How PTSD Is Treated

Not everyone who has experienced trauma needs to be treated, but some people may need professional help to overcome the psychological distress from a traumatic event. Approximately 10% to 20% of individuals exposed to trauma experience post-traumatic stress disorder (PTSD) symptoms that are persistent and associated with impairment. 

Thankfully, PTSD is very treatable, and treatment often includes different forms of psychotherapy and prescription medications. Most people with PTSD need to confront, process, and integrate the traumatic experiences that caused their symptoms of PTSD in order to get relief from this mental disorder. Lifestyle interventions can also help people with PTSD manage their symptoms and prevent them from interfering with their everyday life.

Prescription Medications

A range of medications are available to treat PTSD. The best medications for managing post-traumatic stress disorders depend on the symptoms a person has and what other mental health conditions they have, like anxiety or depression. Antidepressants, mood stabilizers, anti-anxiety medications, and alpha-1 blockers may be prescribed.

Healthcare providers will tailor each person’s treatment to fit their needs. Currently, the only two medications that are FDA-approved to treat PTSD are both selective serotonin reuptake inhibitors (SSRIs).

Selective Serotonin Reuptake Inhibitors (SSRIs)

Selective serotonin reuptake inhibitors are commonly prescribed for mood and anxiety disorders. They affect serotonin, a neurotransmitter that plays a key role in regulating mood and anxiety. It also influences bodily functions like appetite and sleep. Research has shown that up to 60% of PTSD patients see improvement when treated with SSRIs, while 20% to 30% achieve full remission.

The two FDA-approved SSRIs for PTSD are sertraline (Zoloft) and paroxetine (Paxil). Studies have shown that people who took sertraline and paroxetine showed significant improvement in PTSD symptoms after 12 weeks compared with placebo.

However, sertraline was associated with significantly higher rates of insomnia, diarrhea, nausea, and decreased appetite compared with placebo. Similarly, paroxetine use was associated with a higher rate of side effects compared with placebo, and the most common effects are asthenia (abnormal physical weakness), diarrhea, abnormal ejaculation, impotence, nausea, and somnolence (drowsiness).

Other SSRIs are commonly used for the treatment of PTSD, but since they are not FDA-approved, their use for this mental disorder is considered off-label.

Selective Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs)

An SNRI that has been found to be effective at treating PTSD is venlafaxine. SNRIs affect serotonin, a neurotransmitter that plays a key role in regulating mood and anxiety.. The use of this medication for PTSD is also considered off-label.

Venlafaxine acts primarily as a serotonin reuptake inhibitor at lower dosages and as a combined serotonin–norepinephrine reuptake inhibitor at higher dosages. Extended-release venlafaxine was shown to be effective in two trials involving more than 800 patients with non–combat-related PTSD: Remission rates were 50.9% for those who took the medication and 37.5% for placebo.

Anti-Anxiety Medications

Benzodiazepines such as diazepam (Valium), clonazepam (Klonopin), and lorazepam (Ativan) are a group of medications that have been used in the management of PTSD symptoms. However, a review of several studies has found them to be ineffective and carry several risks.

Research has shown that benzodiazepines can worsen outcomes for PTSD in areas like aggression, depression, and substance abuse. Benzodiazepines may actually interfere with the extinction of fear conditioning and worsen recovery from trauma. This family of drugs also carries an FDA warning of a high risk of dependency and addiction.

Mood Stabilizers 

Mood stabilizers can help treat extreme mood changes and may be prescribed for people who don’t respond to antidepressants. Mood stabilizers work by balancing brain chemicals that regulate emotions. Although there is not much research to support their use in PTSD, healthcare providers will sometimes prescribe these to people with PTSD when the main symptoms are anger, agitation, or irritability.

Lithium and carbamazepine (Tegretol) are mood stabilizers that can be used for PTSD. Side effects of mood stabilizers may include nausea, vomiting, and drowsiness.

