Therapy for Trauma
Trauma at a Glance
You haven’t been the same since it happened. You’d rather forget about it altogether, but your mind won’t let you. You may be experiencing intrusive memories, recurrent nightmares, or flashbacks of the trauma you experienced. You go out of your way to avoid being reminded of it; you avoid thoughts, feelings, people, and places that remind you of what happened. Sometimes your avoidance interferes with work, activities of daily living, and relationships.
You may find that you’re unable to recall certain details of the trauma, and your thoughts and emotions feel skewed. Perhaps you’ve noticed an increase in negative thoughts about yourself, others, and the world. For example, you may view yourself as “bad,” others as “untrustworthy,” and the world as “a dangerous place.” Your emotions are more intense these days too. Perhaps you’ve noticed an increase in feelings of fear, horror, or anger. Many trauma survivors also experience unwarranted feelings of guilt and shame. While these emotions seem everpresent, other emotions such as joy, happiness, and love feel diminished.
It takes a lot of energy to suppress distressing thoughts, emotions, and memories and to avoid reminders at every turn. Even though you feel exhausted, you stay on guard. In fact, it may feel like you’re constantly on edge. Perhaps you startle more easily and notice you’re more irritable these days. It may be harder to concentrate, and you may have difficulty falling or staying asleep. You feel worn down physically, mentally, emotionally, and spiritually.
Recovering from Trauma
Imagine no longer feeling tormented by intrusive thoughts, nightmares, and flashbacks. Imagine no longer brainstorming ways to avoid people and situations that remind you of the trauma you experienced. Your thoughts about yourself, others, and the world are more compassionate and hopeful. In place of chronic feelings of fear, guilt, shame, and anger you notice a range of human emotion. You feel like yourself again; you’re able to enjoy moments throughout the day, and you feel more at ease around others. Instead of feeling adrift and worn down, you feel connected and engaged.
Reasons to be Hopeful
Most People Recover
Most people who seek treatment for PTSD recover or experience significant improvements in their functioning. While treatment for PTSD is challenging at times, clients who have endured traumatic events are as brave and capable as anyone else. It’s worth noting that the development of PTSD is influenced by genetics, early life experiences, the timing and severity of trauma, and the presence or absence of supportive relationships. The development of PTSD has nothing to do with courage. Seeking treatment, on the other hand, often requires a great deal of courage.
Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) are well-researched and effective interventions for PTSD. Hundreds of randomized clinical trials have shown these therapies to significantly reduce symptoms of PTSD. Follow-up studies show that therapeutic gains are maintained over time.
Specialized Treatment is Available
COPE is a cognitive behavioral therapy that is helpful for treating patients with PTSD and substance use disorders. It was developed due to the growing realization that PTSD and substance use disorders often overlap (PTSD usually comes first), and there are special considerations that need to be made for patients who present with this combination of symptoms. It is no longer standard practice to address a patient’s SUD and then address symptoms of PTSD. Rather, patents fare better when symptoms are addressed simultaneously with evidence-based practices for each set of concerns.
Medication Can Help
Medications are often helpful in the treatment of PTSD. Medications recommended by the American Psychological Association’s PTSD practice guidelines and the VA/DOD include Zoloft, Paxil, and Prozac, and Effexor. There are times when certain medications may be a hindrance to treatment. For example, patients participating in Prolonged Exposure (PE) therapy need to access their fear response in session, and medications such as Xanax and Valium may mute a patient’s emotions too drastically. Psychologists often support their patients by collaborating with psychiatrists and primary care physicians as needed.
Drs. Casey and Christopher have spent their careers helping patients with all sorts of traumas. It’s often the case that patients come to therapy seeking help for other concerns (substance use disorders, depression, anxiety, eating disorder), and it later becomes apparent that their presenting concerns are likely caused or exacerbated by symptoms of PTSD. Drs. Casey and Christopher ultimately entered this profession out of a desire to help individuals who have experienced trauma in all its forms. While Drs. Casey and Christpher are well practiced with the interventions mentioned above, they are also attuned to the needs and desires of each client. Not all clients need a formal treatment protocol such as PE or COPE whereas others do. Drs. Casey and Christopher have a collaborative approach when talking with patients about their treatment plan.
