Just before Independence Day, I was contacted by a news reporter who was curious about how fireworks might affect a veteran with PTSD. As I explained this common trigger for combat veterans, I found myself hoping the story would emphasize recovery rather than fear. Trauma has entered our national dialogue and, as a society, we are increasingly sensitive to its effects. But how much do we know about effective treatment? Recent news coverage on the Veterans Administration has implied that approaches to treating trauma are scattershot and lack outcome data on effectiveness. However, it is incorrect to think that effective, research-backed treatments for PTSD do not exist.
PTSD is a constellation of symptoms marked by reliving traumatic memories, excessive watchfulness, and avoidance of many things that trigger the memories. For PTSD to develop, a person must be exposed to circumstances of extreme threat such as physical or sexual assault, wartime violence, or other life-threatening circumstance. Not everyone who lives through these circumstances develops PTSD, but for those who do, there are several approaches to treatment that are backed by decades of research:
Prolonged Exposure Therapy
Trauma can link memories and everyday activities with extreme anxiety, causing isolation and withdrawal. In PE, a person first identifies activities or situations that have become linked to an anxious response because of a traumatic experience. Self-calming techniques are taught, and the person gradually confronts the things that are triggering stress. Additionally, with the help of a therapist, the person reviews his or her own account of the traumatic response to reduce the power of the memory. This approach has been effective for female assault survivors (Foa et al, 2005) and veteran populations (Institute of Medicine, 2012).
Cognitive Processing Therapy
Trauma is known to change the way a person interacts with others and the world, as well as how they view themselves and their worth. Cognitive Processing Therapy focuses on how the trauma has changed the way a person interprets everyday events. The goal is to develop balanced beliefs regarding safety, trust, control, and intimacy, so that the impact of the trauma can be minimized. This approach has produced significant reductions in symptoms for survivors of childhood sexual abuse (Chard, 2005), survivors of rape/physical assault (Resick 2008), and combat-induced PTSD for multiple war eras (Chard, et al, 2010).
Dialectical Behavior Therapy
When trauma occurs from a young age, or recurs for a long period of time, it can deeply shape how a person learns to form relationships. Although trauma is not the focus of this treatment, DBT targets the relational instability that can develop in cases of complex trauma and teaches skills to handle negative feelings in a way that preserves relationships.
Sometimes people affected by trauma attempt to numb distressing memories and feelings through use of substances, in this case, it can be difficult to treat PTSD without developing additional skills to manage symptoms without substance use. Seeking Safety combines treatment for substance abuse and PTSD. The focus of this treatment is coping and stabilization. Seeking safety has been effective in reducing symptoms of PTSD among women in community treatment centers (Gatz et al., 2007) and in pilot studies with male veterans (Norman et al., 2010). As research continues to emerge, therapists specializing in trauma are able to select the best approach based on a person’s needs and readiness for treatment. We continue to improve and refine treatment based on advances in research, much of which is funded and conducted by the VA. As the national dialogue continues, it is my hope that effective treatment options will continue to gain notoriety.
Chard, K.M. (2005). An Evaluation of Cognitive Processing Therapy for the Treatment of Posttraumatic Stress Disorder Related to Childhood Sexual Abuse. Journal of Consulting and Clinical Psychology, 73 (5) 965-971.
Chard, K.M., Schumm, J.A., Owens, G.P., & Cottingham, S.M. (2010). A comparison of OEF and OIF veterans and Vietnam veterans receiving cognitive processing therapy. Journal of Traumatic Stress, 23 (1) 25-32.
Foa, E.B., Hembree, E.A., Cahill, S.P., Rauch, S.A., Riggs, D.S., Feeny, N.C., & Yadin, E. (2005). Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73 (5) 953-964.
Gatz, M., Brown, V., Hennigan, K., Rechberger, E., O’Keefe, M., Rose, T., Bjelejac, P. (2007). Effectiveness of an integrated trama-informed approach to treating women with co-occuring disorders and histories of trauma. Journal of Community Psychology, 35, 863-878. Institute of Medicine. (2012). Treatment for posttraumatic stress disorder in military and veteran populations: Initial assessment. Washington, DC: The National Academic Press.
Norman, S.B., Wilkins, K.C., Tapert, S.F., Lang, A.J., Najavits, L.M. (2010). A pilot study of seeking safety therapy with OEF/OIF veterans. Journal of Psychoactive Drugs, 42, 83-87
Resick, P.A., Galovski, T.E., Uhlmansiek, M.O., Scher C.D., Clum, G.A., Young-Xu, Y. (2008) A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. Journal of Consulting and Clinical Psychology, 76 (2) 243-258.