Experiencing a traumatic event can disrupt a person’s world, leaving them disoriented and unsure of how to rebuild. Recovery from trauma is an inherently gradual process, with each individual naturally healing in their own unique way and timeline. Nevertheless, understanding the five key stages of PTSD and the post-trauma healing process can offer a glimpse into what lies ahead on the path to moving forward.
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What Is PTSD?
Post-traumatic stress disorder (PTSD) is a psychological condition that may emerge after exposure to a traumatic event. While not everyone develops PTSD, individuals experiencing symptoms lasting beyond one month may consider assessing whether they align with the diagnostic criteria for PTSD. Symptoms may encompass re-experiencing, avoidance, arousal and reactivity, as well as cognition and mood symptoms.1
According to the National Center for PTSD, approximately 6 out of every 100 people will encounter PTSD at some point in their lifetime,1 with certain populations being at a heightened risk of diagnosis. Development of PTSD is more common in individuals who have experienced severe forms of trauma such as rape, childhood sexual abuse, or military combat.2
Stage 1: The Impact or Emergency Stage
Following a traumatic event, individuals enter a state of traumatic shock as they seek to process what they have just witnessed or experienced. Individuals may experience heightened awareness in the form of fear, anxiety, confusion, or disbelief in the hours after the event, finding it challenging to restore their sense of calm and safety.
Common symptoms of the impact or emergency stage are:3
- Hypervigilance
- Sleep disturbances
- Intense emotional reactions
- Difficulty concentrating
- Feeling jumpy or easily startled
- Powerlessness
The Emergence of Coping Mechanisms
Those possessing a range of effective coping mechanisms to overcome challenges are likely to move through the initial stage with speed and composure. In contrast, individuals without a basis in positive coping may resort to maladaptive behaviors in an effort to alleviate feelings of distress.
As an illustration, an individual well-versed in healthy coping mechanisms might swiftly come to terms with their experience, acknowledging the importance of seeking support and practicing self-care. On the other hand, an individual deficient in coping skills might face challenges in recognizing these needs, resorting instead to seeking solace in substances like drugs, alcohol, or other harmful alternatives.
Managing the Impact or Emergency Stage
The crucial aspect of navigating this stage involves achieving stabilization for the individual. It is essential to focus on restoring safety and stability to help the person alleviate the hyperactive nature of their survival instincts. After witnessing or experiencing trauma, individuals often feel a sense of insecurity in their bodies and surroundings.
Therefore, guiding the individual in regaining control over their bodily integrity and abilities of self-protection becomes necessary. Development of healthy self-care and self-soothing practices will greatly assist the individual as he/she progresses in the healing process.
Stage 2: The Denial or Numbing Stage
As the initial shock subsides following the event’s impact, individuals may grapple with intense emotions related to what they witnessed or experienced. If these emotions become too intolerable, individuals may find themselves becoming entrenched in the denial or numbing stage. Employing these strategies acts as a defense mechanism, allowing individuals to engage in avoidance coping as a means to evade confronting challenging thoughts and emotions.
Common symptoms of the denial or numbing stage are:3
- Avoiding activities, places, thoughts, or feelings that remind you of the trauma
- Feeling emotionally numb and detached from others along with withdrawing from social activities
- Loss of interest for participating in everyday life
- Refusing to talk about the event
- Inability to remember important aspects of the event
- Engaging in self-destructive behaviors; i.e. substance abuse, self-mutilation, impulsive risk-taking, etc
- Sense of a limited future
The Risks of Untreated Denial
“Denial of reality makes them feel crazy, but acceptance of the full reality seems beyond what any human being can bear.”4 As quoted here by American psychiatrist and author, Judith Herman, the paradox between denial and acceptance is complex for someone working through trauma. These individuals often find themselves merely going through the motions of life, experiencing a sense of detachment from activities and people they once found joy in. Failing to address denial appropriately may lead to a state of stagnation, impeding progress towards the subsequent stages of healing.
Managing Denial & Numbing
Individuals navigating denial and numbing will benefit from patience and compassion. Once someone acknowledges the existence of these defense mechanisms, they can adopt constructive strategies to navigate through them.
Engaging in mindfulness exercises, journaling about trauma, or participating in activities that facilitate emotional expression can be beneficial. Additionally, establishing supportive connections with a therapist or trusted confidants who foster open communication, provide a non-judgmental environment for reflection, and validate emotions is instrumental in the healing journey.
