Is PTSD Treatable?
When you experience the symptoms of Post Traumatic Stress Disorder it can sometimes feel like you are stuck in your trauma and that there is no way of escaping the negative feelings it has brought to you.
The good news is that PTSD is treatable and can be overcome. Even long after a traumatic event, the right kind of help can allow you to work through, process, and ultimately recover from your trauma.
If you have mild symptoms of PTSD, or you have had symptoms for less than 4 weeks, an approach called watchful waiting may be helpful. This involves carefully monitoring your symptoms to see whether they improve or get worse. This can be useful as sometimes people who develop problems after a traumatic experience get better within a few weeks without treatment. This is usually the case if your initial symptoms are relatively mild; you feel that although the trauma was horrific it was just a one off event and you are safe again now; you have a good support network of family, friends or work colleagues and it feels that there are no longer-term consequences arising from the trauma.
If your symptoms are severe or they persist beyond the four week period of watchful waiting, it is recommended to seek professional help to decide on the best way to address your trauma.
The Process & Benefits of Seeking Help
If you are in any way concerned that your symptoms are not easing after the period of watchful waiting it is advised that you contact your GP or a registered mental health professional. They should help you with an assessment or, in the case of a GP, arrange for you to see the right mental health professional in order to carry out an assessment. By undergoing this assessment you will be able to find out more accurately the extent to which you may have been affected by a traumatic event and what trauma or stressor-related condition you may be suffering from. This process will help to ensure that you receive the most appropriate help for your specific problem.
PTSD can in many cases be mistaken for depression or anxiety as some of the syptoms are very similar. The problem with this is that depression and anxiety are often treated with medication as a first line of intervention, whereas there is evidence that this should not be the first treatment choice for PTSD. Properly diagnosing PTSD requires sufficient time, specialist training and experience in conducting trauma assessments. Because of this, it is important to ensure that you are assessed by a properly qualified mental health professional. In England, The Department of Health sponsors NICE (National Institute for Health and Care Excellence). NICE guildelines state that if you are still experiencing problems four weeks after your trauma or your symptoms are very troublesome, your medical practitioner (in the UK, your GP) should refer you to a mental health specialist who has sufficient trainig and experience in the assessment of trauma or stress related problems.
PTSD Treatment Options
Finding The Right Type Of Therapy
At the end of your assessment process your mental health specialist should explain to you what your options are for receiving therapeutic help.
The aim of any type of trauma therapy should be to enable a client to re-visit their traumatic experience/s under specific conditions of safety created in the here-and-now of the therapy so that the full emotional and sensory content of their experiences and its impact on their life can be remembered and relieved.
This enables new understanding and meaning to be gained, the trauma/s to be integrated as part of the person’s life experiences and dissociation to be resolved. Different types of therapy try to achieve this aim in different ways.
Every situation is different and depending on each person’s particular circumstances, the type/s of trauma experienced and the ages at which this happened therapy will require different lengths of time to be able to achieve this aim. It is helpful to meet for a specialist assessment with a trauma therapist to determine which type of therapeutic approach may be most suitable for you and the length of therapy that may be required for this integration to be achieved. As a general guideline the more severe, prolonged, repeated or early on in life your trauma was the more impact it is likely to have had on you and the more specialist and in-depth your road towards recovery will usually be. The field of trauma psychology is growing rapidly. There are now many new psychological treatments emerging for trauma-related problems and it can be confusing to decide on what might be most beneficial to you.
If you are seeking help within the public health sector in England for PTSD following a trauma, NICE guidelines recommend that you should be offered a course of trauma-focused psychological treatment as part of the National Health Service (NHS). If your post-traumatic symptoms or your PTSD is severe this should be made available to you in the first month after the traumatic event.
In accordance with the NICE guidelines you should NOT be offered medication as a first line of treatment in preference to trauma-focused psychological therapy.
Currently, the only two trauma-focused psychological treatments NICE recommends for PTSD are Trauma-focused Cognitive Behavioural Therapy (TF-CBT) and Eye-movement Desensitisation and Reprocessing (EMDR). This is beacuse NICE only recommends treatments if they have been subjected to randomised controlled trial (RCT) research, which is a very stringent form of evaluation. Both TF-CBT and EMDR have been evaluated through RCT research and as such are recommended by NICE and, also, the World Health Organisation (WHO) as effective PTSD treatments for children, adolescents and adults with PTSD.
TF-CBT, EMDR & Body-Oriented Options
Trauma-Focused Cognitive Behavioural Therapy (TF-CBT)
Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) is a form of talking therapy (grown out of Cognitive Behavioural Therapy (CBT)) aimed at helping you work through the impact of the traumatic events and the way this may have shaped your thinking, feeling and subsequent actions.
Following a thorough assessment and formulation of your problems, TF-CBT should be tailored to your specific needs. Your therapist may employ a number of different components depending on your circumstances. These may include, for example, psycho-education in relation to your PTSD or dissociative symptoms; identification, evaluation and re-scripting of some unhelpful thoughts and beliefs in relation to what happened; behavioural experiments to empower you to try out things differently; breaking problems down into smaller components so that you can tackle them more easily; empowering you to take control of your trauma-related problems by trying different strategies to the ones you have used so far to cope; finding new understanding and meaning in relation to your traumatic experiences.
