“Children, adults, and families are resilient and can heal from the experience of trauma. There are treatments and approaches that work to support both children’s and families’ recovery,” says Kay Connors, licensed clinical social worker, program director of the family informed trauma treatment center, and instructor in the department of psychiatry at the University of Maryland School of Medicine in Baltimore. First, know that PTSD is a mental health condition that develops in response to a severely traumatic event or experience, and that it can have widely varying responses to treatment. (1) During any given year, about eight million adults have PTSD — which represents only a small portion of those who have gone through a trauma, explains Ken Yeager, PhD, director of the stress, trauma, and resilience (STAR) program at The Ohio State University Wexner Medical Center in Columbus. Some people with PTSD recover within six months of starting a treatment plan, while others battle symptoms of the condition for the rest of their lives. “Everyone reacts in their own way to the experience of trauma,” Connors explains. “There are a number of risk and resiliency factors that help determine the course of illness, including gender, previous history of trauma, etc.” Psychotherapy is increasingly seen as the “gold standard” first-line of treatment for PTSD by many clinicians. (8) In many cases, PTSD treatment also involves medication, usually in combination with psychotherapy. And increasingly, alternative therapies — such as yoga, meditation, and acupuncture — are becoming more accepted approaches for PTSD treatment. (2) Older patients may sometimes have less success with medication approaches for PTSD treatment compared with younger patients because they do not process medication the same way. (3) Common drugs prescribed to treat PTSD include: Antidepressants These drugs help control symptoms of depression and anxiety. Antidepressants, like paroxetine (Paxil), sertraline (Zoloft), venlafaxine (Effexor) — a serotonin and norepinephrine reuptake inhibitor (SNRI), rather than a selective serotonin reuptake inhibitor (SSRI) like the others — are commonly prescribed for PTSD; but only sertraline and paroxetine are currently approved by the Food and Drug Administration (FDA), Yeager says. (3) Side effects of these drugs may include headache, nausea, muscle spasms, agitation, or sexual problems. (4) Antidepressants also carry a warning because they may raise the risk of suicidal thoughts in children, teens, and young adults. (4) Benzodiazepines These drugs can help relieve feelings of anxiety and stress. They’re usually not taken long term because of their potential for abuse. (5) Prazosin (Minipress) This drug is sometimes prescribed to help reduce recurrent nightmares or other symptoms of insomnia. (5) Some of the side effects of prazosin include drowsiness, weakness, headache, and nausea. (6) Additional Drugs Psychedelics like ketamine, psilocybin, and methylenedioxymethamphetamine (MDMA, colloquially known as ecstasy) are being explored as potential treatments, along with cannabinoids and other novel treatments. Some of these are used in conjunction with psychotherapies. MDMA received permission from the FDA to enter phase 3 of clinical trials, where its effectiveness will be tested, says Scott R. Hunter, MD, a board-certified psychiatrist in Santa Monica, California. He cautions that these studies have just started in the past few years, so it’s likely still a few years before the drug, if approved, would be available for use. In addition, the doses are just a fraction of what would be used for a recreational dose, he notes. “PTSD is one diagnosis for which the psychotherapy modalities, which are evidence-based, are shown to be far more effective than any medication,” Dr. Hunter says. Those modalities include therapies like prolonged exposure therapy, cognitive processing therapy, and eye movement desensitization (all described later). “A core component of the most effective therapies is that you talk to someone who helps you learn how to manage your symptoms yourself,” Hunter explains. Essentially, the idea behind talk therapy is that it can bring out a patient’s flight or fight response, and then help him or her move thoughts from survival mode to the intellectual processing areas of the brain, like the frontal cortex, Yeager explains. That process, in turn, helps the patient process his or her experience on a logical level and helps reframe the traumatic experience so they no longer blame themselves or make statements like “I should have” or “if I had only,” he says. You may undergo just one type of talk therapy, or your doctor may use a combined treatment approach. “Depending on the traumatic experience, biopsychosocial issues, symptom