Understanding PTSD and Finding an Effective Therapy
Post-traumatic stress disorder (PTSD) is a painful and debilitating mental health condition suffered by millions of people each year in the United States. Many different types of traumatic situations and events can cause a person to develop PTSD, and not everyone who experiences trauma gets PTSD.
For those who are affected by this mental health diagnosis, finding a mental health provider with the right experience and interpersonal rapport can be both a challenge and a key to regaining control of life as quickly as possible.
Understanding the nature of PTSD as a mental health condition and knowing about the available treatment options are the first steps in finding a PTSD provider who works for you. Each person affected by PTSD is different, and many who are struggling with this condition try several therapeutic options before finding the right approach for their situation.
If you or a loved one suffer from PTSD symptoms, it is essential to know that help is available, and recovery is possible. The critical point is to keep working toward healing, be patient with yourself, and seek a compassionate and experienced PTSD provider who can support and help you along the way.
Symptoms and Prevalence of PTSD
According to the National Institute of Mental Health, 3.6 percent of the adult U.S. population has PTSD symptoms each year. In any given year, this equals approximately 10 million adults with a PTSD diagnosis. Women are more likely to develop PTSD as a result of trauma than men, and children can also be diagnosed with this condition.
People who develop PTSD have some or all of these symptoms:
- Intrusive flashbacks of images, sensations, or emotions associated with the traumatic events
- Difficulty controlling emotions, especially rage and fear
- Hyper-vigilance and difficulty feeling safe or trusting people
- Increased startle response
- Nightmares and difficulty sleeping
- Suicidal or homicidal thoughts
- Avoidance of reminders of the trauma
- Substance and alcohol abuse
- Relationship difficulties
- Persistent feelings of depression, shame, or guilt
PTSD is often associated with military combat, experiencing a natural disaster, being in a car accident, or being a victim or witness of violent crime. A significant portion of PTSD cases reported each year are attributable to these causes. However, people also develop PTSD from:
- Child abuse when growing up
- Sexual abuse at any age
- Ongoing, highly stressful work and living situations involving mental and emotional abuse
- Domestic violence and abuse of any kind
Complex-PTSD (C-PTSD) is a form of PTSD recognized by an increasing number of therapeutic practitioners. C-PTSD results from exposure to ongoing traumatic situations over an extended time and includes abusive interpersonal contact.
People diagnosed with C-PTSD may have experienced child abuse, sexual trafficking, domestic violence, or similar types of trauma. Symptoms of C-PTSD include emotional flashbacks, emotional dysregulation, and a heightened loss of personal trust and capacity for intimacy.
Physical Basis of PTSD Symptoms
A common misconception about PTSD is that the symptoms come from emotions a person can control, if only they try hard enough. However, scientific evidence supports the conclusion that the causes of PTSD and Complex-PTSD lie in physical changes inside the brain and nervous system. Therapies addressing these underlying neurological changes have the greatest potential for alleviating the symptoms of this disorder.
Effects of Stress Hormones and PTSD Symptoms
When a person experiences trauma, their body releases large amounts of stress hormones, which allow for the "fight or flight" response. These stress hormones include cortisol, norepinephrine, and adrenaline. Any time you feel frightened, you experience the effect of these hormones, but usually these chemicals quickly return to normal levels.
During chronic and extreme stress conditions leading to PTSD, stress hormones remain elevated, and stress reactions are more easily triggered. Cortisol is the stress hormone most associated with PTSD symptoms. Chronic excess cortisol levels can lead to elevated blood pressure, weight gain, loss of sex drive, suppression of the immune system, and other physical health problems.
Cortisol and other stress hormones work with a structure in the brain called the amygdala. This brain structure controls feelings of fear, rage, and the "fight or flight" instinct. When a person has PTSD, the amygdala becomes over-reactive, and rational thought and empathy for others become difficult or impossible.
