This fact sheet provides information about the resources that are available to individuals who suffer from PTSD and offers a guide for how one might seek help for treatment of PTSD.

Why seek help for PTSD?

Most people experience considerable distress and avoidance after being exposed to a severely traumatic experience. This is a normal and adaptive response and often includes reliving the event in thoughts, images, and dreams. This initial rumination of the event may in fact contribute to the healing process and provide a way of achieving mastery over the event. For most people, these symptoms usually become less severe and gradually disappear over time. For others, the symptoms persist and become chronic, leading to PTSD. About 8% of men and 20% of women develop PTSD after experiencing a traumatic event, and roughly 30% of these individuals develop a chronic form that persists throughout their lifetimes.

The symptoms and problems associated with PTSD can interfere with a person’s life and become difficult to manage. Turning to someone for help is the first step in addressing the impact of PTSD in your life. Psychologists and other appropriate mental-health providers help educate people about reactions to extreme stress and ways of processing the event and dealing with the emotional impact.

With children, continual and aggressive emotional outbursts, serious problems at school, preoccupation with the traumatic event, continued and extreme withdrawal, and other signs of intense anxiety or emotional difficulties all point to the need for professional assistance. A qualified mental-health professional can help such children and their parents understand and deal with thoughts, feelings, and behaviors that result from trauma. For information about how trauma affects children see "PTSD in children and adolescents" below.

Knowing what kind of help is available, where to look for help, and what kind of questions to ask might make the process of seeking help easier and lead to more successful outcomes.

How is PTSD assessed and treated?

In recent years, a great deal of attention has been aimed at developing reliable assessment tools to aid in the diagnosis of PTSD. Today, there is a range of available measures that clinicians can use to diagnose PTSD. For more on how PTSD is assessed see the fact sheet on "Assessment of PTSD" below.

PTSD is treated with a variety of forms of psychotherapy and medication. Today there are some promising treatments that include cognitive behavioral interventions such as cognitive restructuring and exposure. For more information on these treatments see the fact sheet on "Treatment options" below.

How do I get an evaluation?

While it may be tempting to identify PTSD for yourself or someone you know, the diagnosis generally is made by a mental-health professional. This will usually involve a formal evaluation by a psychiatrist, psychologist, or clinical social worker specifically trained to assess psychological problems.

What can I expect from an evaluation for PTSD?

The nature of an evaluation for PTSD can vary widely depending on how the evaluation will be used and the training of the professional evaluator. As part of a screening, an interviewer may take as little as 15 minutes to get a sense of your traumatic experiences and its effects. On the other hand, a specialized PTSD assessment can last several hours and involve detailed, structured interviews and questionnaires Whatever the particulars of your situation, you should always be able to find out in advance from the professional conducting the evaluation what the assessment will involve and what information they will be looking for to determine a diagnosis.

How is PTSD treated?

The many therapeutic approaches offered to PTSD patients are presented in Foa, Keane, and Friedman's (2000) comprehensive book on treatment. The most successful interventions are cognitive-behavioral therapy (CBT) and medication. Excellent results have been obtained with some CBT combinations of exposure therapy and cognitive restructuring, especially with female victims of childhood or adult sexual trauma. Sertraline (Zoloft) and Paroxetine (Paxil) are selective serotonin reuptake inhibitors (SSRI) that are the first medications to have received FDA approval as indicated treatments for PTSD. Success has also been reported with Eye Movement Desensitization and Reprocessing (EMDR), although rigorous scientific data are lacking and it is unclear whether this approach is as effective as CBT.

What is psychotherapy and how can it help treat PTSD?

Psychotherapy is meant to help with a person’s emotional, behavioral, or mental distress. In practice, psychotherapy is the relationship between a professional psychotherapist and a client who work together to make changes in the client’s thoughts, feelings, and behaviors. How the psychotherapist goes about helping a client will depend upon the client’s goals and the therapist's training and theoretical orientation. Theoretical underpinnings can determine what techniques a therapists uses and the focus of therapy, and they can affect the psychotherapist’s style of interaction.

However, sometimes a person’s diagnosis will influence the decision about what type of therapeutic orientation the person should engage in. PTSD is a good example of this type of diagnosis because there are many psychotherapeutic treatments that have been designed specifically to treat PTSD. A client’s response to treatment will have a lot to do with the unique values, hopes, and personality factors of that individual, but there are some treatments that have been rigorously studied and shown to be helpful for PTSD

Psychotherapeutic approaches commonly used to treat PTSD

As stated above, there are a number of different therapeutic approaches used to treat PTSD. We will briefly explain some of the more effective approaches.

