How to deal with PTSD

Dealing with PTSD symptoms can be very challenging. They can interfere with daily living, strain relationships, and lead to withdrawal from social situations. Some individuals try to avoid the symptoms because they think it will make them go away. Unfortunately, that approach only works temporarily. The symptoms come back eventually, in situations you did or didn’t anticipate them returning. Avoidance maintains the symptoms long-term – it reinforces the fear. At that point, you have decisions to make on how you want to deal with the symptoms. 

In this article, we’ll identify and explain some psychological options for how to deal with PTSD. We’ll address the question of “is PTSD treatable?” Short answer: YES! With this information, you can make a more informed decision on what is the best fit for you. That awareness can help with moving forward in recovery. 

Side note: I don’t cover medication options for PTSD in this article because it’s beyond my scope of practice. Also, medications aren’t first-line treatments for PTSD, whereas certain individual trauma-focused psychotherapies are.

How to deal with PTSD: Psychological options

There are several psychological options for dealing with PTSD: psychotherapy, coping skills, or their combination. In this article, coping skills refers to using skills to manage PTSD symptoms in the moment or generally. Treatment refers to a deeper approach to get at the roots of the traumatic event(s) by changing unrealistic/unhelpful trauma-related thoughts or processing traumatic memories in safe and controlled environments. Deciding which option is the best fit for you depends upon your needs, characteristics, preferences, and evaluating the benefits and risks of each option. It’s important to speak with your healthcare providers (PCP, mental health providers, etc.) and support persons about this so you can make an informed decision.

Option #1: Psychotherapy for PTSD

Two treatments consistently have the strongest science-backed support for treating PTSD in U.S. adults: Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) Therapy. CPT and PE are two of the gold standard treatments for PTSD, according to VA/DoD Clinical Practice Guidelines for Treatment of PTSD (2023). In addition, they are strongly recommended by the American Psychological Association Clinical Practice Guideline for the Treatment of PTSD in Adults (2017). Thus, CPT and PE have strong recommendations for civilians, veterans, and active duty members who have experienced various numbers and types  of traumas. Research has shown CPT and PE provide lasting results (Resick et al., 2012).

CPT and PE are Cognitive Behavior Therapy-based approaches, which focus on the thoughts, emotions, and behaviors related to the traumatic event(s) and the aftermath. CPT targets the thoughts, which then can influence emotions and behaviors. PE targets the unhelpful trauma-related avoidance behaviors, which then can influence the emotions and thoughts.

Where CPT & PE directly target on the CBT triangle

Cognitive Processing Therapy (CPT)

CPT (Resick, Monson, Chard, 2024) is a short-term treatment that examines how traumatic events can impact thoughts, emotions, and behaviors. It provides information about common reactions to trauma and how people can get stuck in the recovery process after a traumatic event(s). Then, clients learn skills to 1) identify thoughts getting in the way of the recovery process (“stuck points”), 2) examine the accuracy and/or helpfulness of the thought, and 3) for unrealistic/unhelpful thoughts, to generate more realistic and helpful views. It is not just thinking positively. The thoughts can be understanding of how/why the traumatic events happened and how the traumatic events have impacted views on self, others, and world in regards to safety, trust, power/control, esteem, and intimacy. The skills learned in CPT can be applied to thoughts about daily life – identify unrealistic/unhelpful thoughts, explore the accuracy/helpfulness, and generate more realistic/helpful thoughts. This treatment includes daily practice of the skills between sessions. 

Prolonged Exposure (PE) Therapy

PE (Foa & Rothbaum, 1998; Rothbaum, Foa, & Hembree, 2007) is another short-term treatment that has individuals gradually and systematically face trauma-related memories, emotions, and situations they have avoided since the trauma. These are called exposures. PE facilitates emotional processing of a trauma memory through exposures in safe and controlled environments. The treatment starts with psychoeducation, including common reactions to trauma and teaching breathing retraining. Then treatment proceeds with identifying and doing in-vivo exposures and imaginal exposures. NOTE: Clients are not asked to face things that are objectively dangerous. In-vivo exposure consists of facing people, places, situations, activities, etc. that have been avoided since the trauma and are getting in the way of daily life. The client and provider collaboratively create a list of what the client has avoided. Clients start with in-vivo exposures that are less distressing and gradually and systematically face increasingly distressing situations. Imaginal exposure consists of the client repeatedly revisiting and recounting the trauma memory in vivid detail followed by processing the details of the event, emotions, and thoughts experienced in the trauma. The imaginal exposure is audio recorded. This treatment includes daily practice of 1) listening to the imaginal exposure audio recording and 2) doing in-vivo exposures. 

