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Posttraumatic Stress Disorder

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Written by Dr. Rieka Yu
Published on February 12, 2024
Research Highlights

Posttraumatic Stress Disorder (PTSD) interferes with day-to-day activities through intrusive thoughts, depression, and increased reactivity.

 

Cognitive behavioral therapies, psychotherapies, and medication are used to treat PTSD.

 

Treatment for PTSD is effective when patients finish treatment, but 20-30% of patients drop out of treatments.

PTSD can interfere with daily living.

PTSD is a mental health condition caused by experiencing or witnessing a traumatic event (Mayo Clinic 2022). Symptoms can last for months or years and interfere with day-to-day functioning. Symptoms are categorized as intrusive memories (e.g., nightmares), avoidance (e.g., avoiding trauma reminders), negative changes in thinking and mood (e.g., emotional numbness), and changes in physical and emotional reactions (e.g., easily scared).

 

People with PTSD have higher levels of certain hormones that can lead to a “fight or flight” response, with a higher heart rate, blood pressure, and awareness and startle response (Cleveland Clinic 2023). They also have changes in their brain that changes how they regulate and process motivation, emotion, learning, memory, and fear.

 

About 5% of U.S. adults have PTSD in any given year (U.S. Department of Veteran Affairs (VA) a). Women are twice as likely as men to develop PTSD, partially because women are more likely to experience sexual assaults (U.S. Department of VA a). Veterans are more likely than civilians to develop PTSD (U.S. Department of VA a).

 

Some form of talk therapy is the recommended PTSD treatment.

The American Psychological Association (APA) strongly recommends cognitive behavioral therapy, which includes cognitive processing therapy, cognitive therapy, and prolonged exposure therapy as interventions for adults with PTSD (Table 1; APA 2017). The VA also recommends eye movement desensitization and reprocessing (EMDR) as a treatment for PTSD (U.S. Department of VA b).

 

The APA conditionally recommends brief eclectic psychotherapy, narrative exposure therapy, and medication as treatment (APA 2017). These treatments are conditionally recommended because evidence of their effects is not as strong as other treatments, there may be different pros and cons for each patient, or the intervention is not suitable across all settings. Medications for treating PTSD include Fluoxetine, Paroxetine, Sertraline, and Venlafaxine. Only Paroxetine and Sertraline are FDA-approved for PTSD treatment (APA 2017). These medications are selective serotonin reuptake inhibitors, also known as SSRIs, which increase the levels of serotonin in the brain (Mayo Clinic). Serotonin, a neurotransmitter, regulates learning, memory, and mood.

 

Recommended treatments have been shown to help PTSD symptoms.

Cognitive behavioral therapy is effective for reducing PTSD symptoms when patients complete treatment, however treatment requires 12-16 sessions and dropout rates range from 20-30% (personal communication Bruce).

 

Among U.S. veterans, cognitive processing therapy led to significant improvement in PTSD symptoms, depression, anxiety, guilt, and social adjustment (U.S. Department of VA c). Forty percent of veterans that entered treatment with cognitive processing therapy lost their PTSD diagnosis by the end of treatment.

 

Patients that received cognitive therapy showed significant improvements in their clinical PTSD symptoms and quality of life compared to patients that received support therapy (Ehlers et al. 2014). Support therapy is used for people with mental health and emotional challenges and uses guidance and encouragement for patients to develop their own resources for their mental health (American Psychiatric Association 2023).

 

Prolonged exposure has been found effective for reducing PTSD symptoms and issues such as anger, guilt, negative health perceptions, and depression (Rauch et al. 2012, McLean et al. 2022). In Vietnam War veterans, prolonged exposure was particularly effective for reducing intrusive thoughts (Rothbaum & Schwartz 2002).

 

Eye movement desensitization and reprocessing has led to similar reductions in PTSD symptoms as CBT (Seilder & Wagner 2006, Kar 2011).

