For Patients & Families

Individual suffering from PTSD getting emotional support from a family member
Posttraumatic stress disorder affects patients and families alike. The information here will help you understand PTSD, its causes, its effects — and most importantly, its treatment.

What is PTSD?

Posttraumatic stress disorder (PTSD) is an anxiety problem that develops in some people after extremely traumatic events, such as combat, crime, an accident or natural disaster.

Posttraumatic stress disorder, or PTSD, is a mental health condition that some people develop after experiencing or witnessing traumatic events. These events pose significant physical, emotional or psychological threat to the victim or to loved ones, and are overwhelming, shocking or dangerous.

People can develop PTSD after serious accidents, natural disasters, acts of terror and combat or other military situations. PTSD can also result from serious personal violations, such as sexual assault, domestic abuse, muggings and other scary or dangerous events. Some experiences that are not immediately life-threatening, like the sudden death of a loved one, can also cause PTSD.

During a traumatic event, the brain and nervous system switch into a hypervigilant, reactive mode. In people with PTSD the brain hasn’t shifted back into its normal state, resulting in a variety of symptoms and behaviors that interfere with everyday living.

PTSD can range from relatively mild to totally debilitating. It may disrupt your relationships, cause problems for you at work, or leave you feeling anxious, depressed, angry and isolated. The good news is that it’s treatable, and with treatment, people with PTSD symptoms can learn to cope with them. Some even resolve the symptoms entirely.

If you suspect that you have PTSD, you aren’t alone. Estimates suggest that about 7-8 percent of the population will experience PTSD at some point in their lives.

More on PTSD

Helpful National Organizations

What is the Clinical Practice Guideline for PTSD?

APA developed its PTSD guideline after careful review of the effectiveness of different PTSD treatments.

The information about the treatment of PTSD on this website is based on the clinical practice guideline developed by the American Psychological Association (APA). The guideline is intended to help mental health care providers treat adults with PTSD, but you can benefit from learning about it, too.

The APA developed the guideline based on a systematic review of the evidence for different PTSD treatments. The guideline makes recommendations based on the effectiveness of these treatments.

Together, you and your mental health care provider can use the guideline to determine which treatment, or combination of treatments, will work best for you.

Symptoms of PTSD

Common PTSD symptoms include unwanted recurring memories, avoidance of people or events that remind one of the original trauma, negative emotions and feelings of agitation.

Most people who experience traumatic events have reactions to those events. But most of them do not go on to develop PTSD.

In the aftermath of trauma, it’s normal to have intrusive memories of the event, have trouble concentrating, and experience other reactions. Most of the time, these reactions fade within a month or so — but if they don’t, they become clinical symptoms, and may meet the criteria for a diagnosis of PTSD.

Symptoms fall into four categories. People with PTSD may experience some or all of them, and may experience them differently depending on their temperament, past experiences, support systems and other factors.

Common PTSD symptoms include:
  • Intrusive or recurrent memories of the trauma. Because of the way the mind and body manage post-traumatic stress, you may have a difficult time forgetting about your trauma. You may have nightmares and flashbacks — vivid memories of the event that feel like they are real. Sometimes, these reactions can be triggered by environmental cues, such as a news report that reminds you of a storm that devastated your community, or an environment that looks or feels like a setting where you experienced an assault.
  • Avoidance of trauma reminders. People with PTSD may avoid people or situations that remind them of the event — in essence, screening their environment so they don’t have to face potential triggers. This is understandable, but can interfere with your ability to work, go to school, interact with others and otherwise live your life normally. You may also try to “lose yourself” in work and other activities to avoid thinking about the event.
  • Feeling sad, angry or numb. People with PTSD often experience more negative emotions than they did before the event, including sadness, anger and a loss of pleasure in things that used to make them happy. If the trauma is a personal violation, you may feel guilt or shame about what happened. You may have trouble trusting people. You may become emotionally numb, shuttering your feelings or using alcohol or drugs to suppress memories and emotions.
  • Feeling “on edge,” or other changes in reactivity or arousal. This symptom is directly related to the physiological changes that occur in response to trauma. You may be more jittery than normal, and feel and act impatient or irritable. You may have trouble sleeping or concentrating. 
Keep in mind that PTSD symptoms are often interrelated. For example, someone with PTSD may avoid going to sleep because they’re afraid they will experience nightmares. The resulting fatigue can result in a poor mood and make it hard to function during the day. 

