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National Institute of Mental Health (NIMH)

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What is post-traumatic stress disorder (PTSD)?

Post-traumatic stress disorder (PTSD) is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event.

It is natural to feel afraid during and after a traumatic situation. Fear is a part of the body's "fight-or-flight" response, which helps us avoid or respond to potential danger. People may experience a range of reactions after trauma, and most people recover from initial symptoms over time. Those who continue to experience problems may be diagnosed with PTSD.

Who gets PTSD?

Anyone can develop PTSD at any age. This includes combat veterans and people who have experienced or witnessed a physical or sexual assault, abuse, an accident, a disaster, or other serious events. People who have PTSD may feel stressed or frightened, even when they are not in danger.

Not everyone with PTSD has been through a dangerous event. Sometimes, learning that a friend or family member experienced trauma can cause PTSD.

According to the National Center for PTSD , a program of the U.S. Department of Veterans Affairs, about six out of every 100 people will experience PTSD at some point in their lives. Women are more likely to develop PTSD than men. Certain aspects of the traumatic event and some biological factors (such as genes) may make some people more likely to develop PTSD.

What are the signs and symptoms of PTSD?

What are the risk factors for PTSD?

How is PTSD treated?

How can I find help for PTSD?

How can I help a friend or relative who has PTSD?

How can I find a clinical trial for PTSD?

Where can I learn more about PTSD?

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Learn about post-traumatic stress disorder, including signs and symptoms, risk factors, treatments and therapies, and next steps for PTSD research.

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PTSD can be seen to affect most people who have a traumatic moment in their lives for men mostly it could be due to the war, the best way of treating that will to always seek help no matter how they feel they need all the help they will need mentally

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Symptoms of PTSD do not typically depend on sex or gender. However, they may vary from person to person. Learn more about PTSD in males here.

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How Common is PTSD in Adults?

Posttraumatic stress disorder (PTSD) can occur after you have been through a trauma. A trauma is a shocking and dangerous event that you see or that happens to you. During this type of event, you think that your life or others' lives are in danger.

Going through trauma is not rare. About 6 of every 10 men (or 60%) and 5 of every 10 women (or 50%) experience at least one trauma in their lives. Women are more likely to experience sexual assault and child sexual abuse. Men are more likely to experience accidents, physical assault, combat, disaster, or to witness death or injury.

PTSD can happen to anyone. It is not a sign of weakness. A number of factors can increase the chance that someone will develop PTSD, many of which are not under that person's control. For example, if you were directly exposed to the trauma or injured, you are more likely to develop PTSD.

Facts about How Common PTSD Is

The following statistics are based on the U.S. population:

About 7 or 8 out of every 100 people (or 7-8% of the population) will have PTSD at some point in their lives.

About 8 million adults have PTSD during a given year. This is only a small portion of those who have gone through a trauma.

About 10 of every 100 women (or 10%) develop PTSD sometime in their lives compared with about 4 of every 100 men (or 4%). Learn more about women, trauma and PTSD.

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Posttraumatic stress disorder (PTSD) can occur after you have been through a trauma. A trauma is a shocking and dangerous event that you see or that happens to you. During this type of event, you think that your life or others' lives are in danger. Going through trauma is not rare.

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PTSD for men can mostly been seen in abuse and death of a loved one as they do not know how to truly feel at times like during the war, they cannot stop mourn and pray because they cant stop fighting, leading to a never ending guilt that might linger forever.

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PTSD tends to stem as seen and mentioned many times in reality and fiction it seems to stem most from war as people are forced to kill people who had families or maybe even begged for mercy but they had no choice as the others were the enemy and they were the executioner, leading to guilt and fear that one day they will suffer the same fate that they had put that person through.

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. 2021 Nov-Dec;118(6):546-551.

