Psychotherapy and PTSD symptoms: Your questions answered

Posted November 1st, 2017 by

Recently, a number of PatientsLikeMe members shared some of the questions they had about psychotherapy and  remission from PTSD symptoms, so we asked Meaghan Zisk, R.N. M.P.H., a nurse and Health Data and Patient Safety Clinical Specialist, to investigate. She took a deep dive into variations of PTSD, psychotherapy types, how they work and resources to help you choose which therapy type is right for you. She also touched on the possibility of remission from PTSD symptoms. Check out what she found…

PTSD vs C-PTSD

  • Complex PTSD (C-PTSD) is a relatively new diagnostic term intended to describe the symptoms associated with prolonged, repeated trauma. Examples of such trauma include long-term child abuse, long-term domestic violence, concentration camps, prisoner of war camps, among others. Individuals with C-PTSD generally have all of the symptoms associated with PTSD. However, individuals with C-PTSD also experience additional symptoms such as difficulty with emotion regulation, feeling worthless or guilty, and interpersonal problems that are not seen as frequently in PTSD.
  • Due to the combination of interpersonal and emotional symptoms with other PTSD symptoms, C-PTSD can be harder to treat and may take longer to recover from than PTSD.
    • The International Society of Traumatic Stress Studies (ISTSS) has published treatment guidelines for C-PTSD that focuses on a 3 step approach:
      • Phase 1 focuses on ensuring the individual’s safety and increasing emotional, social and psychological skills. This phase may involve the use of medications.
      • Phase 2 focuses on processing traumatic memories, reviewing the memories so individuals build an adaptive sense of self and the world.
      • Phase 3 focuses on consolidating treatment gains, using gains to engage more in interpersonal relationships, work and social life, and the community.
  • C-PTSD is not a recognized subtype in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V); however, it is expected to be included as a diagnosis in the International Classification of Diseases, 11th revision (ICD-11), which is due to be finalized in 2018.

Therapies for PTSD

Trauma-focused psychotherapies are typically the most highly recommended treatment for PTSD. Some of the most common trauma-focused psychotherapies are Cognitive Behavior Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR) and Prolonged Exposure (PE). These treatments use various techniques intended to help process the trauma.

  • CBT
    • CBT is one of the oldest and most commonly used types of psychotherapy. It focuses on the relationship between thoughts, feelings, and behaviors. CBT often involves controlled exposure to reminders of the trauma or emotions associated with the trauma in order to process and reduce maladaptations. Interested to know what other patients are saying about CBT? Take a look at these evaluations.
  • EMDR
    • EMDR is type of psychotherapy that uses external stimuli along with accessing traumatic memories or thoughts to help the individual process the trauma.
    • Lateral eye movements directed by the psychotherapist are the most common type of external stimulus used, although hand-tapping or audio stimuli have also been used. With lateral eye movements, the therapist might have the individual follow their hand while it moves back and forth across the field of vision.
    • There isn’t agreement about how EMDR works, although research studies have shown it to be effective for PTSD.
      • Some researchers theorize that the focus on an external stimulus while holding a traumatic memory in mind allows for enhanced information processing and the development of new mental pathways to alleviate the distress associated with the memory.
      • It is also thought to be similar to how the brain process information during REM (rapid eye movement) sleep.
    • Although EMDR has been shown to be more effective than no treatment at all, it has not been shown to be more effective than other trauma-focused therapies like CBT or PE. There are more than sixty evaluations for this treatment on PatientsLikeMe, see what those who have tried it have said.
  • PE
    • Prolonged exposure is a specific type of CBT that teaches individuals to gradually approach trauma-related memories, feelings, and situations. Since exposure can be very anxiety-provoking for patients, the therapist works to ensure the relationship is a safe space for confronting stimuli. Read what PatientsLikeMe members have said about the approach here.

Other types of treatments

  • Electroconvulsive therapy
    • Electroconvulsive therapy (ECT) is a procedure, done under general anesthesia, in which small electric currents are passed through the brain in a controlled setting. The electric currents cause a brief seizure and change the brain chemistry.
    • Immediately following the procedure, some people may feel disoriented or confused for a few hours. In certain cases, people may not remember the events leading up to the procedure.
    • Since the effects on memory are not completely understood, ECT should be considered when other treatments have failed.
    • ECT has primarily been used for severe depression and has not been studied extensively for PTSD. However, some studies have shown it may be helpful for people who have both depression and PTSD.
    • There are 120 evaluations from patients who have tried this treatment on PatientsLikeMe. Read what they said.
  • Biofeedback
    • Over the years, research on biofeedback, which may be neurofeedback, heart rate variability biofeedback, or another type, has been mixed with some studies showing positive results, others being inconclusive, and some showing no benefit. Researchers and clinicians are still pursuing neurofeedback as a treatment option for PTSD and other conditions such as TBI or ADHD.
    • It is thought that neurofeedback may help to stabilize brain activity and improve focus and attention. Since many symptoms of PTSD are related to hyperarousal, stabilizing brain activity may be helpful in reducing symptoms.
    • Insurance coverage for biofeedback treatments would vary depending on the insurer.
    • Patients have offered feedback on how effective this treatment has been for them here.

Choosing therapy

Different types of therapy may work for each person – it really depends on the individual and the relationship to the care provider. The VA offers a tool (https://www.ptsd.va.gov/apps/decisionaid/) to explore different types of therapy and medication based on your preferences; for example, whether you want to discuss the trauma, whether you want to participate in individual or group therapy, or whether you want to focus on medications.

The American Psychological Association (APA) also publishes clinical guidelines for recommendations on therapies or medications based on available evidence. Although primarily intended for clinicians, these guidelines can also be used by patients to understand various options.

Is remission possible?

Many providers believe most people with PTSD can experience remission of symptoms. People who experienced childhood trauma, interpersonal violence, or who have an anxiety disorder in addition to PTSD may experience lower rates of remission or a longer time to remission. In all cases, there is a chance of symptoms returning and people may need additional treatment if that happens. Some people may continue receiving care through their psychiatrist to ensure they are on the right medications; there’s not necessarily a right time to stop seeing a specialist. It depends on each individual’s relationship with their provider and who is available in their area.

Data about different types of treatment for PTSD is limited and as shown above, it’s hard to know what treatment to try first.

On PatientsLikeMe there are more than 29,000 members living with and discussing their experiences with PTSD and C-PTSD. Want to join the conversation? Become a member here.

Resources

https://www.psychiatry.org/patients-families/ect

https://www.istss.org/ISTSS_Main/media/Documents/ISTSS-Expert-Concesnsus-Guidelines-for-Complex-PTSD-Updated-060315.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4165723/

https://neurodevelopmentcenter.com/psychological-disorders/ptsd/neurofeedback-for-ptsd/

http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0166752

https://www.ncbi.nlm.nih.gov/pubmed/21130362

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