Numerous brain imaging studies of people diagnosed with PTSD show an enlargement of the amygdala as a result of continuous stress. Therapies that address these physiological changes are the most successful for treating PTSD.
Effective PTSD Therapies
For some people who are healing from PTSD, talk therapy alone is sufficient. Talk therapy for PTSD may or may not involve discussing the details of the traumatic events with the therapist. Identifying and changing disruptive and negative thoughts, emotional responses, and behaviors are often the focus of therapy sessions instead. In other cases, the therapist and client may discuss details of the trauma and the emotions associated with it.
Other therapies use systematic exposure to the disturbing memories, which the client may or may not discuss in detail with the therapist. These treatments still involve talking between therapist and client, but they also include the use of bilateral stimulation, breathing and relaxation exercises, mindfulness meditation, and similar techniques. These non-verbal techniques help address underlying causes of PTSD symptoms in the person's brain, nervous system, and hormonal system.
Treatment Options for PTSD
These are the most commonly used and effective therapies for treating PTSD:
- The U.S. Department of Veterans Affairs considers Eye Movement Desensitization and Reprocessing (EMDR) among the most effective treatments for PTSD. EMDR involves thinking about traumatic events in stages over a series of therapy sessions while using bilateral eye movement, auditory, or physical stimulation. The therapist can provide the stimulation by a variety of methods, including a flashing light or headphones alternating a sound from the right to the left ear.
Some researchers question whether the bilateral stimulation is part of the effectiveness of this treatment. Other research indicates that bilateral stimulation is crucial for the success of EMDR treatment for reasons which are still not understood.
- Exposure Therapy is another effective PTSD therapy. There are several forms of exposure therapy. In one type, the person recalls traumatic memories slowly over a series of sessions, beginning with less traumatic events and gradually moving toward more disturbing memories of the trauma.
Flooding is another form of exposure therapy in which traumatic memories are revisited quickly while the person expresses their emotional response in a safe environment with the therapist. Exposure therapies can include talking, writing, or drawing images about the traumatic events, and some therapists use virtual reality technology in conjunction with this therapeutic approach.
- Cognitive-behavioral therapy (CBT) assists clients with changing negative thought patterns and behaviors through a combination of talk therapy and activities outside of the therapy sessions. During therapy sessions, the client and therapist discuss problem areas and outline activities for the person to engage in to support new habits and behaviors. CBT often requires the client to engage in homework activities like journaling, learning new skills, or attending support groups as well as regular meetings with the therapist.
- Mindfulness Meditation is not a form of psychotherapy, but it is a well-researched technique for calming the mind and nervous system using breathing and awareness. Mindfulness meditation techniques are taught and used by many PTSD therapists because this type of meditation can help with control of the stress hormone response.
- Medications are often prescribed in conjunction with other therapies to assist people in recovering from PTSD in dealing with troublesome symptoms. Antidepressants are commonly prescribed because PTSD symptoms frequently include persistent feelings of sadness and depression, which hold the person back from making needed changes. Anti-anxiety medications are also used to alleviate feelings of anxiety and agitation associated with PTSD flashbacks.
What to Look for in PTSD Provider
The traumatic events which cause PTSD are varied and complex, and each person is different in how they respond to treatment. When seeking PTSD counseling, it's essential to consider your traumatic experience and symptoms and find a provider you are comfortable with who also has the right expertise and training.
People who are healing from single event trauma, such as a sexual assault, robbery, or a car accident can often heal from PTSD in only a few sessions. Others with more prolonged exposure to trauma often need a more extended time to recover fully. Some people require several months or more of therapy and/or medication treatment, and some people benefit from trying different forms of therapy at different stages of healing.
Note: Intrepid Mental Wellness (IMW) provides predominantly medication management for the treatment of PTSD and symptoms associated with this diagnosis to include but not limited to nightmares, insomnia, irritability or aggression, depression, suicidal thoughts, anxiety, and paranoia or hallucinations. If you are needing other treatments such as EMDR therapy, we will refer you to a trusted therapist in the community.