Andrew L. Martin, PsyD
This is the third article in a series on posttraumatic stress, or PTS. In this article, we explore how psychotherapists treat PTS.
Providers begin treating PTS with a psychological evaluation or interview. Your provider needs to know you and your goals well in order to help you best. Next, your provider will build trust, and show that you are in a safe environment, and in a supportive relationship. Those are essential for most types of psychotherapy.1
If depressive and anxious symptoms are severe, your provider may teach you some practical tools to help with those symptoms, like stress management and relaxation techniques. They may also ask you to complete a symptom questionnaire from time to time, so that you can see how your symptoms improve over time.
Next, you start the main therapy. There are many psychotherapies proven to help with PTS. In this article, we will focus on Cognitive Processing Therapy, or CPT. CPT is currently the most successful treatment for PTS. It has a 70% success rate.2
Researchers carefully developed CPT, which has specific, measured steps.3 Providers using CPT will ask you to meet once or twice per week, for an hour at a time, for about 12 sessions. The first session is a complete explanation of CPT. In my experience, after the first session, people frequently report feeling validated, or “more normal.” Some say, “That explains something I’ve felt all my life but couldn’t put into words.”
The provider will then ask you to write about your most troubling trauma – not details about the event, but rather what you have been thinking about the cause of the event. You’ll also be asked to write about how you think the event may have changed the way you think about yourself, others, and the world, in terms of safety, trust, power/control, esteem, and intimacy. Traumatic events usually disrupt thinking in those areas.
Next, you develop the skills necessary to feel better. CPT teaches you how to become your own therapist. The main skill is cognitive restructuring, or ‘thought-changing.’ You learn how to see your own unconscious thoughts – thoughts that are probably causing you distress and blocking you from recovering from the traumatic event. Next, you learn how to challenge your troubling thoughts, by learning about logic, and learning about the unrealistic thoughts we all have. Finally, you learn to develop more realistic and balanced thoughts. You will develop and practice these skills on your traumatic event and anything else that bothers you. CPT often makes you feel better about lot of life’s bothersome events/situations.
Here’s an over-simplified, but good example of therapist-patient talk in CPT:
Therapist: What thoughts do you have when you think about the sexual assault?
Patient: I feel guilty.
Therapist: Why do you feel guilty when you think about the sexual assault?
Patient: It’s my fault because I let it happen.
Therapist: Think about the definition of sexual assault. Is it something you LET happen, or is it something that happens TO you?
Patient: Oh [tearful]. I guess I couldn’t stop it.
Therapist: Why do you think your mind sometimes blames you for the sexual assault?
Patient: Because I don’t want to think that things like that can happen to me without my control.
Therapist: But they can.
Therapist: And that’s upsetting.
Patient: Yes, and I wish it didn’t happen to me. BUT – it’s not likely to happen again. It’s possible, but very unlikely, and I am older now and better able to protect myself.
Therapist: Next time you feel guilty or catch your mind telling you it was your fault, practice thinking what you just said to me.
In the last treatment phase, you now take your powerful new skills, and use them on the ‘usual suspects’ of post-traumatic stress – your thoughts about safety, trust, power/control, esteem and intimacy. As your mind thinks more realistically about those areas and about traumatic events, you feel better, and your PTS symptoms reduce.
You may ask for extra sessions to further develop a skill, or work on another traumatic event. And your therapist may ask to see you again in a month or two to check that you are still feeling better and are still practicing your new skills.
I hope this posttraumatic stress article series has helped to educate not only those who may have trauma-related stress issues, but also those that love, care and work with those people. Thank you for reading.
1Norcross, J. C. (2010). The therapeutic relationship.
2Card, P. (2017). VA/DoD clinical practice guideline for the management of posttraumatic stress disorder and acute stress disorder.
3Resick, P. A., Monson, C. M., & Chard, K. M. (2016). Cognitive processing therapy for PTSD: A comprehensive manual. Guilford Publications.