PTSD is Treatable

Effective treatment is available, and it can be tailored to fit the differing needs of patients.

If you had a broken leg, would you: a) splint it yourself and wait for it to get better, or b) go to the hospital?

Chances are, you’d go to the hospital. Well, the same logic holds true if you have symptoms of posttraumatic stress disorder, or PTSD: You can hope that the symptoms go away on their own, or you can get help that is tailor-made to help you gain relief from and mastery over your symptoms.

Fortunately, many studies show that a number of treatments work extremely well for treating PTSD. These include different kinds of cognitive therapy — which help you change your thought processes around the negative event — and prolonged exposure therapy, which guides you to re-experience the event in a safe and controlled manner that eventually helps you face and accept it. Other forms of therapy can be effective as well, as can certain medications.

Other points to keep in mind when you’re considering treatment:

  • If PTSD symptoms last longer than a year, they probably won’t resolve on their own. Symptoms can interfere with a happy and healthy life, and with your ability to maintain positive relationships at home and work. Treatment can help you address, relieve and in some cases lose negative symptoms entirely, and move on to a more peaceful, easy, joyful quality of life.
  • It is never too late to get treated for PTSD. Even if you’ve had symptoms for a long time, or tried treatment before and it didn’t work, it’s wise to try again. Treatments have improved, and there are many qualified professionals who can help.
  • Finally, you may be reluctant to seek treatment because you don’t want others to know you have these problems. But remember: You aren’t alone, and in fact, people who undergo PTSD treatment report feeling proud of themselves for having addressed their symptoms. They also report being better able to cope with, and enjoy, their lives. Furthermore, both therapists and insurance companies are required by law to maintain your confidentiality, so your treatment will remain private unless you decide to share it.

Getting Help for PTSD

How to determine if you need help, and how to identify the type of professional who will serve you best in treatment of PTSD.

Choosing to seek help for PTSD is a big decision — one that has the potential to improve your well-being and quality of life. But it can be difficult to know how to find help. What kind of therapist should you seek, and what kind of background should they have? Look here for some guidance

Sources for Help

To start, look for a professional who has specific training in one of the treatments shown to be effective for PTSD. If your primary care provider can’t provide you with possible referrals, a number of organizations can. These groups offer lists of providers who specialize in trauma-specific treatments:

Most state psychological associations also provide referrals.

Finally, if you’re a veteran and think you have PTSD, check with the VA about whether you’re eligible for treatment there, or visit this website for a VA PTSD program near you.

Treatment Options

Treatments with the strongest research backing are cognitive behavioral therapy, cognitive processing therapy, cognitive therapy and prolonged exposure therapy. Other effective treatments include brief eclectic psychotherapy, eye movement desensitization and reprocessing (EMDR), and narrative exposure therapy, as well as specific medications. These treatments are described in detail below.

Evaluating Potential Treatment Providers

Once you’ve located one or more providers with this expertise, ask them about their credentials and experience working with PTSD clients. Have they worked at the Veterans Administration, at a sexual assault center or with refugees, for example? For how long, and how have they helped these clients? Questions like these can give you a better sense of a provider’s background and capabilities.

Just as important as having good credentials is liking who you’re working with. Here, trust your instincts. If you sense the therapist is highly qualified, genuine and caring, you’ve probably found a good match. Don’t be afraid to try more than one provider. For this important and sometimes difficult work, you want someone you trust and feel comfortable with.

While it may be easy to find qualified providers in large urban areas, it can be more of a challenge to do so in rural or small town settings. If you live in such an area and are not able to find someone to meet your needs, consider getting therapy via telehealth — communicating with a PTSD-trained therapist by computer or smartphone, for example. Many experts provide therapy in this manner, and research shows that it can be just as effective as in-person therapy. Look here for more information about telehealth and online therapy.

If you want to pursue treatment via telehealth, keep in mind that your mental health care provider usually (though not always) needs to be licensed in your state, just as if you are receiving traditional in-office services. Check with the licensing board in your state if you have questions about how to verify a provider’s licensure status.

A final note: Your own forms of self-care can complement the work you do in therapy. Spiritual practice, doing yoga or a martial art, practicing good sleep habits, exercising in ways that you enjoy, eating healthy foods, and activities that give your life meaning can all facilitate your healing.

