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Effective Treatments for PTSD

Posttraumatic stress disorder, or PTSD, is an umbrella term for the symptoms people experience after being exposed to a traumatic event. Trauma includes a wide range of events from natural disasters, terrorist acts, war/combat, and sexual assault to threats of death, violence, or serious injury. Per statistics from a recent survey, most people will experience at least one traumatic event within their lifetime. Women are twice as likely to be diagnosed with PTSD. Per the American Psychiatric Association, three specific ethnic groups (U.S. Latinos, African Americans, and American Indians) are disproportionately affected by PTSD and have higher rates of diagnosis than non-Latino white individuals

Before reviewing types of treatment, I'll cover the symptoms of PTSD, which fall into four categories. It warrants mentioning that you may not experience all of these symptoms despite having experienced a traumatic event. While that might result in your symptoms being more consistent with another diagnosis (e.g., depression, anxiety, adjustment disorder), evidence-based treatment remains available.

Intrusive symptoms consist of reminders of the event. These may include unwanted, intrusive memories or dreams/nightmares. We may find ourselves thinking about the event when attempting to focus, relax, or even sleep. Often, individuals then attempt to engage in avoidance behaviors; these consist of efforts to avoid reminders of the trauma. More specifically, individuals might avoid people, places, sights, sounds, memories, or objects associated with the event. While this is a common response to reminders of the event, avoidance serves to maintain the symptoms. Treatment will seek to reduce avoidance, in order to help the individual process the trauma. The next category of symptoms involves persistent changes in mood and cognitions. Mood changes can include frequent guilt and anger, as well as difficulty experiencing pleasant emotions. Changes in one’s cognitions or belief system are typically the primary target of trauma-focused treatment. Inaccurate and dysfunctional thoughts about the self, others, the world, and the future often result from traumatic experiences. As such, PTSD is a thought-based disorder. As treatment progresses, people typically notice their beliefs becoming more flexible (i.e., increased cognitive flexibility) along with subsequent decreases in emotional distress levels. The final cluster of symptoms consists of changes in arousal and reactivity. This reflects the sympathetic nervous system and our “fight/flight/freeze” response. Subsequent to trauma, individuals often experience heightened states of arousal, despite the absence of threatening stimuli. This may present itself in difficulty sleeping or relaxing and is the mind's effort to protect the self. Treatment also aims to reduce these arousal symptoms and essentially prevent the nervous system from “setting off the alarm” inaccurately. Again, we expect these symptoms after a trauma. They are indicative of work that needs to be done, specifically if they persist and we are “stuck” in the recovery process.

There are numerous types of treatment for symptoms resulting from trauma. I’ll review the two in which I am trained. However, other treatments are available and I am able to refer you to other providers that are trained in those specific treatments (e.g., EMDR).

First, I’ll review Prolonged Exposure (PE). This evidence-based treatment typically consists of 8-20 sessions. In attempting to recover from the impact of a traumatic event, we often first notice our emotional experience. More specifically, when feeling distressed we tend to avoid. While this response might not be incredibly impactful in some areas of life (i.e., we dislike a food and avoid eating it), the impact of trauma can grow and become persistent in our lives as a result of avoidance. Let’s use a car accident as an example. Following a car accident, we would expect a range of emotions. One emotion in particular that we would expect is anxiety; we would also expect this emotion upon getting back into a car for the first time. Now, this is the crucial moment at which we can see the impact of the trauma and how the mind learns. If we get in the car, feel anxious, and get out, the anxiety will typically dissipate. However, we’ve just created a learning trial for the mind. Avoidance of car=less anxiety. The mind has now learned that "cars are unsafe." As life continues, the mind will continue to seek associations and we may eventually find ourselves avoiding others’ cars, roads, and parking lots entirely. The avoidance has led us to perceive cars as unsafe and other aspects of our lives are being classified similarly.

Cars are not unsafe. Car accidents are unsafe. In order to learn this, we must decrease the avoidance, feel the emotion, and develop mastery. We must get in the car, feel the anxiety/fear, and allow the mind to learn that nothing bad will occur as a result of being in the car. PE involves creating a hierarchy of events; these will be challenged weekly with the goal of developing mastery in response to the cues/situations which are reminding us of the event. In addition to these “in-vivo” exposures (taking place in between sessions), we participate in “imaginal exposures” within the session. During these, we revisit the memory of the traumatic event that occurred with the same goal in mind; we are attempting to develop mastery via processing the memory of the event and feeling related emotions (as they run their course). With PE, we are going through the amygdala, a part of the brain which is responsible for our emotions. We must activate the emotions for the learning to occur.

Cognitive Processing Therapy (CPT), another evidence-based treatment with a 12-session duration, differs in that we are going around the amygdala. This description is slightly inaccurate as we cannot truly avoid emotions. But, this treatment emphasizes the cognitive impact of trauma. In the 12 sessions, we are exploring the impact of the trauma on our belief system. Via cognitive challenging and restructuring techniques, we assess the accuracy and validity of our beliefs in order to lessen the impact of the trauma. As a result, we seek to establish accurate and functional beliefs by focusing on how the trauma impacted our views of safety, trust, intimacy, esteem, and power/control (the themes commonly impacted by trauma).

If you believe these treatments might be appropriate for you or someone you know, a free consultation might help you better understand specific treatment goals. The most important outcome is that you receive the treatment you are seeking. If you have questions about how you or someone you know can get started with the recovery process from trauma, please reach out to Roswell Psychology today.

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