Treatment for PTSD

Dealing with post traumatic stress disorder alone is very difficult, which is why seeking professional help is beneficial to the improvement of or recovery from PTSD symptoms. In the future, The Ghost Rider Foundation aims to be able to provide financial assistance to veterans who are seeking treatment for PTSD.
 
There are different methods used to treat post traumatic stress disorder, with the most common being different therapeutic options and medications. The National Center for Posttraumatic Stress Disorder outlines and explains the different types of therapies available, as well as different medications, that are discussed below.
 
There is not one distinct way to develop PTSD, and there is also not one distinct path of treatment. Different people react differently to certain therapies and medications, and there is a variety of different treatment options out there. There are also some less scientific treatments that could also prove beneficial as a supplement to professional help.

Veterans Affairs (VA) medical centers and clinics can be found by looking in the “government offices” section of your local phone book, searching online at www.va.gov/rcs, calling 1-877-222-VETS (VA Health Benefits Service Center) or 1-800-905-4675 (Vet Center). Local mental-health care providers are also listed in the phone book, as are different medical professionals such as counselors, psychologists, and social workers who can help you find the appropriate treatment path.

Contacting a family physician is also a step in the right direction, because that medical professional can also offer suggestions on how to pursue treatment.The National Center for Posttraumatic Stress Disorder, www.ncptsd.va.gov, also has a wealth of valuable information about PTSD treatment for veterans.

If someone is having suicidal thoughts or behaviors and there is an emergency, call 911 immediately. Call 1-800-273-TALK, the VA’s suicide hotline, for information on how to get treatment for someone expressing suicidal thoughts or behavior.

Treatment can last from three to six months, or one to two years1, but it entirely depends on the person and circumstances of the traumatic event outlined in the symptoms section. Some people go through treatment and eventually recover from PTSD and do not continue to have symptoms. For others, PTSD is a lifelong struggle because those traumatic memories remain etched in the brain, but symptoms can greatly improve from going through treatment.  

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) involves speaking with a therapist in order to manage the feelings of anxiety and stress and learning to cope with them in a way that is less stressful. The therapist will help to change the thought patterns which lead to anxiety and stress while helping one understand why the current thought process exists1.

CBT is a form of psychotherapy that addresses how one feels and what he or she does. The therapist will aim to teach the person with PTSD how to respond to an undesirable situation with calmness instead of anxiety. CBT emphasizes that there are undoubtedly going to be undesirable situations in anyone’s life, but the response to that situation does not have to upsetting because that kind of response creates another problem in and of itself2. 

Exposure Therapy

Exposure therapy involves speaking with a therapist about traumatic memories in order to lessen the fear that one may have about talking about or reliving them. Constantly speaking about these memories will teach one how to control the feelings he or she has toward the memories of the traumatic event that occurred. Confronting memories in a straightforward way and learning how to cope with them and being prepared to deal with them in a healthier way can be an effective treatment for PTSD.

Sometimes there will be a gradual desensitization to the therapy, whereby less stressful memories are discussed before more stressful ones so that dealing with the more intense memories is not as daunting or difficult because the process has been practiced with the less stressful ones.

Sometimes the opposite occurs, and the therapist will suggest flooding, the recollection of many traumatic memories all at the same time. Being faced with all this anxiety while in the presence of a professional will make it possible not to become overwhelmed by all the feelings associated with the traumatic memories1.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is a more recent kind of psychotherapy that addresses how information is processed in the brain. A traumatic event is etched into the brain, and there are certain feelings attached to the event that one feels about him or herself – “I am not in control,” or “I am worthless”3. A therapist utilizing EMDR will ask the person in therapy to follow his or her hand (or will use other distractions like taps or tones) while simultaneously recollecting a certain traumatic memory4.

EMDR has been described as a subconscious process that works to reprocess how one feels about a certain memory by replacing negative feelings with positive ones. It focuses on the past, present, and future to discover where the negative feelings came from, what triggers those feelings now, and what can be learned to have different responses in the future. The sessions put the person in control, for he or she has the opportunity to stop the session at any time by just raising his or her hand3.

Group Therapy

Group therapy can be beneficial because it involves sharing one’s experiences with people who also have experienced traumatic events which resulted in developing PTSD. Often, people with PTSD might be reluctant to share their feelings with others because they feel as though those people won’t understand what they are going through, so group therapy provides an outlet where that person is surrounded by people who have had similar experiences and won’t prejudge them. 

