Treating PTSD

Common therapeutic methods for PTSD include psychotherapy, CBT, and drug therapy. Treatments for PTSD aim to decrease stress and hyperarousal when recalling highly traumatic events. Several therapies reduce positive and negative symptoms by altering pathways involved in memory reconsolidation or by interfering with the hypothalamus-pituitary-adrenal axis. Detection and intervention techniques usually involve monitoring and stabilizing cortisol levels to control stress responses in patients. Many treatments have shown varied results among patients with different subtypes of PTSD.

Cognitive-Behavioral Therapy for PTSD

Perhaps the most widely practiced approach for treating PTSD is cognitive behavioral therapy (CBT). The goal is that patients identify the sources of their trauma and cope with them thereby eliminating negative emotional reactions associated with the memories.^[1] In general, around eight to 12 sessions are done with the patients prolonging about 60 to 90 minutes each, during which therapists ask challenging questions about the source of the stress-inducing memory. CBT has been shown to be successful in a wide variety of PTSD subtypes of different age groups.

Clients usually meet with their therapists for sessions once or twice per week. Each session begins with the individual closing their eyes and recalling the trauma as if the event is presently occurring. The clients retell all their emotions and physical senses while the event happened. Clients are also given homework assignments to complete, usually watching video footage of previous sessions. Studies have observed symptom reduction after about two weeks of intervention therapy.^[2]

Eye Movement Desensitization & Reprocessing (EMDR)

Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy developed by Francine Shapiro starting in 1988 in which the person being treated is asked to recall distressing images. The therapist then directs the patient in one type of bilateral stimulation, such as side-to-side eye movements or hand tapping. According to the 2013 World Health Organization practice guideline, “This therapy [EMDR] is based on the idea that negative thoughts, feelings, and behaviors are the result of unprocessed memories. The treatment involves standardized procedures that include focusing simultaneously on (a) spontaneous associations of traumatic images, thoughts, emotions and bodily sensations and (b) bilateral stimulation that is most commonly in the form of repeated eye movements.”^[3]

Eye movement desensitization and reprocessing (EMDR) is included in several evidence-based guidelines for the treatment of PTSD. As of 2020, the American Psychological Association lists eye movement desensitization and reprocessing (EMDR) as an evidence-based treatment for PTSD, but stresses that “the available evidence can be interpreted in several ways” and notes there is debate about the precise mechanism by which EMDR appears to relieve PTSD symptoms with some evidence EMDR may simply be variety of exposure therapy.^[4]

This form of treatment is a hybrid of many different types of interventions such as imaginal exposure as well as free association. The EMDR session commences with the patient remembering their traumatic memories while simultaneously looking at external visual or auditory cues, often with the therapist moving their finger across the individual’s visual field. The patients’ eyes move in the direction of the cue. However, several studies have suggested that the eye movements or sensory stimulation is not essential to the effectiveness of the therapy. Further research is necessary to discover the influence and importance of the bilateral stimulation in eliminating symptoms.

As a result, current research studies are finding new therapies that cater to specific types of PTSD patients. For instance, virtual reality therapy (VRT) is being specifically used for treating combat-related PTSD .

Virtual Reality Therapy

Figure 1. VRT is a way to successfully treat combat-related PTSD.

Virtual reality therapy (VRT) is currently being used as treatment for various psychological disorders. Ranging from anxiety disorders to stroke rehabilitation, virtual reality therapy (VRT)  is being utilized to eliminate debilitating symptoms associated with each of these situations. VRT consists of viewing a computerized combat or war scene on a visor screen. The computerized scenes closely resemble a real combat environment experienced by soldiers during deployment. Common among soldiers and military personnel arriving from overseas missions, combat-related PTSD is efficiently treated with this computerized therapy. After making a script of their traumatic memories, veterans undergo around six sessions of VRT. In contrast to other therapeutic methods, VRT has been shown to be extremely efficient in reducing negative symptoms such as avoidance and guilt. Since drug strategies and other therapies mainly treat positive symptoms and are inefficient in decreasing the negative symptoms, VRT is revolutionary for PTSD treatment. As a result, the patients are able to converse with the therapist while actively re-experiencing their memories. Due to this study, computerized intervention strategies have become increasingly common for treating PTSD.

Even though PTSD was only added to the DSM thirty years ago, the disease had been documented in literature many years before. For instance, Henry IV, in Shakespeare’s historical play of the same name, displayed several symptoms of someone experiencing PTSD. More recently, numerous films in popular culture feature main characters with PTSD. In particular, Rambo, the famous protagonist played by Sylvester Stallone in the First Blood film series, suffers from PTSD. In the 2009 movie Brothers, actor Tobey Maguire portrays a young soldier who was a prisoner of war while in Afghanistan. The character displays avoidance, withdrawal, and paranoia, which are all indicators of the disease. Over the years, CBT accompanied with drug therapy has been accepted as the first-line intervention for the disease.