Atypical Antipsychotics

Atypical (second-generation) antipsychotic medications are also used sometimes when other treatments fail to provide relief. They may be used alongside an antidepressant to boost its effects or alone. These antipsychotics can help a patient with intrusive and mood symptoms, as well as hypervigilance. Quetiapine (Seroquel) and risperidone (Risperdal) are antipsychotics commonly prescribed for PTSD. 

Research has shown that the addition of quetiapine and risperdal to antidepressant therapy significantly improved outcomes among people with PTSD. Adverse events are more common with risperidone, including weight gain, fatigue, somnolence, and hypersalivation. Moreover, these types of medications were shown to be particularly effective in combat-induced PTSD, so they may support positive outcomes for veterans.

Alpha-1 Blockers

If a person has trouble sleeping or frequent nightmares, their healthcare provider may prescribe an alpha-1 blocker like prazosin (Minipress), which can help decrease the brain’s fear and startle responses. Alpha-1 blockers have been shown to reduce the occurrence of nightmares and sleep disturbances in combat veterans with PTSD. Side effects of these medications may include dizziness, low blood pressure, and fainting.

Therapies

The goal of psychotherapy for PTSD is to make it easier for people with this mental disorder to cope with and decrease the distress caused by their reaction to their trauma. A psychotherapist will often work to educate the patient on what trauma is, what causes it, and how it can affect them. Interventions recommended for the treatment of PTSD are often variations of cognitive behavioral therapy.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy focuses on the relationships between thoughts, feelings, and behaviors, and targets current problems and symptoms. It also focuses on changing patterns of behaviors, thoughts, and feelings that lead to problems with daily functioning. In people with PTSD, the types of CBT that are used include:

• Cognitive processing therapy: This is a specific type of cognitive behavioral therapy that helps patients learn how to modify and challenge unhelpful beliefs related to the trauma. Treatment begins with psychoeducation regarding PTSD, thoughts, and emotions to make the patient become more aware of the relationship between thoughts and emotions. It also begins to identify automatic thoughts that may be maintaining the PTSD symptoms. Then the patient begins more formal processing of the trauma by trying to break the pattern of avoiding thoughts and feelings associated with the trauma. This can be delivered in individual or group sessions.
• Cognitive therapy: This involves modifying the pessimistic evaluations and memories of trauma, with the goal of interrupting the disturbing behavior and thought patterns that have been interfering in the person’s daily life. A therapist works with the patient to identify the relevant evaluations, memories, and triggers of the trauma that sustain the patient’s specific PTSD symptoms. They help the patient understand the meaning behind traumatic memories and how they are appraised, and recognize that excessively pessimistic evaluations of the trauma or its sequelae may exaggerate the feeling of threat. 
• Prolonged exposure: This teaches patients to gradually approach trauma-related memories, feelings, and situations. By facing what has been avoided, a person with PTSD learns that the trauma-related memories and cues are not dangerous and do not need to be avoided. There are two forms of exposure: imaginal exposure and in vivo exposure. During imaginal exposure, the patient describes the event in detail in the present tense with guidance from the therapist. In vivo exposure involves confronting the feared stimuli outside of therapy.

In one study, CBT that also combined exposure therapy helped between 61% and 82.4% of patients eliminate their PTSD.

Psychodynamic Therapy

Psychodynamic therapy is a form of therapy that focuses on changing unconscious processing to reduce the influence of past events on present behavior. Psychodynamic therapy interventions can help people with PTSD reduce instances of nightmares related to the traumatic event, as well as the fear related to these events. Additionally, psychodynamic therapy has been shown to reduce anxiety and depressive symptoms, as well as attentional bias.

Alternative Treatments

Additional treatment approaches that are not supported by as strong evidence as the interventions above may be used to help people with PTSD.

Brief Eclectic Psychotherapy

This approach combines elements of cognitive behavioral therapy with a psychodynamic approach. It focuses on changing the emotions of shame and guilt, and emphasizes the relationship between the patient and therapist. Brief eclectic psychotherapy aims to change painful thoughts and feelings that are the result of a traumatic event.

