Counseling for PTSD

When you have post-traumatic stress disorder (PTSD), dealing with the past can be hard. Instead of telling others how you feel, you may keep your feelings bottled up. But talking with a therapist can help you get better.

Cognitive-behavioral therapy (CBT) is one type of counseling. It appears to be the most effective type of counseling for PTSD.^{1, 2} In CBT, a therapist helps you deal with your feelings about the past. You'll have weekly hour-long visits for a few weeks or months, or as long as it takes for you to feel better. CBT may help you have fewer PTSD symptoms over time.²

What is cognitive therapy?

After a traumatic event, you might blame yourself for things you couldn't have changed. For example, a soldier may feel guilty about decisions he or she had to make during war. Cognitive therapy, a type of CBT, helps you understand that the traumatic event you lived through was not your fault.

In cognitive therapy, your therapist helps you understand and change how you think about your trauma and its aftermath. Your goal is to understand how certain thoughts about your trauma cause you stress and make your symptoms worse.

You will learn to identify thoughts about the world and yourself that are making you feel afraid or upset. With the help of your therapist, you will learn to replace these thoughts with more accurate and less distressing thoughts. You also learn ways to cope with feelings such as anger, guilt, and fear.

What is exposure therapy?

Exposure therapy is similar to cognitive therapy. In exposure therapy, your goal is to have less fear about your memories. It is based on the idea that people learn to fear thoughts, feelings, and situations that remind them of a past traumatic event.

By talking about your trauma repeatedly with a therapist, you'll learn to get control of your thoughts and feelings about the trauma. This may be hard at first. It might seem strange to think about stressful things on purpose.

But you'll feel less overwhelmed over time. With the help of your therapist, you can change how you react to the stressful memories. Talking in a place where you feel secure makes this easier.

You may focus on memories that are less upsetting before talking about worse ones. This is called "desensitization," and it allows you to deal with bad memories a little bit at a time. Your therapist also may ask you to remember a lot of bad memories at once. This is called "flooding," and it helps you learn not to feel overwhelmed.

You also may practice different ways to relax when you're having a stressful memory. Breathing exercises are sometimes used for this.

What is EMDR?

Eye movement desensitization and reprocessing (EMDR) is a fairly new therapy for PTSD. Like other kinds of counseling, it can help change how you react to memories of your trauma.

While talking about your memories, you'll focus on distractions like eye movements, hand taps, and sounds. For example, your therapist will move his or her hand near your face, and you'll follow this movement with your eyes.

Experts are still learning how EMDR works. Studies have shown that it may help you have fewer PTSD symptoms.² But research also suggests that the eye movements are not a necessary part of the treatment.

EMDR may not be available at all clinics or hospitals.

Citations

1. Rothbaum BO, et al. (2000). Cognitive-behavioral therapy. In EB Foa et al., eds., Effective Treatments for PTSD: Practice Guidelines From the International Society for Traumatic Stress Studies, pp. 60–83. New York: Guilford Press.

2. Bisson J (2006). Post-traumatic stress disorder, search date December 2005. Online version of Clinical Evidence (15): 1–18.