PTSD Treatment: Therapy, Medication, & Self-Help

Therapy for PTSD

There are multiple therapeutic interventions that help treat PTSD, which helps people struggling with the disorder make their way through the five stages of PTSD and find an approach that works best for them. The specific therapy people choose typically depends on a variety of factors, including a person’s PTSD symptoms, which symptoms are the most impairing, and how pervasive these symptoms are. While most approaches fall under the umbrella of cognitive behavioral therapy (CBT), other approaches include hypnosis and EMDR.

Some of the most common, effective forms of therapy used to treat PTSD are:

Cognitive Processing Therapy(CPT)

Cognitive processing therapy is a form of CBT that aims to address and re-evaluate pervasive, detrimental thoughts related to a person’s trauma.  For example, trauma victims often blame themselves or feel ashamed of what happened to them. Therapy can help the patient view the situation more objectively; this can be done by a combination of activities like talk therapy, writing exercises, journaling, art therapy, or other tasks. This helps victims eventually restructure their thinking patterns and see the reality of what happened more clearly so that they are no longer stuck in the self-blaming mindset.

Exposure Therapy

In exposure therapy, the person is gradually exposed to the traumatic situation with the guidance of a therapist, with the aim of undoing the negative association to the stimulus or situation. This exposure may be imagined, in real life (in vivo), or through virtual reality exposure therapy. In each of the methods, the therapist gradually exposes their patient to the traumatic stimulus until the person eventually becomes desensitized and associates the stimulus with a new type of response. Keep in mind that before any exposure occurs, the first “exposure” actually involves the therapist and patient talking at length about what the exposure therapy will look like, and preparing the client for the experience.

EMDR

EMDR for PTSD focuses specifically on the traumatic memories and the neurological associations from those events. It aims to change the brain’s response to past trauma, in effect reducing the PTSD symptoms, but it does not require the person to talk through the details of the traumatic event.

Stress Inoculation Training

Stress inoculation training aims to teach people how to become less sensitive to their triggers or stressors, thus “inoculating” them from the negative associations. It may be used alone or along with other therapies to teach ways to manage PTSD symptoms. Some examples of techniques used in stress inoculation training are deep-breathing exercises, progressive muscle relaxation exercises, and improving communication skills.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a form of therapy directed at changing a person’s thoughts, behaviors, and responses to traumatic stimuli to change emotional outcomes. Many of the treatments listed above actually have their roots in CBT treatments for PTSD. These various CBT approaches for PTSD are all well researched and evidence-based; many studies show their significantly positive impacts on PTSD patients.

PTSD Medication

Another important tool in helping manage PTSD symptoms is medication, which often works in tandem with therapy. Trauma can result in an imbalance of the brain’s natural chemicals, known as neurotransmitters, which change the brain’s response to stressful stimuli and trauma. A person may be more jumpy or anxious because their physiological “fight or flight” response is more easily triggered.¹ Other symptoms of PTSD, including nightmares and flashbacks, can also result from changing brain chemistry. Medication can help regulate a person’s neurotransmitters, reducing some of the negative symptoms associated with different types of PTSD.

Some of the medications used to manage PTSD symptoms are:

Antidepressants

Although antidepressants were not specifically designed to treat PTSD, they have been shown to be helpful in managing symptoms of PTSD. Two of these medications, paroxetine (Paxil) and Sertraline (Zoloft), have been FDA-approved for treating PTSD. Other antidepressant medications have not been reviewed by the FDA, but are prescribed “off-label” for PTSD.

The two common classes of antidepressants prescribed for PTSD are:

1. Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs such as Paroxetine (Paxil), Sertraline (Zoloft), and Fluoxetine (Prozac) are the most frequently prescribed antidepressants for PTSD. They work by increasing the amount of serotonin in the brain. However, this class of drugs is associated with the risk of a serious condition known as serotonin syndrome, so it is important that people taking these medications keep track of their symptoms and adverse effects. There are also risks of depressed mood and suicidal thoughts when used by teens and young adults.²

2. Serotonin Norepinephrine Reuptake Inhibitors(SNRIs)

SNRIs are a second class of drugs used to treat anxiety as well as depression. Like SSRIs, they increase the reuptake of serotonin in the brain, but unlike SSRIs, they do the same for another neurotransmitter called norepinephrine. In particular, Venlafaxine (Effexor) has been found to be very effective in treating PTSD.(FN1) Common adverse effects may include: nausea/vomiting, headaches, dizziness, diarrhea, insomnia, and changes in sexual function. Some evidence suggests that the SNRIs may have fewer adverse effects than the SSRIs, including less restlessness.³

Anti-Anxiety Medications

Although antidepressants like SSRIs are now one of the more common treatments for anxiety and PTSD, benzodiazepines are medications used to treat some anxiety conditions, such as panic attacks. Patients may be prescribed benzodiazepines to manage symptoms associated with PTSD and anxiety, such as restlessness, insomnia, and panic attacks.

