Mind Help

Treatment Of Post-Traumatic Stress Disorder (PTSD)

PTSD Treatment

Treatment for post-traumatic stress disorder can help one to manage their symptoms better and regain control over their lives. As there are different types of PTSD treatment available, seeking help from a qualified healthcare professional is crucial.

Goal Of PTSD Treatment

The primary objective of PTSD treatment is to limit the impact of physical and emotional symptoms and to enhance the patient’s ability for daily functioning and improve overall quality of life. Effective treatment under the guidance of a mental health professional can also enable the patient to better manage trauma and triggers related to the traumatic event as well. Treatment for PTSD typically involves psychotherapy, medication or a combination of both 1 .

Treatment can help to manage PTSD symptoms by –

  • Teaching necessary skills to overcome symptoms
  • Empowering the patient to develop a positive mindset and perspective about themselves & the world
  • Providing helping coping strategies in case symptoms resurface
  • Addressing other important associated issues, like anxiety, depression, substance abuse

Importance Of PTSD Treatment

Even though there is no particular cure for this disorder, a multidimensional treatment approach that includes both psychotherapeutic & pharmacological interventions can prove to be highly effective. Moreover, patient education and social support can also play a crucial role. With treatment becoming widely available, research is indicating the growing effectiveness of treatment for people with post traumatic stress disorder.

A 2003 study shows that around 46% of patients with this condition can improve within a period of 6 weeks with psychotherapy. Moreover, 62% of people tend to improve after receiving medication. However, around 50% of people with this disorder are left untreated. This is why it is crucial to identify the condition, diagnose it accurately and seek PTSD treatment with support of friends and family. “Traumatic events can be very difficult to come to terms with, but confronting your feelings and seeking professional help is often the only way of effectively treating PTSD. It’s possible for PTSD to be successfully treated many years after the traumatic event or events occurred, which means it’s never too late to seek help,” adds the NHS, UK.

Types Of PTSD Treatment

Here are some of the most effective PTSD treatment options available for post-traumatic stress disorder:

1. Psychotherapy

Psychotherapeutic interventions are believed to be one of the most effective treatment options for post traumatic stress disorder, including combat-induced disorders. Some psychotherapy techniques work better than others, while some approaches are more effective during the initial phases of the trauma. “Psychotherapy is the centerpiece of most PTSD treatment,” explains Harvard Health. It can help patients to gain coping skills and successfully manage their symptoms. Psychotherapy can also educate the patient and their family about the condition and enable them to work on their phobias related to the trauma. The MHA explains that therapy “can be a great way to change behaviors, gain confidence, learn new skills, and talk with someone openly and honestly.” As there are different types of therapies, a mental health professional can combine various approaches depending on the severity and needs of each patient.

Psychological interventions 2 are regarded as first-line treatment 3 for this condition and have been found to be more effective than pharmacotherapy in some studies 4 . Harvard Medical School adds “The aim of psychotherapy is to help a person cope with painful memories and manage emotional and physical reactions to stress.” Regardless of the approach used, therapy can be greatly helpful, along with support from family and friends.

Here are some of the psychotherapy techniques recommended by doctors for PTSD treatment:

A. Cognitive behavioral therapy (CBT)

CBT, also known as talk therapy, encourages the patient to identify and modify thought and behavior patterns which can result in difficult emotions and unhealthy behaviors. It empowers the sufferer to acknowledge the traumatic event and bring about a change to their negative thought patterns. CBT teaches them how to change their thinking process and better regulate their distress and fears associated with the trauma. A form of CBT, Trauma-focused cognitive behavioural therapy (TF-CBT 5 ) has been found to be specifically effective in PTSD treatment.

TF‐CBT may involve a number of variations, such as eye movement desensitization and reprocessing, cognitive therapy, prolonged exposure, imagery rescripting therapy and cognitive processing therapy. Even though these approaches are usually considered distinctive, all of them focus on “emotional processing of the traumatic memory and integration of new corrective information.” According to research 6 , this type of CBT can be significantly helpful for victims of combat, assault, rape, terrorist attacks, childhood abuse and refugee camps. The researchers explain “The core component of this treatment typically involves exposure, i.e. the patient is directed to engage with the trauma memory for a prolonged period. This strategy is commonly conceptualized as a form of extinction learning, insofar as the person learns that the trauma reminder is no longer a signal of threat.”

