Posttraumatic stress disorder (PTSD), a type of anxiety disorder, can happen after a deeply threatening or scary event. Even if you weren't directly involved, the shock of what happened can be so great that you have a hard time living a normal life.
People with PTSD can have insomnia, flashbacks, low self-esteem, and a lot of painful or unpleasant emotions. You might constantly relive the event -- or lose your memory of it altogether.
When you have PTSD, it might feel like you'll never get your life back. But it can be treated. Short- and long-term psychotherapy and medications can work very well. Often, the two kinds of treatment are more effective together.
PTSD therapy has three main goals:
- Improve your symptoms
- Teach you skills to deal with it
- Restore your self-esteem
Most PTSD therapies fall under the umbrella of cognitive behavioral therapy (CBT). The idea is to change the thought patterns that are disturbing your life. This might happen through talking about your trauma or concentrating on where your fears come from.
Depending on your situation, group or family therapy might be a good choice for you instead of individual sessions.
Cognitive Processing Therapy
CPT is a 12-week course of treatment, with weekly sessions of 60-90 minutes.
At first, you'll talk about the traumatic event with your therapist and how your thoughts related to it have affected your life. Then you'll write in detail about what happened. This process helps you examine how you think about your trauma and figure out new ways to live with it.
For example, maybe you've been blaming yourself for something. Your therapist will help you take into account all the things that were beyond your control, so you can move forward, understanding and accepting that, deep down, it wasn't your fault, despite things you did or didn't do.
Prolonged Exposure Therapy
If you've been avoiding things that remind you of the traumatic event, PE will help you confront them. It involves eight to 15 sessions, usually 90 minutes each.
Early on in treatment, your therapist will teach you breathing techniques to ease your anxiety when you think about what happened. Later, you'll make a list of the things you've been avoiding and learn how to face them, one by one. In another session, you'll recount the traumatic experience to your therapist, then go home and listen to a recording of yourself.
Doing this as "homework" over time may help ease your symptoms.
Eye Movement Desensitization and Reprocessing
With EMDR, you might not have to tell your therapist about your experience. Instead, you concentrate on it while you watch or listen to something they're doing -- maybe moving a hand, flashing a light, or making a sound.
The goal is to be able to think about something positive while you remember your trauma. It takes about 3 months of weekly sessions.
Stress Inoculation Training
SIT is a type of CBT. You can do it by yourself or in a group. You won't have to go into detail about what happened. The focus is more on changing how you deal with the stress from the event.
You might learn massage and breathing techniques and other ways to stop negative thoughts by relaxing your mind and body. After about 3 months, you should have the skills to release the added stress from your life.
The brains of people with PTSD process "threats" differently, in part because the balance of chemicals called neurotransmitters is out of whack. They have an easily triggered "fight or flight" response, which is what makes you jumpy and on-edge. Constantly trying to shut that down could lead to feeling emotionally cold and removed.
Medications help you stop thinking about and reacting to what happened, including having nightmares and flashbacks. They can also help you have a more positive outlook on life and feel more "normal" again.
Several types of drugs affect the chemistry in your brain related to fear and anxiety. Doctors will usually start with medications that affect the neurotransmitters serotonin or norepinephrine (SSRIs and SNRIs), including:
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
- Venlafaxine (Effexor)
The FDA has approved only paroxetine and sertraline for treating PTSD.
Because people respond differently to medications, and not everyone's PTSD is the same, your doctor may prescribe other medicines "off label," too. (That means the manufacturer didn't ask the FDA to review studies of the drug showing that it's effective specifically for PTSD.) These may include:
- Monoamine oxidase inhibitors (MAOIs)
- Antipsychotics or second generation antipsychotics (SGAs)
It's OK for you to use a medicine off-label if your doctor thinks there's a reason to.
Medications might help you with specific symptoms or related issues, such as prazosin (Minipress) for insomnia and nightmares.
Which one or combination of meds is likely to work best for you depends in part on the kinds of trouble you're having in your life, what the side effects are like, and whether you also have anxiety, depression, bipolar disorder, or substance abuse problems.
It takes time to get the dosage of some medications right. With certain medications, you might need to have regular tests -- for example, to see how your liver is working -- or check in with your doctor because of possible side effects.
Medications probably won't get rid of your symptoms, but they can make them less intense and more manageable.
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