Stage 3: The Intrusive or Repetition Stage
Upon acknowledging and accepting the gravity of what they have witnessed or experienced, the individual transitions from the denial and numbing stage to a phase marked by intense memories. Traumatic memories often inundate the individual’s thoughts and dreams, resulting in a pervasive sense of distress in both the mind and body.
Research indicates that the factor distinguishing a person from temporarily being overwhelmed after trauma to developing PTSD is them becoming “stuck” on the trauma; individuals with PTSD often repeatedly relive the traumatic experience in thoughts, feelings, or images.5 These flashbacks and triggers may disrupt daily functioning, leading individuals to grapple with the challenge of integrating their trauma with their sense of identity.
Common symptoms of the intrusive or repetition stage are:
- Anger and irritability
- Fear and panic
- Depression and hopelessness
- Grief
- Despair
- Guilt, shame, or self-blame
- Questioning moral integrity
- Nightmares and insomnia
- Memory disturbances and dissociation
- Thoughts of suicide
- Intense physical reactions to reminders of the event
Managing Intrusive Thoughts
When individuals face intrusive thoughts and intense trauma triggers, it’s common for them to seek an escape from the associated pain. Nevertheless, the most effective approach involves confronting the pain and developing resilience to withstand the thoughts and emotions that come with it. Seeking assistance from a professional or exploring strategies to stay grounded in the present moment can empower individuals to regain control over their inner and external sense of safety.
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Stage 4: The Transition or Integration Stage
During the transition or integration phase, individuals reach a point where they are prepared and capable of articulating their thoughts and emotions surrounding the trauma they’ve experienced. They can now discern between present-day stressors and past traumatic events, avoiding the conflation of the two.
As individuals come to grips with the impact of their trauma, they eventually choose to explore avenues for improvement. This could involve adapting their outlook for the future, integrating the trauma more effectively into their life, or seeking a form of acceptance over their experience to facilitate the healing process.
Common experiences of the transition or integration stage are:
- Insomnia
- Anxiety
- Enhanced boundary setting
- Rediscovery of identity
- Renewed trust in self and others
- Reconnection with friends and family and interest in forming new relationships
Strategies for Integration
Individuals must find a way to acknowledge the reality of what has happened without having to re-experience the trauma all over again.5 Collaborating with a trained professional well-versed in integration strategies and mindful pacing is highly advantageous. Furthermore, paying attention to how the trauma fits into the person’s broader life narrative, along with discovering a greater purpose in their pain, can both prove helpful in shaping post-trauma identities.
Stage 5: The Recovery or Post-Traumatic Growth Stage
Recovery aims to restore an individual’s sense of control. People who have endured trauma need opportunities to take action and feel triumphant over helplessness and despair.5 In order to experience post-traumatic growth, individuals must develop a new perspective on their self-identity and their place in the world following the transformative impact of trauma.
Common aspects of the recovery or post-traumatic growth stage are:6
- An appreciation of life
- Return to pre-trauma functioning
- Demonstrating personal strength and resilience
- Positive relationships with others
- A renewed sense of life purpose and possibilities worth exploring
- Planning for the future
- Exhibiting a spiritual change
- A call to action around social issues and social reform
Optimizing Post-Traumatic Growth
The potential for post-traumatic growth can be heightened by taking deliberate, positive actions to enhance both general well-being and symptoms related to trauma.
Adopting healthy coping strategies, such as participating in survivor support groups, gaining knowledge about trauma and PTSD, spending time with trustworthy and supportive individuals, practicing self-care, incorporating relaxation techniques, and immersing oneself in nature, can collectively contribute to regaining a sense of power and control during the recovery process.3
How Long Does PTSD Last?
Numerous factors influence an individual’s response to trauma and subsequently shape their progression in the healing process. The degree of unexpectedness, lack of control, and inescapability of a traumatic event contributes to the manifestation of PTSD symptoms and significantly influences the duration of those symptoms.3 While some individuals may navigate through PTSD in a matter of weeks or months, others may grapple with symptoms for an extended period.
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Factors that influence how long PTSD can last include:3
- Severity of the trauma: The severity of PTSD symptoms tends to be highest in individuals who have faced a threat to their life or personal safety. Those who have endured intentional, human-inflicted harm, such as rape, assault, and torture, will need additional time to recover from the profound interpersonal wounds caused by these traumas.
