What Are The Most Effective Trauma Therapy Programs?

According to the World Mental Health Survey Consortium, approximately 70% of U.S. adults have experienced some type of traumatic event during their lives. Trauma can develop in response to a variety of situations, such as witnessing violence, the loss of a loved one, abuse, injury, illness, natural disasters, and childhood neglect. The impacts of these traumatic experiences can vary greatly, potentially affecting an individual’s mental, emotional, and physical health. 

Recognizing the need for effective trauma therapy can be important, as untreated trauma may lead to long-term psychological conditions, relationship difficulties, and an overall lower quality of life. A variety of trauma therapy programs can treat trauma-related disorders, but which programs are the most effective may vary from person to person. 

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How to recognize trauma-related disorders 

While not everyone who experiences trauma will develop a mental health condition, there are several disorders that may be associated with trauma.

• Reactive attachment disorder: Reactive attachment disorder (RAD) typically impacts children who have experienced abuse or neglect. These experiences often prevent them from forming healthy relationships with their parents, which can make it more difficult for them to connect with others later in life. RAD may also lead a child to withdraw from social situations, avoid contact that could be viewed as comforting, and frequently engage in emotional outbursts. In adulthood, individuals with RAD may struggle to maintain stable relationships due to trust-related challenges and insecurities. 
• Acute stress disorder: Acute stress disorder (ASD) can have many of the same symptoms as other stress-related disorders, but it often differs in how long it lasts. ASD typically develops quickly after a traumatic event occurs but doesn’t persist past one month (without developing into another disorder). Symptoms of ASD can include helplessness, fear, and difficulty concentrating immediately following trauma. Early intervention can be crucial to prevent this disorder from progressing to post-traumatic stress disorder (PTSD).
• Disinhibited social engagement disorder: Disinhibited social engagement disorder (DSED) is an attachment disorder that often develops during early childhood. Children experiencing DSED may not understand or adhere to appropriate boundaries with strangers. For example, a child with DSED might follow a stranger without worry or fear, even if the person leads them away from their parents. Long-term risks of DSED may include vulnerability to exploitation and difficulties in forming appropriate social boundaries. 

However, one of the most common disorders associated with trauma may be post-traumatic stress disorder (PTSD). 

What is PTSD?

PTSD is a mental health condition that may develop after a person experiences trauma. According to the American Psychiatric Association (APA), PTSD can involve a variety of symptoms, such as the following:

• Flashbacks: Individuals with PTSD can experience vivid sensory events known as flashbacks. These events may cause a person to see, hear, smell, or taste things that remind them of their traumatic experiences. Flashbacks can also involve physical sensations, including pain, excessive sweating, involuntary shaking, and nausea. 
• Changes in mood or cognition: PTSD can involve frequent changes in mood, which may manifest as emotional outbursts, anger, fear, or feelings of guilt and shame. Those with PTSD may also be unable to enjoy previously enjoyable activities, become isolated from loved ones, or believe they are a “bad person” or responsible for the traumatic event they’ve experienced. Regarding cognition, PTSD can impact memory. Those with PTSD may struggle with memory, particularly memories associated with trauma. 
• Trigger avoidance: Those with PTSD may attempt to avoid any situations, people, places, or objects that could remind them of traumatic events. This can include avoiding certain areas of town, backing out of social engagements, and quitting jobs or extracurricular activities. Individuals with PTSD may also avoid discussing their traumatic experiences, which could increase the difficulty of treatment. 
• Hyperarousal: PTSD can also involve hyperarousal and reactivity symptoms, such as constantly sensing one is “on edge,” being easily startled, experiencing paranoia, struggling with sleep disturbances, and having a constant sense of dread. Additionally, those with PTSD can strongly react to specific situations, such as loud noises, bright lights, or quick movements. These reactions may involve irritability, angry outbursts, or self-destructive behavior. 

Due to the potential severity of this disorder, it may be necessary to seek treatment. Effective treatment programs often include therapy, though various approaches can be used. 

What are the most effective treatment programs for PTSD?

• Prolonged exposure therapy: While some individuals living with PTSD may prefer to avoid anything that could remind them of traumatic events, this behavior could worsen symptoms and increase the continuing impact of their trauma. Prolonged exposure therapy typically works by exposing individuals to memories, images, or sounds that remind a person of their experiences. For example, a mental health provider may lead a client through a discussion of traumatic events, highlighting the emotions and thoughts they had during their experience. Providers could also show clients pictures or videos that gradually introduce them to components of their trauma, easing them in and helping them build up a tolerance to previously avoided topics. 
• Trauma-focused CBT: This type of CBT, also known as TF-CBT, was specifically designed to address the impacts that trauma can have on children, adolescents, and their caregivers or parents. TF-CBT can help those who have experienced various forms of abuse, including sexual, mental, and physical abuse. 

TF-CBT sessions typically involve traditional elements of CBT, such as the identification and modification of maladaptive thoughts and behaviors, as well as trauma-specific and family therapy components. A TF-CBT provider may teach affected individuals valuable coping skills that could alleviate symptoms and help them process their experiences. In addition, TF-CBT may teach individuals how to create a trauma narrative and engage in cognitive restructuring to address maladaptive thoughts. In many cases, the involvement of parents or caregivers is crucial, as their support may improve treatment outcomes. 

• Cognitive processing therapy: Cognitive processing therapy (CPT) may help individuals of all ages process trauma and learn how to reduce the negative impact of PTSD symptoms. A CPT program can start with psychoeducation, which can increase a person’s awareness of the thoughts and feelings that may contribute to their symptoms. 

From there, CPT providers could guide clients in exercises that could be essential for processing trauma, such as recording audio tapes or writing down an account of their traumatic experiences, which may be reviewed later. Throughout CPT sessions, clients may learn to challenge negative beliefs and develop more balanced ways of thinking. Over time, CPT may help them understand how trauma has impacted their beliefs about themselves and their environment. 

• Eye movement desensitization and reprocessing therapy: Eye movement desensitization and reprocessing therapy (EMDR) is a specialized form of treatment that typically combines specific eye movements with trauma-related discussions. EMDR therapy may begin with an assessment and explanation of what sessions can involve. After that, a provider may determine which memories need to be targeted. 

Once found, clients can discuss these memories while moving their eyes in a bilateral pattern, which may reduce the impact of associated emotions or reactivity. This desensitization can increase over several sessions, strengthening a person’s resilience and improving their ability to cope. After that, EMDR providers may help an individual to form more positive beliefs or identify any residual tension the person may be experiencing in their body. 

While in-person forms of therapy can be beneficial for those experiencing trauma or PTSD, they may not be accessible or convenient for everyone. Some individuals may not be comfortable traveling to in-person appointments or discussing traumatic topics face-to-face. Others might live in an area with an insufficient number of mental health professionals, which are often referred to as healthcare provider shortage areas (HSPAs). 

In these situations, it can be beneficial to explore alternatives, such as online therapy. Online therapy may offer a more flexible and accessible treatment option, particularly for those in remote areas who may not have access to specialists. Furthermore, online therapy can enable individuals to attend sessions from their own homes, which may increase their comfort levels.

Research suggests that online therapy programs can be an effective treatment for PTSD. In a 2022 study, researchers compared internet-based and in-person trauma-focused CBT (CBT-TF). They found that guided online CBT-TF produced similar results to face-to-face CBT-TF. In addition, researchers indicated that online CBT-TF should be considered a first-line treatment for individuals with mild to moderate PTSD.