine both types of treatment.

 

Therapy for PTSD

The three most effective types of trauma-focused psychotherapy are:

1. Cognitive Processing Therapy (CPT) 

CPT was developed specifically to address PTSD symptoms. It’s based in Cognitive Behavioral Therapy or CBT, which is a type of therapy examining thoughts, feelings, and behaviors. CBT is one of the most studied (and studiable) approaches to therapy, making it one of the most evidence-based treatments available.

CPT is based in the belief that the nature of PTSD symptoms makes it a ‘disorder of non-recovery’. It is impossible to allow natural recovery mechanisms to kick in and process what’s happened when PTSD sufferers are experiencing extremely strong negative emotions about the event(s).

There are three stages to CPT:

• Education. In this stage, the patient and therapist work together to identify the impact on the patient’s life, identifying and reviewing the beliefs they had since the trauma.
• Processing. The patient writes an account of their experience and is encouraged to read it aloud to the therapist. The therapist asks questions about how the patient has processed the event, with the aim of seeing the experience from new angles.
• Coping strategies. Cognitive Processing Therapy allows patients to learn techniques and skills to understand how trauma changed their thoughts and feelings. The patient can then use these outside of the therapy room and as an ongoing toolkit to tackle any residual symptoms.

2. Prolonged Exposure (PE)

The symptoms of PTSD are all about trying to repress, avoid, or otherwise ‘forget’ the traumatic event(s) that caused the condition. However, anyone who has experienced PTSD knows that this is very difficult to do, and memories or visions of the event return in the form of flashbacks or nightmares.

Prolonged Exposure is a form of exposure therapy that enables people to talk about their trauma repeatedly until the memories are no longer upsetting.

This is achieved in two different ways:

1. Imaginal exposure, is about revisiting the traumatic memory, repeatedly recounting it aloud, and processing the revisiting experience. This usually takes place in the form of patients retelling the story of the traumatic event to a therapist.
   In vivo exposure requires repeated confrontation with situations and objects that cause distress but are not inherently dangerous. This happens progressively, often as ‘homework’ between sessions where patients may take home a recording made for them by the therapist.
2. In vivo exposure requires repeated confrontation with situations and objects that cause distress but are not inherently dangerous. This happens progressively, often as ‘homework’ between sessions where patients may take home a recording made for them by the therapist.

Both approaches are designed to desensitize patients from their fear around the trauma. This helps patients to get more control over their thoughts and feelings about the trauma.

Typically, patients who have experienced PE are able to go to places or do things that are safe, but they have been staying away from because they are reminders of the trauma.

3. Eye Movement Desensitization and Reprocessing (EMDR)

EMDR originated in the 1980s by American psychologist and educator, Francine Shapiro, after she noticed that moving her eyes from side to side helped to reduce how disturbing she found negative thoughts and memories.

The World Health Organization (WHO) guidelines describe EMDR as:

“based on the idea that negative thoughts, feelings, and behaviors are the result of unprocessed memories. The treatment involves standardized procedures that include focusing simultaneously on spontaneous associations of traumatic images, thoughts, emotions and bodily sensations and bilateral stimulation that is most commonly in the form of repeated eye movements.”

In other words, patients are encouraged to briefly recall the distressing and traumatic events they experienced, while also experiencing bilateral stimulation (that is, stimulation on both sides of the body). This could be side-to-side eye movement or physical stimulation, such as tapping either side of the body, or focusing on sounds or hand movements. This helps your brain work through the traumatic memories.

One of the main benefits of EMDR over other types of therapy is the speed at which it can be effective in reducing PTSD symptoms. According to EMDR.com, ‘more than 30 positive controlled outcome studies have been done on EMDR therapy. Some of the studies show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions.’

It’s important to make sure the therapist is fully trained in EMDR before working together, as this is a specialist area of expertise.

Medications for PTSD

Four medications have evidence to suggest that they are useful for treating PTSD symptoms. These are sertraline, paroxetine, fluoxetine, and venlafaxine, which are also used as antidepressants.