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Frequently Asked Questions
What is trauma, exactly?
This is a topic that's near and dear to our hearts, and there’s a lot of information (some of it conflicting) about “what counts” as trauma. Ultimately it comes down to the unique and often subtle impact of an event or series of events on a person’s life. To explore this common question in greater depth, it’s helpful to look at a couple of definitions of trauma.
The DSM (Diagnostic and Statistical Manual of Mental Disorders) has standard criterion for PTSD. It states that a person must be exposed to “actual or threatened death, serious injury, or sexual violence.” Additionally, a person must develop a certain number of specific symptoms to meet strict criterion for PTSD. This criterion was developed thoughtfully, and having a precise definition strengthens research about effective forms of treatment.
SAMHSA (Substance Abuse and Mental Health Services Administration) has a broader view of traumatic stress. Their definition states that traumatic stress develops depending on the interplay of the “three E’s” - the event, the experience, and the effects. The “event” may be anything from poverty and food scarcity, emotional neglect or abuse, witnessing emotional abuse of a caretaker, sexual trauma that wasn’t necessarily experienced as “violent,” or a person’s treatment within the culture at large. It’s noteworthy that none of these “events” would be captured by the DSM. In terms of the “experience,” a person might feel any number of emotions - fear, horror, worthlessness, helplessness, shame, or humiliation. Trauma is often broader than fear. Lastly, the “effect” may be obvious, such as fear of driving after a near-death accident, or more subtle and insidious. Subtle outcomes might include chronic physiological arousal or emotional detachment. These symptoms may not seem as significant as flashbacks or other visible symptoms of PTSD, but they can greatly shape a person’s physical health, emotional wellbeing, academic achievement, career advancement, and relationships.
It may be helpful to think of trauma along a continuum. Perhaps to the far left we have classic symptoms of PTSD. Then, somewhere in the middle are the more insidious symptoms such as high blood pressure, difficulty trusting others, unhealthy relationship patterns, and low self-esteem. Finally, to the far right we have post-traumatic growth - feelings of empowerment, determination, and increased compassion for one’s self and others.
It’s important to highlight that a person who develops PTSD (or any other mental health concern) is not weak or inferior to those who don’t. Protective factors for mental health include a range of variables - the timing of the trauma, the duration of the trauma, access to healthcare, quality of relationships. For example, children who have just one supportive relationship with an adult or who have knowledge of an adult advocating on their behalf fare better than children who don’t have these experiences. As a side note, this great news for adults - we can all make a difference in the lives of the youngest members of our society.
At the end of the day, if life experiences are causing you distress maybe it doesn’t matter if they qualify as “trauma.” Maybe it doesn’t matter if the impact is obvious or insidious. Maybe it’s okay to reach out for support for the simple reason that we all deserve to feel well - to feel compassionate toward ourselves and connected with people who are well enough to treat us well.
How does Prolonged Exposure (PE) therapy work?
In this form of treatment, a mental health care professional helps a client develop a hierarchy of feared memories, feelings, and situations. They then help clients expose themselves to increasingly anxiety provoking situations listed on their hierarchy. In the treatment of PTSD, exposure often involves reliving (in one’s mind) and retelling traumatic events. Although it’s uncomfortable, it’s important for a patient’s fear response to be activated in session because this is what allows memories to evolve. The activation of memories also helps a patient become more habituated to them. The more times we see a scary movie, the less scary it becomes. Finally, activation of emotion helps a patient feel what they already know to be true - that their emotions, albeit painful, will not cause them physical harm or put their long-term mental health in jeopardy. Many people fear that if they allow themselves to experience intense emotions, the feelings will never end and they may “go crazy.”
Prolonged exposure therapy is about experiencing something, because experience is the most powerful teacher. Rather than go it alone, or forgo the learning experience altogether, it’s often helpful to have a knowledgeable guide. We do this in all areas of life without shame, but when it comes to mental health the stigma persists. If you want to learn to scuba dive, you hire a knowledgeable guide. If you want to buy a home, you hire a knowledgeable guide. If you want to become a firefighter, you work with a knowledgeable guide. If you want to become a professional athlete, you work with a knowledgeable guide. When it comes to therapy, a psychologist is just that - a knowledgeable guide.