Cognitive Behavioral Treatment (CBT)

Cognitive-behavioral strategies have been the most frequently studied and most effective form of psychotherapy treatment for PTSD. The essential feature in all cognitive therapies is an understanding of PTSD in terms of the workings of the mind. Implicit in this approach is the idea that PTSD is, in part, caused by the way we think. CBT helps people understand the connection between their thoughts and feelings. CBT can help change the way we think (“cognitive restructuring”) by exploring alternative explanations, and assessing the accuracy of our thoughts. Even if we are not able to change the situation, we can change the way we think about a situation.

CBT is based on the understanding that many of our emotional and behavioral reactions to situations are learned. The goal of therapy is to unlearn the unhelpful reactions to certain events and situations and learn new ways of responding. CBT relies on evaluating thoughts to see whether they are based on fact or on assumptions. Often we get upset because we think something is occurring when it is not. CBT encourages us to look at our thoughts as hypotheses to be questioned and tested. CBT for trauma includes strategies for processing thoughts about the event and challenging negative or unhelpful thinking patterns.

Exposure therapy

Exposure is one form of CBT. Exposure uses careful, repeated, detailed imagining of the trauma (exposure) in a safe, controlled context to help the survivor face and gain control of the fear and distress that was overwhelming during the trauma. In some cases, trauma memories or reminders can be confronted all at once ("flooding"). For other individuals or traumas, it is preferable to work up to the most severe trauma gradually by using relaxation techniques and by starting with less upsetting life stresses or by taking the trauma one piece at a time ("desensitization"). When exposure is conducted by having the person imagine the trauma (such as a rape) it is called “imaginal exposure.” When it is done in real life, such as having the person go into a feared situation such as a crowded place, it is called “in vivo exposure.” In most cases, both forms of exposure are used.

CBT often involves reading assignments and homework so that clients can practice on their own the techniques they have learned in therapy.

Pharmacotherapy (medication)

Medications can reduce the anxiety, depression, and insomnia often experienced with PTSD, and in some cases, they may help relieve the distress and emotional numbness caused by trauma memories. Several kinds of antidepressant drugs have contributed to patient improvement in most (but not all) clinical trials, and some other classes of drugs have shown promise. The FDA has approved two medications, Paroxetine and Sertraline, for use in the treatment of PTSD. Although no medication has been proven to cure PTSD, medications are clearly useful for symptom relief, which makes it possible for survivors to participate in psychotherapy.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is a relatively new treatment for traumatic memories that involves elements of exposure therapy and CBT combined with techniques (eye movements, hand taps, sounds) that create an alternation of attention back and forth across the person's midline. While the theory and research are still evolving for this form of treatment, evidence suggests that it is the exposure and cognitive components of EMDR that make it effective, rather than the attentional alternation.

Group treatment

Group therapy is often an ideal therapeutic setting because trauma survivors are able to share traumatic material within the safety, cohesion, and empathy of other survivors. In such a setting, the PTSD patient can discuss traumatic memories, PTSD symptoms, and functional deficits with others who have had similar experiences. As group members achieve greater understanding and resolution of their individual traumas, they often feel more confident and able to trust. As they discuss and share how they cope with trauma-related shame, guilt, rage, fear, doubt, and self-condemnation, they prepare themselves to focus on the present rather than the past. Telling one's story (the "trauma narrative") and directly facing the grief, anxiety, and guilt related to trauma enables many survivors to cope with their symptoms, memories, and other aspects of their lives.

How can I tell if therapy is working well?

When you begin psychotherapy, you and your therapist should decide together what goals you hope to reach in therapy. Not every person with PTSD will have the same treatment goals. For instance, not all people with PTSD are concerned with lessening their symptoms. Some people want to learn instead the best way to live with existing symptoms and how to cope with other problems associated with PTSD. Perhaps you want to lessen your feelings of guilt and sadness? Perhaps you would like to work on more tangible aspects of your distress, like your relationships at work, or communication issues with your friends and family. Your therapist should help you decide which of these goals seems most important to you, and he or she should discuss with you which goals might take a long time to achieve.

Your therapist should also provide you with a good rationale for the therapy. That is, you should understand why your therapist is choosing a specific treatment for you, how long they expect the therapy to last, and how they will evaluate its effectiveness. The two of you should agree at the outset that this plan makes sense for you and what you will do if it does not seem to be working. If you have any questions about the treatment your therapist should be able to answer them.

Another aspect important to the course of good therapy, is the relationship you have with your therapist. If you feel comfortable with your therapist and feel you are working as a team to tackle your problems, it is likely that the therapy will go well. If you have concerns about your therapist, or concerns about the therapy, you should speak with your therapist about them. Therapy is not easy. It can be difficult to talk about painful situations in your life, or about traumatic experiences that you have had. Feelings that emerge during therapy can be frightening and challenging. Talking with your therapist about the process of therapy, and about your hopes and fears in regards to therapy, will help make therapy successful.

If you have concerns about your therapy or concerns about your therapist that have not been successfully worked out with your therapist, it might be helpful to consult another professional. It is recommended, however, that you let your therapist know you are seeking a second opinion.