Posttraumatic Stress Disorder (PTSD)

Self-care is crucial during and after a crisis or trauma. Self-care includes:

Personal safety is fundamental. After a trauma, people are better able to process the experience when they know that they and their loved ones are safe. It can be difficult, however, to gain complete safety during ongoing crises such as domestic abuse, war, or an infectious pandemic. During such ongoing difficulties, people should seek the guidance of experts on how they and their loved ones can be as safe as possible.

Physical health can be put at risk during and after traumatic experiences. As much as possible, the at-risk person should try to maintain a healthy schedule of eating, sleeping, and exercise. Substances and medications that sedate (eg, benzodiazepines) and intoxicate (eg, alcohol) should be used sparingly, if at all.

A mindful approach to self-care aims to reduce the stress, boredom, anger, sadness, and isolation that traumatized people typically experience. If circumstances allow, at-risk individuals should make and follow a normal daily schedule, remain involved with their family and community, and practice familiar hobbies (or develop new ones).

It is useful to limit the amount of time spent on news and instead shift to other activities (eg, read a novel, do a puzzle, paint a picture, make cookies for a housebound neighbor).

Trauma-focused cognitive-behavioral therapy (CBT) has the most robust evidence for efficacy for most people with PTSD (1 Treatment references Posttraumatic stress disorder (PTSD) is a disabling disorder that develops after exposure to a traumatic event. It is characterized by intrusive thoughts, nightmares, and flashbacks; avoidance... read more ). As for acute stress disorder (ASD), this form of psychotherapy includes patient education, cognitive restructuring, and therapeutic exposure to recollections of the traumatic experience. Cognitive processing therapy is a type of CBT that involves talking through the implications of traumatic experiences and putting negative thoughts about oneself and the traumatic experiences into perspective, seeing them as different from the actual trauma.

Prolonged exposure is another effective psychotherapy that involves addressing a series of traumatic memories while managing the psychophysiologic response to them with techniques such as controlled breathing, thereby gradually desensitizing the impact of the memories.

Eye movement desensitization and reprocessing (EMDR) is a form of exposure therapy that may also be used (2 Treatment references Posttraumatic stress disorder (PTSD) is a disabling disorder that develops after exposure to a traumatic event. It is characterized by intrusive thoughts, nightmares, and flashbacks; avoidance... read more ). For this therapy, patients are asked to follow the therapist's moving finger while they imagine being exposed to the trauma. While some experts think that the eye movements themselves help with desensitization, others attribute its efficacy mainly to the exposure rather than the eye movements.

Therapeutic style is important in the treatment of PTSD (3 Treatment references Posttraumatic stress disorder (PTSD) is a disabling disorder that develops after exposure to a traumatic event. It is characterized by intrusive thoughts, nightmares, and flashbacks; avoidance... read more ). Warmth, reassurance, and empathy are some of the nonspecific factors that may be unusually important when working with people suffering from such core PTSD symptoms as shame, avoidance, hypervigilance, and detachment.

Evidence for pharmacotherapy in PTSD is less robust than that for trauma-focused psychotherapy (4 Treatment references Posttraumatic stress disorder (PTSD) is a disabling disorder that develops after exposure to a traumatic event. It is characterized by intrusive thoughts, nightmares, and flashbacks; avoidance... read more ). Most often, medications are used to treat co-existing psychiatric disorders, or especially prominent PTSD symptoms, such as depression or anxiety.

Selective serotonin reuptake inhibitors (SSRIs) Selective Serotonin Reuptake Inhibitors (SSRIs) Several drug classes and drugs can be used to treat depression: Selective serotonin reuptake inhibitors (SSRIs) Serotonin modulators (5-HT2 blockers) Serotonin-norepinephrine reuptake inhibitors... read more may reduce anxiety and/or depression (5 Treatment references Posttraumatic stress disorder (PTSD) is a disabling disorder that develops after exposure to a traumatic event. It is characterized by intrusive thoughts, nightmares, and flashbacks; avoidance... read more ). Prazosin appears helpful in reducing nightmares (6 Treatment references Posttraumatic stress disorder (PTSD) is a disabling disorder that develops after exposure to a traumatic event. It is characterized by intrusive thoughts, nightmares, and flashbacks; avoidance... read more ). A brief course of sedating medications can help with insomnia. Various other medications are being used with increasing evidence of efficacy; these include mood stabilizers (eg, valproic acid), atypical antipsychotics (eg, aripiprazole), and psychedelics (such as MDMA, ketamine, and psilocybin) (7 Treatment references Posttraumatic stress disorder (PTSD) is a disabling disorder that develops after exposure to a traumatic event. It is characterized by intrusive thoughts, nightmares, and flashbacks; avoidance... read more ).