Hearing others talk about their traumas might make it easier for someone to open up about the traumatic event(s) he or she has experienced. It might be easier to trust people in group therapy because they understand what that person is going through, and it provides a network for sharing different resources about treatment and coping with PTSD1.

Family Therapy

Family therapy can be an important process to helping one’s family understand PTSD and how it affects that person. If one’s family doesn’t have a clear understanding of PTSD and how it affects that person, they could be associating anger, stress, or other emotions projected by that person with something entirely different. By involving the entire family, everyone can become educated about PTSD and be prepared to help and support that person during the treatment process1.

Brief Psychodynamic Psychotherapy

This method of psychotherapy allows one to understand what triggers the recollection a traumatic event(s) and the feelings associated with it. The responses to a trigger of a traumatic memory may be so unconscious that one doesn’t realize or understand why they occur. By addressing the reactions, dealing with the past, and being consciously aware of thoughts and feelings, those responses can be changed so that they are healthier and more positive1.

Medication

It’s important to note that medication should not be taken without first consulting a medical professional. Based on one’s symptoms and family history, a medical professional can prescribe medication that is best suited to each individual. The mechanisms of PTSD are still not fully understood, and every case of PTSD is different, so the medication(s) prescribed will vary from person to person. It’s not uncommon to be prescribed more than one type of medication to deal with the multiple symptoms associated with PTSD, such as depression and insomnia. It’s also common to be prescribed one medication in order to counteract the side effects of another.

After beginning a medication, it can take effect as soon as two weeks, or it might take up to six weeks to see a difference5. If medication doesn’t immediately alleviate symptoms, one shouldn’t be discouraged from continuing to take it. On that same token, different medications produce different side effects and results in different people, so one might have to try more than one medication before finding the combination that works best.

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are often prescribed to deal with the depression associated with PTSD1. Serotonin is a neurotransmitter, a chemical that travels between neurons in the brain. There are many different types of neurotransmitters in our brains which control our motor skills, mood, and other daily functions. Serotonin is a neurotransmitter that controls mood and sleep, among other functions, which is why an imbalance of serotonin has been linked to depression6.

Taking an SSRI increases the amount of serotonin in the brain by blocking nerve cells from immediately absorbing serotonin and allowing more to remain in the brain7. Medications that are SSRIs include citalopram (Celexa), fluoxetine (such as Prozac), paroxetine (Paxil), and sertraline (Zoloft) 1. Often in combat veterans with PTSD, taking SSRIs like fluoxetine (Prozac) allows veterans to think more before they act, which better controls anger8.

Antidepressants

An SSRI is only one type of antidepressant, and there are other antidepressants that also are prescribed to treat PTSD. Whereas serotonin is commonly associated with affecting one’s mood, the neurotransmitter dopamine also has a part in regulating one’s mood. The neurotransmitter norepinephrine is also linked to depression because norepinephrine regulates emotions6.

Various medications work to balance these neurotransmitters within the brain to counteract depression. Tricyclic antidepressants (TCAs) mainly prevent the reuptake of serotonin and norepinephrine, although they slightly also prevent the reuptake of dopamine as well9, so more of these chemicals remain in the brain. However, they can be problematic in people with heart disease or high blood pressure5.  Wellbutrin is a newer antidepressant that also might be prescribed, as it works to block the reuptake of norepinephrine and dopamine10. 

Anti-anxiety medication (anxiolytics)

Benzodiazepines are a class of anti-anxiety medications that should be avoided if substance abuse is one of the symptoms of the person with PTSD because of its high potential for abuse8. Valium, Xanax, and Ativan are examples of benzodiazepines that, for someone who is already abusing drugs or alcohol to cope with the symptoms of PTSD, can bring about a similar level of abuse and dependency that is counter-productive in treatment.

BuSpar is an anti-anxiety medication that is often prescribed in addition to other medications but seldom by itself to alleviate anxiety5. It does not have the immediate results of benzodiazepines (it takes a few weeks to see effects), but it also does not have the high risk for abuse or dependency8. 

Beta blockers

Beta blockers like Inderal and Corgard work to block adrenalin from overwhelming someone with PTSD in high-adrenalin situations. Triggers of traumatic memories or feeling extremely angry can cause an increase in adrenalin, which overpowers one’s ability to make clear and thoughtful decisions. By blocking that adrenalin from taking over, the mind can overcome the immediate reaction of the body, which is often a purely combat-related reaction8.

