Therapy for Trauma, PTSD, Posttraumatic Stress Disorder

Posttraumatic Stress

Posttraumatic stress (PTSD) is a common reaction to traumatic or stressful events. PTSD takes many forms and may arise immediately after the experience or even decades later. People may or may not experience PTSD after trauma, but they might also experience responses to trauma that are not diagnostically categorized as PTSD. There is no direct correlation between resilience and PTSD; in other words, living with PTSD is not an indication a person is weak or lacks resilience.

PTSD is highly treatable, and various treatment methods make it very possible to overcome symptoms of PTSD and move on from posttraumatic stress altogether.

What Is Posttraumatic Stress (PTSD)?

It is natural to experience aftereffects following a shocking, upsetting, dangerous, or scary event. When the “fight or flight” mechanism is set off during such an event, the mind might work quickly toward a resolution or become stuck in a harmful pattern that can change the brain substantially. Therefore, reactions may be temperate and easily worked through or intensely unpleasant and life-altering. The American Psychiatric Association (APA) classifies PTSD as any response to trauma that meets diagnostic criteria or influences the ability to cope or function in everyday life. 

The condition is commonly associated with military service and was long understood to be an aftermath of combat; in fact, what is now known as PTSD was previously known as shell shock or combat fatigue. But while some of the first applications of posttraumatic stress were in the context of war, the APA now applies this concept broadly to many types of trauma.

PTSD can occur after any type of physically or psychologically stressful event. Situations and events that may bring about PTSD in some individuals include:

Studies indicate 3.5% of the U.S. population will experience PTSD in any given 12-month period. Almost 37% of these cases can be classified as “severe.” Although men are statistically more likely to experience traumatic events than women, women are more than twice as likely to develop PTSD, perhaps because sexual assault leads to PTSD more frequently than do other forms of trauma, and women experience sexual assault at higher rates.

A distressed woman looks out the window

Diagnosis and Symptoms

The APA’s Diagnostic and Statistical Manual (DSM) outlines four categories of PTSD symptoms: re-experiencing, avoidance, arousal and reactivity, and cognition and mood. To diagnose an individual with PTSD, mental health professionals look for at least one symptom in each of the first two categories and at least two symptoms in each of the second two categories.  

Re-experiencing symptoms in PTSD:

  • Reliving trauma with physiological signs such as rapid heartbeat and sweating
  • Flashbacks
  • Nightmares
  • Disturbing or scary thoughts

Avoidance symptoms:

  • Escaping reminders of the traumatic experience including people, situations, places, or objects
  • Repressing or ignoring emotions or thoughts related to the event

Arousal and reactivity PTSD symptoms:

  • Startling easily
  • Tension or a feeling of being “on edge”
  • Difficulty falling or staying asleep
  • Emotional outbursts, especially in anger

Symptoms of cognition or mood issues:

  • Memory problems
  • Self-deprecating thoughts, hopeless thoughts about the world
  • Feelings of guilt, self-blame, or blame of others
  • Lack of passion related to previously enjoyed activities

Mental health professionals look for ways these issues affect an individual’s everyday routine and influence habits or behaviors in a lasting or detrimental way. A therapist would also watch for words or situations that might trigger the individual’s symptoms, as well as ongoing moods or emotions related to the stress response. For example, things like avoiding all car transportation after an accident, ongoing anger issues, or difficulty eating might be indicative of PTSD symptoms.

PTSD and Co-Occurring Mental Health Conditions

It is not uncommon for other mental health issues to be present with PTSD. Some might increase the chance an individual experiences PTSD after a traumatic event while others might arise from PTSD symptoms or be totally unrelated. Typical mental health issues seen in conjunction with PTSD include depression, substance abuse issues, anxiety, grief, and suicidal ideation

If other mental health issues complicate PTSD symptoms–such as by worsening mood symptoms or bringing out aggressive tendencies–it may be more difficult for a person to find help. Someone with PTSD and complicating issues that affect behavior and temperament may feel detached from family and friends and alienated from adequate support systems. 

Treatment Options and Therapy for PTSD

Recovery from PTSD is a journey that takes a different shape for each individual. It is never too early or late to seek psychotherapy after experiencing a traumatic event or beginning to experience symptoms of PTSD. Therapy or counseling can help people make sense of their experiences and feelings, develop plans to stay safe, learn healthy coping skills, connect with other resources and support, and experience posttraumatic growth.

Among the therapeutic modalities that have been used successfully to treat PTSD, either as a primary or adjunct treatment method, are the following:

Individuals might also participate in group therapy or logotherapy, the goal of which is to heal through addressing existential questions arising in the aftermath of trauma and by discovering meaning in life.

In some cases, psychotropic medication can also be used in conjunction with therapy to reduce the severity of symptoms or eliminate them completely. People with PTSD may find medication especially helpful for improving sleep, alleviating anxiety, and stabilizing mood issues. 

The majority of people with PTSD who receive treatment are able to recover. In instances where therapy is not effectively treating PTSD, it is usually because a person-centered approach is not being used or underlying or co-occurring mental health issues present with PTSD have not been adequately addressed. Further assessment, and/or the help of a different mental health care provider, may be helpful in either of these situations. A good psychotherapist takes into account all relevant aspects of a person’s history and unique situation during treatment.

According to trauma therapist Susanne Dillmann, "We may avoid situations or people that remind us of the trauma. We may be emotionally numb, depressed, or anxious. Sometimes, people turn to drugs to numb feelings of terror that last for weeks, months, and in some cases, years after a trauma. If you experience such feelings, thoughts, or behaviors after a trauma, know that such experiences are very human and nothing to be ashamed of. Through the assistance of a trained professional, one can heal from the consequences of a trauma."