Abstract

Current treatment strategies for control of trauma-associated symptoms of Post Traumatic Stress Disorder (PTSD) have recently been updated by the Veterans Affairs (VA) and the Department of Defense (DoD, after over a decade of dedicated research. The most recent evidence is compelling that its use of trauma-focused therapies such as Cognitive Processing Therapy (CPT), Prolonged Exposure Therapy (PE), Eye Movement, Desensitization, and Restructuring (EMDR), and others with significant trauma focus are the current gold standard for treatment. Additional medication use may be of assistance in treatment of symptomology, with special avoidance of benzodiazepines or other sedative hypnotic medications which are causal of increased intrusive and dissociative symptoms over time.

Introduction

In his early theories of the mind, Sigmund Freud hypothesized that the individual has stages of psychological development: that of forming an unconscious defense against pain and shock through the turning away from the triggers of unpleasure and finally the conscious disapproval of an impulse through use of judgement.¹ Much of his early work focused on the traumatic shocks that his patients had endured through their lifetime; many of them through workplace accidents, loss of life or loved ones, involvement in war, and from sexual assault. Despite the efforts and work of many before and after him, those same traumatic experiences have historically elicited very similar reactions from those who have suffered through them and have so far, been difficult to appropriately treat. What we have known for some time is that trauma is no respecter of persons, status, or intellectual capacity, and that the after effects of trauma can significantly impair function in life.

The Modern Concept of Post-Traumatic Stress Disorder

The diagnosis of what is now accepted as Post Traumatic Stress Disorder (PTSD) has changed over the years as we have gained a better understanding of the stress response and its longer-term impact on the body and the brain. During the Seven Years War (1756-1763) a physician from Austria, one Joseph Auenbrugger, observed and documented symptoms in some troops such as excessive physical exhaustion, anger, and irritability (angst), and depressed mood. He termed the condition "nostalgia" after the soldiers being so homesick, and so far distant from that which they knew, that their personality and the core of who they were was significantly changed. In his 1761 book Inventum Novem he wrote:

"When young men who are still growing are forced to enter military service and thus lose all hope of returning safe and sound to their beloved homeland, they become sad, taciturn, listless, solitary, musing, full of sighs, and moans. Finally, these cease to pay attention and become indifferent to everything, which the maintenance of life requires of them. Neither medicaments, nor arguments, nor promises, nor threats of punishment are able to produce any improvement." ²

The diagnosis of what is now accepted as Post Traumatic Stress Disorder (PTSD) has changed over the years as we have gained a better understanding of the stress response and its longer-term impact on the body and the brain.

Granted, the pharmacopeia of that generation was severely limited, ineffective for treatment of PTSD as it often included laudanum, strong spirits (such as rum and whiskey), and certain tinctures that were thought to improve the mood such as that of Saint Johns Wort, as well as other mild sedatives such as Chamomile and Valerian root. His observations though were valid, and matched those of the Greeks and Romans who also shared a history of documentation of similar symptoms among their returning troops.

While war and violent conflict among nations may be historically well documented as a cause of profound emotional changes, it is by sheer number alone the civilian population that will carry the numerical burden of PTSD. By far the most common causes in triggering traumatic events among the entire populace are motor vehicle collisions and assault (inclusive of sexual assault and rape). These trauma experiences are fairly common in childhood, with adolescents between the ages of 14-17 having a 28% lifetime prevalence of sexual victimization with 8% of girls in that age cohort with a history of an attempted or completed rape against them.³ Approximately 6-7% of the adult population in the United States will at some point during their lifetime, meet the criteria for a diagnosis of PTSD.⁴ Amongst the U.S. military veteran population the variance in studies has ranged from approximately 30% of the Vietnam era veterans to more recently 13-14% of veterans serving in the dual wars in Iraq and Afghanistan over the last 20 years.⁵,⁶

We also recognize that the self reporting of symptoms from these populations over the most recent conflicts is under represented due to fears of stigma and concerns over job loss, just as is speculated are the numbers from the general populace, who face the additional hurdle of potential lack of appropriate insurance coverage for appropriate albeit specialized treatments. Our primary care physicians are indeed 'in the trenches' so to speak when addressing mental health concerns of this same populace. Among the general population in 2010 approximately 20% of all primary care visits included treatment for mental health issues or diagnoses - making the primary care settings an important place to screen for and initiate mental health care.⁷ As all providers become more familiar with the diagnosis of PTSD and the current successful treatment options, educational barriers to initiation of care becomes less problematic - and those we serve can start care immediately while waiting on their referral to a mental health professional for continued care.

