Treating trauma responses and simple PTSD​

Treatment approaches

Many forms of treatment are used in trauma therapy including:

• various types of talk therapy,
• somatic psychotherapy,
• therapies that attempt to reach below the level of consciousness
• pharmacotherapy.

Some common approaches to trauma therapy include

• cognitive-behavioural
• psychodynamic and sensorimotor therapies
• eye movement desensitization and reprocessing
• hypnosis
• art and music therapies
• pharmacological treatment of symptoms and responses

Often emotional and physical trauma responses (or effects of trauma) respond to traditional psychotherapies that address maladaptive thinking patterns, work on dissociation, hypersensitivity and anxiety or address sleep disturbances.

Psycho-social approaches

Cognitive-behavioural therapy

Cognitive-behavioural therapy (CBT) helps clients learn to question, analyze and ultimately shift maladaptive and distorted thinking, assumptions and beliefs that can lead to negative emotions and self-destructive behaviour. CBT can be helpful for people who have experienced trauma because the various thinking and coping behaviours that helped them cope with and even survive extreme situations can become barriers to successful interpersonal relationships later in life.

• Cognitive behavior therapy for adults (ISTSS guideline 4) (PDF)
• Cognitive Behavioural Therapy (Royal College of Psychiatrists (UK))  is an overview of CBT: how it works, why it is used, its effects, side-effects and alternative treatments. 

Trauma- focused cognitive behavior therapy (TF-CBT)

Trauma-focused cognitive behavior therapy fact sheet (National Child Traumatic Stress Network)) includes treatment description, target population, components, training requirements and outcome evaluation .

The Medical University of South Carolina, in partnership with the National Child Traumatic Stress Network and others offers, a web-based training course on trauma-focused CBT.

Exposure therapy

Exposure therapy and systematic desensitization are types of CBT that are specifically used to treat phobias and anxiety or fear responses that can develop after a traumatic experience

• Exposure therapy for specific phobias (Society of Clinical Psychology)
• Exposure Therapy Explained (interview with Edna Foa) 

Psychodynamic therapy

Psychodynamic psychotherapy examines the unconscious content of a client's psyche in an effort to relieve emotional pain. It is similar to psychoanalysis; however, psychodynamic therapy tends to be briefer and less intensive. It also relies heavily on the interpersonal relationship between client and therapist (known as the therapeutic alliance).

The evidence base for psychodynamic therapy as a treatment for PTSD is summarized in Effective Treatments for PTSD, 2^nd edition (ISTSS):

• Guideline 11: Psychodynamic therapy for adults (PDF)
• Guideline 12: Psychodynamic therapy for child trauma (PDF)

Sensorimotor psychotherapies: Bodywork, relaxation and stress reduction

Bodywork, relaxation and stress reduction approaches address long-term effects of adrenalin or fight, flight or freeze response to traumatic event. Bodywork involves activating exercises, movement and body awareness. Relaxation or stress reduction exercises include breath work, biofeedback, mindfulness exercises such as yoga, meditation and grounding exercises.

Grounding

Grounding techniques are methods to increase mindfulness – a client's awareness in the here-and-now – to reduce symptoms such as flashbacks, intrusive re-experiencing and dissociation.

Eye Movement Desensitization and Reprocessing

Eye movement desensitization and reprocessing (EMDR) is an information processing therapy that integrates psychodynamic, cognitive behavioural, interpersonal, experiential and body-centred therapies. See the EMDR Institute website for more information.

Hypnosis

Hypnosis has been used experimentally in the treatment of trauma, often in combination with other forms of treatment. For a list of research abstracts compiled by the Traumatic Stress Center of the Stanford School of Medicine, see Dissociation, Hypnosis, and Stress and Trauma (PDF only).

Art and music therapies

Art therapy helps connect the non-verbal to the verbal, which can help clients to do better in other forms of therapy such as CBT. Art therapy helps to express the trauma experience through non-verbal means. The American Art Therapy Association provides a brief description art therapy, including its use in relation to trauma. Here is a list of resources related to art and music therapy. 

Pharmacological treatment of symptoms and responses

Medications used to treat anxiety, depression and sleep problems are often used to treat the symptoms of PTSD or the responses to trauma so people affected by these mental health concerns can function and be well enough to benefit from other forms of therapy.

For an overview see Medications for PTSD (adapted from Clinicians' guide to medications for PTSD, US Department of Veterans' Affairs) and Post traumatic stress disorder medication (MedScape):