Factsheets on Psychology and Getting Treatment

Treatments

Treatment plans are the result of discussion between the patient and the health care provider. Treatment can be a combination of recommended therapies and medication, based on the patient's experience, history and symptoms.

Effective treatments for PTSD include a variety of therapies and some medications.  You and your provider may decide to use a combination of these treatments.

The information here is based on the APA’s clinical practice guideline on PTSD. Your provider can answer your questions about the differences between these treatments and how they work.

For general information on psychotherapy, please visit the APA Help Center.

Strongly Recommended Therapies

The APA strongly recommends the following therapies:

Cognitive Behavioral Therapy (CBT)

CBT is an encompassing term for therapeutic treatments that address learned and conditioned behaviors, thoughts (cognitions) and emotional reactions. These strategies may include exposure, cognitive restructuring, changes in behavior and development of coping skills. Most of the therapies described below involve CBT techniques.

Cognitive Processing Therapy (CPT)

CPT is a specific kind of cognitive behavioral therapy. It focuses on the ways of thinking that developed as a result of the trauma, and the role that inaccurate or distorted thoughts have on emotional responses and behavior. The goals of CPT are to encourage the expression of natural emotions and to promote a balanced set of beliefs about the traumatic event, yourself, others and the world. It involves education about PTSD and CPT, processing the trauma and learning to challenge your thoughts about the trauma. 

Cognitive Therapy (CT)

CT is brief, goal-oriented therapy that helps the patient analyze distorted thinking in order to reshape existing beliefs and conditions, and to modify associated problematic behaviors.

Prolonged Exposure Therapy (PE)

PE is a specific kind of cognitive behavioral therapy. It is designed to help people with PTSD emotionally process their traumatic experiences through repeated revisiting and recounting of their trauma memories, which is called “imaginal exposure.” It also involves repeated, gradual confrontation of feared situations, places and things that are objectively safe but feel more dangerous following the traumatic event.

Conditionally Recommended Therapies

The APA suggests that patients may also benefit from these therapies:

Brief Eclectic Psychotherapy (BEP)

BEP combines various cognitive behavioral therapy techniques, including relaxation and imaginal exposure, with other strategies common to different kinds of treatments. Therapeutic activities may include writing about the trauma, exploring how the experience of trauma changed the patient and conducting a farewell ritual to mark the end of therapy and the period of time in which the experience of trauma dominated the patient’s life.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is an eight-phase psychotherapy that helps the patient process and resolve traumatic memories. During EMDR therapy, the patient concentrates on emotionally disturbing material arising from their trauma while simultaneously focusing on controlled stimuli such as eye movements or sounds. The patient reports any new thoughts that emerge and repeats this process until no longer distressed by the memory.

Narrative Exposure Therapy (NET)

NET is a treatment for trauma disorders during which the therapist guides a patient to establish a chronological narrative of his or her life, concentrating mainly on their traumatic experiences. By doing so, the memory of a traumatic episode can be refined and placed in the broader context of the patient's life.

Medications

Your provider may recommend medication as part of your treatment for PTSD. He or she will determine which medication to prescribe based on your particular experience, history and symptoms. In combination with therapy, these medications can provide your brain with the chemicals it needs to help you manage your stress. See here for more information on choosing among therapy, medications, and their combination.

Your provider may prescribe you one of two kinds of medications: selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs). Talk to your provider about the differences between these medications and which one might be best for you.

Who prescribes your medication may depend on the type of provider you see and the state you live in. If you’re being treated by a psychologist or a Master’s-level provider, they will probably have to coordinate your care with a physician, psychiatrist or nurse practitioner.

More on PTSD treatments

Sources




Note: This website is for informational and educational purposes only. It does not render individual professional advice or endorse any particular treatment for any individuals. APA recommends that individuals consult with a mental health professional in order to obtain an accurate diagnosis and to discuss various treatment options. When you meet with a professional, be sure to work together to establish clear treatment goals and to monitor progress toward those goals. Even treatments that have scientific support will not work for everyone, and carefully monitoring your progress will help you and your mental health professional decide if a different approach should be tried. Feel free to print information from this website and take it with you to discuss with your mental health professional.



Updated July 31, 2017
Questions to Ask a Health Professional
The VA on PTSD
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