Choosing the treatment that is right for you
Reprinted from "Trauma and Victimization" issue of Visions Journal, 2007, 3 (3), pp. 23-24
Post-traumatic stress disorder (PTSD) is a common condition that sometimes arises after a person has experienced a traumatic event such as sexual assault, a natural disaster or combat. Some people with PTSD are unable to hold a job or socialize with friends, because they are so seriously affected by the disorder.
People suffering from PTSD are confronted with a bewildering array of treatment options. To add to the confusion, some practitioners make dramatic claims about the effectiveness of their treatments, often without any supporting evidence. The following are some scientifically supported recommendations for choosing among treatments. (Detailed reviews of treatment approaches appear in the related resources and footnotes sections at the end of this article.)
The first step is to get an evaluation from your family doctor. Your doctor might also decide to refer you to a clinical psychologist or psychiatrist for further evaluation. An important part of the assessment process is to decide when it is appropriate to begin PTSD treatment. Some people with PTSD also have other problems, such as severe depression or a serious drug or alcohol problem. These problems might need to be addressed before treating the person’s PTSD.
If the time is right for you to be treated for PTSD, then there are several options. The two leading, scientifically supported treatments are cognitive-behavioural therapy (CBT) and particular types of medication.1-2
CBT is a form of psychotherapy, typically provided by a clinical psychologist. The goals of treatment partly depend on your particular symptoms and problems, and your specific goals. CBT typically involves teaching you ways of improving your coping skills (e.g., breathing exercises or particular types of relaxation training), along with ways of helping you become less frightened of harmless, but fear-evoking things in your life. CBT can also reduce other PTSD symptoms such as recurrent nightmares.
To illustrate, Alison was tormented each night by terrifying nightmares of a sexual assault that happened several years ago. During her CBT sessions, Alison worked at desensitizing herself to the nightmares by writing a vivid description of the sexual assault and reading it over and over, until it became boring. This and other CBT methods gradually reduced the frequency of Alison’s nightmares.
Medications and CBT
There are several different types of effective medications for PTSD. These include a class of drugs known as “selective serotonin reuptake inhibitors,” such as Prozac, Celexa and Paxil. The choice of medication often depends on the specific nature of your problems. These medications are typically prescribed by a psychiatrist or sometimes by a family doctor.
CBT and medications are equally effective for the average patient. However, for reasons that are currently unclear, some patients benefit more from one treatment than another. Your family doctor or mental health professional (i.e., psychologist or psychiatrist) can help you decide which treatment option is likely to be best for you. People with particularly severe PTSD may require a combination of treatments, such as CBT plus one or more medications.
CBT and medications are effective in treating children and youth with PTSD, although over the past few years there has been some concern that certain medications, such as the serotonin reuptake inhibitors, might increase the risk of suicide. These harmful effects appear to occur in only a minority of patients—possibly those with a history of impulsive, self-destructive behaviour. Not all clinicians are convinced that these medications have these harmful effects, so the issue remains controversial. Health Canada advises that patients (or caregivers) consult the treating physician to confirm that the drug’s likely benefits outweigh any risks.
When choosing a treatment for PTSD, it is important that you take the opportunity to learn about the treatments being proposed. Check out the references and websites at the end of this article. Ask your doctor or therapist about the scientific evidence for whatever treatment is being proposed. Part of overcoming PTSD involves becoming more empowered. This starts with you making informed choices about the treatment you are willing to receive.
There are many other treatments for PTSD, although there is little evidence that some of these treatments are useful, and for other treatments the claims of their effectiveness have been exaggerated.
Eye Movement Desensitization and Reprocessing (EMDR) – may be helpful in some cases1-2
Hypnosis – little evidence that this is effective2-3
Psychoanalysis – little evidence that this is effective2-3
Thought Field Therapy – no evidence that this is useful4
Neuro-Linguistic Programming – no evidence that this is useful4
Emotional Freedom Technique – no evidence that this is useful4
Critical Incident Stress Debriefing – no evidence that this is useful for preventing PTSD; indeed, some evidence suggests that some forms of debriefing may be harmful1-2
About the authorSteven is a Clinical Psychologist and Professor in Psychiatry at the University of British Columbia. He has published over 180 scientific journal articles and book chapters, and 12 books, primarily on the nature and treatment of anxiety disorders.
Taylor, S. (2006). Clinician’s guide to PTSD: A cognitive-behavioral approach. New York: Guilford.
National Collaborating Centre for Mental Health. (2005). Clinical Guidelines 26: Post-traumatic stress disorder: The management of PTSD in adults and children in primary and secondary care. London, UK: Gaskell and the British Psychological Society. www.nice.org.uk/page.aspx?o=CG026fullguideline.
van Etten, M. & Taylor, S. (1998). Comparative efficacy of treatments for post-traumatic stress disorder: A meta-analysis. Clinical Psychology and Psychotherapy, 5, 126-145.
Devilly, G.J. (2005). Power therapies and possible threats to the science of psychology. Australian and New Zealand Journal of Psychiatry, 39(6), 437-445.