- Duration of the trauma: The progression of healing varies significantly between someone who has undergone a specific, time-bound traumatic event and someone who has endured a prolonged traumatic experience. For instance, a survivor of a natural disaster can more readily rebuild hope and safety as they navigate through PTSD, compared to a survivor of domestic violence who faces numerous additional obstacles arising from their enduring traumatic environment.
- Age at the time of the trauma: Trauma encountered during the critical developmental stages of childhood has demonstrated greater harm and a higher likelihood of persisting PTSD symptoms. Children, lacking the necessary tools to effectively process traumatic events, often require prolonged guidance to restore a sense of safety and stability.
- Previous traumatic events: The process of healing becomes more challenging when one trauma is layered upon another, or perhaps even several. Not only is an individual psychologically more vulnerable during this period, but they must also contend with the arduous task of processing multiple traumatic situations, consequently prolonging the duration of the healing journey.
- Support system: Social interaction with someone who cares is the most effective way to calm an overactive nervous system. Hence, without supportive outlets for connection and processing in the aftermath of trauma, an individual may endure an extended period of PTSD as they strive to self-regulate and navigate the challenges alone.
- Co-occurring conditions: Individuals who already have mental health issues such as depression and anxiety, a history of substance abuse, or physical ailments like heart problems are more susceptible to developing PTSD.3 These preexisting conditions can worsen in the face of trauma and also complicate the healing process.
- Timeliness and quality of treatment: Symptoms usually present within the first 3 months1 and tend to worsen without intervention.3 Individuals who are unable or choose not to access timely and appropriate trauma-focused care may encounter greater difficulty on their path to healing.
Do the 5 Stages of PTSD Happen in Order?
Similar to the 5 stages of grief, the 5 stages of PTSD do not always adhere to a strict linear progression. An individual may undergo various stages in any sequence and might even oscillate between these stages. Due to the distinct set of PTSD symptoms experienced by each person, their healing journey will also unfold along a path uniquely tailored to them.
What If I Don’t Go Through the PTSD Stages?
Noting the variability in PTSD responses, one can reason to see that not all will require a multi-staged healing approach. Individuals addressing their PTSD symptoms within a supportive and nurturing environment may not adhere to the typical emotional distress associated with a staged process. Those with sufficient resources and a foundation of coping skills may be able to overcome PTSD and achieve recovery without traversing through the conventional PTSD stages.
The Role of Professional Help
It’s recommended that those seeking to initiate the healing journey first find a therapist who can provide guidance on a personalized treatment plan tailored to their symptoms and individual needs. Collaborating with a mental health professional experienced in treating PTSD is crucial to successful symptom relief. Furthermore, understanding and processing the complexities of PTSD can be a daunting process, requiring careful attention to supportive resources, ample coping strategies, and appropriate pacing, all of which mental health professionals are adept at providing to their clients.
Treatment Options for PTSD
Various PTSD treatment options are accessible to individuals seeking formal therapeutic support, encompassing both established and emerging approaches. Each approach offers a distinct perspective on the healing process, demonstrating efficacy in assisting PTSD sufferers in diverse ways. Given the individual nature of responses to treatment, some may find certain approaches more beneficial than others, necessitating experimentation with different therapies and therapists to identify the most suitable one.
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Irrespective of the chosen treatment modality, individuals will engage in discussions with their mental health professional to outline their treatment objectives. Collaboratively, they will devise a tailored and comprehensive treatment plan that addresses the individual’s desired outcomes, incorporating their unique symptoms and strategies for mitigating their impact through the selected therapy.
Effective treatment options for someone with PTSD include:
- Eye movement desensitization and reprocessing (EMDR): EMDR hypothesizes that the trauma memory, if not fully processed, is stored in its initial state, preserving any misperceptions or distorted thinking patterns that occurred at the time of the trauma.1 EMDR for PTSD therapy techniques aim to “unfreeze” the brain’s information processing system using rhythmic left-right stimulation, such as eye movements, hand taps, or sounds. The goal is to “reprocess” the memory for better consolidation and reintegration.3
- Trauma-focused cognitive behavioral therapy (TF-CBT): TF-CBT, one of the most long-standing evidence based treatment approaches, entails progressively exposing oneself to emotions and situations reminiscent of the trauma, and replacing distorted and irrational thoughts about the experience with a more balanced perspective.3 The belief is that inaccurate interpretation of situations maintains PTSD and therefore, individuals need to undo maladaptive thinking patterns caused by the trauma.
