Sheila Rauch, PhD: What Are the Best Treatments for PTSD?

The two treatments that really have the largest amount of research and the best evidence to support their efficacy are prolonged exposure and cognitive processing therapy. Prolonged exposure is really focused on working with your providers to approach your traumatic memories instead of avoid them so that you feel those emotions, you let yourself consider those emotions, consider what the trauma meant at the time and now, and move through that trauma to the other side where those emotions may be less intense. You’re able to think about that trauma without being derailed. But the basic idea of prolonged exposure is that you’re approaching instead of avoiding, and that has lots of impacts on your life, how you think about yourself, how you think about the world, how you think about that trauma. CPT is kind of the flip of that. So, it’s focusing on the thoughts that came out of your traumatic experience – basically these are thoughts and ways that you think about yourself post trauma – and working on changing those thoughts to reduce the impact of that trauma on your life now. An example of this would be many people who have been sexually assaulted working on those thoughts of self-blame by going back to examine “what do those thoughts mean, what did they say about me then, what are they saying about me now?” can be a good way to move past the trauma. So, the two primary effective psychotherapies, trauma-focused therapies, kind of are working on the same problem of PTSD. One’s coming at it from approaching instead of avoiding the behavioral experiential mode; the other one’s coming at it from the more cognitive, starting with the thoughts and going from there. There are some medications that work I should say. And really, the last VA/DoD Clinical Practice Guideline put trauma-focused therapies as first line and then those meds as second line. These are people who are coming in raising their hand saying I’m having trouble and I want to address it. As a therapist, that’s my opportunity to come in and say it makes a lot of sense that you’re having trouble with this. One thing that we know really fuels PTSD symptoms, fuels people not being able to do the things that they want in their life is avoidance. So what we’re going to do is start to approach instead of avoid. We’ll be doing this together. We’re aligning. We’re doing it at your pace. You’re in charge of how we do it, when we do it, what we do, and are you willing to, you know, take that leap with me. And that’s really where I come from. For most PTSD patients that I work with, over 20 years of working in this field, it makes a lot of sense ’cause they know when they’re avoiding. They know what’s contributing to them not being able to do the things that they want in their life. They also know it may be hard, but with good support and with providers who feel confident and who have worked with this for a long time, they’re usually willing and able to take that leap. And once they start seeing a little bit of progress, it snowballs in a positive way. BrainLine is powered in part by Wounded Warrior Project to honor and empower post-9/11 injured service members, veterans, and their families.