Commonly prescribed benzodiazepines include:

Alprazolam
Xanax
Diazepam (Valium)
Klonopin (Klonazepam)
Lorazepam (Ativan)

Prazosin

Prazosin is an anti-hypertensive alpha-blocker sometimes used to treat sleep-related problems that can occur with PTSD. In particular, it has been helpful in treating insomnia and nightmares.^1,4 Possible adverse effects of taking Prazosin include tiredness, weakness, headache, and nausea. If any of those persist or become severe, it is important that the patient lets their prescriber know.

Additional adverse effects can be serious and require calling a doctor immediately or seeking emergency medical help. These include the following:⁴

•  Hives, rash, or itching
•  Difficulty breathing
•  Fast, pounding, or irregular heartbeat
•  Chest pain
•  Painful or prolonged erection

Medications to Avoid When Treating PTSD

While searching for medications to help manage symptoms of PTSD, keep in mind that some medications are actually associated with worsening anxiety and PTSD symptoms. They are also addictive substances, raising the risk of substance use disorder.

Medications to avoid in the treatment of PTSD include:

Benzodiazepines

This may be counterintuitive, since benzodiazepines are also used to manage some symptoms associated with PTSD and anxiety, but research has shown that these are not effective in treating PTSD long-term. While they can provide short-term relief to someone experiencing a panic attack, over time, they can even worsen PTSD symptoms.⁵ Benzodiazepines are also highly addictive and are often prescribed as a last resort.

Stimulant Medications

Stimulants, such as Adderall, are typically used to treat conditions such as Attention Deficit Hyperactivity Disorder (ADHD). These would not typically be prescribed for PTSD; however, if someone with PTSD had a pre-existing ADHD diagnosis or experiences symptoms such as brain fog and memory problems, they may seek out stimulants to compensate for their deficits. A person with PTSD becomes at high risk for a substance use disorder if using stimulants.⁵

Complementary Therapies for PTSD

While professional therapy and medication are the best place to start for most, there are other ways to continue to promote trauma healing for those who may be skeptical of traditional approaches or who may not have access.

The following complementary therapies can help with the progress of psychotherapy by locating and relieving the physical symptoms of stress, such as muscle tension or pain:

Trauma-Sensitive Yoga

Trauma-sensitive yoga, also known as trauma-informed yoga, helps people discover and relax the parts of their bodies where muscle tension is high, usually indicating built-up emotions and stress. Once the person becomes aware of this excess tension, they use breathing patterns and physical poses to release the tension. It differs from other yoga styles by using gentler movements and less hands-on adjustments, thereby minimizing the feeling of vulnerability participants may experience. In some cases, this process allows the person with traumatic or repressed memories to be able to talk about their trauma with their therapist.  Research has shown that trauma-sensitive yoga can significantly reduce symptoms of PTSD.⁶

When looking for trauma-informed yoga, consider the following:

• One-on-one instruction is the ideal but is more difficult to find
• Classes designed for all levels or beginner levels of skill are a good place to start
• Allow yourself permission to change a pose into one that feels safe for you
• Give yourself permission to leave the room if your anxiety increases
• Ask whether the instructor is trauma-informed, and whether they are certified
• Consider online classes as an alternative to in-person formats.

Acupuncture

Acupuncture is a procedure in which very thin needles are inserted through the skin at strategic pressure points in the body. Although it is most often used to treat pain, it has also been used for stress management and overall wellness. According to traditional Chinese medicine, the needles allow for improved energy flow through the body, thereby relieving pain or stress. Western medicine practitioners use the acupuncture points as places to stimulate nerves, muscles, or connective tissues. It is believed that this stimulation boosts the body’s natural painkillers.⁷

If interested in finding an acupuncture therapist, consider the following:

• Ask a trusted friend or health care provider for a recommendation
• Verify the practitioner’s training and credentials; most states require that acupuncturists be certified by the National Certification Commission for Acupuncture and Oriental Medicine
• Talk with the practitioner and ask about the specific treatment, how it might help your condition, and what the cost will be

5 Self-Help & Lifestyle Changes for People With PTSD

Living with PTSD can be very difficult, and often presents its own set of challenges and difficulties for each patient; however, there are many steps people with PTSD can take to help minimize or manage their symptoms.

