Post-Traumatic Stress Disorder (PTSD) is a trauma-related disorder that can occur after stressful or traumatic life events, also known as adverse experiences. PTSD can leave those impacted by trauma with intrusive and upsetting thoughts and feelings long after the trauma event(s) happened. These symptoms impact the quality of life and, in some cases, the ability to maintain employment and relationships with others.
There are several different therapy approaches, along with medication and lifestyle changes, that are used to treat PTSD symptoms. The goal of these treatments is not to make life perfect, but to make the PTSD-related symptoms and memories bearable and manageable, and to reduce the frequency and intensity of those symptoms and memories.
Prevalence of PTSD
It is important to note that not all exposure to trauma leads to a diagnosis of PTSD. The duration and perceived severity of trauma in conjunction with protective factors, such as whether or not the individual has safe and supportive surroundings, plays a large part in whether or not an individual develops PTSD. However, PTSD can occur in anyone who has experienced trauma. Examples of traumatic events include, but are not limited to, exposure to violence, natural disasters, severe motor vehicle accidents, sexual or physical assaults, medical events that are sudden or catastrophic, neglect, and exposure to violent events in one’s community or work environment.
Here are some recent statistics on the prevalence of PTSD:1
- Approximately 8 out of every 100 people will have PTSD at some point in their lifetime.
- Approximately 8 million adults have PTSD during a given year.
- About 10% of women will develop PTSD during their lifetime compared to approximately 4% of men who will develop PTSD during their lifetime.
All genders and ages are susceptible to suffering from PTSD. While symptoms can vary from person to person, there are some common social and psychological symptoms that disrupt daily living.
Social and Psychological Symptoms of PTSD
Traumatic events can hijack emotions, thoughts, and behaviors which, in turn, impacts self-esteem, relationships with others, and possibly the ability to live up to one’s potential.
Reactions to trauma often manifest in the following symptoms:
- Inability to “bounce back” from a perceived slight
- Inability to trust others
- Lack of cause-and-effect thinking
- Lack of empathy
- Lack of remorse
- Shutting down
- Hypervigilance and overreacting to situations
- Constant Anger
These symptoms can severely impact intra- and interpersonal welfare. Those with PTSD also tend to have a heightened, often exaggerated, sensitivity to potential threats. This results in exaggerated reactivity to perceived threats, difficulties with memory, inability to focus, difficulty sleeping, or even a sense of detachment from the world around them, which creates professional and social difficulty and leads to a heightened cycle of isolation.
According to the DSM-5, individuals diagnosed with PTSD experience recurrent, involuntary, and intrusive thoughts of the trauma experience(s), regardless of the individual’s attempts at avoidance or distraction. Encroachment of negative thoughts and feelings can unexpectedly arise at any time without warning. Individuals who develop PTSD often exhibit characteristics such as depression, a sense of unease, anger, aggression, or dissociation from emotions. Individuals with PTSD can also struggle with maintaining positive self-concept and may carry the belief they are “damaged” or “will never be able to fit in.”
Consequently, people living with PTSD are at higher risk for reckless behavior, suicide attempts, and other difficulties, such as adjustment disorder, anxiety, major depression, conduct disorders, and substance use. PTSD symptoms can lead to difficulties with interpersonal relationships, maintaining employment, and difficulty attaining educational and occupational success, which can ultimately lead to a cycle of hardship and even additional trauma.
Physical Symptoms of PTSD
The Polyvagal Theory2 provides valuable insight connecting the relationship between trauma responses and the way our bodies are wired for survival through the autonomic nervous system. Our body response, or autonomic nervous system, is designed to keep us alive and has a reflexive mechanism that jumps in to action the moment our senses perceive a threat to our safety. These survival responses are known as fight, flight, and freeze.
For the person with PTSD, the body is hypervigilant in perceiving danger. For example, a trigger such as an unexpected loud noise, a certain smell, a tone of voice, or a facial expression might trigger the body’s response system to signal danger. An individual without PTSD will hear a startling noise, become alert, figure out what made the noise and will then return back to what they were doing. In contrast, the person affected by PTSD will hear the noise, but instead of simply becoming alert, their fight, flight, or freeze survival response will kick in and the body will elicit a trauma response, blocking the brain from a quick recovery.
Diagnosing Post-Traumatic Stress Disorder
To be diagnosed with PTSD, symptoms should appear within three months of the experienced trauma. In some cases, there may be a delayed expression of symptoms that can delay meeting the criteria to receive a PTSD diagnosis. Symptoms of PTSD may occur for as little as three months or through the duration of one’s life. It is not fully understood why some individuals recover from PTSD quicker and more successfully than others, though recovery from PTSD is likely due to a number of factors, such as effectiveness of medications, quality of therapeutic interventions, life stressors, and the balance of risk and protective factors.