While CPT and PE are typically available in Veterans Affairs settings, they are not widely available to civilians. I aim to increase civilian awareness and access to CPT and PE – at least in NE Ohio.

You may be thinking, wait a minute. I’ve heard about Eye Movement Desensitization and Reprocessing Therapy (EMDR) to treat PTSD. Isn’t that an option?

The strength of recommendation for EMDR to treat PTSD varies by organization. The VA/DoD Clinical Practice Guidelines for PTSD (2023) list EMDR as a first-line treatment, whereas the APA Clinical Practice Guideline for Treatment of PTSD in Adults (2017) conditionally recommends EMDR. EMDR is a common approach to treat PTSD, especially in civilians, but it is not the only approach.

Things to keep in mind with CPT and PE

Be aware of your expectations with treatment and recovery. You want to make sure your expectations are realistic and helpful. Talk with your CPT/PE provider for more information.

  • Part of recovery means acknowledging the reality of what happened in the trauma(s) and their impact on daily life and doing specific things to reduce their impact. Be aware of your thoughts, feelings, and behaviors related to the traumas. 
  • CPT and PE cannot erase the trauma memories. Skills learned from CPT and PE, such as distinguishing thoughts from facts, asking yourself questions to evaluate the accuracy and/or helpfulness of the thought, facing things you have avoided since the trauma in safe and controlled environments that are practiced consistently and in different situations/contexts can reduce the severity and frequency of PTSD symptoms. 
  • It’s a gradual and ongoing process. Recovery doesn’t mean forgetting what happened or not having more frequent and intense symptoms at times. It means using CPT/PE skills to reduce the intensity and aftermath of the posttraumatic stress symptoms.

Also, consider this risk with not getting PTSD treatment

Untreated PTSD can negatively affect quality of life. Without treatment, symptoms are unlikely to improve and may get worse. A study by Davis and colleagues (2022) found that the cost of PTSD in the United States exceeded $232 billion for the year 2018. That included US civilians, veterans, and active-duty members.

Option #2: Coping skills

There are various coping skills to manage PTSD symptoms generally and in the moment. Below are some helpful coping skills.

  • Psychoeducation. Learn about PTSD symptoms and how they can interfere with daily life, and different types of traumatic events. Having information can allow us to feel more in control, reduce uncertainty, and respond more effectively.
    • Intrusions: intrusive thoughts/memories, nightmares, intense psychological and physical reactions to trauma-related reminders
    • Avoidance: avoid internal (thoughts, emotions, memories) and external trauma-related reminders
    • Negative changes in mood and thinking
    • Hyperarousal: constantly on guard, jumpy/easily startled, difficulty concentrating, trouble falling and/or staying asleep

Check out https://melissagoldsmithphd.org/what-is-ptsd/ for more information on PTSD symptoms.

  • Social support. Seek support from those who validate your emotional experience and you are willing to talk to. These are important pieces that can help with recovery. You are allowed to ask others for what you want/need. In addition, it is important to focus on the quality of your social support over the quantity of it. 
  • Engage in activities that are 1) important to you, 2) enjoyable, or 3) provide a sense of mastery or accomplishment. That can be spending time with friends/family, learning more about a topic that interests you, watching a show or move that makes you laugh, taking a walk, or playing with pets. Doing activities that are important to you can provide a sense of purpose and direction in life. Doing activities you enjoy or give you a sense of mastery or accomplishment can temporarily help with mood, reduce the impact of the trauma symptoms on daily functioning, and help you move forward. Keep the activities simple.
  • Address sleep quality and quantity. Sleep impacts the brain’s ability to process and manage emotions, memories, and stress responses, which are key components that influence PTSD symptoms. You want to identify healthy strategies that are helping you sleep and things that are getting in the way of sleep. They may be personal habits during waking hours, your sleep environment, your bedtime routine, and habits with difficulty falling asleep, staying asleep, or waking up. 