According to the National Institute for Health and Care Excellence (NICE), 8-12 sessions of around 60-90 minutes regularly under the guidance of the same therapist per week can help a person with post traumatic stress disorder recover successfully. However, studies 7 reveal that around 66% of patients respond effectively to TF‐CBT.

Read More About Cognitive Behavioral Therapy Here

B. Exposure therapy

Exposure therapy is another effective PTSD treatment approach which is focused on decreasing anxiety, fear and unhealthy behavior, like avoidance & isolation, by making the patient exposed to or confront the situations, thoughts and feelings associated with the traumatic event(s). The patient is exposed to the experience of the trauma in a safe environment under the guidance of their therapist. The aim of this type of therapy is to relieve the symptoms and desensitize the sufferer. Harvard Health explains “People with PTSD often feel that the only way to reduce their anxiety is to avoid anything that stirs their memories of the trauma. But gradual and repeated exposure can reduce symptoms and help change how you respond to the triggering situations.”

Research 8 has found that exposure-based approaches for PTSD treatment are “the most empirically supported treatment modalities” for this condition. The therapist usually encourages the patient to approach a feared stimuli in a safe manner, instead of avoiding it. The stimuli can involve memories, elements or situations associated with the triggering event. However, as there are no negative consequences, like a perceived or real threat of death or injury, the patient can confront them until the automatic fear response to stimuli related to the trauma subsides. One 2015 study explains “Therapists help patients to confront their traumatic memories through written or verbal narrative, detailed recounting of the traumatic experience, and repeated exposure to trauma related situations that were being avoided or evoked fear but are now safe.” This can enable the sufferer to gain better control over their thoughts, emotions, behaviors and fears. According to the NIMH, exposure therapy “helps people face and control their fear. It uses imagining, writing, or visiting the place where the event happened,” to enable them to overcome the symptoms.

C. Prolonged Exposure Therapy (PE)

This is another variant of CBT that is primarily based on behavioral therapy techniques. PE aims to help sufferers learn how to approach emotions, memories and situations related trauma that cause anxiety. Through exposure, this therapy enables individuals to avoid and overcome reminders and stimuli. It focuses on imaginal exposures that may include recalling details associated with the traumatic event(s). It may also include in vivo exposures which require the patient to confront people or situations related to the trauma repeatedly. There is adequate research that depicts the effectiveness of Prolonged Exposure Therapy in different traumas. One 2015 study 9 explains “Prolonged exposure therapy (PE), a well-known trauma-focused cognitive behavioral treatment (TFCBT), is the most scientifically established treatment for post-traumatic stress disorder (PTSD) among a variety of pharmacotherapies and psychotherapies.”

D. Eye movement desensitisation and reprocessing (EMDR)

This is a new and complex type of psychotherapy that can substantially help in alleviating symptoms and can be an effective PTSD treatment option. However, the technique was originally developed to relieve distress that is caused by traumatic memories. EMDR can be especially helpful in reducing symptoms, like phobias and getting easily startled. According to a 2018 study 10 , “Eye movement desensitization and reprocessing (EMDR 11 ) is an innovative, evidence-based and effective psychotherapy for post-traumatic stress disorder.”

This form of therapy requires remembering aspects of the traumatic event while making rhythmic eye movements. The rapid eye movements aim to create the same effect on how the human brain analyzes and processes experiences and memories while sleeping. It involves the use of bilateral physical stimulation that can stimulate a sufferer’s information processing and incorporate the trauma as an adaptive contextualized memory. It can also create new connections between the event and positive thinking.