According to the DSM-5, assessment criteria for PTSD includes exposure to stressor(s) or traumatic events, as well occurrence of intrusive symptoms, such as avoidance, persistent negative thoughts and feelings, hyperarousal, and reactivity. To meet diagnosis criteria, symptoms must last one month or longer and cause distress or functional impairment related to the trauma. In addition, symptoms should not be due to other influencing factors, such as substance abuse or other non-trauma related mental illness. Because PTSD tends to be complex, treatment is typically needed in order to achieve recovery from intrusive trauma-related symptoms.
Treatment for Post-Traumatic Stress Disorder
The most effective treatment for PTSD is a combination of medication and individual counseling. The effects of PTSD vary person to person; therefore, the treatment options— or combination of treatment options— vary in kind. The DSM-5 classifies PTSD as a Trauma and Stressor-Related Disorder versus previous editions in which PTSD was labeled as an Anxiety Disorder. Because treatment for PTSD can be complex, it is imperative that individuals suffering from PTSD seek treatment from a professional mental health provider (e.g., counselor, psychologist, or social worker) who is experienced in treating trauma-related conditions. There can be some trial and error in finding the right combination of treatment methods, so individuals being treated for PTSD have an increased need for mental health support to determine the most suitable treatment.
Therapy to Treat Post-Traumatic Stress Disorder
All treatment begins with developing a safe and trusting relationship with the mental health (MH) provider. The MH provider begins the counseling process by learning more about who the individual is and what they seek to achieve through counseling. These factors can help distinguish what type of therapeutic methods are most appropriate for the individual.
The American Psychological Association recommends four variations of cognitive behavioral therapeutic treatment in combination with medication. The four therapy treatments for PTSD are:
- Prolonged Exposure (PE)
- Cognitive Processing Therapy (CPT)
- Cognitive Therapy (CT)
- Trauma-Focused Cognitive Behavior Therapy (TF-CBT)
Other treatments that may be effective for some individuals include Eye Movement Desensitization and Reprocessing (EMDR) and Narrative Therapy (NT).3
It should be noted that some, but not all, trauma-focused psychotherapy methods ask clients to talk about the trauma event, but the individual has decision-making power of discussing the trauma at his or her comfort level. Many of the cognitive behavioral techniques do not require conjuring memories of the traumas; rather, they focus on reframing thoughts surrounding the trauma in order to bring about an empowered sense of self. MH providers trained in trauma-informed practices take precautions to ensure a safe and protective relationship that progresses at the client’s ability level. This method is especially important when working with those impacted by PTSD in efforts to prevent re-traumatization.
Prolonged Exposure (PE)
Prolonged Exposure is a type of cognitive-based therapeutic strategy that teaches clients to gradually approach difficult memories associated with their trauma. PE is an individual therapy that takes eight to fifteen 1.5 to 2 hour sessions. This technique involves developing a safe and trusting relationship between the client and counselor, psychoeducation about PTSD, and practicing self-calming techniques, such as regulated breathing, to manage anxiety while undergoing therapy. PE is helpful for individuals who avoid trauma triggers such as certain places, events, and fears.
PE helps clients become able to talk about their trauma in order to manage intrusive and unwanted emotions. The premise behind this strategy is that prolonged exposure to one’s trauma story, while experiencing safe conditions, can help decrease the trauma response associated with those thoughts and feelings. By repeatedly talking about aspects of the trauma memories, PE helps clients gain control over their thoughts until thoughts are no longer intrusive. While no therapy can erase memories, PE can reduce the distressing impact of traumatic memories, thereby allowing individuals with PTSD to manage triggers and continue to function with fewer life disruptions.
Cognitive Processing Therapy (CPT)
CPT is a type of cognitive trauma-focused therapy based on understanding how trauma impacts thoughts and feelings with the objective of teaching clients to reframe negative thoughts about trauma experiences. It operates under the premise that changing one’s thoughts also changes behavior. This therapy, therefore, addresses ways of thinking that may prevent individuals from attaining the relief they are seeking.
CPT takes twelve 50 minute, one-on-one sessions with a trained mental health professional. Treatment addresses the client’s understanding of PTSD, ways to reduce distress about memories of the trauma(s), and seeks to improve the client’s daily life. Clients are also asked to participate in reflective homework as a component of treatment. During this therapeutic process, clients explore how they think about their trauma and how it may have impacted the sense of safety, trust, control, self-esteem, and relationships with others. This modality can be delivered in individual and group therapeutic settings.