Five of these self-help and lifestyle interventions include:

1. Following the Treatment Plan

A person’s treatment plan is typically designed specifically for them, with their particular symptoms and circumstances in mind. The CBT part of treatment is structured to help patients reach certain goals within specific time-frames, and medications for PTSD are meant to be taken exactly as prescribed. Following the plan helps patients find relief sooner rather than later. If a patient wants to make any changes to their treatment plan, or feel like it is not working for them, they should talk to their doctor before changing doses, discontinuing medications, or discontinuing therapy.

2. Learn More About PTSD

Learning about PTSD can be very helpful for people diagnosed with the disorder, as it helps them find crucial information, support services, and online communities experiencing similar difficulties. It helps to know that the symptoms can be different for each person, and that they may come and go over time. Learning about PTSD may also help people identify their triggers so that they can better manage their responses to stressors. Learning about the different treatment options gives you the knowledge to be part of the decisions about which treatments are best for you, and may help you narrow down the search for help.

3. Take Care of Yourself

All the standard advice for well-being and self-care applies to the process of healing from PTSD. Getting eight hours of sleep, eating a healthy diet, and getting daily exercise will help with the function and regulation of the nervous system. Physical and mental health are closely connected, such that anything in your daily routine which promotes physical health will likely also help with your mental and emotional state.

4. Avoid Self-Medicating

Self-medicating is a risk for anyone with persistent pain, whether it is physical or emotional, as it provides temporary relief from symptoms, Many people who have experienced trauma have a chronically high level of anxiety, and they may seek relief from this anxiety through alcohol, nicotine, marijuana, or other substances that can sometimes provide more immediate relief than professional help. Use of these substances may lead to other serious problems in the longer term, such as substance abuse. Professional help is available and offers both short- and long-term benefits.

5. Consider Joining a Support Group

Joining a support group for PTSD gives people the opportunity to share thoughts, fears, or questions about day-to-day concerns with others who are experiencing similar issues. It also provides a chance to learn to ask for help from peers and to rebuild trust in others. Support groups are usually run by peers who themselves have PTSD, not necessarily by professionals, and should not be considered a substitute for therapy. Rather, they can help build a sense of community and acceptance for people struggling with PTSD and trauma.

Where & When to Find PTSD Treatment

When seeking help for PTSD, people should first see their primary care physician (PCP) to address any physical causes for the symptoms. While there is no specific timeframe for getting help, patients are encouraged to seek help as soon as they identify that the problem is persistently affecting their lives negatively. After addressing any health issues with a PCP, patients should seek help from a mental health provider. Look for someone who has experience in trauma-informed care, and don’t be afraid to ask ahead of the first meeting whether they specialize in recovery from trauma.

People might begin the search for a therapist by asking their family and friends for recommendations or checking with their insurance provider to find an in-network therapist; this often helps lower therapy costs. Alternatively, they could begin with an online therapist directory, which allows filtering by insurance coverage, location, gender, specialty, and more.

10 Ways to Help a Loved One With PTSD Treatment

If someone is concerned about a family member, friend, or relationship partner who struggles with PTSD, there are ways to demonstrate support, such as learning more about PTSD, offer assistance, and provide space.

Here are ten ways to provide support and encouragement to someone undergoing PTSD treatment:

1. Learn about the condition!
2. Take time to talk about their situation, or to simply listen
3. Provide personal space whenever needed
4. Offer assistance in scheduling or keeping therapy appointments<
5. Encourage healthy eating, sleep habits, and routine exercise
6. Consider attending one or more treatment sessions to learn how to be more helpful to their loved one
7. Plan activities with their loved one
8. Be a model of good self-care routines
9. Maintain healthy boundaries 
10. Offer assistance applying for PTSD disability benefits

Equally important are the actions to avoid taking, as they can increase distress for your loved one. Things to avoid doing with someone who has PTSD include:

• Avoid giving advice about their specific treatment plan. Leave that to the mental health professional
• Don’t insist that they tell you about the trauma

If you are in a situation where your loved one is experiencing great distress and emergency services are needed, make sure you contact:

• Suicide Prevention Lifeline at 1-800-273-8255.
• 9-1-1 for a life-threatening emergency

Final Thoughts

While coping with PTSD can be difficult, there are many types of therapeutic, psychopharmaceutical, and lifestyle interventions that can help manage PTSD symptoms in patients. Psychotherapy is typically the most recommended treatment, but remember that it can take some time to find the right fit, so do not be discouraged if the first few people are not the best match. Along with different forms of CBT-focused therapy, medications can also help manage the changes in brain chemistry associated with PTSD, thereby improving symptoms for patients. The effects of therapy and medication can be maximized further when combined with lifestyle changes, self-help interventions, and other techniques such as trauma-focused yoga. Managing PTSD can be difficult, but it is never too late to find the right treatment.