TF-CBT also includes the use of grounding and stabilisation techniques to help you develop inner resources before the emotional and sensory impact of a trauma is explored in more depth. It may include working with memories and belief systems in creative ways to minimise the negative impact of a traumatic experience. Usually it entails some form of controlled reliving and processing of the traumatic experience/s once you feel secure and safe enough to be able to do so. Work with changing certain survival-based behavioural strategies can be very helpful in transforming the cycle of avoidance you may employ in your life as a result of the trauma. TF-CBT aims at helping you recover from the effects of the trauma/s so that you can return to healthy functioning in your life.
It is very important that the Trauma-Focused Cognitive Behavioural Therapy is tailored to your specific needs and might be most effective when combined with mindfulness-based, compassion-focussed and body-oriented approaches.
Eye Movement Desensitisation and Reprocessing (EMDR)
Eye Movement Desensitisation and Reprocessing (EMDR) is classed as a therapy which spans both cognitive and body-oriented approaches. EMDR is part of the psychosensory therapies that can achieve a deeper level of processing and healing than might be possible by purely cognitive work. This is achieved by accessing sensory and deeper body feelings in addition to thoughts and emotions, allowing ‘frozen’ or ‘paralysed’ trauma memories to be freed up and viewed from different perspectives compared to when the experience first occurred. This level is reached via what is known as ‘bilateral stimulation’ which can be given to the client in the form of eye movements (as the name suggests) across the visual midline, but can also be in the form of sound or touch.
You can learn more about our approach to EMDR at The Oxford Development Centre here.
Body-Oriented Approaches to PTSD Therapy
There is a growing awareness of the close links between mind and body in trauma. This has grown out of an increased understanding of the neurobiology underlying trauma due to more sophisticated screening technology used in research such as MRIs (Magnetic Resonance Imaging) and CTs (Computed Tomography). Esentially, when a person experiences trauma, alongside the psychological responses, the associated tensions and stress responses can become locked away within the body. Body-oriented therapies can help to release these physical responses to trauma. These therapies require further research before they can be regarded as scientifically proven. However, promising preliminary studies and many positive case studies are beginning to highlight their potential. Some of these approaches may not be sufficient as a standalone trauma treatment but may be helpful when combined with or, in addition, to your trauma-focused psychological therapy.
Alongside EMDR, some other body-oriented approaches include:
- Comprehensive Resource Model
- Sensorimotor Psychotherapy
- Somatic Experiencing
- Calatonia and Subtle Touch Techniques
- Havening Techniques
- Compassion-Focused Trauma Therapy
- Mindfulness Oriented Trauma Therapy
- Trauma-Sensitive Yoga
- Craniosacral Therapy
- Rosen Method Bodwork
- Equine-Assisted Trauma Therapy
Finding The Right Therapist
When you have experienced trauma that has utterly shattered your trust it can take a signficant time to build a relationship that feels safe and secure with your therapist. It is of utmost importance that any actual trauma remembering work is only done when you are resourced and stabilised enough not to feel overwhelmed or out of your emotional comfort zone while doing so. Depending on your particular circumstances, the level to which your nervous system has been affected by the trauma and the degree of dissociative symptoms you may suffer from this can take a significant amount of time. Your therapist should be mindful of this and because of this it is important for you to work with a therapist who has experience in working with more complex trauma.
Finding the right trauma therapist for you can take some time but it is worth perservering to make sure you find somebody who you feel comfortable with. Therapists should be able to tell you about their training and experience with more complex trauma-related conditions. Altough this can seem a bit overwhelming at first, it is very important that you ask for as much information as possible. It is perfectly acceptable to ask professionals about their experience and qualifications. If they are properly registered and qualified they will be more than happy to show you their relevant certificates. If you don’t feel comfortable with a therapist trust your own feelings! You won’t progress with your process of recovery if you feel that you can’t have an honest, open and trustworthy relationship with your therapist.
Registers of approved and qualified mental healthcare professionals should be available in most countries. It is important that you ensure that your therapist is registered with their appropriate professional body. In the UK the following bodies keep records of all elegible practioners within their respective fields.
- The Health and Care Professions Council (HCPC) keeps a register of all practising Chartered Clinical Psychologists and Chartered Counselling Psychologists.
- To be included on their register, professionals will have been approved by the British Psychological Society (BPS).
- The British Association for Behavioural and Cognitive Psychotherapy (BABCP) has a register of Cognitive Behavioural psychotherapists.
- The EMDR Association for Uk and Ireland has a register of EMDR practitioners in the Uk and Ireland.
- EMDR International Association (EMDRIA) has a register of EMDR practitioners internationally.
- The United Kingdom Council for Psychotherapies (UKCP) keeps a register of qualified psychotherapists.
- The British Association for Counselling and Psychotherapy (BACP) keeps a register of qualified counsellors and psychotherapists.
- Qualified psychiatrists are registered with the Royal College of Psychiatrists.
- Mental health nurses (referred to as psychiatric nurses in some countries) are required to be registered with the Nursing and Midwifery council.
While this list helps to highlight the various registers for different mental health practioners, having any of the above qualifications does not automatically mean that a practitioner has experience with working with trauma or PTSD. As mentioned above, it is important to ask questions when initally considering working with a practitioner to make sure they have experience in this field and that you feel confident they will be able to help with your specific circumstances.
By spending time at the outset, trying to determine if you and your prospective therapist will be a good fit for each other, you are giving yourself the best chance of success in healing from your trauma.
You can learn more about how PTSD occurs, PTSD symptoms, and read a PTSD recovery case study by following the links to our other PTSD resource centre pages below.