Janet Ryan-Newell, M.Ed.
Recap
In the last article, we considered the impact of post-traumatic stress disorder (PTSD), including on the development of individual mental and physical health issues, family well being, and the broader implications for society. This week, we will turn our attention toward the evidence-based treatments that have been demonstrated to reduce post-traumatic stress and improve well being. These modalities include psychotherapy, medications, and individual/family supports.
Psychotherapy or talk therapy is the most common and preferred treatment for PTSD; however, depending on the severity of the disorder, a medication may also be prescribed by a client’s general practitioner or specialist psychiatrist. Psychotherapeutic options for treating PTSD can be further broken down into cognitive therapy, exposure therapy, and eye movement desensitization and reprocessing (EMDR); however, these approaches are often used in combination (Mayo Clinic, 2017). Each of the three modalities has independent clinically significant evidence supporting its use in the treatment of PTSD.
Psychotherapy
Cognitive therapy is a form of talk therapy based around helping a client recognize their patterns of negative thoughts and behaviours that are inhibiting their recovery (Mayo Clinic, 2017). For instance, a motor vehicle accident victim may find that their levels of anxiety regarding vehicle travel have significantly escalated, and that this escalated anxiety is becoming increasingly debilitating and is created unnecessary life limitations. A talk therapist will try to help a client in the emotional reaction to driving ‘unstuck’. However, in many cases of PTSD, talk therapy alone is insufficient and exposure therapy and/or EMDR may be introduced.
Exposure therapy is a type of behavioural therapy that helps a client safely face situations and memories with which they have become unable to cope. It tends to be particularly useful when clients experience flashbacks and nightmares (Mayo Clinic, 2017). In recent years, virtual reality technology has also become a popular tool for exposure therapy since it allows a client to re-experience trauma with high fidelity, but in a very protective environment. Hendrinks et al. (2018) found that following 4 weeks of intensive prolonged exposure therapy, 71% of participants with chronic PTSD positively responded (with varying effect sizes). The form of exposure therapy involved escalating exposures over multiple sessions (e.g. beginning with a verbal recounting of the trauma, drawing traumatic memories, actual exposure to trauma-related situations, and then comprehensive debriefing).
EMDR
Eye movement desensitization and reprocessing (EMDR) uses guided bilateral eye movements and physical stimulation to help a client who has experienced trauma reprocess traumatic memories. The mechanism of action is controversial; however, several meta-analyses have demonstrated evidential parity with cognitive behavioural therapy (CBT) and several drug therapies (e.g. Etten & Taylor, 1998). Essentially, EMDR has been found to be effective in treating trauma (i.e. at least as effective as other proven approaches); yet, the underlying mechanism of action is still unknown. Despite this, EMDR has been found to be a strong intervention technique for reprocessing trauma that has overwhelmed an individual’s system.
Pharmacologic
Drug therapies are also sometimes used in the treatment of PTSD; but, only a handful of drugs (mainly antidepressants) have been shown to work better than placebo. The four main antidepressants used in PTSD come from the selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) drug classes. These recognizable brand names include Zoloft, Prozac, Paxil, and Effexor. Krystal & Neumeister (2009) and Jeffreys et al. (2012) have reviewed the evidence for pharmacotherapy in PTSD and conclude that, although psychotherapy alone is often preferred, many clients may also need an antidepressant to control mood and reduce hyperarousal.
Finally, individual and family supports are extremely important on the path to recovery. Friends and family members should learn about PTSD to understand what their loved one is experiencing. Likewise, having someone to listen to you verbalize your symptoms and feelings, accompany you to medical appointments, encourage participation with friends, and help you stay safe are all important landmarks on the path to recovery (Mayo Clinic, 2017). Recovering from PTSD is a difficult journey, but effective treatment options exist and seeking these out relatively soon after a traumatic event can significantly improve future well being. In the next article, we will examine a case study of PTSD in the real world.
References:
- Jeffreys, M., Capehart, B., & Friedman, M. (2012). Pharmacotherapy for posttraumatic stress disorder: Review with clinical applications.
- Krystal, J., & Neumeister, A. (2009). Noradrenergic and serotonergic mechanisms in the neurobiology of posttraumatic stress disorder and resilience. Brain Research, 1293, 13-23. doi: 10.1016/j.brainres.2009.03.044
- Van Etten, M., & Taylor, S. (1998). Comparative efficacy of treatments for post-traumatic stress disorder: a meta-analysis.
- Hendriks, L., Kleine, R., Broekman, T., Hendriks, G., & Minnen, A. (2018). Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts. European Journal Of Psychotraumatology, 9(1), 1425574. doi: 10.1080/20008198.2018.1425574
- Mayo Clinic. (2017). Post-traumatic stress disorder (PTSD) – Diagnosis and treatment. Retrieved from https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/diagnosis-treatment/drc-20355973