Treating Post-Traumatic Stress Disorder (PTSD)
The main treatments for people with post-traumatic stress disorder (PTSD) are psychotherapy (“talk” therapy), medications, or both. Everyone is different, so a treatment that works for one person may not work for another. It is important for anyone with PTSD to be treated by a mental health care provider who is experienced with treating PTSD. Some people with PTSD need to try different treatments to find what works best for their symptoms.
If someone with PTSD is experiencing an ongoing trauma, such as being in an abusive relationship, both of the problems need to be treated. Other ongoing problems can include panic disorder, depression, substance abuse, and suicidal thoughts.
Psychotherapy is “talk” therapy. It involves talking with a mental health professional to treat a mental illness. Psychotherapy can occur one-on-one or in a group. Talk therapy treatment for PTSD usually lasts 6 to 12 weeks, but can take more time. Research shows that support from family and friends can be an important part of therapy.
Many types of psychotherapy can help people with PTSD. Some types target the symptoms of PTSD directly. Other therapies focus on social, family, or job-related problems. The doctor or therapist may combine different therapies depending on each person’s needs.
One helpful therapy is called cognitive behavioral therapy, or CBT. It appears to be the most effective type of counseling for PTSD. In cognitive therapy, the therapist helps patients understand and change how they think about their trauma and its aftermath. The goal is to understand how certain thoughts about the trauma cause the patient stress and make their symptoms worse. There are several parts to CBT, including:
- Exposure therapy. This therapy helps people face and control their fear. It exposes them to the trauma they experienced in a safe way. It uses mental imagery, writing, or visits to the place where the event happened. The therapist uses these tools to help people with PTSD cope with their feelings.
- Cognitive restructuring. This therapy helps people make sense of the bad memories. Sometimes people remember the event differently than how it happened. They may feel guilt or shame about what is not their fault. The therapist helps people with PTSD look at what happened in a realistic way.
- Stress inoculation training. This therapy tries to reduce PTSD symptoms by teaching a person how to reduce anxiety. Like cognitive restructuring, this treatment helps people look at their memories in a healthy way.
There is also a similar kind of therapy called eye movement desensitization and reprocessing (EMDR) that is used to treat PTSD.
The FDA has approved two medications for treating adults with PTSD:
- sertraline (Zoloft)
- paroxetine (Paxil)
Both of these medications are antidepressants, which are also used to treat depression. They may help control PTSD symptoms such as sadness, worry, anger, and feeling numb inside. Taking these medications may make it easier to go through psychotherapy. Other antidepressants are sometimes prescribed off-label for PTSD.
Medications have potential side effects. These side effects, IF they occur, can be annoying, but they usually go away. However, medications affect everyone differently. Any side effects or unusual reactions should be reported to a doctor immediately.
The most common side effects of antidepressants such as sertraline and paroxetine are:
- Headache, which usually goes away within a few days.
- Nausea (feeling sick to your stomach), which usually goes away within a few days.
- Sleeplessness or drowsiness, which may occur during the first few weeks but then goes away. Sometimes the medication dose needs to be reduced or the time of day it is taken needs to be adjusted to help lessen these side effects.
- Sexual problems, which can affect both men and women, including reduced sex drive, and problems having and enjoying sex.
Other types of medications, such as the ones listed below, may also be prescribed. However, there is little information on how well these work for people with PTSD.
- Benzodiazepines. These medications may be given to help people relax and sleep. People who take benzodiazepines may have memory problems or become dependent on the medication. (Valium, Xanax, Klonopin, etc.)
- Antipsychotics. These medications are usually given to people with other mental disorders, like schizophrenia. People who take antipsychotics may gain weight and have a higher chance of getting heart disease and diabetes. (Seroquel, Risperdal, Haldol, etc.)
- Other antidepressants. Like sertraline and paroxetine, the antidepressants fluoxetine (Prozac) and citalopram (Celexa) can help people with PTSD feel less tense or sad. For people with PTSD who also have other anxiety disorders or depression, antidepressants may be useful in reducing symptoms of these co-occurring illnesses.
There are times when large groups of people are impacted by a trauma. For example, a lot of people needed help after Hurricane Katrina in 2005 and the terrorist attacks of September 11, 2001. Most people will have some PTSD symptoms in the first few weeks after events like these. This is a normal and expected response to serious trauma, and for most people, symptoms generally lessen with time. Most people can be helped with basic support, such as:
- Getting to a safe place.
- Seeing a doctor if injured.
- Getting food and water.
- Contacting loved ones or friends.
- Learning what is being done to help.
However, some people do not get better on their own. A study of Hurricane Katrina survivors found that, over time, more people were having problems with PTSD, depression, and related mental disorders. This pattern is unlike the recovery from other natural disasters, where the number of people who have mental health problems gradually lessens. As communities try to rebuild after a mass trauma, people may experience ongoing stress from loss of jobs and schools, and trouble paying bills, finding housing, and getting health care. This delay in community recovery may in turn delay recovery from PTSD.
In the first couple weeks after a mass trauma, brief versions of CBT may be helpful to some people who are having severe distress. Sometimes other treatments are used, but their effectiveness is not known. For example, there is growing interest in an approach called psychological first aid. The goal of this approach is to make people feel safe and secure, connect people to health care and other resources, and reduce stress reactions. There are guides for carrying out the treatment, but experts do not know yet if it helps prevent or treat PTSD.
In single-session psychological debriefing, another type of mass trauma treatment, survivors talk about the event and express their feelings one-on-one or in a group. Studies show that it is not likely to reduce distress or the risk for PTSD, and may actually increase distress and risk.
Psychotherapy and medications are the main treatments for PTSD. Psychotherapy can take several forms, depending on the needs of the patient. Other types of treatment can also help people with PTSD, and people with PTSD should discuss all treatment options with their therapist.
Most importantly, treatments for PTSD do exist now, and research for better treatments is ongoing. If you or someone you know may be suffering from PTSD, don't hesitate to seek treatment. Untreated, PTSD can become more severe and debilitating.
Fact Sheet. "Treatment of PTSD." National Center for PTSD.
Health & Outreach Publications. "How is PTSD treated?" National Institute of Mental Health. January 21, 2009.