E. Other types of therapy

Apart from these, there are many other psychotherapy PTSD treatment approaches that can be useful in enabling a patient to overcome the symptoms. Here are some other common psychological interventions for PTSD:

  • Acceptance and commitment therapy
  • Brief eclectic psychotherapy
  • Cognitive therapy (CT)
  • Cognitive processing therapy (CPT)
  • Cognitive restructuring (CR)
  • Coping skills therapy (e.g. stress inoculation therapy)
  • Group or family therapy
  • Hypnosis and hypnotherapy 12
  • Present Centered Therapy (PCT)
  • Psychological debriefing
  • Psychodynamic therapy
  • Relaxation-based psychotherapies
  • Systematic desensitization

Research indicates that all variants of psychological treatments can significantly help in relieving symptoms. However, exposure-based treatments tend to be the most effective according to high strength of evidence (SOE).

2. Medications

Although there is no specific medication for PTSD treatment, certain medicines can help relieve symptoms. Doctors may often prescribe medications in conjunction with different types of therapies. Harvard Health explains that medication may also be prescribed if psychotherapy fails to resolve symptoms even after several weeks. It adds “Depending on how well an individual tolerates the medication, and how long she’s had PTSD symptoms, an approved drug may be prescribed for 6-24 months.” Some of the most prescribed medications for post-traumatic stress disorder or PTSD treatment include:

  • Antidepressants
  • Antianxiety drugs
  • Adrenergic inhibitors
  • Mood stabilizers
  • Antipsychotic medications
  • Sleep aids
  • Anticonvulsants
  • Alpha-blockers

Antidepressants, like selective serotonin reuptake inhibitors (SSRIs), are perhaps the most commonly prescribed for PTSD treatment and can help to reduce symptoms like anger, anxiety, sadness or worry. According to research 13 , antidepressants and other common medications may include-

  • Serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Tricyclic antidepressants
  • Monoamine oxidase (MAO) inhibitors
  • Adrenergic agents
  • Fluoxetine 14
  • Sympatholytic drugs
  • Topiramate
  • Risperidone

Apart from antidepressants, antianxiety and antipsychotic medications can also be helpful.

Read More About Antidepressants Here

Are Medications Effective?

The American Academy of Family Physicians (AAFP) states “ Approximately 10 percent of patients with PTSD are treated with an antipsychotic medication; these patients tend to have symptoms of PTSD that are more intrusive and severe.” However, “controlled studies have not yet provided clear guidance about which medications are most helpful,” warns Harvard Medical School. SSRIs, like paroxetine 15 (Paxil) and sertraline 16 (Zoloft) are commonly used and have been approved 17 by the Food and Drug Administration (FDA). One 2006 study 18 states, “Sertraline was significantly more effective than placebo on most primary efficacy variables, irrespective of whether patients had experienced interpersonal trauma or childhood abuse.” However, the effect size of these two medications are small in this mental condition.

Apart from depression, SSRIs can also help to cure anxiety and sleep disturbances. However, antidepressants may increase suicidal behavior in patients below 24 years of age. Benzodiazepines, a class of psychoactive drugs, may also be prescribed to relieve symptoms like anxiety, insomnia and irritability. “Benzodiazepines are quick-acting medications that are effective but can be habit forming,” explains Anxiety and Depression Association of America (ADAA). However, these medicines are not recommended by the National Center for PTSD for risk of abuse. Regardless, selective serotonin reuptake inhibitors (SSRI), along with serotonin-norepinephrine reuptake inhibitors (SNRI), like venlafaxine 19 , are considered as the first-line drug of choice 20 for this disorder.

Studies 21 also reveal that pharmacological agents, like prazosin (an alpha1‐adrenergic antagonist), can greatly help in managing hyperarousal and nightmares. Apart from these, clinical trials of propranolol 22 have revealed that can lead to decreased “subsequent reactivity to trauma reminders.” However, this may not reduce the severity of post traumatic stress disorder. Research also reveals that medications like phenelzine, amitriptyline and mirtazapine also proved better than placebo. Mirtazapine 23 was effectively used in treating Korean veterans affected by PTSD. Moreover, using olanzapine along with an antidepressant can significantly help in treating chronic post-traumatic stress disorder. As there are a range of medications available for the treatment of this disorder, “doctors and patients can work together to find the best medication or medication combination, as well as the right dose,” suggests the NIMH.

