Part 2 – Treatment for PTSD
At Battle in Distress, we talk with veterans and active duty service members with PTSD who will say they don’t need help with their PTSD because they feel that they can somehow manage their PTSD on their own. That can happen, but not often. What we see are vets trying to manage their PTSD through alcohol or drug use, or through other unhealthy or risky behaviors. Or the vet simply denies anything is wrong, while life is falling apart around him. Learning to cope with PTSD often takes a therapist trained in trauma therapy working closely with the veteran to find healing. I equate it to a journey the veteran and therapist embark on together. It’s a team effort.
However, it’s important to remember that while the therapist may guide the therapy, it is the client, or in this case the veteran, who sets the pace. A therapist should not move at a faster pace than the veteran, or try to push the veteran to go to a place that he is not willing to go. Some therapists will want the veteran to talk about the trauma too soon in the process. If this happens, it is perfectly okay to tell the therapist, “I’m not ready to go there.” The hope is that eventually the veteran will be willing to talk about the trauma in some way as that is a part of most of the therapeutic interventions, but it is not always necessary.
The first step in trauma therapy is for the therapist to help the veteran feel safe in the therapeutic environment. This sense of safety cannot be emphasized enough. If a person does not feel safe, no therapy can happen. I am not just talking about physical safety, though that can be a part of it. Emotional safety is key. A veteran needs to feel that he or she can open up to the therapist and feel that he as a person and his emotions matter. It’s also important that at the end of a particularly difficult or emotional session in which the traumatic memories are talked about, that the therapist helps the veteran regain that sense of safety again. It can take time to develop trust and safety, but if it doesn’t happen, it may a sign that a different therapist is needed. It certainly is worth talking about with your therapist if you are not feeling safe enough to talk.
Several therapies have been proven effective in treating PTSD. The most often used therapy is under the broad umbrella of Cognitive Behavioral Therapy (CBT) or one of its various forms, such as Cognitive Processing Therapy (CPT) or Cognitive Therapy. In this therapy, the therapist works with the veteran to understand and change how he thinks about the trauma. By understanding thoughts, the therapist can then help the vet change behaviors. This works well with anger, guilt, anxiety and fear, which are a part of PTSD. For example, some vets with PTSD have a difficult time driving, as they anticipate that every action of other drivers is a threat to them. Even a box along the side of the road can present a threat. The therapist works with the vet to put these perceived “threats” into context to help the vet change how he looks at the threat.
A second therapy is Exposure Therapy in which the veteran is exposed to the trauma over and over until the veteran’s anxiety is gone. This can be done by talking it through or using other stimuli. Exposure therapy, depending on the form it takes, can be difficult for the veteran to handle, but the goal is to help the veteran not be afraid of those memories any more.
EMDR – Eye Movement Desensitization and Reprocessing – is another therapy for PTSD and is showing good results, though the actual science behind the therapy is still being researched. The idea behind the therapy is that the brain has the power within itself to heal and the use of bi-lateral stimulation, either with eye movements, tapping, or auditory stimuli, facilitates this. The veteran is guided through memories in an attempt to change the negative beliefs about these memories. EMDR is often used with other therapeutic interventions and after the client has developed the sense of safety in the therapeutic process. Note that EMDR must be done by a therapist who has taken additional coursework in EMDR therapy.
In addition to individual therapy, group and/or family therapy can be important components of PTSD therapy as a strong support system for the veteran cannot be stressed enough. Peer support and therapy groups with veterans who have similar experiences helps the veteran know that he or she is not alone in what they are going through. Family therapy helps the caregiver understand PTSD and how to support their veteran. It also helps them deal with the effects PTSD has on them and the family. In addition, marriage counseling may be needed when the effects of PTSD negatively impact the marital relationship.
The type of therapy used often depends on the training and theoretical orientation of the therapist. Many therapists use a combination of therapies to help their trauma clients and incorporate aspects of mindfulness, stress inoculation (coping skills), and even grief counseling into the therapeutic processes I just described. While there are suggested treatments for PTSD, it is not a one-size-fits-all process and the therapist should be tailoring her treatment plan to the veteran and his or her own goals and needs. Most importantly, the therapist should be talking about the treatment plan with the veteran so the veteran is a full participant in the treatment. Treatment plans are fluid documents meaning they can be changed at any time depending on the veteran and his or her progress.
Finally, a word about medications. Many veterans being treated for PTSD by a therapist are on medications to help manage some of the symptoms. The only therapists licensed to prescribe medications are psychiatrists who are also medical doctors. Most psychiatrists do not do the weekly counseling sessions (this is done by psychologists and licensed clinicians), but meet periodically with the veteran to evaluate how any medications prescribed are working. The most common meds prescribed are SSRIs or Selective Serotonin Reuptake Inibitors which raise the level of serotonin in the brain and helps the veteran feel better. Zoloft and Paxil are two SSRI meds currently approved by the FDA. A psychiatrist may also prescribe other medications to treat specific symptoms, such as depression. If you are on any of these medications, it’s important to note that you cannot just stop the medication cold turkey. Going off any medications requires close monitoring by the psychiatrist and should be discussed with him as the side effects of just quitting a medication can be very harmful.
There is no “cure” for PTSD, but with therapy and often medication, there is healing. It’s a matter of the veteran learning to control his or her PTSD versus his PTSD controlling him.
Additional Resources on Treatments for PTSD