presentation, and patient preferences, a carefully selected and sequenced approach to providing therapy may be necessary,” Connors explains. Because PTSD might show up in a number of different ways, providers have to make complex decisions on how to treat it, including addressing a number of different ongoing stressors to help manage patients’ condition, she says. Hunter also cautions that talk therapy can be a misleading term because all effective therapies for PTSD have a behavioral component to them. Different types of talk therapy include: Prolonged Exposure Therapy This type of therapy exposes you to your trauma in a safe way. It helps you talk about the details of your trauma and confront safe situations that you may have been avoiding. (7) Mental imagery, writing, or a visit to the location where the event occurred may be used to help you face and control your fears. “What helps is essentially, through repetition, changing the physical and emotional response you have when you are reminded of the trauma,” Hunter says. You may even use a virtual reality device that allows you to virtually re-enter the trauma setting. Research has previously shown the effectiveness of prolonged exposure therapy: A review suggested that prolonged exposure therapy is an effective first-line treatment for PTSD, regardless of type of trauma. (8) For example, if a patient has an inaccurate belief, like “Nobody follows the rules, so the world is not safe,” this type of therapy would help that patient find alternative explanations for that evidence, and see their own biases of interpretation, Hunter explains. Stress Inoculation Training This treatment teaches you to reduce anxiety by looking at your memories in a healthy way. Eye Movement Desensitization and Reprocessing (EMDR) This treatment combines exposure therapy with a series of guided eye movements. The goal is to help you process traumatic memories and change how you react to them. A study suggested cognitive restructuring has a “significant impact” and can help reduce PTSD symptoms. (9) Child Parent Psychotherapy (CPP) This is a form of psychotherapy for children up to age 5 who have experienced traumatic events or who are experiencing trauma symptoms, difficulty bonding, or behavioral problems, Connors says. One of the main goals is to support and strengthen the relationship between the caregiver and child to protect the child’s development and recovery from trauma, she explains. Strengthening Families Coping Resources (SFCR) This is a trauma-focused, multifamily, skill-building intervention that offers trauma treatment and therapeutic strategies to help improve families’ abilities to cope with ongoing stress and threats of re-exposure, Connors says. But there are ways that you can cope with PTSD on a daily basis. The following strategies may help supplement your other treatment: Take good care of yourself. Be sure to eat a healthy diet, exercise, and get enough rest. Nicotine may worsen PTSD symptoms, so try to avoid this substance. (10) You may also want to limit caffeine, as it has been shown to disturb sleep, which can affect your symptoms. (11) Join a support group. Support groups are a great way to connect with other people who are going through an experience that may be similar to yours. (12) Avoid self-medicating. People who are living with untreated PTSD may turn to drugs and alcohol as a temporary way to alleviate their social anxiety or escape from unwanted thoughts and memories, Connors explains. Attempting to medicate with drugs or alcohol can prevent progress in your recovery and lead to additional problems in the future. Follow your treatment plan. It may take a while before your therapy and medication help relieve your PTSD symptoms. “Oftentimes, with the psychotherapy interventions, symptoms get worse before they get better,” Hunter says. “And that ought to be made clear to people when you develop their treatment plan.” He notes that within the first couple of weeks of treatment, some people may see a worsening of symptoms, but that they should see improvement within three to four weeks after starting. Be sure to follow your treatment plan even if improvements don’t come as quickly as you’d like, and talk to your provider about any questions or concerns you may have. “The most important thing to know is that PTSD is a very treatable condition, and that with appropriate intervention, people who have PTSD can expect not just to recover from their symptoms, but most likely to experience posttraumatic growth,” Hunter says. PTSD is not a lifelong sentence of difficulties: Even though symptoms may persist, by learning to manage them, people can ultimately develop skills that will lead to great benefits in their lives, he says. Additional reporting contributed by Lynn Marks.