Over the last two decades a wealth of research has been conducted on PTSD, driven primarily by the rising suicide completion rates and daily impairment to military members with that diagnosis. Funded mainly by the U.S. Governmental agencies these projects over the years have added to the medical knowledge and understanding of the brain, human behavior, the effects of persistent stress on the hypothylamic-pituitaryadrenal axis system, stress change to the limbicamygdylar circuitry, as well as more effective treatment strategies. Past well thought of treatments have either passed the rigorous tests of double blind and placebo-controlled studies and continue in use, or did not - and have been discounted. The amount of research was a boon to the mental health community, who at the time of late 1990s had only 15 controlled trials on treatment for PTSD to draw from.⁸

The following decade brought great gains. A large meta-analysis in 2013 reviewed all available research on efficacy of treatments and interventions for PTSD, with a total of 112 non-duplicate studies included. This existing body of research was influential in the formation and updates to the VA and DoD clinical practice guidelines for assessment and treatment of PTSD in that same year.

Diagnosis

In 2013 the diagnosis itself received an update with the Diagnostic and Statistical Manual of Mental Disorders (DSM) - V and shifted from an anxiety disorder and into a new category of trauma associated disorders. This was in part done to provide an updated diagnosis representing the underlying pathology of the illness and to further differentiate it from anxiety and depressive disorders which it does share some symptomatology with. At present, to have a diagnosis of PTSD a person must have had a significant trauma exposure that has caused significant impairment to occupational and social function for greater than one month.

Symptoms must include one intrusive (recurrent, involuntary, distressing memories and/or dreams, dissociative reactions such as flashbacks, intense or prolonged psychological distress to triggers, or marked physiological reactions to triggers); one avoidance symptom (avoidance of memories, feelings, or thoughts of trauma or avoidance of external reminders of trauma); two negative alterations to cognition or mood related to the trauma (dissociate amnesia, negative beliefs of self or the world, persistent negative emotional state, anhedonia, feelings of detachment or estrangement from others, inability to experience positive emotions); two symptoms of marked alterations in arousal and reactivity (irritability or anger outbursts, reckless or self-destructive behaviors, hyper vigilance, exaggerated startle response, problems with concentration, sleep disturbance). A provider may specify if there are persistent dissociative symptoms such as depersonalization (feeling detached from oneself, as if observing from out of body) or derealization (feelings of the unreality of the environment). Because of the prevalence of childhood trauma and differences in the brain and personality development of children at that age, specific criteria for children ages 6 and younger are also detailed in the DSM-V.⁹

Non-Pharmacologic Treatment for PTSD

Shared Decision Making and Collaborative Care (Strong Recommendation for)

Both are important early interventions which have been shown to improve patient-centered care and treatment outcomes. Review of the relevant diagnosis along with treatment options with consistent use of decision aids with patients has been shown to improve clinical outcomes, enhance psychoeducation on the diagnosis of PTSD, and reduce ambivalence in regards to accepting the most efficacious treatment strategies.¹⁰ In particular for the collaborative care model (inclusive of telehealth modalities to improve access), a stepwise treatment approach in the primary care setting has been shown to increase patient compliance with treatment and to potentially reduce the possibility of the patient stopping medication or therapy treatment too early.¹¹

Trauma-Focused Therapy as First Line Treatment for PTSD (Strong Recommendation for)

Prior to 2013 there was little evidence to suggest that there is a differentiation in treatment with pharmacotherapy versus psychotherapy. One of the larger changes to the updated clinical practice guidelines was to recommend therapy over medication for treatment of PTSD, to the recommendation now that manualized trauma focused therapies are the first line treatments. This change was a result of two large meta-analyses which did a head-to-head comparison between existing pharmacotherapy and manualized psychotherapy with a comparison of treatment outcomes. A manualized therapy is one in which the therapist or psychiatrist uses a guide manual to assist in care delivery, ensuring that all important trauma related topics are addressed. Use of a manual for trauma therapy is the gold standard for treatment delivery. It was noted in both that the psychotherapy alone presented a longer duration of symptom resolution with a reduction in risk of side effects from ongoing medication use amongst the studied patient populations.¹²

