What is the treatment for PTSD?
Treatments for PTSD usually include trauma-focused psychological and medical interventions. Providing information about the illness, helping the individual manage the trauma by talking about it directly, teaching the person ways to manage symptoms of PTSD, and exploration and modification of inaccurate ways of thinking about the trauma are the usual techniques used in psychotherapy for this illness. Education of PTSD sufferers usually involves teaching individuals about what PTSD is, how many others suffer from the same illness, that extraordinary stress causes PTSD rather than personal weakness, how it is treated, and what to expect in treatment. This education thereby increases the likelihood that inaccurate ideas the person may have about the illness are dispelled, and any shame they may feel about having it is minimized. This may be particularly important in populations like military personnel that may feel particularly stigmatized by the idea of seeing a mental health professional and therefore avoid doing so.
Teaching people with PTSD practical approaches to coping with what can be very intense and disturbing symptoms is a useful way to treat the illness. Specifically, helping sufferers learn how to manage their anger and anxiety, improve their communication skills, and use breathing and other relaxation techniques can help individuals with PTSD gain a sense of mastery over their emotional and physical symptoms. The health care professional might also use exposure-based cognitive behavioral therapy by having the person with PTSD recall their traumatic experiences using images or verbal recall while using the coping mechanisms they learned. Individual or group cognitive behavioral psychotherapy can help people with PTSD recognize and adjust trauma-related thoughts and beliefs by educating sufferers about the relationships between thoughts and feelings, exploring common negative thoughts held by traumatized individuals, developing alternative interpretations, and by practicing new ways of looking at things. This treatment also involves practicing learned techniques in real-life situations. Intensive exposure therapy, which often involves multiple extensive sessions over several days followed by several weekly sessions over six months or more, is an evidence-based treatment that has been found to help people who have chronic PTSD. The Veterans Administration has invested in expanding the availability of this treatment to the people it serves.
Eye-movement desensitization and reprocessing (EMDR) is a form of cognitive therapy in which the health care professional guides the person with PTSD in talking about the trauma suffered and the negative feelings associated with the events, while focusing on the professional's rapidly moving finger during one-on-one treatment sessions. While some research indicates this treatment may be effective, it is unclear if this is any more effective than cognitive therapy done without the use of rapid eye movement.
Helping PTSD sufferers maintain their employment and other tasks of their daily lives is an important part of treatment. Occupational therapy (OT) is an important treatment modality in that regard, in that it focuses on rehabilitation and recovery through participation in activities. This can range from assisting helping people with PTSD regain independence in basic self-care to helping them reintegrate into previously held work and community roles. Another potentially powerfully positive activity-based intervention for individuals with PTSD can be the use of a service dog. Particularly toward the completion of more conventional treatments, service dogs have been found to be effective in improving PTSD suffers' sense of safety, responsibility, optimism, and self-awareness.
Families of PTSD individuals, as well as the sufferer, may benefit from family counseling, couples counseling, parenting classes, and conflict-resolution education. Family members may also be able to provide relevant history about their loved one (for example, about emotions and behaviors, drug abuse, sleeping habits, and socialization) that people with the illness are unable or unwilling to share.
Directly addressing the sleep problems that can be part of PTSD not only helps alleviate those problems but thereby helps decrease the symptoms of PTSD in general. Specifically, rehearsing adaptive ways of coping with nightmares (imagery rehearsal therapy), training in relaxation techniques, positive self-talk, and screening for other sleep problems can be helpful in decreasing the sleep problems associated with PTSD.