However, this is not a complete “cure” for PTSD. For all four medications, residual PTSD symptoms are likely to remain^[5], which is why medication is recommended alongside therapy.

 

Other treatments for PTSD

Exercise as a treatment for PTSD

The National Center for PTSD recommends exercise for those suffering with PTSD. The rationale behind this recommendation is that exercise can be a way to distract from disturbing emotions, build self-esteem, and increase feelings of being in control again.

Does cannabis help PTSD?

Cannabis is known to be used to manage PTSD symptoms, particularly by veterans. However, there is no scientific evidence to suggest that cannabis is effective for this purpose, and adverse effects are common.

Tetris as a treatment for trauma

Studies have shown that playing the computer game Tetris can help prevent development of trauma symptoms after exposure to a traumatic event^[6], and even improved symptoms of PTSD in men with combat-related trauma^[7].

Tetris is a game that involves stacking different shaped blocks as efficiently as possible before the time runs out. It can be downloaded to a smartphone, and some therapists recommend keeping it available as an app in case of exposure to trauma. One study^[8] even described it as a ‘cognitive vaccine’.

 

Treatments at The Center • A Place Of HOPE

Because PTSD affects all aspects of a person’s life, it’s important to seek treatment for the Whole Person. Here at The Center • A Place Of HOPE we have pioneered an award winning treatment program for PTSD. Our Whole Person Care approach focuses on the emotional, mental, physical, relational, and spiritual aspects of life, treating individuals in the best way for them.

Our approach to care is proven to help trauma & PTSD sufferers regain their life, balance, and happiness.

Please call during opening hours, Mon-Fri 9am-5pm PT, Verify Insurance or complete the form below.

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[1] Price JL. “Findings from the National Vietnam Veterans’ Readjustment Study – Factsheet”. United States Department of Veterans Affairs. National Center for PTSD.
[2] Kessler RC, Aguilar-Gaxiola S, Alonso J, Benjet C, Bromet EJ, Cardoso G, et al. (27 October 2017). “Trauma and PTSD in the WHO World Mental Health Surveys”. European Journal of Psychotraumatology. 8 (sup5): 1353383. doi:10.1080/20008198.2017.1353383.
[3] Panagioti M, Gooding PA, Triantafyllou K, Tarrier N (April 2015). “Suicidality and posttraumatic stress disorder (PTSD) in adolescents: a systematic review and meta-analysis”. Social Psychiatry and Psychiatric Epidemiology. 50 (4): 525–537. doi:10.1007/s00127-014-0978-x. PMID 25398198. S2CID 23314414
[4] Bisson JI, Cosgrove S, Lewis C, Robert NP (November 2015). “Post-traumatic stress disorder”. BMJ. 351: h6161. doi:10.1136/bmj.h6161. PMC 4663500. PMID 26611143.
[5] Krystal JH, Neumeister A (October 2009). “Noradrenergic and serotonergic mechanisms in the neurobiology of posttraumatic stress disorder and resilience”. Brain Research. 1293: 13–23. doi:10.1016/j.brainres.2009.03.044. PMC 2761677. PMID 19332037.
[6] Muriel A. Hagenaars, Emily A. Holmes, Fayette Klaassen & Bernet Elzinga (2017) Tetris and Word games lead to fewer intrusive memories when applied several days after analogue trauma, European Journal of Psychotraumatology, 8:sup1, DOI: 10.1080/20008198.2017.1386959
[7] Butler, O. et al. (2020) “Trauma, treatment and Tetris: Video gaming increases hippocampal volume in male patients with combat-related posttraumatic stress disorder,” Journal of Psychiatry and Neuroscience, pp. 279–287. Available at: https://doi.org/10.1503/jpn.190027.
[8] Holmes, E.A. et al. (2009) “Can playing the computer game ‘Tetris’ reduce the build-up of flashbacks for trauma? A proposal from Cognitive Science,” PLoS ONE, 4(1). Available at: https://doi.org/10.1371/journal.pone.0004153.