The main treatments for people with 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 behavioral health care provider who is experienced with PTSD. Some people with PTSD need to try different treatments to find what works for their symptoms.
If someone with PTSD is going through 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 feeling suicidal.
Psychotherapy involves talking with a behavioral 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 practitioner or therapist may combine different therapies depending on each person’s needs.
One helpful therapy is called cognitive behavioral therapy, or CBT which teaches different ways of thinking and reacting to the frightening events that trigger PTSD symptoms and can help bring those symptoms under control. 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 encourages survivors to talk about upsetting (often incorrect) thoughts about the trauma, question those thoughts, and replace them with more balanced and correct ones. Cognitive restructuring 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.
Other types of treatment can also help people with PTSD so ensure you diskuss all treatment options with a therapist.
How Talk Therapies Help People Overcome PTSD Talk therapies teach people helpful ways to react to 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 visit places and people that are reminders of the trauma.
Treatment after mass trauma Sometimes large numbers of people are affected by the same event. For example, a lot of people needed help after the Victorian Black Saturday bushfires in 2009 and other natural disasters. 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 practitioner if injured
• Getting food and water
• Contacting loved ones or friends
• Learning what is being done to help.
But 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.6 This pattern is unlike the recovery from other natural disasters, where the number of people who have behavioral 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.7 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.8 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.9
Mass Trauma Affects Hospitals and Other Providers Hospitals, health care systems, and health care providers are also affected by a mass trauma. The number of people who need immediate physical and psychological help may be too much for health systems to handle. Some patients may not find help when they need it because hospitals do not have enough staff or supplies. In some cases, health care providers themselves may be struggling to recover as well.
Researchers are testing creative approaches (e-therapy or telephone therapy) to making CBT widely available following mass trauma situations such as bush fires, floods or bombings. Less formal treatments for those experiencing acute stress reactions are also being explored to reduce chances of developing full blown PTSD
For example, in one preliminary study, researchers created a self-help website using concepts of stress inoculation training. People with PTSD first met face-to-face with a therapist. After this meeting, participants could log onto the website to find more information about PTSD and ways to cope, and their therapists could also log on to give advice or coaching as needed. Overall, the researchers found delivering therapy this way to be a promising method for reaching a large number of people dealing with PTSD symptoms.12
Researchers are also working to improve methods of screening, providing early treatment, and tracking mass trauma survivors; and approaches for guiding survivors through self-evaluation/screening and prompting referral to behavioral health care providers based on need.