However, studies reveal that psychological interventions are more effective than pharmacotherapy 24 for treating PTSD. According to a 2019 study, there is limited compelling evidence for the effectiveness of pharmaceutical drugs in the treatment of this mental illness. Moreover, pharmacological treatment may involve potential adverse side effects as well as relapse after discontinuation. A 2015 research paper states “The National Institute for Health and Care Excellence and World Health Organization recommend drug treatment second to trauma focused therapy.”

Recovery Is Possible

Seeking medical attention is very important when you are suffering from post-traumatic stress disorder. A qualified and experienced healthcare professional can help you figure out the best PTSD treatment plan with minimal side effects and fast recovery. Talk openly with your doctor to work out the best combination of therapy and medications to avoid side effects and problems. With the right medications and therapy you may experience an improvement in your symptoms and mood within weeks.

Treatment Of Post-Traumatic Stress Disorder (PTSD) Reviewed By :


References:
  1. Hetrick, S. E., Purcell, R., Garner, B., & Parslow, R. (2010). Combined pharmacotherapy and psychological therapies for post traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd007316.pub2 []
  2. Sripada RK, Rauch SA, Liberzon I. Psychological Mechanisms of PTSD and Its Treatment. Curr Psychiatry Rep. 2016 Nov;18(11):99. doi: 10.1007/s11920-016-0735-9. PMID: 27671916. []
  3. Bajor LA, Ticlea AN, Osser DN. The Psychopharmacology Algorithm Project at the Harvard South Shore Program: an update on posttraumatic stress disorder. Harv Rev Psychiatry. 2011 Sep-Oct;19(5):240-58. doi: 10.3109/10673229.2011.614483. PMID: 21916826. []
  4. Sareen J. (2014). Posttraumatic stress disorder in adults: impact, comorbidity, risk factors, and treatment. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 59(9), 460–467. https://doi.org/10.1177/070674371405900902 []
  5. de Arellano, M. A., Lyman, D. R., Jobe-Shields, L., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Huang, L., & Delphin-Rittmon, M. E. (2014). Trauma-focused cognitive-behavioral therapy for children and adolescents: assessing the evidence. Psychiatric services (Washington, D.C.), 65(5), 591–602. https://doi.org/10.1176/appi.ps.201300255 []
  6. Bryant R. A. (2019). Post-traumatic stress disorder: a state-of-the-art review of evidence and challenges. World psychiatry : official journal of the World Psychiatric Association (WPA), 18(3), 259–269. https://doi.org/10.1002/wps.20656 []
  7. Bradley R, Greene J, Russ E, Dutra L, Westen D. A multidimensional meta-analysis of psychotherapy for PTSD. Am J Psychiatry. 2005 Feb;162(2):214-27. doi: 10.1176/appi.ajp.162.2.214. Erratum in: Am J Psychiatry. 2005 Apr;162(4):832. Erratum in: Am J Psychiatry. 2006 Feb;163(2):330. PMID: 15677582. []
  8. Lancaster, C. L., Teeters, J. B., Gros, D. F., & Back, S. E. (2016). Posttraumatic Stress Disorder: Overview of Evidence-Based Assessment and Treatment. Journal of clinical medicine, 5(11), 105. https://doi.org/10.3390/jcm5110105 []
  9. Asukai N. [Prolonged Exposure Therapy for Post-traumatic Stress Disorder]. Seishin Shinkeigaku Zasshi. 2015;117(6):457-64. Japanese. PMID: 26524872. []
  10. Landin-Romero, R., Moreno-Alcazar, A., Pagani, M., & Amann, B. L. (2018). How Does Eye Movement Desensitization and Reprocessing Therapy Work? A Systematic Review on Suggested Mechanisms of Action. Frontiers in psychology, 9, 1395. https://doi.org/10.3389/fpsyg.2018.01395 []