- Narrative exposure therapy (NET): NET helps individuals contextualize traumatic experiences within their life narrative. The person will establish a chronological story of their life which includes both traumas and positive events. They are to reflect upon their thoughts and feelings regarding the integration of the traumatic memories within their life history in hopes of identifying strengths and personal identity.7
- Cognitive processing therapy (CPT): CPT for PTSD posits that after trauma people will try to make sense of what happened by integrating the traumatic event into prior held schemas about themselves, the world, and others. They do this through a process of assimilation, accommodation, or over-accommodation. The goal of CPT is to help the person appropriately accommodate so they do not develop distorted perceptions about reality.2
- Prolonged exposure therapy (PE): PE is an 8-15 session long process where the participant is first taught relaxation breathing exercises and psycho-education about PTSD symptoms. Next, the participant is instructed to revisit the trauma memory for a prolonged period of time in an attempt to remove the fear response associated with the memory. They are also given homework between sessions which aid in this process.2
- Somatic therapy: Many of these trauma therapies also incorporate somatic therapy components. Given that PTSD symptoms manifest physically, addressing them necessitates physical healing as well. Employing a somatic approach enables therapists to guide clients in processing through different parts of the body and releasing the stored trauma sensations within those areas.
- Group therapy: Group therapy allows individuals an opportunity to connect with others who have experienced similar traumas and who may also be experiencing similar symptoms. Groups offer a community space for people to reconnect and find safety again while simultaneously developing skills to express what has happened to them.
- Medication: Medication may complement other therapies to mitigate the effects of PTSD symptoms. While medication can offer significant relief for those struggling with PTSD symptoms, it doesn’t address the underlying thoughts and emotions that can exacerbate the diagnosis. Individuals may benefit from incorporating talk therapy alongside medication to effectively process their trauma experiences and achieve long-term symptom reduction. Research shows serotonin reuptake blocker (SSRI) drugs to be the most helpful in managing the core PTSD symptoms.5
How to Find Professional Support
One of the fundamental aspects of all therapeutic work, particularly in trauma therapy, is the therapist’s ability to establish a safe environment. Therapists well-versed in trauma-informed practices recognize that trauma recovery cannot progress beyond the initial stage without building a trusting alliance from the outset. It may require meeting with several therapists before finding the right fit. One way to find a therapist in your area is using an online therapist directory, which provides a list of licensed therapists, along with their specialization and how to reach them.
Another option is using an online therapy platform, which allows you to access therapy from the comfort of your home. You can browse through therapist profiles, read reviews, and choose a therapist who specializes in the type of trauma therapy that you want to explore.
In My Experience
Choosing Therapy strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.
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National Institute of Mental Health. (2023). What is post-traumatic stress disorder (PTSD)? Retrieved from: https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd
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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, DOI: 10.3390/jcm5110105
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Smith, M., Robinson, L., & Segal, J. (2023). Post-traumatic stress disorder (PTSD). Helpguide.org. Retrieved from: https://www.helpguide.org/articles/ptsd-trauma/ptsd-symptoms-self-help-treatment.htm
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Herman, J.L. (2002). Recovery from psychological trauma. Psychiatry and Clinical Neurosciences. 52(S1), S98-S103, https://doi.org/10.1046/j.1440-1819.1998.0520s5S145.x
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Kolk, B.V., M., D., Hart, O.V., Ph, D., & Burbridge, J.A. (2010). Approaches to the treatment of PTSD. Trauma Clinic. DOI: 10.4324/9781315809847-14
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Collier, L. (2016). Growth after trauma: Why are some people more resilient than others and can they be taught? American Psychological Association. Vol. 47, No. 10, (p. 48). Retrieved from: https://www.apa.org/monitor/2016/11/growth-trauma
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Narrative Exposure Therapy (2017). American Psychological Association. Retrieved from: https://www.apa.org/ptsd-guideline/treatments/narrative-exposure-therapy
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9 Types of Therapy for Trauma
Experiencing trauma can result in distressing and debilitating symptoms, but remind yourself that there is hope for healing. If you or a loved one is suffering from the aftereffects of trauma, consider seeking therapy. Trauma therapy can help you reclaim your life and a positive sense of self.