Department of Psychiatry
Penn Behavioral Health

Center for the Treatment and Study of Anxiety

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Post-traumatic Stress Disorder

Treatment of PTSD


 




Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) has been implemented for the treatment of a wide range of psychological disorders. The specific CBT techniques used to treat PTSD vary by case but the approach generally seeks to alter irrational thoughts and dispel any negative emotions associated with the traumatic experience.

Several forms of cognitive behavioral therapy have been proven effective in treating PTSD.

  • Exposure Therapy: patient exposed to repeated exposure of stressful stimuli
  • Stress Inoculation Training (SIT): patient educated about anxiety symptoms and coping mechanisms
  • Cognitive Therapy: patient taught to identify trauma-related irrational or dysfunctional beliefs that influence decision-making and emotional responses
  • Eye Movement Desensitization and Reprocessing (EMDR): patient discusses trauma while tracking the movement of a rapidly moving finger with his/her eyes
  • Combination: patients may undergo many of the above techniques concurrently (e.g. exposure therapy with stress inoculation training)

CBT reduces both the severity of PTSD as well as other psychological states associated with the disorder such as general anxiety and depression. The benefits of treatment are typically retained with low rates of relapse without continued CBT sessions or other forms of treatment (medication, supportive counseling, and relaxation). Other forms of treatment that are incorporated into CBT include general supportive counseling and deep breathing exercises, a form of relaxation treatment.

Exposure therapy, SIT, and cognitive therapy are the most widely accepted CBT treatments of PTSD and controlled research studies and case reports provide strong empirical evidence for the efficacy of these techniques. While clinical studies also demonstrate the efficacy of EMDR, the unconventional aspects of the treatment still raise questions about the technique. The technique was devised by Dr. F. Shapiro and the protocols and discussion of the treatment are recorded in Shapiro (1999, 2001, 2002).

Prolonged Exposure (PE) has been shown to be one of the most effective treatment strategies developed and tested by Dr. Edna Foa. Treatment typically involves 9-12 weekly sessions that last 90-120 minutes. The CTSA offers a treatment program based upon PE. The Center’s program is focused upon discussing fears, recalling the traumatic event, relaxation training, and confronting safe situations that involve memories of the trauma.

Learn more about Prolonged Exposure (PE) for PTSD.




Psychosocial treatments

Brief psychological debriefings directly following traumatic incident are common preventative measures for the development of chronic PSTD. Debriefings facilitate open discussion about the sequence of events as well as emotions, thoughts, and impressions associated with the incident. They also aid in the development of coping mechanisms for future stresses. Although patients subjectively indicate the treatment to be helpful, research suggests psychological debriefings are unable to facilitate long-term recovery. Short-term amelioration of symptoms is thus attributed to natural recovery.

Short-term cognitive behavioral therapy (CBT), however, has also been shown to prevent chronic symptoms. Patients who undergo 4-5 CBT sessions 2-4 weeks after the episode experience significant reduction in the severity of post-traumatic stress. These sessions implement the same techniques used in chronic PTSD scenarios and have been deemed effective in preventing chronic PTSD.

There is strong evidence that conversation-based therapy can be effective in treating PTSD. Counseling and group therapy sessions have both been used to relieve PTSD symptoms and these counseling strategies draw from an intervention approach familiar to many therapists. PTSD therapy has a strong focus upon education and the development support networks. However, there is a growing body of support for the necessity of incorporating cognitive behavioral techniques into effective therapeutic practices.




Self-help treatment

There is a small collection of books written for PTSD sufferers that record potentially useful self-help techniques. The books aim to help the individual manage and transform their disorder by furthering their own self-awareness and understanding. Self-help texts may provide some symptomatic relief but it is widely believed that professional treatment is necessary for a complete recovery.


More Information: Books


Foa, E. B. & Wilson, R. (1991). Stop Obsessing! How to overcome your obsessions and compulsions. New York: Bantam Doubleday Dell. Translated into Spanish: (1993). Venza sus obsesiones. (Stop obsessing!). Barcelona, Spain: RobinBook. Translated into German: (1994). Hor endilch auf damit. (Stop obsessing!). Heyne: Germany.

Davidson, J. R. T. & Foa, E. B. (Eds.) (1992). Posttraumatic stress disorder: DSM-IV and beyond. Washington, D.C.: American Psychiatric Press, Inc.

Foa, E. B. & Rothbaum, B. O. (1997). Treating the Trauma of Rape. New York: Guilford Publications, Inc.


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Medication

The use of drugs in PTSD treatment has been helpful in relieving symptoms of PTSD patients. A collection of antidepressants have been found helpful and three medications more specifically designed for PTSD treatment are listed below:

  • Fluoxetine
  • Sertraline
  • Paroxetine

Unfortunately, because these drugs do not treat the underlying cause of the disorder, PTSD medications are commonly associated with relapse. They do nonetheless provide some symptomatic relief.


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