According to the US Department of Veterans Affairs (VA), post-traumatic stress disorder (PTSD) was first listed in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) in 1980. Before that, known variously as shell shock or battle fatigue, among other names, it was considered largely to be a sort of burnout that occurred to soldiers after being in battle.
Experts in psychology now know that PTSD is more pervasive, affects people from various walks of life and with a range of trauma experiences, and is more than just a sort of fatigue. It is a recognized mental health disorder that occurs in people who have experienced severe trauma. As such, over the past 30 years, various forms of treatment, including medications, have been used to help people control the difficult symptoms of the disorder.
Unfortunately, while medications have been a big help in treating the disorder, they often are not an option for people who have substance abuse disorders, or those at risk for developing them, because the medications often have a high addictive potential. Over the years, however, research has found that people with the debilitating symptoms of PTSD, such as flashbacks and nightmares, situational avoidance, hypervigilance, and cognitive and emotional challenges, can learn to manage their symptoms and achieve recovery through therapy without medication.
Types of therapy That Treat PTSD
- Exposure Therapy
- Cognitive Restructuring or Cognitive Processing
- Eye Movement Desensitization and Reprocessing (EMDR)
- Stress Inoculation Therapy
Below are discussions of each of these types of therapy and how they help people with PTSD learn to manage their symptoms.
1. Exposure Therapy
Also known as Prolonged Exposure Therapy, this type of treatment gets directly to the source of the PTSD by exposing the individual to situations that trigger PTSD symptoms, always in a safe environment. The therapy is based in the idea of emotional processing – that is, that people who experience PTSD usually avoid triggers, so they are unable to process the thoughts, feelings, and experiences that result in symptoms. According to the Center for Deployment Psychology, this can result in the person being unable to process the event and continuing to manifest symptoms.
There are two ways in which this type of therapy can be applied:
- In vivo exposure directly engages the person in experiences that are normally avoided due to fears of triggering a PTSD response but that are not dangerous in themselves. For example, a person who has experienced a shooting at a mall might be encouraged to go back to the mall to help process that the mall itself is not dangerous. In vivo exposure may also include virtual reality tools to help the person explore a facsimile of the area or situation where the trauma occurred.
- Imaginal exposure occurs when the person simply listens to or discusses the narrative of what happened in the traumatic event. Through this sort of exposure, the person can explore the distressing thoughts and feelings about the event and learn that those personal responses are themselves not harmful and do not need to be avoided.
Both types of exposure therapy have been shown to have high levels of success in helping people overcome some of their PTSD symptoms. In fact, exposure therapy is so effective in helping to reduce PTSD symptoms that a study from Behaviour Research and Therapy showed it to help even combat veterans with co-occurring forms of severe mental illness, including schizophrenia. In the individuals from the study who were treated with exposure therapy, their PTSD symptoms decreased significantly, even considering the presence of other serious mental illnesses.
2. Cognitive Restructuring or Cognitive Processing
Cognitive restructuring is a type of behavioral therapy that encourages individuals to observe their own thoughts and evaluate them. Through this evaluation, individuals can learn to gain control over their thought processes, understanding that negative thoughts can be modified into more positive outcomes, and resulting behaviors can therefore be changed.
An example of cognitive restructuring is to analyze a negative thought, such as the previous example that the mall where the trauma took place is inherently dangerous. As described in Psychology Today, the following steps might be taken:
- Learn to notice the negative thought when it happens. Often, these types of thoughts are predictive and prevent the person from even trying to begin with.
- Observe the accuracy of the thought by testing it and noting the results. In this case, it might involve honestly analyzing whether or not the thought is true.
- Replace the thought with a new one based on the evidence, such as, “The mall is where this event happened, but the location itself is not the reason for the trauma.”
- Practice mindfulness and self-compassion to strengthen the value of the new thought, helping the person to begin to reshape beliefs about the situation.
In cognitive processing, the individual does this work over the course of about 12 weeks with a therapist who helps in the thought analysis. It can be difficult for the individual to discuss or write the specific feelings about the event. However, it is the act of purposefully engaging thoughts that cause distress that helps the person begin to recover from the PTSD symptoms the thoughts trigger.
In a study from the journal Evidence-Based Mental Health, cognitive restructuring was applied both alone and with and exposure therapy to treat PTSD symptoms. At the end of the study, 50 percent of those treated with cognitive therapy alone were improved, while 60 percent of those who received the combined therapy showed reduced symptoms. This demonstrates that combining these various therapies can, in some cases, be even more helpful than using any one treatment alone.
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3. Eye Movement Desensitization and Reprocessing (EMDR)
EMDR, as described by an article in Scientific American, may seem at first to be a strange process. The therapy is, in many ways, similar to cognitive restructuring. However, after a few sessions of this regular therapy, a different step is added in, involving the individual moving their eyes quickly back and forth while recounting the events and feelings from the trauma. For people who have undergone this treatment, there are reports of further symptom reduction than from the cognitive therapy alone.
As described in a paper from the Vanderbilt University Psychology Department, the idea of EMDR is based in the assumption that a person’s ability to mentally process information may be, in effect, short-circuited by a traumatic event. By constructing new thoughts about the event, and then connecting them and the event itself to the eye movements, the person is thought to create a new link to these processing centers, making it easier to work through the memories and insert new thought patterns and beliefs.
While there is controversy about the effectiveness of this therapy, recent research – such as a study from Frontiers in Human Neuroscience of the treatment’s use for people who suffer from PTSD after automobile accidents – has shown that EMDR can be more effective than other cognitive therapies alone.
4. Stress Inoculation Therapy
Stress Inoculation Therapy involves helping the individual learn to manage the anxieties and fears that arise in PTSD the same way many people manage their stresses and fears – through applying relaxation techniques and positive thinking practices. Importantly, however, this therapy is applied before an anticipated stress event occurs.
For example, the individual might be going into a situation likely to trigger PTSD symptoms. By applying stress inoculation techniques like positive thoughts about the situation, relaxation techniques such as breathing exercises, and mindfulness before the situation occurs, the person reduces the chances that symptoms will arise. This therapy requires the person to recognize triggers, and learn to stop and apply the techniques as needed, which takes therapy, training, and practice. Stress inoculation can also be used during a situation to keep a person calm if an unexpected trigger arises.
A study from the Society of Federal Health Professionals (AMSUS) showed that Marines who practiced these techniques before a stressful situation helped to lower arousal and stress and seemed to demonstrate a preventive effect for PTSD. While some of the other techniques described above are more effective in treating PTSD, this method can supplement them and also shows potential for preventing the development of PTSD to begin with for some people.
Treating PTSD can be a challenge, especially without the use of drugs. Nevertheless, with trained professionals, the therapies above have shown definite results in reducing PTSD symptoms and helping people with the condition to recover and return to a productive life with a higher degree of control of the anxieties and fears that the condition can produce.