PTSD treatment decision
author image Dr. Paul Greene
author image Dr. Paul Greene
Dr. Paul Greene is the founder and director of the Manhattan Center for Cognitive Behavioral Therapy in New York City. With 14 years of dedicated service in private practice, Dr. Greene brings a wealth of experience to his role. His career also includes teaching at the Mount Sinai School of Medicine and conducting research at the Memorial Sloan Kettering Cancer Center.

There are a lot of options out there for PTSD treatment. Do any of them really work? Which one is the best?

Post-traumatic stress disorder (PTSD) is a serious condition that can set in following a traumatic event (or series of events).  Many different kind of events can cause PTSD. These include assaults, motor vehicle accidents, combat experiences, rape, abuse, some medical events, and several other situations. These events do not always cause PTSD. When they do, it is smart to seek treatment. 

The reason for this is that certain types of therapy can be very effective for PTSD, and can cause significant improvements in quality of life.  Very recently, the American Psychological Association assembled a guideline for PTSD treatment options. This guideline is based on extensive reviews of high quality research. The four treatment options that were “strongly recommended” were:

  • Cognitive-Behavioral Therapy
  • Cognitive Processing Therapy
  • Cognitive Therapy
  • Prolonged Exposure

These four treatments have a lot in common, and will be discussed below.  But first, here are the PTSD treatment options that were only “conditionally” recommended:

  • Eye Movement Desensitization Retraining (EMDR)
  • Medications
  • Narrative Exposure Therapy
  • Brief Eclectic Therapy

One important fact to take away from this list is that medications alone are generally not the best PTSD treatment option. Psychotherapy is typically a necessary part of the solution for people suffering from PTSD.  Further, the best treatment doesn’t merely involve “finding someone to talk to,” as many people seek to do when they need a therapist.  It involves seeking out one of the specific types of therapies listed above.

Cognitive-Behavioral Therapy

Cognitive-Behavioral Therapy (CBT), the first of the “strongly recommended” treatments, is becoming widely available. This type of therapy involves examining and changing some of the thoughts and actions that inadvertently contribute to PTSD.  A skilled CBT therapist works collaboratively with patients using skills-building exercises and homework assignments to help them start to change their thinking about the traumatic event(s) and to change their reactions to reminders of the traumatic event(s). Finding the right therapist for a given problem can be a real challenge. To find someone with good training in CBT we recommend the “find-a-therapist” feature at www.abct.org.

Cognitive Processing Therapy

Cognitive Processing Therapy (CPT) is a therapy that helps people change their reactions to a traumatic event in specific ways. It is a specialized version of cognitive therapy, described below.  CPT is especially useful for people who, to some extent, blame themselves for the traumatic event.  This self-blame is not uncommon in survivors of abuse or sexual assault in particular. Even for those without much self-blame, this type of therapy can be very effective. Often, traumatic events change the way we think about the world in an unhealthy way. CPT can help us make our thinking healthy again.

PTSD treatment options - woman mulling choices.

Cognitive Therapy

Cognitive Therapy (CT) is a form of therapy quite similar to CBT.  It emphasizes techniques that help change thinking patterns that contribute to anxiety, depression, anger, and other difficulties. The therapy is based on the premise that our thoughts affect our mood and our behavior. By practicing thinking differently, we can reduce depression, anxiety, and other problems.

Prolonged Exposure

Prolonged Exposure (PE) is a type of behavior therapy that involves reducing avoidance of reminders of the traumatic event(s). It is the longest-established PTSD treatment option. This is accomplished by doing exposure exercises.  Exposure exercises for PTSD can involve facing uncomfortable reminders of a traumatic event. As an example, consider someone who was in a serious car accident and stopped driving thereafter.  He or she might spend some time sitting in the car as an exposure exercise.  This exercise would be repeated until it no longer produced any anxiety.  The therapist would then introduce a slightly more challenging exercise.  This is repeated until PTSD symptoms have reduced so significantly that the memory no longer causes undue anxiety or distress.  PE has been used successfully to treat combat veterans, cancer survivors, victims of assault, car accident survivors, refugees, and others. It is an established and effective means to treat PTSD.

Treatment Options for PTSD: Summary

We are fortunate that organizations like the APA, AMA, NICE (in the UK) and others are able to thoroughly examine and summarize existing research findings to create guidelines for providers and patients.  The just-published APA guidelines for PTSD treatment options are a great example.  They suggest that certain therapies (not medications) should be a first-line treatment for PTSD.  We encourage you to seek out these therapies if at all possible; if you are having trouble finding these therapies in your area, please feel free to check the find-a-therapist directory from ABCT or to contact us at info@manhattanCBT.com.

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Dr. Paul Greene Psychologist
Dr. Paul Greene is the founder and director of the Manhattan Center for Cognitive Behavioral Therapy in New York City. With 14 years of dedicated service in private practice, Dr. Greene brings a wealth of experience to his role. His career also includes teaching at the Mount Sinai School of Medicine and conducting research at the Memorial Sloan Kettering Cancer Center.

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