In conjunction with specific positive research supporting use of manualized, trauma-focused therapies such as PE, EMDR, and CPT have shown consistent reduction of symptoms of PTSD with completion of 12-16, 60 minute weekly sessions.¹³,¹⁴,¹⁵ While those three 'main' trauma therapies have been the foundation of trauma-focused therapy research, new subtypes of manualized focused therapy such as cognitive behavioral therapy for PTSD (CBT for PTSD), Narrative Exposure Therapy (NET) and Written Exposure have also shown evidence to support their use in treatment.¹⁶,¹⁷,¹⁸, ¹⁹ All of the therapies that have shown the greatest treatment benefit have been individual therapy, not group. Recent research also highlights that therapy through video call is as effective as in person and is a cost effective first line treatment strategy.²⁰ Use of a manual to guide and structure therapy with a patient has been shown in the above, and many more studies to improve outcomes - both in terms of adherence to and attendance in the treatment program, and in improved symptom reduction over time as compared to therapy that does not use a manualized approach. It in no way limits the therapist or reduces their expertise-in fact it has been shown to enhance it by providing a scaffolding that addresses all core issues of trauma is a systematic way, and provides for evidence-based work for the patient in treatment outside of the treatment sessions. Of the newer researched therapies, written exposure therapy has been showing excellent benefit with good treatment retention. Especially for people whose learning style may be more tactile or experiential, it allows for the patient's written narrative with additional cognitive therapy to be the mechanism for improvement, rather than a verbal repeated retelling as in Prolonged Exposure therapy.

The verbal with imagining retelling of the trauma experience as is performed in PE is effective, though described as difficulty at best, by the patient undergoing that type of therapy. Drop out rates from PE tend to be higher than that of other more cognitively-focused therapies such as CPT and EMDR. Written exposure therapy provides a mid point between the two with emerging data suggesting a much improved retention rate in therapy when compared to PE.

There is strong evidence for:

Individual, manualized trauma-focused psychotherapy, 12-20, 60-minute sessions weekly, as main and first line treatment for treatment of PTSD.

Cognitive Processing Therapy

Eye Movement Desensitization and Restructuring (

Written Exposure Therapy

Narrative Exposure Therapy

Prolonged Exposure

Any of the above therapies delivered through video teleconferencing (aka, virtual health)

Pharmacologic Treatment of PTSD

Pharmacotherapy as a Treatment for PTSD (Strong Recommendation for)

As based on the most relevant and recent research, the medications fluoxetine, venlafaxine, or paroxetine have shown the most benefit as monotherapy in treatment of posttraumatic stress disorder symptomology. The relative benefits of use of the selective serotonin reuptake inhibitors (SSRI) or selective norepinephrine reuptake inhibitors (SNRI) are that the side effect profiles are generally well tolerated. In clinical practice a psychiatrist will often switch to different SSRI or SNRI medications based on patient response, tolerability, or other issues of slow or rapid metabolism of those particular medications. Specifically, paroxetine is less prescribed as it tends to have greater anticholinergic side effect profiles than the other SSRIs and has an extremely short half-life often requiring twice daily dosing. Other medications such as des-venlafaxine and duloxetine are both acceptable alternatives, as is sertraline in the treatment of post traumatic stress disorder. Specifically noted Celexa and Lexapro in the research have a less significant impact on reduction of symptoms than these other medications.²¹

There is strong evidence for use of the following medications for treatment of PTSD:

Fluoxetine, initial dose 10-20mg daily, response range 20-80mg daily.

Paroxetine, initial dose 10-20mg daily, response range 20-50mg daily.

Sertraline, initial dose 25-50mg daily, response range 50-200mg daily.

Venlafaxine XR, initial dose 37.5mg daily, response range 75-225mg daily.

