PTSD is a serious condition that can totally upend your life. Learn about symptoms and more about how therapy for trauma and PTSD can help give you your life back.
After a traumatic event, it is certainly normal to feel scared, alone, or that things will never be the same. If these feelings persist for longer than a month, it is possible you have post-traumatic stress disorder (PTSD). Traumatic events include experiences like motor vehicle accidents, being the victim of a crime, physical or sexual abuse, combat experiences, unwanted sexual contact, and many others. PTSD is more common than you might think; it affects 10% of women and 4% of men at some point in their lives.
Intrusions include nightmares, unwanted memories, flashbacks and other symptoms. Flashbacks are a symptom unique to traumatic stress disorders. A flashback is different from a typical memory. It is a consuming experience that makes one feel like the traumatic event is happening again. (Think of it this way: if recalling a memory is like watching a movie, having a flashback is like being in the movie.)
Avoidance is a common symptom of PTSD. It can take many forms. it might involve avoiding places or people that remind you of the traumatic event. For example, many people with PTSD as a result of a motor vehicle accident will not drive. This can sometimes last for years after the accident. Avoidance can also mean avoiding thoughts or feelings associated with the traumatic event.
Changes in thinking or mood
A traumatic event will often affect the way we think about things. It can also affect our mood. These symptoms can be subtle but their effects can be profound. For example, following a traumatic event, some people begin to see themselves as doomed, tarnished, or incapable. Without treatment, changes like this can wreak havoc on one’s mood and self-esteem, sometimes for years to come.
Changes in reactivity or arousal
This category of symptom can include trouble sleeping, trouble concentrating, or feeling “on guard” all the time. These two symptoms are quite common after a traumatic event, especially for those with PTSD. Another common characteristic of people with PTSD is an exaggerated “startle response.” When startled, someone with PTSD is more likely to have an extreme reaction than someone else.
Some sufferers of PTSD will exhibit risky or destructive behavior. This symptom is, of course, very serious. It can put the sufferer or others at risk of harm or further traumatic events.
PTSD often goes unrecognized by those suffering from it. Sometimes this is due to a lack of familiarity with the condition. It can also stem from thinking that one is “over” a past difficult event, even though difficulties continue. People suffering from posttraumatic stress who do not realize it often blame themselves for not having been able to “just get over” the event. However, for these people, it’s not as simple as “just getting over” their difficulties — professional treatment is often necessary. Others with posttraumatic stress fall into the habit of blaming themselves for the traumatic event. Still others come to increasingly believe that the world is an unsafe place, or that other people should be seen as potentially dangerous.
PTSD can impact relationships with friends, family, and loved ones. In particular, the ability to trust others can be affected. Survivors of trauma often describe feeling distant from loved ones after the traumatic event. Communication and intimacy can become challenging in ways they weren’t before.
Sexual assault and unwanted sexual contact
In some ways, the impact of PTSD can be the worst for those who have endured a sexual assault or other unwanted sexual contact.
Survivors of traumas like 9/11, serious car accidents, combat, assault, and traumatic loss of a loved one are more likely to discuss the traumatic event. They are also more likely to recognize their PTSD symptoms for what they are.
For people who have been through a sexual assault or unwanted sexual contact, the situation is often different. For one, the event is less likely to be known to the survivor’s loved ones. Secondly, the survivor themselves may be more reluctant to discuss it than they would another type of trauma. Thirdly, they may think about the incident as something common, something they should “get over,” and therefore ignore their symptoms. For example, some survivors make a distinction between “what happened to me” and “rape,” and thus conclude that their experience should not have been that impactful. Unfortunately, this often precludes people from seeking professional help, or even from seeking support from friends or loved ones.
Common PTSD myths
Myth: PTSD is only for war veterans.
Fact: anyone can develop PTSD — men, women and children. No one is immune.
Myth: Any difficult event can be a trauma.
Fact: There are many upsetting things in life, but only certain types of events can cause PTSD (see above). Bad breakups, losing a job, or the death of a beloved pet cannot cause PTSD.
Myth: If someone has PTSD it means they’re weak.
Fact: PTSD is not about strength or weakness. Risk factors for PTSD include previous traumatic experiences, family history of PTSD, lack of social support, and ongoing stress. None of these are about strength or weakness.