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
TF-CBT is an empirically-based model designed to help children and adolescents heal from trauma experiences. TF-CBT provides twelve to fifteen sessions of psycho-education to children and their caregivers while working together in individual (child-specific or parent-specific) and combined (parent and child) counseling sessions. In addition to providing psycho-education, TF-CBT teaches skills such as relaxation, emotion regulation, and cognitive reframing. Key to TF-CBT is a safe, collaborative relationship between the child/adolescent, the parent/guardian(s), and the mental health provider.
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR is an individual therapy that involves asking the client to think about upsetting feelings from certain memories while engaging in the EMDR process of focusing on external stimuli and eye movement exercises. EMDR has the ability to help the client rapidly treat repressed memories from the trauma. Treatment is provided by a trained mental health professional over the course of about one to three months of therapeutic sessions composed of standardized protocols and procedures. EMDR is endorsed for treating symptoms of PTSD by the American Psychiatric Association, the U.S. Department of Veterans Affairs, and the U.S. Department of Defense.
Narrative Exposure Therapy (NET)
Conditionally recommended as a treatment modality, Narrative Exposure Therapy is often used in group or community settings to assist individuals with complex trauma, including those who experienced political or cultural trauma, such as war in one’s country or becoming a refugee. This modality seeks to reframe trauma in a manner that allows the client to contextualize the trauma experience(s) in order to decrease the overarching power the trauma has in the person’s life. This therapeutic model asks clients to recount life events, but in a way that brings into focus aspects of positive thoughts of self and acknowledgement of human rights. NET is often utilized in small groups or individually in four to ten sessions.
Medications for Post-Traumatic Stress Disorder
There are medications that can help with symptoms associated with PTSD, such as anxiety and depression. Individuals should consult with their primary care physician or a psychiatrist who specializes in medications for treatment of psychiatric disorders.
Medications often first used to treat PTSD are in the category of selective serotonin reuptake inhibitors (SSRIs). These medications help manage symptoms of anxiety and depression. SSRIs are recognized as effective medications to aid in relief from mood and anxiety disorders. SSRIs are not safe for everyone, especially when there are co-occurring disorders that require medications which might interact adversely with other medications.4 There are other types of antidepressants, anti-anxiety medications, mood stabilizers, and antipsychotics that will also sometimes be tried for PTSD. These medications are usually selected to try to target a specific symptom of a patient with PTSD.
Lifestyle Changes to Help with Post-Traumatic Stress Disorder
While lifestyle changes alone are not enough to efficiently treat PTSD, they can be helpful in collaboration with treatment from a mental health provider.
The following lifestyle changes may be positive additions to a therapeutic and medical regimen designed by a mental health professional:
- Get enough rest— at least 8 hours of sleep a night
- Decrease caffeine intake
- Practice self-care techniques when feeling overwhelmed (e.g., massage, positive self-talk)
- Identify triggers that may cause stress and develop emotion regulation techniques
- Practice relaxation techniques (e.g., deep breathing, prayer, meditation, or yoga)
- Eat a balanced diet
- Incorporate exercise into an everyday routine
- Practice reframing negative thoughts about self
Intended Treatment Outcome and Timeline
The ultimate goal of treatment for Post-Traumatic Stress Disorder (PTSD) is to reduce the overall frequency, intensity, and severity symptoms related to PTSD so that one’s daily function is not impaired. Clinicians who provide treatment for PTSD indicate the goal is not to remove memories or to make life perfect; rather, the goal of treatment is to make the symptoms and memories related to PTSD to become bearable and manageable.
Getting Help for Post-Traumatic Stress Disorder
If symptoms related to a traumatic event impact your ability to live an active life, it is imperative to seek out help from a mental health provider. A natural first step is to visit a primary care doctor to assess the symptoms to ensure that what you are experiencing is not a physical or medical illness. Once physical causes of the symptoms are addressed, you should seek out services from a mental health provider. Many primary care doctors can provide contact information for mental health providers.
When looking for a mental health provider for treatment of PTSD, take your time and seek out someone who has the expertise in trauma-informed care. You may research mental health providers by using an online directory, getting a list of providers from your insurance company, getting a referral from your primary care doctor, and/or getting a recommendation from a colleague, friend, or family member.