  11. Shapiro F. (2014). The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences. The Permanente journal, 18(1), 71–77. https://doi.org/10.7812/TPP/13-098 []
  12. Lynn SJ, Malakataris A, Condon L, Maxwell R, Cleere C. Post-traumatic stress disorder: cognitive hypnotherapy, mindfulness, and acceptance-based treatment approaches. Am J Clin Hypn. 2012 Apr;54(4):311-30. doi: 10.1080/00029157.2011.645913. PMID: 22655333. []
  13. Miao, X. R., Chen, Q. B., Wei, K., Tao, K. M., & Lu, Z. J. (2018). Posttraumatic stress disorder: from diagnosis to prevention. Military Medical Research, 5(1), 32. https://doi.org/10.1186/s40779-018-0179-0 []
  14. Davidson JR, Malik ML, Sutherland SN. Response characteristics to antidepressants and placebo in post-traumatic stress disorder. Int Clin Psychopharmacol. 1997 Nov;12(6):291-6. doi: 10.1097/00004850-199711000-00001. PMID: 9547130. []
  15. Stein DJ, Ipser JC, Seedat S. Pharmacotherapy for post traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2006 Jan 25;2006(1):CD002795. doi: 10.1002/14651858.CD002795.pub2. PMID: 16437445; PMCID: PMC6993948. []
  16. Brady K, Pearlstein T, Asnis GM, Baker D, Rothbaum B, Sikes CR, Farfel GM. Efficacy and safety of sertraline treatment of posttraumatic stress disorder: a randomized controlled trial. JAMA. 2000 Apr 12;283(14):1837-44. doi: 10.1001/jama.283.14.1837. PMID: 10770145. []
  17. Thomas E, Stein DJ. Novel pharmacological treatment strategies for posttraumatic stress disorder. Expert Rev Clin Pharmacol. 2017 Feb;10(2):167-177. doi: 10.1080/17512433.2017.1260001. Epub 2016 Dec 7. PMID: 27835034. []
  18. Stein DJ, van der Kolk BA, Austin C, Fayyad R, Clary C. Efficacy of sertraline in posttraumatic stress disorder secondary to interpersonal trauma or childhood abuse. Ann Clin Psychiatry. 2006 Oct-Dec;18(4):243-9. doi: 10.1080/10401230600948431. PMID: 17162624. []
  19. Stein DJ, Seedat S, van der Linden GJ, Zungu-Dirwayi N. Selective serotonin reuptake inhibitors in the treatment of post-traumatic stress disorder: a meta-analysis of randomized controlled trials. Int Clin Psychopharmacol. 2000 Aug;15 Suppl 2:S31-9. doi: 10.1097/00004850-200008002-00006. PMID: 11110017. []
  20. Mann SK, Marwaha R. Posttraumatic Stress Disorder. [Updated 2020 Nov 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559129/ []
  21. Singh B, Hughes AJ, Mehta G, Erwin PJ, Parsaik AK. Efficacy of Prazosin in Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis. Prim Care Companion CNS Disord. 2016 Jul 28;18(4). doi: 10.4088/PCC.16r01943. PMID: 27828694. []
  22. Pitman RK, Sanders KM, Zusman RM, Healy AR, Cheema F, Lasko NB, Cahill L, Orr SP. Pilot study of secondary prevention of posttraumatic stress disorder with propranolol. Biol Psychiatry. 2002 Jan 15;51(2):189-92. doi: 10.1016/s0006-3223(01)01279-3. PMID: 11822998. []
  23. Chung MY, Min KH, Jun YJ, Kim SS, Kim WC, Jun EM. Efficacy and tolerability of mirtazapine and sertraline in Korean veterans with posttraumatic stress disorder: a randomized open label trial. Hum Psychopharmacol. 2004 Oct;19(7):489-94. doi: 10.1002/hup.615. PMID: 15378676. []
  24. Stein DJ, Zungu-Dirwayi N, van Der Linden GJ, Seedat S. Pharmacotherapy for posttraumatic stress disorder. Cochrane Database Syst Rev. 2000;(4):CD002795. doi: 10.1002/14651858.CD002795. Update in: Cochrane Database Syst Rev. 2006;(1):CD002795. PMID: 11034765. []