Treatment for Post Traumatic Stress Disorder (PTSD)
Victims of traumatic events experience numerous symptoms which can greatly interfere with their lives. Treatment must address not only the traumatic memories, but many other distressing symptoms, such as interpersonal difficulties, emotional withdrawal, anger, guilt, and depression. Support groups and treatment groups can be extremely beneficial. Prolonged exposure therapy has been found to be quite beneficial and consists of four components: 1) psychoeducation about the effect of trauma, 2) breath retraining, 3) imaginal exposure, and 4) in vivo exposure (Foa, Hembree, & Rothbaum, 2007; Foa, Rothbaum, Riggs, & Murdock, 1991).
People with PTSD are often troubled by their lack of control over their symptoms and their lives. Psychoeducation helps therapy participants (and their families INSERT LINK TO FAMILY THERAPYp59) to understand that their symptoms are a predictable and normal response to trauma. A better understanding of their disorder enables therapy participants to regain a sense of control.
Individuals with PTSD may also benefit from breath retraining, which serves to reduce the uncomfortable physical symptoms of anxiety. Breath re-training is a method of consciously regulating breath, which helps the body "turn-off" the sympathetic nervous system. Furthermore, engaging in deep breathing may facilitate falling asleep, which is a common struggle for individuals with PTSD.
Because direct exposure to the traumatic event is not possible (nor advisable!) imaginal exposure therapy is conducted to help the therapy participant confront their traumatic memories. This involves the therapist gently and systematically assisting the person to gradually recall the traumatic event in greater and more vivid detail. Imaginal exposure is most effective when the person is guided to fully engage in the memory exercises using all five senses. The goal of imaginal exposure therapy is for the therapy participant to integrate the memories of the experience, while developing the ability briefly recall the event, without experiencing panic or anxiety.
In vivo exposure (or real-life exposure), involves confronting situations that trigger the traumatic memory, such as a loud, crowded baseball game that reminds a combat soldier of battle. In addition to these therapeutic techniques, some people will benefit from the addition of medication. Treatment for PTSD can be quite challenging due to the disturbing nature of the traumatic event itself.
Acceptance and Commitment Therapy (ACT) has also become a promising treatment for PTSD. ACT is based on the principle that individuals can learn to tolerate and accept distressing thoughts and emotions, rather than attempting to change them. Therapy participants are guided to live accordingly to their values, rather than according to their symptoms. ACT is particularly useful for people who are unable or unwilling to participate in exposure therapy.
The various forms of exposure therapy are designed to promote new learning, and the extinction of fear responses associated with trauma. A very new and still quite experimental therapy for PTSD, which as of yet has no official name but which we will call Memory Reconsolidation Therapy functions by exploiting a newly discovered and game-changing insight into how learning and memory work called memory reconsolidation. Where extinction based treatments simply compete with or attempt to starve to death established fear responses, reconsolidation-based PTSD treatments, utilizing a combination of imaginal exposure and medications appear to be able to completely erase fear responses. More information on Memory Reconsolidation Therapy for PTSD can be found here.
PTSD and Borderline Personality Disorder are two disorders that frequently co-occur. Borderline Personality Disorder is a fairly severe disorder characterized by emotional dysregulation, interpersonal disharmony, impulsivity, and self-destructive behaviors. In one study, 68% of people with Borderline Personality Disorder also met the criteria for PTSD (Shea, Zlotnick, & Weisberg, 1999). In cases of co-morbid PTSD and Borderline Personality Disorder, Dialectical Behavior Therapy (DBT) is incorporated into the treatment process.