The following are essential considerations when finding a medical professional to treat PTSD:
- They are accepting new patients
- They take your insurance plan or offer an affordable cash rate
- They have availability on days that you are available
- They meet your guidelines of characteristics to feel safe and comfortable
- They hold expertise in the area of concern in which you are seeking treatment
How to Get Help for a Loved One with Post-Traumatic Stress Disorder
While no one has all of the answers, there are things you can do to help a loved one impacted by PTSD. In addition to connecting yourself and the individual suffering from PTSD with crucial, life-saving mental health resources, the following tips are essential for individuals looking to help anyone affected by PTSD:
- Learn about PTSD and its symptoms. The National Center for PTSD is a great place to start
- Accompany your loved one to doctor’s visits
- Encourage your loved one to maintain prescribed medications and counseling appointments
- Show unconditional positive regard, compassion, and listening
- Avoid giving advice or making judgements
- Plan activities with your loved one
- Give space if needed
- Practice self-care and maintain boundaries that are healthy for you
- Don’t push them to tell you about their trauma
- If a veteran, contact the Veteran’s Crisis Line at 1-800-273-8255
For emergency situations, call 911, as well as the Suicide Prevention Lifeline at 1-800-273-8255.
How to Get Help for a Child with Post-Traumatic Stress Disorder
Treatment for children with PTSD includes cognitive behavioral techniques, particularly trauma- focused cognitive behavior therapy, in addition to techniques developmentally appropriate for children and adolescents. Additional therapies developed specifically for children as young as three who have experienced trauma include the Oaklander Model of Play Therapy and Theraplay. Similar to EMDR, these models require MH clinicians to seek additional training and certification.
There are many situations that can impact how a child responds to a traumatic event. If a child has experienced trauma, it is important to not only get the child assessed by a mental health provider, but to also work collaboratively with teachers who are with the child, so the right services can be provided. Children who have experienced trauma have higher rates of success when schools adopt trauma-sensitive practices and intentionally develop teacher-student and student-student relationships that are safe, trustworthy, and foster a sense of connectedness.
It is additionally important that classroom curriculum teaches students vocabulary for emotional expression and how to regulate one’s emotions independently or by seeking help. Many schools adopt the trauma-sensitive practice of providing access to self-directed calming spaces in the classroom, known as Calming Corners and Safe Spaces.
Living with PTSD: Coping and Management Strategies
People who are diagnosed with Post-Traumatic Stress Disorder are able to live fulfilling lives. However, it is imperative to seek out professional treatment. Every person is different when dealing with PTSD, so everyone’s management strategies will vary.
Strategies that can be considered when coping with symptoms of PTSD include:
- Seek professional treatment and consider therapy, medication, and lifestyle changes along the way to help with symptoms related to PTSD
- Build an effective support system that includes people who can support you through this journey, such as your mental health provider, psychiatrist, family, and friends
- Practice healthy coping strategies, such as exercise, meditation, and mindfulness
- Avoid using substances and other negative coping strategies to self-soothe and/or to self-medicate
Post-Traumatic Stress Disorder’s Relation to Other Concerns/Issues
Post-Traumatic Stress Disorder can also present with a number of other mental health diagnoses, like depressive disorders, substance use disorders, and other anxiety disorders. Therefore, it is essential for a person who has been exposed to traumatic experiences to seek professional mental health support. During the initial assessment, it is important to share information that will allow the mental health provider to do a thorough evaluation to identify the actual diagnosis and co-occurring disorders that may be present. Once the mental health provider has assessed the client, a treatment plan can effectively be created to help support the client in treatment.
PTSD Screening, Tests, and Self Diagnosis Tools
While individuals cannot self-diagnose PTSD, it is important to be mindful of available resources that assist with identifying signs and symptoms. These should not be a substitute for professional help or a clinical diagnosis, but may be useful for those looking for more information.
Resources where you can learn more about symptoms of PTSD include:
- The National Center of PTSD website provides some useful information on screening tools
- The National Association of Mental Illness provides information, resources, and advice for identifying, treating, and living with PTSD
- The American Psychiatric Association provides great resources to loved ones affected by PTSD
- The PTSD Alliance has various materials to support people who have PTSD.
Remember, while these resources and assessment tools may be helpful in identifying signs and symptoms, they are not reliable tools for diagnosing Post-Traumatic Stress Disorder. If you or someone you know is concerned about Post-Traumatic Stress Disorder, seeking professional help from a mental health provider is highly recommended. Licensed professional counselors, social workers, psychologists, or psychiatric medication prescribers are able to determine whether a person is experiencing Post-Traumatic Stress Disorder and also help the person understand this disorder and their options for treatment.