Medications that help PTSD sufferers include serotonergic antidepressants (SSRIs), like fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil), and medicines that help decrease the physical symptoms associated with illness, like prazosin (Minipress), clonidine (Catapres), guanfacine (Tenex), and propranolol. Individuals with PTSD are much less likely to experience a relapse of their illness if the person continues antidepressant treatment for at least a year. SSRIs are the first group of medications that have received approval by the U.S. Food and Drug Administration (FDA) for the treatment of PTSD. Treatment guidelines provided by the American Psychiatric Association describe these medicines as being particularly helpful for people whose PTSD is the result of trauma that is not combat related. SSRIs tend to help PTSD sufferers modify information that is taken in from the environment (stimuli) and to decrease fear. Research also shows that this group of medicines tends to decrease anxiety, depression, and panic. SSRIs may also help reduce aggression, impulsivity, and suicidal thoughts that can be associated with this disorder. For combat-related PTSD, there is more and more evidence that prazosin can be particularly helpful. Although other medications like duloxetine (Cymbalta), bupropion (Wellbutrin), venlafaxine (Effexor), and desvenlafaxine (Pristiq) sometimes treat PTSD, little research has studied their effectiveness in treating this illness.
Other less directly effective but nevertheless potentially helpful medications for managing PTSD include mood stabilizers like lamotrigine (Lamictal), tiagabine (Gabitril), and divalproex sodium (Depakote), as well as mood stabilizers that are also antipsychotics, like risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), aripiprazole (Abilify), asenapine (Saphris), and paliperidone (Invega). Antipsychotic medicines seem to be most useful in the treatment of PTSD in those who suffer from agitation, dissociation, hypervigilance, intense suspiciousness (paranoia), or brief breaks in being in touch with reality (brief psychotic reactions). The antipsychotic medications are helpful treatment options for managing PTSD when used in combination with an SSRI.
Benzodiazepines (tranquilizers) such as diazepam (Valium) and alprazolam (Xanax) have unfortunately been associated with a number of problems, including withdrawal symptoms, and risks of overdose and addiction, and have not been found to be significantly effective for helping individuals with PTSD.
Ahmed, A.S. "Post-traumatic stress disorder, resilience and vulnerability." Advances in Psychiatric Treatment 13 (2007): 369-375.
American Academy of Child and Adolescent Psychiatry. Child and adolescent
mental health statistics Resources for Families, 2007.
American Psychiatric Association. Diagnostic Criteria from the Diagnostic and
Statistical Manual of Mental Disorders, Fifth edition, Treatment Revision,
Washington, D.C., 2013.
Andreasen, N.C. "Acute and delayed posttraumatic stress disorders: a history and
some issues." American Journal of Psychiatry 161 August 2004:1321-1323.
Autry, D. "VA to review 72,000 PTSD claims." Disabled American Veterans Magazine Nov.-Dec. 2005.
Beals, J., Novins, D.K., Whitesell, N.R., Spicer, P., Mitchell, C.M., Manson, S.M.
Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective
Factors Project Team. Prevalence of mental disorders and utilization of mental
health Services in two American Indian reservation populations: mental health
disparities in a national context." American Journal of Psychiatry 162
September 2005: 1723-1732.
Benedek, D.M., M.J. Friedman, D. Zatzick, and R.J. Ursano. "Guideline watch: Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder." Arlington, Virginia: American Psychiatric Association, 2009.
Bryant, R.A., Harvey, A.G. "Gender differences in the relationship between acute
stress disorder and posttraumatic stress disorder following motor vehicle
accidents." Australian and New Zealand Journal of Psychiatry 37.2 April
Cahill, S.P. "Counterpoint: evaluating EMDR in treating PTSD." Psychiatric Times
17.7, July 2000.
Cohen, L.R., and D.A. Hien. Treatment outcomes for women with substance abuse and PTSD who have experienced complex trauma. Psychiatric Services 2006 January; 57: 100-106.
Davidson, J.R.T. "Effective Management Strategies for Posttraumatic Stress
Disorder." Focus 1 (2003): 239-243.
Davidson, J.R.T. "Surviving disaster: what comes after the trauma?" The British
Journal of Psychiatry 181 (2002): 366-368.
Davidson, J.R.T, Stein, D.J., Shalev, A.Y., Yehuda, R. "Posttraumatic stress disorder:
acquisition, recognition, course and treatment." Journal of Neuropsychiatry
16 May 2004: 135-147.
Department of Mental Health and Developmental Disabilities. Initiatives
promoting mental health, 2007.
