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.
Medically Reviewed on 9/14/2018
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