Augmentation Strategies (Weak or Insufficient Evidence for)

Augmentation strategies (Weak or Insufficient Evidence for)

Augmentation strategies for treatment resistant comorbid symptomology can be done in conjunction with a primary SSRI or SSRI. The most studied of these medications include the short half-life alpha adrenergic antagonist prazosin for the treatment of PTSD associated nightmares and hyper arousal response, though recent research concluded that there was only weak evidence for use in some studies even in this limited capacity. Typical dose ranges for prazosin range from 1-12mg usually nightly, though some individuals may respond well to a split dosing regimen with a smaller morning dose and larger even dose. Another augmentation medication with weak evidence for use is mirtazepine, dosed to target reduction of sleep latency, improvement of sleep duration, and augmentation of the primary SSRI or SNRI in anxiolytic effects. As a nightly anxiolytic this medication not only improves sleep architecture but may reduce anxiety symptoms in as early as two to three weeks which can be a remarkable benefit to those who do respond well to it-especially those not with PTSD but with Generalized Anxiety Disorder or Panic Disorder, with or without Agoraphobia. It is also important to note that all medications targeting reduction of anxiety symptoms tend to assist in reduction of the active anxiety components of PTSD rather than decreasing the avoidant and negative symptoms of post traumatic stress disorder. This again leaves therapy is the primary choice a first line treatments in that it can address all aspects of symptomology.

Weak or insufficient evidence for augmentation with:

Prazosin, for reduction of nightmares/hyper arousal symptoms

Mirtazapine, for augmentation with an SSRI or SNRI and sleep benefit for PTSD

PTSD Non-Advised Treatments

Given the amount of research conducted over the last two decades, and the interest in PTSD as a diagnosis due to the active military conflicts over that same time period, many medications have also been studied. Of particular note, benzodiazepines have been found to carry a 'strong against' use recommendation. In some studies that class of medications carries an 'X' recommendation as well due to evidence that they cause harm with long term use with a diagnosis of PTSD. This is thought to be due to the strong sedative, addictive, and dissociative properties of the benzodiazepines (sedative hypnotics) when used to attempt to treat a condition in which dissociation and hypnotic sedation fosters trauma reliving intrusive symptoms which in turn worsened avoidant symptoms of PTSD. That said, acute or emergent use of benzodiazepines for reduction of imminent risk aggression in an emergency room or inpatient setting, or to treat seizures or alcohol withdrawals is medically indicated and does not worsen outcome of PTSD symptoms. Other medications studied included all anti-convulsants, which are often used in psychiatry as mood stabilizers to treat both subtypes of bipolar disorder, and many typical and atypical antipsychotic medications which have been shown to be of benefit in treatment resistant major depressive disorders, in psychotic disorders such as schizophrenia, and also in bipolar disorders.

Additional procedures that have been effective in other areas of psychiatry were also well researched. While Electroconvulsive Therapy (ECT) and the newer repetitive transcranial magnetic stimulation (rTMS) are effective for treatment of severe major depressive disorder and bipolar disorders, there was no conclusive evidence that they effectively were able to reduce symptoms in PTSD as did on those primary mood disorders. Additional procedures showed benefit to a small subset of patients but those findings were not generalizable to a broad population base.

The following have been found to not be recommended for use in treatment of PTSD:

Risperidone, quetiapine, olanzapine, and other atypical antipsychotics

Divalproex, tiagabine, guanfacine, ketamine, hydorcortisone, D-cycloserine

Benzodiazepines (Causes harm)

Cannabis or cannabinoids

There was insufficient evidence to support use of the following procedures for treatment of PTSD:

Summary

There has been a wealth of new and updated research into PTSD and its treatment over the last 15 years. Out of the many treatments researched, the trauma-focused therapies, delivered individually, with use of a manual by the therapist showed the most benefit in treatment. While very effective the patient may be limited by access to a therapist who has been trained in trauma-focused therapy, who may not wish to use a manualized treatment approach, or by cost and/or insurance coverage. More research needs to be conducted to directly discover and address the reasons underlying the lack of broader availability of manualized trauma focused therapy by therapists. For those desiring such, or in the absence of good access to trauma focused therapy there is also strong evidence for use of SSRIs and SNRIs such as fluoxetine, paroxetine, sertraline, and venlafaxine, and at appropriate doses will assist with symptom reduction.