 

Brief eclectic psychotherapy has also been shown to significantly reduce PTSD and general anxiety symptoms (Lindauer et al. 2005). When compared to support therapy, narrative exposure therapy significantly reduced PTSD symptoms (Robjant & Fazel 2010). For medication treatment, one study on Paroxetine showed that it significantly improved PTSD symptoms and social functioning (Marshall et al. 2001).

 

Although few studies have documented the effect of PTSD treatments on suicidal ideation, symptoms for depression improve when PTSD symptoms improve (personal communication Bruce).

 

Table 1. Cognitive behavioral therapy and psychotherapy treatments for PTSD. Descriptions from APA 2017.

 

References

American Psychiatric Association. (2023). What is Psychotherapy? https://www.psychiatry.org/patients-families/psychotherapy.

American Psychological Association. (2017). Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults. https://www.apa.org/ptsd-guideline/ptsd.pdf.

Cleveland Clinic. (2023). PTSD (Post-Traumatic Stress Disorder). Access February 7, 2023. https://my.clevelandclinic.org/health/diseases/9545-post-traumatic-stress-disorder-ptsd.

Ehlers A, Hackmann A, Grey N, Wild J, Liness S, et al. (2014). A Randomized Controlled Trial of 7-Day Intensive and Standard Weekly Cognitive Therapy for PTSD and Emotion-Focused Supportive Therapy. American Journal of Psychiatry. 171, 294-304. https://ajp.psychiatryonline.org/doi/epdf/10.1176/appi.ajp.2013.13040552.Mayo Clinic. (n.a.). Selective Serotonin Reuptake Inhibitors (SSRIs). Accessed February 8, 2024. https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825.

Kar N. (2011). Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: a review. Neuropsychiatric Disease and Treatment. 7, 167-181. https://www.tandfonline.com/doi/pdf/10.2147/NDT.S10389.

Lindauer RJL, Gersons BPR, van Meijel EPM, Blom K, Carlier IVE, et al. (2005). Effects of Brief Eclectic Psychotherapy in patients with posttraumatic stress disorder: Randomized clinical trial. https://onlinelibrary.wiley.com/doi/10.1002/jts.20029.

Marshall RD, Beebe KL, Oldham M, & Zaninelli R. (2001). Efficacy and Safety of Paroxetine Treatment for Chronic PTSD: A Fixed-Dose, Placebo-Controlled Study. The American Journal of Psychiatry. 158(12), 1982-1988. https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.158.12.1982.

Mayo Clinic. (2022). Post-traumatic stress disorder (PTSD). Accessed February 7, 2024. https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967.

Rauch SA, Eftekhari A, Ruzek JI. (2012). Review of exposure therapy: A gold standard for PTSD treatment. Journal of rehabilitation Research and Development. 49(5), 679-688. https://www.researchgate.net/profile/Sheila-Rauch/publication/.

Robjant K, & Fazel M. (2010). The emerging evidence for Narrative Exposure Therapy: A review. Clinical Psychology Review, 30(8), 1030-1039. https://www.sciencedirect.com/science/article/abs/pii/S0272735810001261.

Rothbaum BO, Schwartz AC. (2002). Exposure Therapy for Posttraumatic Stress Disorder. American Journal of Psychotherapy. 56(1), 59-75. https://psychotherapy.psychiatryonline.org/doi/epdf/10.1176/appi.psychotherapy.2002.56.1.59.

Seilder GH, & Wagner F. (2006). Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD: a meta-analytic study. Psychological Medicine. 36(11), 1515-1522. https://www.cambridge.org/core/journals/psychological-medicine/article/.

U.S. Department of Veterans Affairs a. (n.a.). PTSD: National Center for PTSD. Accessed February 9, 2024. https://www.ptsd.va.gov/understand/common/.

U.S. Department of Veterans Affairs b. (n.a.). Talk Therapy. Accessed February 8, 2024. https://www.ptsd.va.gov/understand_tx/talk_therapy.asp.

U.S. Department of Veterans Affairs c. (n.a.). Cognitive Processing Therapy for PTSD. Access February 7, 2024. https://www.ptsd.va.gov/professional/treat/txessentials/cpt_for_ptsd_pro.asp.

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