Treatments for Posttraumatic Stress Disorder
Posttraumatic stress disorder (PTSD) is a mental health condition that can significantly affect a person’s thoughts, feelings, behaviors and relationships. The medical diagnosis of PTSD includes a group of symptoms that last for more than a month and cause significant problems in social, work and other situations. PTSD can develop after experiencing a traumatic event such as combat, physical or sexual assault, or a serious accident. PTSD may also result from direct, indirect or repeated exposure to disturbing details of an event, as in the case of first responders, health care providers or other caregivers who work with trauma patients.
While there are many treatments advertised as effective for PTSD, only a few are proven to be safe and effective using sound research methods. Psychotherapy, also known as talk therapy, is a treatment where patients work with trained mental health providers to better understand their symptoms and learn new coping skills. There are also several medications that are effective in treating some of the symptoms of PTSD. This web page provides basic information on treatments for PTSD available in the Military Health System.
Common Elements of Cognitive Behavioral Therapies
Cognitive behavioral therapies (CBTs) for PTSD involve a relatively structured, short-term treatment that includes both cognitive (thought) and behavioral (action) interventions that can include one or more of the following components:
- Education about PTSD
- Anxiety management techniques/relaxation skills
- Cognitive restructuring
- Exposure therapy
Education about PTSD usually involves learning about the disorder including its symptoms, what causes it and what can be done to treat it.
Anxiety management techniques/relaxation skills are often taught in treatment for PTSD and involve learning and practicing techniques that lower your anxiety or feelings of stress. Several techniques such as meditation, progressive muscle relaxation or deep breathing exercises are used to reduce anxiety and are helpful for reducing the symptoms of PTSD.
Cognitive restructuring focuses on how thinking patterns may influence emotions. Cognitive therapy involves identifying and changing troublesome thinking patterns and beliefs. For example, people who believe that other people want to harm them might be very uncomfortable in crowds or other public areas where they aren’t in control. Cognitive therapy can help them view the world differently in order to live more fully.
Exposure therapy helps patients who avoid situations, thoughts and people that are associated with a trauma. Sometimes this pattern of avoiding anxiety-provoking things will lead to difficulty coping with life. Exposure therapy involves thinking about or actually being in situations which that trigger feelings of anxiety, such as being near a crowd. Repeatedly picturing these situations with the support and guidance of a mental health provider can often help.
- How much time does it take? A usual course of CBT for PTSD lasts about eight to 20 sessions but can vary based on the specific type of therapy.
- Who does this therapy? This type of therapy should be conducted by a trained mental health provider and is usually available at mental health clinics.
- Who does it work for? CBT is an effective treatment for adults with PTSD.
- What are some types of evidence-based cognitive behavioral therapies for PTSD? There are several variations of effective CBTs for PTSD. The specific therapies recommended by the Defense Department and Department of Veterans Affairs include:
- Prolonged exposure
- Cognitive processing therapy
- Eye movement desensitization and reprocessing therapy
- Stress inoculation training
Variations on Cognitive Behavioral Therapy for PTSD
Prolonged exposure therapy (PE) aims to reduce the distressing symptoms of PTSD through repeated exposure to stressful thoughts, feelings, memories and situations related to the trauma. Working together, the therapist educates the patient about the treatment, symptoms of PTSD, and skills for relaxing. Then exposure begins by the patient retelling the trauma story, as well as describing real world situations where the patient experiences stress. This process is paired with exercises intended to reduce anxiety and increase relaxation while the patient imagines the stressor. By gradually increasing the level of stress in situations described or imagined while remaining in a relaxed stated, patients learn to improve coping skills to better manage memories of trauma, and regain control over their life. PE therapy usually lasts eight to 15 sessions.
Cognitive processing therapy (CPT) is similar to PE in that it helps the patient reduce PTSD symptoms while teaching skills to cope with current and future stress. This therapy begins with education about CPT and the symptoms of PTSD. Therapists and patients then work together to gain understanding about how the patient’s thoughts and perceptions may impact the way they feel about their trauma story. This helps patients think about the trauma in a different way and gain better control of their thoughts and emotions.
Eye movement desensitization and reprocessing (EMDR) includes similar techniques as other CBTs but also involves the patient following an alternating stimulus (like a moving light) while describing the memory of a trauma.
Stress inoculation training is designed to help prevent people from having heightened anxiety reactions by learning anxiety management skills. It usually involves at least one of many of the following components: education on coping skills, assertiveness training, role playing, relaxation techniques and thought stopping. Stress inoculation training for PTSD will also include some exposure therapy exercises as well as learning about how to modify thoughts and beliefs that may cause anxiety.
Medications for PTSD
There are several types of medications that are commonly used to treat the symptoms of PTSD.
Some antidepressant medications are used for a variety of anxiety disorders, including PTSD. There is strong research to support the use of the selective serotonin reuptake inhibitors (SSRIs) fluoxetine, paroxetine, or sertraline and the serotonin/norepinephrine reuptake inhibitor (SNRI) venlafaxine for patients with PTSD. Prazosin is an alpha-blocker that is approved for use as an adjunct to the previous medications to help reduce or control nightmares.
- How much time does it take? The time frame for medications to start working and the duration for taking them depends on the type of medication and the severity of the symptoms of PTSD. Usually, it takes a few weeks to gradually increase the dose and achieve the desired benefit.
- Who prescribes medications for PTSD? Antidepressants can be prescribed by primary care managers, nurse practitioners, prescribing psychologists, physician assistants or psychiatrists in mental health clinics.
Resource: VA/DoD Clinical Practice Guidelines
Complementary and Alternative Medicine
Complementary and alternative medicine (CAM) approaches are often considered alternative to typical medical practices. Acupuncture is often considered a CAM treatment. There is some evidence that acupuncture may improve PTSD symptoms and acupuncture may be considered a treatment for patients with PTSD. Broadly, other forms of CAM include natural products, mind-body medicine, body manipulation and movement techniques, and energy techniques. Overall, there is insufficient evidence to recommend CAM approaches as a first line of treatment for PTSD. Several CAM approaches, such as mindfulness and yoga, are similar to traditional medical relaxation techniques and may be considered as adjunctive treatment of hyperarousal symptoms, although the relative effectiveness of these treatments is unknown. CAM approaches may be considered for patients who refuse other treatments, but providers should consider the risks of CAM approaches and keep in mind that treatments that have a limited evidence base for effectiveness also have a limited evidence base for potential harm and side effects.
Guidelines and Resources
The Defense Department collaborated with the VA to develop an evidence-based guideline to assist health professionals with the management of post-traumatic stress.
“PTSD 101,” made available by the VA National Center for PTSD, is a Web-based educational resource designed for practitioners who provide services to military men and women and their families as they recover from combat stress or other traumatic events.