Ferenc, M., Brown, E.B., Zhang, H., Koke, S.C., Prakash, A. "Fluoxetine v. placebo in
prevention of relapse in post-traumatic stress disorder." The British Journal of
Psychiatry 181 (2002): 315-320.
Friedman, M.J. "Acknowledging the psychiatric cost of war." New England
Journal of Medicine 351.1 July 1, 2004: 75-77.
Friedman, M.J. "Posttraumatic stress disorder among military returnees from
Afghanistan and Iraq." American Journal Psychiatry 163 April 2006:
Giannopoulou, I., Dikaiakou, A., Yule, W. "Cognitive-behavioral group intervention for PTSD symptoms in children following the Athens 1999 earthquake: a pilot study." Clinical Child Psychology and Psychiatry 11.4 (2006): 543-553.
Holtzheimer, P.E., Russo, J., Zatzick, D., Bundy, C., Roy-Byrne, P.P. The impact of comorbid posttraumatic stress disorder on short-term clinical outcome in
hospitalized patients with depression. American Journal of Psychiatry 162:
970-976, May 2005.
Kaminer, D., Seedat, S., Stein, D.J. Post-traumatic stress disorder in children.
World Psychiatry 4(2): 121-125, June 2005.
Keane, T.M., Marshall, A.D., Taft, C.T. Posttraumatic stress disorder: etiology,
epidemiology and treatment outcome. Annual Review of Clinical Psychology 2:
161-197, April 2006.
Kenardy, J.A., Spence, S.H., Macleod, A.C. Screening for posttraumatic stress
disorder in children after accidental injury. Pediatrics 118: 1002-1009. 2006.
Knaevelsrud, C., Maercker, A. Internet-based treatment for PTSD reduces distress
and facilitates the development of a strong therapeutic alliance: a randomized
controlled clinical trial. BioMed Central Psychiatry 7: 13, 4/19/07.
Lamarche, L.J., De Koninck, J. Sleep disturbance in adults with posttraumatic
stress disorder: a review. Journal of Clinical Psychiatry 68(8): 1257-1270.
Levin, A. "Early intervention offers hope for preventing PTSD." Psychiatric News 48.1 Jan. 2013: 21.
Levin, A. "Role of sociodemographics still unclear in PTSD." Psychiatric News 43.21 (2008): 17.
Loo, C.M. PTSD among ethnic minority veterans. National Center for PTSD, 2007.
Lorber, J. "For the battle-scarred, comfort at leash's end." The New York Times, 2010.
McLean, L.M., Gallop, R. Implications of childhood sexual abuse for adult
borderline personality disorder and complex posttraumatic stress disorder. American Journal of Psychiatry 160: 369-371, April 2003.
Meiser-Stedman, R., Smith, P., Glucksman, W.Y., Dalgleish, T. parent and child
agreement for acute stress disorder, post-traumatic stress disorder and other
psychopathology in a prospective study of children and adolescents exposed to
single-event trauma. Journal of Abnormal Child Psychology 35(2): 191-201. April
Mental Health News. Prevalence and Correlates of Post Traumatic Stress
Disorder and Chronic Severe Pain in Psychiatric Outpatients. June 1, 2007.
Mol, S.S.L., Arntz, A., Metsemakers, J.F.M., et al. "Symptoms of post-traumatic stress disorder after non-traumatic events: evidence from an open population study." The British Journal of Psychiatry 186 (2005): 494-499.
NARSAD. Post-traumatic stress disorder can damage children's brain
development. www.narsad.org, 11/20/07.
NIMH. Post traumatic stress disorder: a real illness. www.nimh.nih.gov,
Perilla, J.L., Norris, F.H., Lavizzo. Ethnicity, culture and disaster response:
identifying and explaining ethnic differences in PTSD six months after hurricane
Andrew. Journal of Social and Clinical Psychology 21(1): 20-45, March 2002.
Perrin, M.A., DiGrande, L., Wheeler, K., Thorpe, L., Farfel, M., Brackbill, R.