The patient is asked to talk about the traumatic event as if it is happening in the present. They are taught relaxation exercises. The therapist helps the patient with any distressing emotions and memories that occur as they recount their experience. Patients will also be taught how to prevent a relapse and apply what they learned in the sessions in the future.

In one study, 96% of 566 police officers no longer fulfilled the PTSD diagnosis after brief eclectic psychotherapy treatment. However, 60% still showed minor symptoms of concentration problems after treatment. More studies need to be done to confirm the effectiveness of brief eclectic psychotherapy for PTSD.

Eye Movement Desensitization and Reprocessing (EMDR) Therapy

Eye movement desensitization and reprocessing therapy has shown to have some effectiveness in treating PTSD. EMDR is a treatment that helps a traumatic memory become more fully processed, which makes it easier for someone to overcome distorted thinking patterns and heal from a painful memory. 

Specifically, it uses bilateral eye movements to help someone re-experience a traumatic memory so that they can associate it with more positive feelings. EMDR has been shown to work just as effectively as exposure therapy, so some researchers note that the exposure may be all that’s required.

Specifically, one study compared eight weeks of EMDR treatment with eight weeks of treatment with an SSRI. The results showed that 91% of the group that underwent EMDR experienced long-term improvement, compared to 72% in the SSRI group.

Narrative Exposure Therapy

Narrative exposure therapy helps people with PTSD establish a coherent life narrative in which to contextualize traumatic experiences. It is known for its use in group treatment for refugees.

The patient establishes a chronological narrative of their life, concentrating mainly on their traumatic experiences, but also incorporating some positive events. It is believed that this contextualizes the network of cognitive, affective, and sensory memories of a patient’s trauma. By expressing the narrative, the patient fills in details of fragmentary memories and develops a coherent autobiographical story. The memory of a traumatic episode is then refined and understood.

Narrative exposure therapy appears to be effective at treating PTSD, but more research with a larger sample size and randomized, controlled trials are needed to validate this.

Lifestyle

Researchers show that people with PTSD are more likely to experience metabolic and cardiovascular disease, which may exacerbate PTSD symptoms. This results from higher rates of smoking, sedentary lifestyle, and poor diet among people with PTSD.

Physical Activity

Research has shown that physical activity can improve outcomes for PTSD patients, especially when physical activity is combined with leisure activity. Since PTSD patients are less likely to be motivated to engage in physical activity on their own, it’s helpful to have a support system or group environment to encourage physical activity and boost self-worth and motivation.

Relaxation

Relaxation techniques have also been found to be beneficial for PTSD, including meditation, mindfulness, and yoga. In one study, 52% of women with PTSD no longer showed symptoms after a weekly one-hour trauma-informed yoga class. Researchers believe that yoga helps with PTSD because it helps people with this disorder better tolerate adverse environments, including physical and sensory experiences related to traumatic memories. This helps reduce fear and helplessness and boost emotional awareness, making people with PTSD more resilient in the face of adversity. 

Mindfulness has also been shown to help reduce PTSD symptoms. Specifically, a 12-week study on loving-kindness meditation, which supports positive and loving thoughts toward self and others, had a positive effect on depressive symptoms among people with PTSD. It also improved thoughts about self-compassion, elevated overall mindfulness, and provided a greater sense of life purpose, personal growth, and self-acceptance. 

Sleep

Better sleep plays an important role in helping people overcome PTSD, especially since PTSD causes nightmares, anxiety, and other factors that result in poor sleep. Image reversal therapy (IRT) is one treatment that has been shown to help improve sleep quality in people with PTSD. A subset of CBT, IRT asks patients to recall their nightmare, then write it down and change it into something more positive. One study showed that IRT reduced the severity of PTSD, improved sleep, and reduced instances of nightmares.

A Word From Verywell

PTSD is a difficult condition that can greatly affect a person’s quality of life. It can take time to find the right treatment, which can be frustrating for a person and their loved one. However, researching all available options and talking with a healthcare professional specialized in helping people with PTSD can help ensure that you get the help you need to overcome the pain of the past to live a better life.