ATrain Education

 

Continuing Education for Health Professionals

Post Traumatic Stress Disorder (PTSD)

Module 5

Treatments and Therapies

Because of the improvement in recognizing and diagnosing PTSD, a more robust patient population has provided research that now identifies an evidence-based treatment guideline:

  • Immediate response by sympathetic health professionals is effective.
  • Trauma-focused cognitive behavioral therapy (TFCBT) has been beneficial within a few months after the trauma.
  • Eye movement desensitization and reprocessing is effective to help the brain refocus.

In addition, eye movement reprocessing supports the hypothesis that appropriately qualified and trained healthcare professionals can become a solution to both acute and chronic PTSD (Shalev et al., 2017).

Although there are effective treatments for PTSD, not everyone who experiences a trauma seeks treatment. Women may be more likely than men to seek help after a traumatic event. At least one study found that women respond to treatment as well as or better than men. This may be because women are generally more comfortable sharing feelings and talking about personal issues with others than men (PTSD, 2015).

The preeminent treatments for people with PTSD are medication, psychotherapy (“talk therapy”), or both. Because everyone responds to trauma and stress uniquely, 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 provider who is experienced with PTSD. People with PTSD may need to try a variety of treatments to find what works best for them.

 

Understanding and Treating Chronic Post Traumatic Stress Disorder. https://www.youtube.com/watch?v=B4xWUgykSEw

 

PTSD Treatment: Know Your Options. https://www.youtube.com/watch?v=FeLLt39DI8A

 

Medications

The most studied medications for treating PTSD are antidepressants, which may help control PTSD symptoms such as sadness, worry, anger, and feeling numb inside. Antidepressants and other medications may be prescribed along with psychotherapy. Other medications may be helpful for specific PTSD symptoms.

The current guidelines for psychopharmacology are strongest for use of the selective serotonin reuptake inhibitors (SSRIs), and currently only sertraline (Zoloft) and paroxetine (Paxil) are approved by the Food and Drug Administration (FDA) for PTSD (Hoskins et al., 2015).

Although it is not currently FDA-approved, research has shown that Prazosin, an alpha blocker often used to treat hypertension, may be helpful with sleep problems, particularly nightmares commonly experienced by people with PTSD.

Medications used for PTSD are those that act upon neurotransmitters related to fear, stress, and anxiety such as serotonin, norepinephrine, gamma-aminobutyric acid (GABA), excitatory amino acids, and dopamine. Patients must be monitored for comorbidities, depression, and suicidal ideation among the more common side effects. Much research is being done to examine the pharmacokinetics and pharmacodynamics for mood stabilizers, for PTSD and even bipolar disorders.

Doctors and patients can work together to find the best medication or combination, as well as the right dose. Check the FDA website (http://www.fda.gov/) for the latest information on patient medication guides, warnings, and newly approved medications.

Psychotherapy

Psychotherapy (sometimes called “talk therapy”) 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 it can last longer. Research shows that support from family and friends can be an important part of recovery.

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.

Cognitive Behavior Therapy (CBT)

Effective psychotherapies tend to emphasize a few key components, including education about symptoms, teaching skills to help identify the triggers of symptoms and skills to manage the symptoms. One helpful form of therapy is called cognitive behavioral therapy, or CBT. CBT can include:

  • Prolonged Exposure therapy (PE). This helps people face and control their fear. It gradually exposes them to the trauma they experienced in a safe way. It uses imagining, writing, or visiting the place where the event happened. The therapist uses these tools to help people with PTSD cope with their feelings.
  • Cognitive Processing Therapy (CPT). This 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 something that is not their fault. The therapist helps people with PTSD look at what happened in a realistic way.

Studies have provided positive results in both of these types of cognitive therapy, with equal to or greater results than medications alone. There are other types of treatment that can help as well. People with PTSD should talk about all treatment options with a therapist. Treatment should equip individuals with the skills to manage their symptoms and help them participate in activities that they enjoyed before developing PTSD.

 

Online Resources

 

Can I go back there? Post Traumatic Stress Disorder 101. https://www.youtube.com/watch?v=KRNKZ7HuBCs

 

Cognitive Processing Therapy for PTSD. https://www.youtube.com/watch?v=Jqj5zDbkPxY

 

60 Minutes Advanced PTSD Therapy. https://www.youtube.com/watch?v=7frOWBiU8D4

 

Talk Therapies

Talk therapies teach people helpful ways to react to the frightening events that trigger their PTSD symptoms. Based on this general goal, different types of therapy may:

  • Teach about trauma and its effects
  • Use relaxation and anger-control skills
  • Provide tips for better sleep, diet, and exercise habits
  • Help people identify and deal with guilt, shame, and other feelings about the event
  • Focus on changing how people react to their PTSD symptoms. For example, therapy helps people face reminders of the trauma.

 

Online Resource

 

Four Tips on How to Help Someone with PTSD (Military Treatment Support Trauma Community)
https://www.youtube.com/watch?v=X_A6SrvfbUI

 

Eye Movement (EMDR)

Eye movement, desensitization and reprocessing (EMDR) has shown to help mindfulness, meditation, and yoga are also effective modalities to control and decrease stress for people with PTSD, anxiety, depression, and stress disorders. EMDR is a form of psychotherapy that teaches patients with PTSD to control their eye movements while re-imagining the traumatic event. The client then learns to control their body and eye movements as the memory is reframed and controlled.

* * *

Many other therapies have been shown to be useful. Prominent among them are mindfulness and yoga.

 

Online Resources

 

NIMH Website
https://www.nimh.nih.gov/health/topics/posttraumatic-stress-disorder-ptsd/index.shtml

 

PTSD Visualization for Trauma Relief and Healing (spoken meditation). https://www.youtube.com/watch?v=H8e4sATalz8

 

Healing Trauma Recovery: Guided Meditation for Relaxation, PTSD, Anxiety, and Sleep. https://www.youtube.com/watch?v=e-RxDFgJOok

 

Answer: D

Test Your Learning

Which statement best summarizes the treatment for PTSD?

  1. Unfortunately, there is no treatment and the patient will suffer from PTSD for the rest of their life.
  2. The best results are from medication for PTSD.
  3. The best medication class is the SSRIs.
  4. The best treatment for PTSD needs to be a customized combination of pharmacotherapy and psychotherapy to help the patient regain control.
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