Trauma-Focused Treatments And Trauma Therapy Techniques For PTSD

Post-traumatic stress disorder (PTSD) is a serious mental health condition that can have significant impacts on a person’s ability to function. It can develop in some people after they survive a traumatic experience or a series of traumatic experiences, which can range from childhood neglect to sexual abuse to workplace bullying to serving in the military and others. The symptoms of PTSD can also lead to the development of other mental health challenges, such as substance use disorders and suicide ideation. One study found that the estimated societal cost of PTSD in the United States is over $200 billion.

However, there are effective treatment options for PTSD, such as trauma-focused therapy. Research suggests that over half of people who receive trauma-focused therapy treatment experience a reduction in their PTSD symptoms to the point where they no longer meet diagnostic criteria for the disorder. These therapies include cognitive processing therapy, prolonged exposure therapy, eye movement desensitization and reprocessing therapy, and, for certain types of trauma, narrative exposure therapy. 

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Cognitive processing therapy

Cognitive processing therapy (CPT) is one such form of talk therapy. CPT is a variant of cognitive behavioral therapy (CBT), which is also sometimes referred to more simply as cognitive therapy. Cognitive behavioral therapy is based on the idea that a person’s thoughts and behaviors are related, and that changing unhelpful thoughts can then reduce instances of unwanted behaviors. Cognitive processing therapy more specifically focuses on the cognitive side of the equation: examining unproductive thoughts.

Many PTSD symptoms are related to suppressed negative emotions connected to the trauma, which may then surface in disturbing ways, such as nightmares and flashbacks. CPT can teach people to evaluate and change their thoughts about their trauma, which may then lead to changes in a person’s emotional response to the traumatic memories. 

Prolonged exposure therapy

Avoidance is a signature symptom of PTSD. People with PTSD may avoid people, places, and situations that remind them of their trauma, which can impede their ability to function in their day-to-day lives. Alternatively, they may seek to avoid thoughts or emotions related to the trauma, which can then lead to problematic numbing behaviors like self-harm or substance misuse.

Prolonged exposure therapy (PET) is a form of PTSD treatment designed to help clients confront what they have been avoiding. This process can help people to retrain their brains, bodies, and nervous systems to become less easily activated. In general, coming to understand that situations and feelings related to the trauma are not going to cause further trauma can help decrease PTSD symptoms.

With PET, a client will work with a therapist to gradually start re-engaging with situations that have prompted avoidance. They will learn breathing and relaxation exercises to calm the anxiety these situations may provoke. Most people begin by confronting the least frightening situations and gradually working their way up to the ones most closely associated with the trauma. 

With this therapy approach, therapists and clients also often engage in what is called “imaginal exposure.” With imaginal exposure, a person will talk through the specific details of their trauma with their therapist, who records the conversation. The patient then listens to the recording afterward, which research suggests may help reduce incidences of intrusive PTSD symptoms like flashbacks and nightmares.

Eye movement desensitization and reprocessing (EMDR) therapy

Eye movement desensitization and reprocessing (EMDR) therapy is a newer but promising treatment for PTSD. One of the central concerns with many forms of PTSD therapy is that engaging with traumatic memories can result in re-traumatization, which may sometimes actually make PTSD symptoms worse. With EMDR therapy, however, therapists help clients enter an alternative state of mind in which memories of their traumatic experiences may be compartmentalized. While the therapy can be distressing in the moment, it usually does not result in the kind of lasting emotional turmoil that other PTSD therapies may elicit.

EMDR therapy sessions involve a technique called bilateral stimulation. This involves the two opposite sides of a person’s brain being activated while they are asked to recall aspects of the trauma, typically by following a therapist’s finger back and forth with their eyes, having a therapist tap on the backs of their hands, or holding alternating buzzers in their palms. The resulting mental state is thought to be similar to rapid eye movement (REM) sleep. 

While the neurological underpinnings of EMDR therapy are still being researched, existing studies suggest that this technique can be an effective treatment for PTSD. Its effectiveness has been so noteworthy that it is now recommended as one of the first courses of PTSD treatment by the American Psychological Association. 

Narrative exposure therapy

Narrative exposure therapy (NET) is one of a group of specialized treatments for particular kinds of trauma. It has been suggested to be effective in treating:

• Complex trauma. Complex trauma refers to traumatic experiences that are not single events, like surviving a one-time natural disaster or sexual assault. Instead, complex trauma involves repeated, ongoing traumatic situations that typically relate to a person’s most formative relationships, like caregivers in childhood or intimate partners in adulthood. Examples of events that can lead to complex trauma include abuse, neglect, domestic violence, and human trafficking.
• Multiple traumas. Like complex trauma, the term “multiple traumas” also refers to traumatic experiences that are repeated over time. However, multiple traumas usually do not center around meaningful relationships, but rather larger societal issues. Common examples of multiple traumas include community violence, racism, discrimination, war, poverty, imprisonment, and torture.

Narrative exposure therapy is based on the idea that the story a person tells themselves about their life can influence their perceptions of their own experiences and well-being. It involves the following steps:

1. A person develops a chronological story about their life, focusing in large part on their traumatic experiences but also including other, more positive life events.
2. The therapist encourages the person to fill in the details of their traumatic memories, which can often be fragmented. The person is asked to focus on their emotions, thoughts, sensory memories, and physiological response to the trauma.
3. The therapist creates an autobiographical document summarizing the person’s story and gives it to them at the conclusion of NET treatment.

It is believed that engaging in NET can help a person refine, process, and understand their perception of traumatic experiences. NET may also help a person build a sense of personal identity and self-respect, acknowledge their dignity and humanity, and help them contextualize their emotional responses to trauma. 

Finding support for processing traumatic experiences

Connecting with a therapist to work together using one of the above therapeutic techniques can be a crucial component of recovering from trauma and trauma-related disorders like PTSD. Working with a therapist may help a person reduce PTSD symptoms and learn ways to build their resilience to trauma through techniques like stress inoculation training, which may decrease the odds of PTSD symptoms recurring in the future.

Attending an in-person therapy appointment can be a stressful experience for some trauma survivors, though. Online therapy may be a beneficial alternative for people who may be more comfortable being vulnerable from their own home. 

Peer-reviewed research indicates that therapy attended online may be just as effective as traditional in-person therapy when it comes to treating symptoms of PTSD. For example, findings from one study suggest that engaging in online CBT—the umbrella term for treatments that include cognitive processing therapy and prolonged exposure therapy—may reduce PTSD symptoms to a similar degree as in-person CBT. 

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