A tiny sprout emerges from black rocks and soilCase Examples

  • Iraq war veteran finds it difficult to readjust to civilain life: Ricky, 26, has recently returned from Iraq, where she witnessed heavy combat. She tells her therapist she was fine until the week before when a robbery occurred in a local store while she was there. Suddenly, she was paralyzed by graphic memories of her time in combat and has since had nightmares about Iraq, mixed with images of her home. Ricky feels overwhelmed and anxious about these flashbacks, as well as guilty for surviving while two of her friends did not. She also has some guilt associated with not stopping the local robbery, having internalized acts of bravery as her duty and responsibility. In therapy Ricky finds talking about her feelings helps somewhat, as does focusing on ways to stay safe. Ricky’s guilt is addressed by exploring her beliefs about what it means to be a veteran and her high expectations of herself. The therapist teaches Ricky some relaxation and grounding exercises and, at Ricky’s request, offers a psychiatric referral for anti-anxiety medications to help Ricky sleep. Ricky decides to join a therapy group for veterans who experience similar issues. A year after her first visit, she is no longer taking medications and is feeling more hopeful, though she still occasionally struggles with intense grief about the war.
  • Anxiety and other repercussions of childhood abuse: Pat, 52, calls himself a highly anxious person and seeks therapy for help with his anxiety. His history reveals severe physical abuse as a child, which Pat is reluctant to revisit. Pat’s therapist does not push or force him to revisit the events but gently brings it up in later sessions. When she does, Pat becomes very upset and angry. Upon examining his response, Pat agrees that his reaction indicates the abuse he experienced is still affecting him, that he has not fully addressed it. Pat’s therapist suggests eye movement desensitization and reprocessing (EMDR) therapy and explains how it works. With the therapist’s recommendation, Pat begins EMDR sessions, which help him start by acknowledging the abuse in a relatively passive way. Because Pat is able to confront his abusive past more openly and heal from it, his anxiety gradually begins to diminish until it is considerably less.

Resources Related to Trauma/PTSD

  • Making Peace With Chronic PTSD: Marla's Story: This video takes a look at chronic PTSD with trauma expert, Frank Ochberg MD, once the Associate Director for the National Institute of Mental Health (NIMH), and Dr. Marla Handy, a former university lecturer with a difficult history of chronic PTSD as a result of childhood abuse and sexual trauma. This DVD is being used for counseling education, and by clinicians, social workers, educators, and trauma survivors. You can buy the full DVD from Gift From Within, a nonprofit organization for survivors of trauma and victimization. Video is copyright Gift From Within and is used by special permission for GoodTherapy.org from Gift From Within.
  • Helping Traumatized Children at School: This article by Kathleen Nader, DSW, addresses the effects of trauma on children.
  • The Trauma & Mental Health Report: Written by Dr. Robert Muller, this blog is oriented toward making the difficult topic of interpersonal trauma interesting and accessible to both therapists and the general public.

Share Your Story About Posttraumatic Stress

If you are a writer or blogger who has had personal experience with posttraumatic stress, please consider sharing your story with other GoodTherapy.org readers through Share Your Story. If your story is accepted, it will be published alongside other thoughtful and inspirational mental health stories on The Good Therapy Blog.

References:

  1. Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D. (2005). A multidimensional meta-analysis of psychotherapy for PTSD. The American Journal of Psychiatry, 162(2), 214-27. Retrieved from http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.162.2.214 
  2. Brady, K. T., Killeen, T. K., Brewerton, T., & Lucerini, S. (2000). Comorbidity of psychiatric disorders and posttraumatic stress disorder. The Journal of Clinical Psychiatry. Retrieved from http://psycnet.apa.org/record/2000-15466-003 
  3. Friedman, M. (2015). PTSD history and overview. National Center for PTSD. Retrieved from https://www.ptsd.va.gov/professional/ptsd-overview/ptsd-overview.asp 
  4. Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048-1060. Retrieved from https://jamanetwork.com/journals/jamapsychiatry/article-abstract/497313 
  5. Perkonigg, A., Kessler, R. C., Storz, S., & Wittchen, H. U. (2000). Traumatic events and post‐traumatic stress disorder in the community: prevalence, risk factors and comorbidity. Acta Psychiatrica Scandinavica, 101(1), 46-59. Retrieved from http://onlinelibrary.wiley.com/doi/10.1034/j.1600-0447.2000.101001046.x/full 
  6. Post-traumatic stress disorder. (2016). National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml 
  7. Southwick, S. M., Gilmartin, R., McDonough, P., & Morrissey, P. (2006). Logotherapy as an adjunctive treatment for chronic combat-related PTSD: A meaning-based intervention. American Journal of Psychotherapy, 60(2), 161-74. Retrieved from https://pdfs.semanticscholar.org/20c7/e8a4b4da1f2b6ddd72d96853980c05d35742.pdf 
  8. Tedeschi, Richard G., and Calhoun, Lawrence G. (2004). Posttraumatic Growth: Conceptual Foundations and Empirical Evidence. Psychological Inquiry, 15(1). Retrieved from http://data.psych.udel.edu/abelcher/Shared%20Documents/3%20Psychopathology%20(27)/Tedeschi,%20Calhoun,%202004.pdf 
  9. What is posttraumatic stress disorder? (2013). American Psychiatric Association. Retrieved from https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd  
  10. Women, trauma and PTSD. (2015). National Center for PTSD. Retrieved from http://www.ptsd.va.gov/public/pages/women-trauma-and-ptsd.asp 

 

Last updated: 12-01-2017

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