What Kind Of PTSD Therapy Do I Need?
You feel like you’re barely treading water. Sometimes you feel numb. Other times you feel angry. You’re tired of the constant anxiety and avoiding anything that will trigger your past. Instead of feeling like you are slowly sinking in quicksand, you want to feel like you are moving forward and you need to address what’s holding you back.
You are ready to face your trauma.
But you are scared. You can’t even THINK about what happened, let alone say it out loud. Where do you even start? How do you know what kind of treatment even works - and then on top of that - who is a good therapist?
In mental health, it’s important to match the treatment with the symptoms/diagnoses. Kind of how chocolate and peanut butter go together - there are certain therapies that are for certain problems.
evidence based ptsd therapy
In 2017, the American Psychological Association published their recommendations for the treatment of PTSD. These guidelines highlighted a number of treatments that were strongly recommended, and three that were conditionally recommended (with the caveat that these will likely become strongly recommended after more research has been completed).
It’s interesting to note that the therapies that are strongly recommended have been around since the 1960’s, or they are offshoots of the therapies that have been around since then. That means that there has been a lot more time for researchers to conduct studies to verify their effectiveness.
The three that are “conditionally recommended” are much newer therapies that have already shown strong evidence that they are effective, the research is just a few decades behind the others. I’ve broken these down with links to other resources to help you figure out what’s best for you - that way you can go down those rabbit holes yourself!
Strongly Recommended Treatments for PTSD
Cognitive Therapy (CT) - This therapy has been around since the 1960s, and it is the precursor to Cognitive Behavioral Therapy (CBT) and Cognitive Processing Therapy (CPT). In psychology, you’ll hear the word “cognitive” a lot.
Basically, “cognitive” means how you think about something.
Cognitive Therapy (CT) focuses on identifying thoughts about a particular situation and analyzing the truth of these thoughts. For example, sometimes we make an assumption about why someone said or did something (known as “jumping to conclusions” or “mind reading”). CT helps us analyze our thoughts and how they may be creating suffering. CT also focused on changing our thoughts (known as restructuring) to be more rational or accurate to the given situation. For some more info, you can check out The American Institute of Cognitive Therapy.
Cognitive Behavioral Therapy (CBT) - This therapy builds off of CT and adds other behavioral interventions to enhance treatment outcomes. So not only would you learn cognitive restructuring, but there would be added elements, such as relaxation training combined with gradual (and sometimes prolonged) exposure to feared situations. Rather than give you an exhaustive list of the behavioral interventions, click here and here for more info.
Cognitive Processing Therapy (CPT) - CPT is a subset of CBT that has been around since the 1980s. CPT focuses on the impact that the traumatic event has had on your life. Initially, you’ll learn about common trauma responses and will be asked to identify which thoughts about your trauma are causing the most suffering. Those thoughts will be examined and reframed. Thoughts like, “it’s all my fault,” or “I deserved it” fit here. The treatment also looks at feelings of lack of safety, trust, power, control, self esteem and intimacy. This treatment requires a great deal of out of session work/homework as well. This link has a lot of good information.
The Cognitive Therapies focus more on the “here and now,” so rather than focusing on the traumatic event(s), they focus on how those events are currently bothering you.
Prolonged Exposure - Prolonged exposure is often one of the behavioral tasks in CBT. Have you ever been afraid of something, approached it slowly, and learned that it’s actually ok? The theory behind this treatment is that if you are gradually exposed to a frightening cue (or memory) and stay with it, your anxiety will initially increase and then eventually come down. This way, your brain learns that the cue is actually irrelevant now. If you approach the cue a number of times, without a negative result, your brain no longer reacts to the cue - because it’s meaning has shifted. The VA explains it here.
Conditionally Recommended By The APA for PTSD Therapy
EMDR, Narrative Exposure Therapy and Brief Eclectic Therapy are “Conditionally Recommended” by the APA. This means that these treatments have strong promise and with more research completed will likely move into the “Strongly Recommended” category. Unlike the cognitive therapies, these focus more on treating and healing the actual trauma(s).
Eye Movement Desensitization Reprocessing (EMDR): This therapy has been around since the late 80’s/early 90’s. The theory of this treatment is that your brain has “recorded” the traumatic incident(s) but doesn’t know what to do with it. This means that it’s on an ongoing loop in your mind, stored with the same emotions, physical sensations and beliefs as when the event happened. Anytime something remotely similar to the trauma happens, it activates the memory that’s on the “loop” and you get flooded with the same experiences. The adaptive information processing theory is that your brain actually knows what to do with these memories, it just got stuck and needs a little bit of help .
This is done by activating images, negative beliefs, emotions and physical sensations of the trauma while using distraction techniques (to ground you in the “here and now”). These distraction techniques are often eye movements (from left to right), buzzers in your hands, or headphones over your ears with alternating sounds. This allows your brain to take the “stuck” memory (that’s on a loop) and move it into your long term memory where it no longer has the same intensity. For more info, click here.
Brief Eclectic Psychotherapy - This therapy has been around since the 1980’s and is mostly intended for people who have experienced a single traumatic event. In this therapy, you would be asked to describe the event in detail and relive it in some form (similar to prolonged exposure). You might be asked to bring photos, etc. to deepen the process of re-experiencing the event. This treatment will also focus on the impact the event has had in your life. Some good info is here.
Narrative Exposure Therapy - This has been around since the early 2000s. It is focused on helping you create an autobiography of your life, including your traumatic experience(s). You would then read this story aloud while connecting with your emotions and physical responses. The therapist’s role is to keep you in the present as you review the past (similar to EMDR - but EMDR adds a distraction element and does not require you to create an autobiography). One of the goals of this treatment is to help you place the trauma in the context of your entire life, minimizing it’s power. More details here.
Medications For PTSD Treatment
There are some medications that have been recommended by the APA to assist in managing the emotional disruption of PTSD, these include: Sertraline (Zoloft), Paroxetine (Paxil), Fluoxetine (Prozac) and Venlafaxine (Effexor). Consult with a psychiatrist to decide whats right for you based on your circumstances.
PTSD Help - There Is Hope
Right now, you might feel like what you went through is holding you back and there’s no returning to who you used to be. I’m here to tell you that that is simply not true. Your past does not need to define you and it does not need to be ever present, guiding everything you do. It can be something that just happened to you and is over now.
If you are ready to put the past in the past - where it belongs - click here to book a free 15 minute video consultation for online EMDR Therapy and PTSD treatment in California.
Online EMDR Therapy and Trauma Counseling in California and Carlsbad, CA.