Footnotes

Christian Schrader, MD, is at Carl R. Darnall Army Medical Center Psychiatry Residency, Fort Hood, Texas. Abigail Ross, MS, is at the New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York.

References

7. CDC. National Ambulatory Medical Care Survey; 2010. [online, accessed 11/02/2021]. http://www.cdc.gov/nchs/ahcd.htm . [Google Scholar]

15. Ehlers A, Grey N, Wild J, et al. Implementation of cognitive therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample. Behav Res Ther. 2013 Nov;51(11):742-752. doi: 10.1016/j.brat.2013.08.006. [DOI] [PMC free article] [PubMed] [Google Scholar]

17. Sloan DM, Marx BP, Bovin MJ, Feinstein BA, Gallagher MW. Written exposure as an intervention for PTSD: A randomized clinical trial with motor vehicle accident survivors. Behav Res Ther. 2012 Oct;50(10):627-635. doi: 10.1016/j.brat.2012.07.001. [DOI] [PMC free article] [PubMed] [Google Scholar]

19. Sloan DM, Marx BP, Resick PA, Young-McCaughan S, Dondanville KA, Mintz J, Litz BT, Peterson AL STRONG STAR Consortium. Study design comparing written exposure therapy to cognitive processing therapy for PTSD among military service members: A noninferiority trial. Contemporary clinical trials communications. 2019;17:100507. doi: 10.1016/j.conctc.2019.100507. [DOI] [PMC free article] [PubMed] [Google Scholar]

20. Pande RL, Morris M, Peters A, Spettell CM, Feifer R, Gillis W. Leveraging remote behavioral health interventions to improve medical outcomes and reduce costs. Am J Manag Care. 2015;21(2):e141-151. [PubMed] [Google Scholar]

Articles from Missouri Medicine are provided here courtesy of Missouri State Medical Association

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A Review of PTSD and Current Treatment Strategies

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Current treatment strategies for control of trauma-associated symptoms of Post Traumatic Stress Disorder (PTSD) have recently been updated by the Veterans Affairs (VA) and the Department of Defense (DoD, after over a decade of dedicated research. ...

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A great solution to men suffering from PTSD from war or other traumatic moments in their life is these ways of therapy especially Cognitive processing therapy its 12 weeks long therapy where they try and focus on PTSD and ways to help the man solve it.

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Posttraumatic stress disorder (PTSD), a type of anxiety disorder, can happen after a deeply threatening or scary event. Even if you weren't directly involved, the shock of what happened can be so great that you have a hard time living a normal life.

People with PTSD can have insomnia, flashbacks, low self-esteem, and a lot of painful or unpleasant emotions. You might constantly relive the event -- or lose your memory of it altogether.

When you have PTSD, it might feel like you'll never get your life back. But it can be treated. Short- and long-term psychotherapy and medications can work very well. Often, the two kinds of treatment are more effective together.

Eye Movement Desensitization and Reprocessing

With EMDR, you might not have to tell your therapist about your experience. Instead, you concentrate on it while you watch or listen to something they're doing -- maybe moving a hand, flashing a light, or making a sound.

The goal is to be able to think about something positive while you remember your trauma. It takes about 3 months of weekly sessions.

Continued

It's OK for you to use a medicine off-label if your doctor thinks there's a reason to.

Continued

Medications might help you with specific symptoms or related issues, such as prazosin ( Minipress) for insomnia and nightmares.

Which one or combination of meds is likely to work best for you depends in part on the kinds of trouble you're having in your life, what the side effects are like, and whether you also have anxiety, depression, bipolar disorder, or substance abuse problems.

It takes time to get the dosage of some medications right. With certain medications, you might need to have regular tests -- for example, to see how your liver is working -- or check in with your doctor because of possible side effects.

Medications probably won't get rid of your symptoms, but they can make them less intense and more manageable.

Stress Inoculation Training

SIT is a type of CBT. You can do it by yourself or in a group. You won't have to go into detail about what happened. The focus is more on changing how you deal with the stress from the event.

