2 posts tagged “c-PTSD”

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…


  • 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.








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“I finally feel like there is hope for me to have a life that has purpose.” – Member Robin shares her story living with complex PTSD

Posted June 21st, 2017 by

Robin (survivinglife) is a PatientsLikeMe member living with complex PTSD. Recently, she shared her story with us, from her childhood to now, delving into the hardships she’s faced and how she continues to find the courage to forge through. Content within this story may be triggering for some readers. Here’s her story…

complex PTSD story

I am a 41 yo female. I’ve never been married. I’ve never dated or had any type of long term relationships – even long term friendships. My mood swings and constant need to be reassured that I am cared about and wanted is too much for people to put up with for more than a couple of years at best, a few months at worst. My faith is very important to me – it is one of the reasons I have been able to be as successful as I have been in my life. I struggle every day with my faith – with believing that I was not an accident and that I have purpose to my life.

I live on 6 acres which I enjoy watching the wildlife and listening to the birds. I have 2 dogs – a pit mix and a poodle mix. They are so important in my life. They are my constant. My pit mix is a rescue and is extremely nervous around people she doesn’t know. My friends say we are like two peas in a pod, and I guess we are on some level. She is the reason I am still here. The only reason I chose to live was because she didn’t deserve to die and I know she will be put down if something happens to me – because of her nervousness around people and her breed.

I enjoy reading and watching TV. I also do most of my home repair and enjoy working with my hands – from building to plumbing to electrical. I use art to deal with emotions I can’t figure out or when I’m feeling overwhelmed. I used to self-injure but now have learned to channel that energy into art and writing. My art isn’t so good as I am self-taught, but I am learning about different mediums and also learning not to judge myself so harshly.

My PTSD is a result of childhood abuse and neglect. I was sexually abused by six different perpetrators from the ages of 3 to 15. At the age of 14 I miscarried my brother’s baby – alone and not knowing what was happening to me. I thought I was going to die. None of my sexual abusers knew about the others. I was physically abused by my brother, father, step-father and mother. I was mentally abused by my brother, step-father and mother. My mother stopped caring for me at the age of 6 when she and my dad divorced. I learned that it was best to be invisible from an age before I can remember. I only remember that I tried to hide constantly when I was home. I either stayed outside or in my room silently. I became a latchkey kid in kindergarten. In fourth grade while I was at my dad’s one weekend my step mom threw all my stuff on the lawn and told me never to come back.


“My escape from all that went on at home was school. I wanted to be there, I wanted to stay there and never go home. The only bad thing about school was that I never had any friends. I never learned how to make friends. I was always alone even though I went to the same school all twelve years.”


In 6th grade I was labeled gay by the kids in my class. I lived in a small town in the Midwest and this was the 80’s – being gay was absolutely unacceptable. I didn’t even know what gay was.  One of the teachers pulled me aside and ask me if what they were saying was true. I told her I didn’t even know what it meant. She told me to ask my parents and I said I couldn’t. I knew that if she couldn’t tell me then asking my parents would only result in violence. She finally told me in an age appropriate way what it meant and then ask me again. I told her I didn’t know. That I didn’t really like anyone that way and did that mean something was wrong with me. She assured me there was nothing wrong with me and told me the teachers would do what they could to get the kids to leave me alone. I was a total outcast from that point on, but I still excelled in school. It was my only out.

By high school my only friends were the custodians and teachers. They all knew something was wrong, but no one would address it because of my family’s standing in the community. I remember thinking the whole time I was in school, “What’s wrong with me. Why can’t I function like the other kids?” I didn’t know that everyone else wasn’t having sex with members of their family multiple times a week for their whole life. I thought it was normal to have sex with family members and to get beat up and told I was stupid and a waste of time. “Why can’t I smile, why can’t I laugh and have fun, what’s wrong with me?” I started being suicidal around 10 years old and began self-injuring in 6th grade. When I finally graduated from high school I got a scholarship for twelve hours’ tuition at a college a couple of hours away and even though I was told I would never make it, I packed up and went. My first roommate’s boyfriend was stalking her and would break in in the middle of the night. I thought I had escaped, but I just landed back in an unsafe environment. After that semester I changed roommates and things got a bit better. I still didn’t feel safe, but I could justify that I was. I was constantly suicidal and I still battle those feelings today, just not as often.


“While I was in college I met a family that kind of adopted me. They wanted me around. They invited me to their house over and over. I had no idea what a family looked like – what a family was supposed to be. It was the first time in my life I felt accepted.”


They loved me in spite of my anger and suicidal thoughts and addictions. They didn’t try to change me, they just loved me. They did tell me about counseling and helped me find my first counselor. At that point I had already been on antidepressants for several years. My first counselor decided I didn’t need help – that I had it all together. I tried a different place and while they realized I needed help, my counselor didn’t show up for my appointments pretty often so I quit going. I talked about my symptoms to my doctors and spent the next 17 years seeing different doctors and counselors. I was labeled as major depressive disorder with dysthymia, generalized anxiety disorder, psychosis, dissociative disorder / dissociative fugue, and a host of personality disorders including borderline personality disorder. None of my doctors or psychiatrists ever did a complete history on me. None of them asked me questions about my past – just how I was doing currently. In 2010 I was hospitalized 3 times in 6 months. I was in a middle management position at work and the stress and feelings of inadequacy finally triggered me to the point that I was catatonic. I still had no friends and no family support. My doctor had her nurse take me to the ER and get me admitted. I would come out of the hospital with more diagnoses and on so much medication I couldn’t function and then I would go back to work unable to perform the way I had before.