Differences in PTSD prevalence and associated risk factors among World Trade
Center disaster rescue and recovery workers. American Journal of Psychiatry
164(9): 1385-1394, September 2007.
Pole, N., Best, S.R., Metzer, T., Marmar, C.R. Why are Hispanics at greater risk for PTSD?
Cultural, Diversity and Ethnic Minority Psychology 11(2): 144-161, 2005.
Psychology Today. "Complex PTSD." Psychology Today, 2010.
Reeves, R.R. Diagnosis and management of posttraumatic stress disorder in
returning veterans. Journal of the American Osteopathic Association 107(5):
181-189, May 2007.
Ruchkin, V., Schwab-Stone, M., Jones, S., Cicchetti, D.V., Koposov, R., Vermeiren. R. Is
posttraumatic stress in youth a culture-bound phenomenon? A comparison of
symptom trends in selected U.S. and Russian communities. American Journal of
Psychiatry 162: 538-544, March 2005.
Ruzek, J. "Coping with PTSD and recommended lifestyle changes for PTSD patients."
National Center for Post Traumatic Stress Disorder, May 22, 2007.
Schneider, S.L., L. Haack, J. Owens, et al. "An interdisciplinary treatment approach for soldiers with TBI/PTSD: issues and outcomes." Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders 19.2 June 2009: 36-46.
Schoenfeld, F.B., Marmar, C.R., Neylan, T.C. "Current concepts in pharmacotherapy for
post traumatic stress disorder." Psychiatric Services 55 May 2004: 519-531.
Schuster, M.A., Stein, B.D., Jaycox, L.H., Collins, R.L., Marshall, G.N., Elliott, M.N., Zhou, A.J., Kanouse, D.E., Morrison, J.L., Berry, S.H.
"A national survey of stress reactions
after the September 11, 2001 terrorist attacks." New England Journal of Medicine
345.20 Nov. 15, 2001: 1507-1512.
Seng, J.S., Graham-Bermann, S.A., Clark, M.K., McCarthy, A.M., Ronis, D.L. "Posttraumatic
stress disorder and physical comorbidity among female children and adolescents:
results form service-use data." Pediatrics 116.6 December 2005: 767-776.
Smith, M.V., K. Poschman, and M.A. Cavaleri, et al. Symptoms of posttraumatic stress disorder in a community sample of low-income pregnant women. American Journal of Psychiatry 2006 May; 163: 881-884.
Udwin, O., Boyle, S., Yule, W., Bolton, D., O'Ryan, D. "Risk factors for long-term
psychological effects of a disaster experienced in adolescence: predictors of
post traumatic stress disorder." The Journal of Child Psychology and Psychiatry
and Allied Disciplines 41 (2000): 969-979.
Vlahov, D., Galea, S., Resnick, H., et al. "Increased use of cigarettes, alcohol and marijuana among Manhattan, New York residents after the September 11th terrorist attacks." American Journal of Epidemiology 155.11 (2002): 988-996.
Winter, H., Irle, E. "Hippocampal volume in adult burn patients with and without posttraumatic stress disorder." American Journal of Psychiatry 161 (2004): 2194-2200.
Wu, P., Duarte, C.S., Mandell, D.J., Fan, B., Liu, X., Fuller, C.J., Musa, G., Cohen, M., Cohen,
P., Hoven, C.W. "Exposure to the World Trade Center attack and the use of cigarettes
and alcohol among New York City public high-school students." American Journal of
Public Health 96.5 (2006): 804-807.
Yehunda, R., Engel, S. M., Brand, S.R., Seckl, J., Marcus, S.M., Berkowitz, G.S.
"Transgenerational effects of post traumatic stress disorder in babies of mothers
exposed to the World Trade Center attacks during pregnancy." The Journal of
Clinical Endocrinology and Metabolism 90.7 (2005): 4115-4118.
Zayfert, C., DeViva, J., Hofmann, S.G. "Comorbid PTSD and social phobia in a treatment-seeking population: an exploratory study." The Journal of Nervous and Mental Disease 193.2 (2005): 93-101.