You might learn massage and breathing techniques and other ways to stop negative thoughts by relaxing your mind and body. After about 3 months, you should have the skills to release the added stress from your life.

Medications

The brains of people with PTSD process "threats" differently, in part because the balance of chemicals called neurotransmitters is out of whack. They have an easily triggered "fight or flight" response, which is what makes you jumpy and on-edge. Constantly trying to shut that down could lead to feeling emotionally cold and removed.

Continued

Medications help you stop thinking about and reacting to what happened, including having nightmares and flashbacks. They can also help you have a more positive outlook on life and feel more "normal" again.

Several types of drugs affect the chemistry in your brain related to fear and anxiety. Doctors will usually start with medications that affect the neurotransmitters serotonin or norepinephrine (SSRIs and SNRIs), including:

The FDA has approved only paroxetine and sertraline for treating PTSD.

Because people respond differently to medications, and not everyone's PTSD is the same, your doctor may prescribe other medicines "off label," too. (That means the manufacturer didn't ask the FDA to review studies of the drug showing that it's effective specifically for PTSD.) These may include:

Antidepressants

Monoamine oxidase inhibitors (MAOIs)

Antipsychotics or second generation antipsychotics (SGAs)

Beta-blockers

Benzodiazepines

Therapy

PTSD therapy has three main goals:

Improve your symptoms

Teach you skills to deal with it

Restore your self-esteem

Most PTSD therapies fall under the umbrella of cognitive behavioral therapy (CBT). The idea is to change the thought patterns that are disturbing your life. This might happen through talking about your trauma or concentrating on where your fears come from.

Depending on your situation, group or family therapy might be a good choice for you instead of individual sessions.

Cognitive Processing Therapy

CPT is a 12-week course of treatment, with weekly sessions of 60-90 minutes.

At first, you'll talk about the traumatic event with your therapist and how your thoughts related to it have affected your life. Then you'll write in detail about what happened. This process helps you examine how you think about your trauma and figure out new ways to live with it.

For example, maybe you've been blaming yourself for something. Your therapist will help you take into account all the things that were beyond your control, so you can move forward, understanding and accepting that, deep down, it wasn't your fault, despite things you did or didn't do.

Prolonged Exposure Therapy

If you've been avoiding things that remind you of the traumatic event, PE will help you confront them. It involves eight to 15 sessions, usually 90 minutes each.

Early on in treatment, your therapist will teach you breathing techniques to ease your anxiety when you think about what happened. Later, you'll make a list of the things you've been avoiding and learn how to face them, one by one. In another session, you'll recount the traumatic experience to your therapist, then go home and listen to a recording of yourself.

Doing this as "homework" over time may help ease your symptoms.

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Posttraumatic stress disorder (PTSD), a type of anxiety disorder, can happen after a deeply threatening or scary event. Even if you weren't directly involved, the shock of what happened can be so great that you have a hard time living a normal life.

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As explained in this article another way to help with PTSD is medications even though not the best way as having to talk with someone could have a better impact medications will help calm it down.

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There are other types of trauma-focused psychotherapy that are also recommended for people with PTSD. These include:

Brief Eclectic Psychotherapy (BEP)
A therapy in which you practice relaxation skills, recall details of the traumatic memory, reframe negative thoughts about the trauma, write a letter about the traumatic event, and hold a farewell ritual to leave trauma in the past.

Narrative Exposure Therapy (NET)
Developed for people who have experienced trauma from ongoing war, conflict, and organized violence. You talk through stressful life events in order (from birth to the present day) and put them together into a story.

Written Narrative Exposure
Involves writing about the trauma during sessions. Your provider gives instructions on the writing assignment, allows you to complete the writing alone, and then returns at the end of the session to briefly discuss any reactions to the writing assignment.

Specific cognitive behavioral therapies (CBTs) for PTSD
Include a limited number of psychotherapies shown to work for PTSD where the provider helps you learn how to change unhelpful behaviors or thoughts.