The last time my company put me on administrative leave and told me I couldn’t come back to work until my doctor said I could. My doctor released me to go back to work 3 months later with the stipulation that I could not go back to work there so I had to quit my job. When I quit my job I lost my insurance and couldn’t afford my meds so I went off them cold turkey. It was horrible. I thought I was going to die before I made it through the withdrawals. After 4-5 months, I finally found another job only to be fired 6 months later due to behavioral problems. I had begun to see a different psychologist, but because of all my diagnoses she treated me as a child instead of a 35-year-old woman. Once again I lost my insurance, but could still afford my meds because they were all generics and my psychiatrist supplied the one that wasn’t generic through samples. This time it took 10 months for me to find a new job. I had been black balled in my career due to my behavioral problems on the last two jobs. I finally found a place that would take a chance on me and I still work there. It is a low paying job for my career field, but I have a job and insurance.

I finally got fed up with my psychiatrist treating me like a child and not listening to me so I searched for a new one. The one I finally decided to try actually did a history on me during my first appointment. I walked into her office with about 13 diagnoses and came out with 3. Major depressive disorder, generalized anxiety, and “complex” PTSD. I felt like a million pounds had been lifted from my shoulders. The course of my life finally made sense. My lack of being able to trust people, my lack of friendships, the “moodiness” that is really reactions to triggers that I know and some that I am continuing to figure out. Why I always felt different, like I didn’t fit in, why I still feel that way today. We changed my meds and realized the adult levels of medications are too strong for me – often resulting in serotonin syndrome, excessive sleepiness, liver damage, and more. My current psychiatrist works with a child psychiatrist in her group to get me on meds at a level that I can tolerate. This has made a difference, although I still stay in the severe depression category nearly 100% of the time. The frequency of self-injury and suicidal thoughts have decreased dramatically. The amount and severity of my panic attacks has decreased for the most part although I still have times that I can’t go to a store or public place alone.

There was one point about 2 years ago when I was triggered constantly at work and I ended up in intensive outpatient therapy and then inpatient and back into intensive outpatient, but I was able to go back to work. I know I have a therapist that is experienced in treating PTSD in both children and adults. She is able to meet me where I am emotionally – which is around 6-8 years old – and she doesn’t try to force me to “be an adult”. She is okay with whatever way I can figure out how to tell her what I am feeling and if I can’t put words or pictures on it she is okay with that too.


“I am finally making progress at the age of 41. I am finally being able to change some behaviors and figure out why I react the way I do and work to change it. I finally feel like there is hope for me to have a life that has purpose.”


I finally understand that there isn’t anything inherently wrong with me. I finally realized and have been able to acknowledge that what I thought was normal was some of the worst abuse my psychiatrist and therapist have dealt with. They both tell me that because of the severity of the neglect and abuse I may never be fully rid of the triggers and mood changes, but that with time, hard work and taking care of myself I should be able to come to a place that I am no longer haunted by the first 18 years of my life. I’ve never had hope before, it is a foreign feeling, but one I am getting used to. In the last few months I have finally been able to talk about my miscarriage, to separate that life from the events that surrounded it. I have been able to memorialize that life and begin to grieve the child that I lost 27 years ago. The child I always said I never wanted because it was just too painful to say anything else. The only child I will ever have. Today is my 41st birthday. No one has wished me a happy birthday, but I didn’t expect anyone to since I still live a pretty isolated life. Yesterday I realized that the only thing I wanted for my birthday was to say goodbye to my child in some way. Today I had the courage to purchase 27 daisies which I took to the local lake (we don’t have any rivers near me) and I dropped the flower heads one by one into the water and watched them float away. In so doing I said goodbye to the part of my past that says my child was not wanted and embraced the fact that I was a scared child myself who didn’t know what to do or say. It was very hard to do, but I did it. I said some words over the daisies as they floated away on the water and I could see the hard and painful part of that story going away. As I left that place I was a bit more free, a little less burdened by the secret that I have carried for 27 years. Moments like this are priceless for me. All the pain of therapy is worth it when there is a breakthrough like this. I took pictures and recorded what I said so that I can remember the positive, so I can remember the service that I finally had, that my child finally received. This gives me hope. This is why I continue to fight for my life, for my future….


“The advice I would give someone in my situation is to not give up just because your therapist / counselor / doctor / psychiatrist has given up on you. If you feel like they have written you off as someone who will never get better fire them and find someone new…. over and over if you have to until you find the one who does believe in you.”


Be open to trying new things, unconventional things – eastern medicine, art therapy, or other types of therapy you might not know about. Even if something hasn’t worked for you before with another therapist, be open to trying again with a different one.  Even if you have given up on ever being better, try to find the courage to fight one more time, and then one more time. You are worth it, worth every ounce of courage and strength you can find. Take comfort in the things you can – art, nature, pets, friends, family, a stuffed animal or a weighted blanket. Keep looking for things that work for you no matter what anyone else says. Let people care for you especially when it’s hard. Learning to trust is hard, learning to have healthy relationships is hard, learning to love yourself is hard…. they are all so worth it though! Be kind to yourself, learn to accept where you are, but not to settle for less than you can be. The next step may be the one that takes you on the journey to wholeness, to freedom from your past, to freedom to live in the now and look to the future.

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