Clinical Practice Guidelines for PTSD
Post-traumatic stress disorder (PTSD) may develop within days, weeks, months, or years after a traumatic event. However, regardless of the time PTSD takes to manifest, it is a treatable condition.
Before initiating the treatment, a doctor performs a physical examination to rule out all the medical problems that might be causing PTSD symptoms. Next, a psychological evaluation is performed to discuss a patient’s symptoms and events (e.g., violence or serious injury) that led up to them. For this evaluation, the American Psychiatric Association (APA) has also published the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
It is noteworthy that PTSD diagnosis requires re-exposure to the actual or perceived traumatic event in one or more ways. An individual is diagnosed with PTSD only if they experience symptoms for more than a month that interfere with their ability to function.
The PTSD treatment often takes time, with periods of symptom remission followed by periods where symptoms are exacerbated. A team of medical professionals, including a mental health specialist, a psychologist, a psychiatrist, a community psychiatric nurse, and/or a social worker, are often involved in treating a PTSD patient.
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Clinical Practice Guidelines for PTSD
APA’s Clinical Practice Guidelines recommend four interventions for treating PTSD. Another four APA recommendations are conditional. The primary PTSD treatment is psychotherapy, but it can also include medication, all of which combine together to help improve PTSD symptoms. Here’s an outline for the treatment of PTSD.
In people with mild symptoms that have been present for less than four weeks after experiencing a traumatic event, a watchful waiting approach may be adopted, where the person is closely monitored to see if symptoms worsen. If watchful waiting is prescribed, a follow-up appointment after one month is usually scheduled.
Psychotherapy is one of the main approaches to treating PTSD. It may be carried out one-on-one or as group-based therapy, typically delivered over 12 to 16 sessions. Psychotherapy treatment for PTSD may last for six to 12 weeks or more.
All four strongly recommended psychotherapy-based interventions are variations of cognitive behavioral therapy (CBT).
- CBT is a form of psychotherapy that helps patients recover from the negative effects that disrupted their thought patterns or attitude, focusing on changing patterns of behaviors, thoughts, and feelings. This is achieved by individually breaking down problems arising daily and analyzing and changing any negative thoughts that might be triggering them. Patients usually attend 90-minute sessions of CBT once or twice weekly for eight to 12 weeks. However, less may be needed if the therapy is started within one month of when the patient initially experienced the traumatic event.
- Cognitive processing therapy (CPT) is a specific type of CBT that helps patients modify and change unhelpful trauma-related beliefs. In the process, the patient develops a new understanding of the traumatic event, reducing its ongoing adverse effects in the current life.
- Cognitive therapy is typically delivered in weekly sessions over three months. It aims to alter the disturbing memories of trauma, interfering with a patient’s everyday routine.
- Prolonged exposure teaches patients to gradually accept that trauma-related memories need not be avoided. Therefore, this type of CBT is typically provided in weekly individual sessions for three months.
APA also recommends three psychotherapies and four medications conditionally.
- Brief eclectic psychotherapy combines elements of CBT with a psychodynamic approach to treat PTSD patients who have experienced a single traumatic event. It focuses on changing the emotions of shame and guilt and emphasizes the relationship between the patient and therapist. The treatment comprises 16 individual sessions, each with a specific objective, lasting between 45 minutes and one hour, typically scheduled once per week.
- Eye movement desensitization and reprocessing (EMDR) is a relatively new approach to treating PTSD. It involves the patient moving their eyes from side-to-side (bilateral stimulation) while remembering the traumatic event. This technique helps the hippocampus in the brain to process unpleasant memories and flashbacks so that their impact on the mind is decreased. EMDR reduces the intensity and emotion associated with trauma memories. The distinguishing feature of EMDR is that it does not require a patient to reminisce on distressing detailed descriptions of the trauma.
- Narrative exposure therapy (NET) helps individuals establish a coherent life narrative to contextualize traumatic experiences. It is a popular mode of PTSD treatment for refugees.
The distinguishing feature of NET is that it explicitly focuses on recognizing and creating a testament of the traumatic event, such that the patient recaptures their self-respect. Four to 10 sessions of NET are recommended as a group-based therapy, although it can be provided individually.
Medications are generally used in severe cases that have not responded to psychotherapy or CBT alone. Although sertraline is typically the first class of medications used in PTSD treatment, individual histories of side effects, drug response, comorbidities, and personal preferences are also considered before a doctor prescribes these medications.
Below are the types of medications that can help improve PTSD symptoms:
- Anti-depressant drugs treat symptoms of depression and anxiety and help improve sleep- and concentration-related problems faced by PTSD patients. Currently, only sertraline and paroxetine, two selective serotonin reuptake inhibitor (SSRI) medications, have received the Food and Drug Administration (FDA) approval for treating PTSD.
- Anti-anxiety drugs relieve severe anxiety in PTSD patients; however, some have the potential for abuse, so they are generally prescribed only for a short time.
- Prazosin. Previous several studies have indicated that this type of drug had no benefit in PTSD cases over placebo, although they reduced or suppressed nightmares in some people with PTSD. Therefore, it is best to seek the advice of a doctor before using prazosin because, in some cases, this drug might work.
To conclude, treatment helps PTSD patients gain a sense of control over life. It teaches them to address their symptoms directly, improve self-worth, and cope with symptoms if they reappear. Most importantly, these treatment treats other problems related to PTSD, including substance abuse, anxiety, and depression.
Identifying and Treating Post-Traumatic Stress Disorder | Chivonna Childs, PhD