Antidepressants (SSRIs and SNRIs)

Medications that have been shown to be helpful in treating PTSD symptoms are some of the same medications also used for symptoms of depression and anxiety. These are antidepressant medications called SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors). SSRIs and SNRIs affect the level of naturally occurring chemicals in the brain called serotonin and/or norepinephrine. These chemicals play a role in brain cell communication and affect how you feel.

There are four antidepressant medications that are recommended for PTSD:

Sertraline (Zoloft)

Paroxetine (Paxil)

Fluoxetine (Prozac)

Venlafaxine (Effexor)

NOTE: Medications have two names: a brand name (for example, Zoloft) and a generic name (for example, Sertraline)

There are other types of antidepressant medications, but these four medications listed above are the ones that are most effective for PTSD.

If you decide try one of these medications, your provider will give you a prescription. Once you fill your prescription, you will begin taking a pill at regular time(s) each day. You will meet with your provider every few months or so. Your provider will monitor your response to the medication (including side effects) and change your dose, if needed.

Suggested treatments: Treatments with some research support

Some psychotherapies do not focus on the traumatic event, but do help you process your reactions to the trauma and manage symptoms related to PTSD. The research behind these treatments is not as strong as the research supporting trauma-focused psychotherapies (listed above). However, these psychotherapies may be a good option if you are not interested in trauma-focused psychotherapy, or if it is not available:

Stress Inoculation Training (SIT)
A cognitive-behavioral therapy that teaches skills and techniques to manage stress and reduce anxiety.

Present-Centered Therapy (PCT)
Focuses on current life problems that are related to PTSD.

Interpersonal Psychotherapy (IPT)
Focuses on the impact of trauma on interpersonal relationships.

There are also other medications that may be helpful, although the evidence behind them is not as strong as for SSRIs and SNRIs (listed above). These include:

Nefazodone (Serzone)
A serotonin reuptake inhibitor (SRI) that works by changing the levels and activity of naturally occurring chemical signals in the brain.

Imipramine (Tofranil)
A tricyclic antidepressant (TCA) which acts by altering naturally occurring chemicals which help brain cells communicate and can lift mood.

Phenelzine (Nardil)
A monoamine oxidase inhibitor (MAOI) which inactivates a naturally-occurring enzyme which breaks down the neurotransmitters serotonin, norepinephrine and dopamine.

Other treatments: Treatments that do not yet have research support

There may be other options available such as certain complementary and integrative medicine approaches (like yoga, meditation, or acupuncture), biological treatments (like hyperbaric oxygen therapy or transcranial magnetic stimulation), or online treatment programs. These treatments do not have strong research behind them at this time, but you and your doctor can discuss the benefits and risks of these options to determine whether or not they are right for you.

Choosing a Treatment

No one treatment is right for everyone. You can discuss treatment options with your health care provider, and determine which ones are best for you based on the benefits, risks, and side effects of each treatment.

Some people are uncomfortable with the idea of seeking treatment because of concerns with stigma or worries about having to talk about difficult life experiences. However, treatment provides the opportunity to improve symptoms, personal and professional relationships, and quality of life.

To learn about evidence-based treatments:

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There are other types of trauma-focused psychotherapy that are also recommended for people with PTSD. These include: Brief Eclectic Psychotherapy (BEP) A therapy in which you practice relaxation skills, recall details of the traumatic memory, reframe negative thoughts about the trauma, write a letter about the traumatic event, and hold a farewell ritual to leave trauma in the past.

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Again this article explains the benefits of just having therapy as it can help find solutions for the person to try and be able to let the heavy burden of it off their chest and mind to their therapist leading to a better outcome.

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The thesis of my article "War & Military Mental Health: The US Psychiatric Response in the 20th Century" is about how the men of war were treated at first after the war, to later in time when it was figured out the war had left a long term disorder called PTSD

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After the war the men had gone back home with their symptoms were referred to "as cowards lacking moral fiber"(Pg. 2). Most men in the war had gotten PTSD due to "Witnessing acts of warfare, including killing, torture, and widespread devastation"(Pg. 2). At first before PTSD was even classified as such it was referred as shell shock and its main symptoms were "stuttering, crying, trembling, paralysis" (Pg. 5).