Myth: PTSD is not treatable.
Fact: There are now several evidence-based treatments for PTSD. See below for more.
Why does PTSD happen?
Why does PTSD develop? And why does it develop for some people who have been through a traumatic event, and not for others? We don’t know all the answers. However, there are several research-supported models of understanding PTSD that help us understand this complex condition.
Remember Pavlov’s dogs? Pavlov demonstrated classical conditioning by ringing a bell before feeding his dogs. After several repetitions, the dogs learned that the bell preceded the food, and began to salivate at the sound of the bell. How does this relate to PTSD? Our brains are hardwired to protect us from danger. So if a threatening situation was preceded by something we remember, we will have a strong aversion to that thing. For example, if you get violently ill after eating at a certain restaurant, you’ll have a strong aversion to visiting that restaurant again. You might even feel unable to eat that food again, even though you might have eaten it hundreds of times before with no problem. According to this model, PTSD is an extreme version of this same scenario.
Mowrer’s two-factor theory
In 1947 psychologist Hobart Mowrer suggested a different theory for how fear and phobia-related problems developed. His theory as applied to PTSD suggests that classical conditioning explained the initial post-traumatic response. But over time, rewards and punishments for trauma-related behaviors sustain (or worsen) the PTSD.
The cognitive model of PTSD holds that a trauma changes the way we think. These changes are what lead to, and then maintain, PTSD symptoms. Consider the example of someone who experienced a sexual assault on a date. If that person ends up believing that the assault would have been prevented if only they hadn’t trusted their date, the resulting self-blame can lead to PTSD. (The reasons for this are complex and explained well in cognitive processing therapy.)
Emotional processing theory
This theory suggests that we all have mental “networks” of unhealthy thinking. These networks impact our thinking once fear or anxiety occur. They involve thoughts about the stimulus (e.g., a mugger with a knife), our response (e.g. pounding heart, wanting to run away, trembling), and the meaning we associate with the situation (e.g., “I should have screamed” or “everyone is dangerous”). By changing the elements of these networks, the theory holds, we can treat PTSD. This theory has shaped much of the scientific understanding of PTSD in the past 30 years.
PTSD treatment options, including trauma therapy in NYC
Although the effects of traumatic events were known for decades, PTSD was only added to the system of formal mental health diagnoses (the Diagnostic and Statistical Manual, or DSM) in 1980. The past four decades of research have yielded several effective treatments that can change the lives of someone with PTSD.
The primary treatments for PTSD involve specific types of psychotherapy. Medication is sometimes used as well, but the psychotherapy is typically considered primary. Medication is typically prescribed by a different provider than the psychotherapist. Cognitive-behavioral therapy (CBT) is an effective treatment for PTSD. Research studies have demonstrated that specific types of CBT have been proven particularly effective for PTSD, including Cognitive Processing Therapy (CPT), Prolonged Exposure therapy (PE), and STAIR (Skills Training for Affective and Interpersonal Regulation). Not all psychotherapists provide these specific therapies, so you will need to find one with specific training in these type of therapy.
Cognitive Processing Therapy
CPT is a treatment developed by psychologists at the VA in the 1990s. It is typically twelve sessions long, and has been proven effective in research trials. CPT emphasizes changing your thinking in order to change the way you feel. Traumatic events often change our beliefs. For those of us who develop PTSD, these changes are profound. Unfortunately, the changes are often unhelpful and feed into PTSD. CPT helps people examine and eventually to readjust their thinking in ways that are uniquely helpful.
Prolonged exposure therapy helps people to gradually improve the ability to cope with difficult memories and feelings related to a traumatic event. This treatment helps us reduce the number of things, places, memories and emotions that, typically, have been avoided since the event occurred.
STAIR helps you with present functioning as well as with how to more healthily understand what occurred in the past. It can be particularly effective for survivors of childhood trauma or abuse, but is also effective for people who have been through other traumatic events.
PTSD can be uniquely debilitating and demoralizing. But there is effective help! Several structured therapies with good scientific evidence supporting them are available.
If you think you or a loved one might be suffering from PTSD, consider setting up an evaluation with a therapist with expertise in the treatments described above.
Last updated: May 15, 2020