For more information on tips to improve sleep quality and quantity, visit https://www.mirecc.va.gov/docs/visn6/Readjustment_brochure_sleep_color_generic041619.pdf and https://www.sleepfoundation.org/sleep-hygiene.

  • Breathing retraining. Breathing retraining is a coping skill I love for several reasons.
    • 1) We’re already breathing, so why not? 
    • 2) It’s free. 
    • 3) You can use it in various situations and don’t need anything else to do it. 
    • 4) You can practice breathing retraining without others around you knowing you’re doing it.

Our breathing rate speeds up when we perceive danger/threat. Breathing retraining involves taking a normal breath in and then breathing out slowly. You want to breathe from your diaphragm, not from your chest. You want to do a minimum of 10-15 breaths in one sitting to notice a difference.

Check out these smartphone applications: PTSD Coach and COVID Coach for more information on breathing retraining and other coping skills.

Things to keep in mind with coping skills

Be aware of your expectations with coping skills and recovery:

  • Set realistic goals using the SMART framework to practice coping skills. SMART stands for specific, measurable, achievable, relevant, and time-bound. 
  • Practice coping skills in lower stress situations first. As you build the skill, you can practice it in higher stress situations. Think about it this way: it’s easier to repair a leaky roof when it’s sunny, not when it’s a torrential downpour. It’s unrealistic to expect a new coping skill to work perfectly in a high stress situation.
  • The section on things to keep in mind with CPT and PE mentioned earlier also applies here for coping skills.

Option #3: Combination of psychotherapy and coping skills

If you decide that a combination of psychotherapy for PTSD and coping skills is the best fit for you, speak with your therapy provider about what coping skills may be realistic to do and when to use them, especially when doing CPT or PE. You want to keep it simple. 

The takeaway: You’ve got options. PTSD doesn’t have to be a life sentence. It is treatable.

PTSD symptoms can disrupt functioning in different areas of a person’s life. Although avoidance may provide short-term relief from the symptoms, it prolongs and maintains the fears and the symptoms. Navigating PTSD effectively requires making informed decisions about how you want to handle it. This article explores psychological options to deal with PTSD symptoms and aims to empower individuals with knowledge to aid their recovery. I am committed to increasing awareness and access to CPT and PE, two of the first-line psychotherapies for PTSD.

References

APA Clinical Practice Guideline. (2017). Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults. Washington, DC.

Davis, L. L., Schein, J., Cloutier, M., Gagnon-Sanschagrin, P., Maitland, J., Urganus, A., Guerin, A., Lefebvre, P., & Houle, C.R. (2022). The economic burden of posttraumatic stress disorder in the United States from a societal perspective. Journal of Clinical Psychiatry, 83(3): 21m14116. http://dx.doi.org/10.4088/JCP.21m14116

Foa, E. B., & Rothbaum, B. O. (1998). Treating the trauma of rape: Cognitive-behavioral therapy for PTSD. Guilford Press.

Resick, P. A., Monson, C. M., & Chard, K. M. (2024). Cognitive processing therapy (2nd edition): A comprehensive therapist manual. Guilford Press.

Resick, P.A., Williams, L. F., Suvak, M. K., Monson, C. M., & Gradus, J. L. (2012). Long-term outcomes of cognitive–behavioral treatments for posttraumatic stress disorder among female rape survivors. Journal of Consulting and Clinical Psychology, 80(2): 201-210. http://dx.doi.org/10.1037/a0026602

Rothbaum, B. O., Foa, E. B., & Hembree, E. A. (2007). Reclaiming your life from a traumatic experience: A prolonged exposure treatment program. Oxford University Press.

VA/DoD Clinical Practice Guideline. (2023). Management of Posttraumatic Stress Disorder and Acute Stress Disorder Work Group. Washington, DC: U.S. Government Printing Office.

Scroll to Top