Other medications

Low doses of Lithium work as a mood stabilizer, especially helping to control anger. Other medications like the antidepressant Trazodone (Desyrel) may be prescribed to help one sleep better8.

Other types of treatment

There are other types of less formal treatment that can be beneficial as supplements to therapy and medication. For instance, there is a program called “Rivers of Recovery” in Utah that hosts veterans with PTSD so they can enjoy the company of fellow veterans while fishing on Green River11.

For one man, taking care of a pet who also suffered trauma helped them both get through the healing process12. Using video-game simulators has also been known to help improve symptoms as a type of exposure therapy, with some being more receptive because it is packaged as a video game rather than ordinary therapy13. Some find that yoga can be a helpful addition to professional treatment in relieving tension14.

There are a multitude of additional activities that can be beneficial to partake in alongside therapy and/or medication. The main message that goes along with them is to stay active and involved in life. Treatment for PTSD comes in different forms, but what’s important to remember is that it is treatable. 

FOOTNOTES

  1. "What is Posttraumatic Stress Disorder?" National Center for Posttraumatic Stress Disorder. 30 Nov. 2007. United States Department of Veterans Affairs. 7 July 2008 <http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_what_is_ptsd.html>.
  2.  "What is Cognitive-Behavioral Therapy?" NACBT Online Headquarters. 2008. National Association of Cognitive-Behavioral Therapists. 7 July 2008 <http://www.nacbt.org/whatiscbt.htm>.
  3. "A Brief Description of EMDR Therapy." EMDR Network. 7 July 2008 <http://www.emdrnetwork.org/description.html>.
  4. "Eye Movement Desensitization and Reprocessing (EMDR): Questions and Answers." HealthPlace.Com. 2006. 7 July 2008 <http://www.healthyplace.com/Communities/Depression/treatment/emdr/q_and_a.asp>.
  5. "Frequently Asked Questions About PTSD Medications." Posttraumatic Stress Disorder. Facts for Health. 9 July 2008 <http://ptsd.factsforhealth.org/medfaq.html>.
  6. "Synapses/Neurotransmitters." The Brain From Top to Bottom. Canadian Institutes of Health Research. 7 July 2008 <http://thebrain.mcgill.ca/flash/i/i_01/i_01_m/i_01_m_ana/i_01_m_ana.html>.
  7. "Selective Serotonin Reuptake Inhibitors (SSRIs)." Mayo Clinic. 2008. Mayo Foundation for Medical Education and Research. 7 July 2008 <http://www.mayoclinic.com/health/ssris/MH00066>.
  8. Shay, M.D., Ph.D, Jonathan. "About Medications for Combat PTSD." The Virtual En-Psych-Lopedia by Dr. Bob. 23 Sept. 1999. 9 July 2008 <http://www.dr-bob.org/tips/ptsd.html>.
  9. "Tricyclic Antidepressants (TCAs)." Mayo Clinic. 2008. Mayo Foundation for Medical Education and Research. 9 July 2008 <http://www.mayoclinic.com/health/antidepressants/MH00071>.
  10. "Medications Used for PTSD And." PTSD Support Services. 4 July 2008. Anxiety Disorders Association of America. 9 July 2008 <http://www.ptsdsupport.net/ptsd_medication.html>.
  11.  LaPlante, Matthew D. "Rivers of Recovery Offers Fishing Therapy for Wounded Troops." The Salt Lake Tribune 1 July 2008. 7 July 2008 <http://www.sltrib.com/news/ci_9741446>.
  12. Bell, Diane. "Dog Helps a Marine See Himself." The Union-Tribune 26 June 2008. 7 July 2008 <http://www.signonsandiego.com/news/metro/bell/20080626-9999-1m26bell.html>.
  13. Saint-Martin, Emmanuel. "'Virtual Iraq': the Video Game as Therapy." France 24 3 July 2008. 7 July 2008 <http://www.france24.com/en/20080703-iraq-war-veterans-psychological-PTSD-traumatic-us-united-states-troubles>.
  14. Steffenson, Sharon. "The Healing Effect of Yoga on PTSD." YogaChicago. Mar.-Apr. 2007. 7 July 2008 <http://www.yogachicago.com/mar07/yoganidra.shtml>.