Meg Seymour, PhD, National Center for Health Research
As many as 1 in 11 adults in the United States will be diagnosed with post-traumatic stress disorder (PTSD) in their lifetime.1 PTSD can develop following a single traumatic event, such as a natural disaster or a sexual assault, or long-term, repeated traumas such as childhood abuse. Many people have experienced traumatic events in their lifetimes, but not everyone who experiences trauma will develop PTSD. There is no way to perfectly predict who will develop PTSD following trauma, but researchers have identified some traits that make it more likely that someone will develop it. For example, someone is more likely to develop PTSD if they lack social support, were younger when the trauma occurred, are female, or have a prior history of mental disorders.2
Those who develop PTSD keep reliving their trauma, and their nervous system is stuck in “fight-or-flight” mode.3 Common symptoms of PTSD are re-experiencing the trauma through flashbacks or bad dreams, avoidance, and feeling jumpy or “on edge.”4 Some lesser-known symptoms of PTSD are how it can make people feel emotionally numb or even cause problems with attention, memory, and learning that look similar to the symptoms of attention deficit disorder.3
Many people try to avoid thinking about their trauma, but research has shown that denial or trying to repress the trauma leads to further distress.5 If you are struggling to psychologically recover following trauma, or if you are concerned that you have developed PTSD, there is hope. Several types of therapy have been shown to be effective for helping people recover from trauma, and this article will explain them to you.
What Types of Therapy Are Available for People Who Have Experienced Trauma?
Cognitive Processing Therapy
Those who have experienced trauma sometimes avoid thinking about what happened to them as a way of coping with the trauma, but avoiding painful memories can actually interfere with recovery. Cognitive Processing Therapy (CPT) helps people identify their “stuck points,” which are the parts of their trauma story that are the most difficult to revisit and overcome. CPT helps people change harmful beliefs, such as rape victims who blame themselves. One activity in CPT is writing a “trauma narrative,” which is the story of the trauma, and then reading it out loud to the therapist. This can be done as either individual therapy or group therapy, and both versions of CPT have been shown to help relieve symptoms of PTSD.6,7 A study from 2012 followed up with rape victims after they completed CPT, and found that only 22% of patients still had PTSD 5 to 10 years after completing the therapy.8
Dialectical Behavior Therapy
Another type of therapy that can help those with PTSD is called Dialectical Behavior Therapy (DBT). DBT teaches skills like mindfulness, tolerating distress, and learning to handle negative emotions without feeling overwhelmed or depressed.9 A study from 2020 compared CPT and DBT for helping victims of childhood abuse (either sexual or physical or both) who had PTSD. Although both forms of therapy helped reduce symptoms of PTSD, DBT patients showed even more improvement.10
Eye Movement Desensitization and Reprocessing
Eye Movement Desensitization and Reprocessing, known as EMDR, is a therapy that was developed for treating PTSD. In an EMDR session, the patient describes a traumatic memory while stimulating both sides of their brain. This is often done by moving one’s eyes in order to follow a moving light or following the therapists’ finger as it moves from side to side. Sometimes EMDR is done with sound in alternating ears or by being touched on alternating sides of the body while recounting the traumatic memory. The idea behind EMDR is that moving the attention back and forth between left and right will stimulate both sides of the brain. It is believed that talking about the traumatic memory while both sides of the brain are stimulated will help change how the memory is processed by the brain, ultimately reducing the negative emotions that come from recounting the memory.11
Some researchers believe EMDR works because activating a traumatic memory while focusing on something else can reduce how intense that memory feels.12 There is disagreement over why EMDR works, but regardless of why it works, it has been shown to be effective. EMDR has been shown to treat PTSD in several studies, reducing symptoms and removing diagnoses.12 For example, one study found that 80% of PTSD patients who did EMDR therapy had their diagnosis reversed.13 However, there is some other evidence that it is unclear whether or not EMDR is more effective than other forms of therapy.12
Unlike many other therapies, somatic therapies do not require patients to extensively or fully describe their traumatic experiences. Instead, they teach patients to reduce the negative feelings of remembering the trauma through working with how their bodies respond to feelings of threat and fear. Many other therapies try to reduce physical symptoms of trauma by changing a patient’s thoughts, but somatic therapies work on changing negative feelings by changing how the patient experiences the physical symptoms of trauma. Somatic therapies are based on the neuroscience of how trauma affects the body, helping patients feel safe in their body and teaching them to regulate their emotions by working on skills like bodily awareness.14,15
These therapies are more recent, so there is less research on them, but the research that exists is promising. For example, one study looked at the effect of somatic therapy for people who survived a tsunami, providing every participant with somatic therapy and following up 8 months later to study the effect on their PTSD symptoms. Ninety percent of the participants showed over a 50% improvement in their trauma symptoms such as jumpiness or recurring thoughts and avoidance.16 A clinical study from 2017 looked at the effect of somatic therapy for people with PTSD. Patients were either assigned to receive somatic therapy, or were assigned to a waitlist and were eventually given somatic therapy. Diagnoses of PTSD were reversed for 44% of the participants, and participants also experienced a reduction in depression.15
Prolonged Exposure Therapy
In Prolonged Exposure Therapy (PE), a PTSD patient is asked to continually retell the story of the traumatic event, reliving it and describing it aloud as they are imagining it, using present tense and vivid details. The retelling is recorded, and the patient is asked to listen to the recording at home between therapy sessions, in order to get further exposed to the traumatic story. A typical course of PE therapy lasts between 8 and 15 sessions.17 The theory behind PE is that recounting the traumatic story enough times will make it lose its traumatic influence and make it feel like a regular memory.18 There have been a number of studies done evaluating the effectiveness of PE. For example, one study from 2012 found that 5 to 10 years after receiving PE, only 14% of rape victims still met the criteria for a PTSD diagnosis.8
However, the effectiveness and use of PE is controversial, and some therapists have reported concerns about using it.19 One criticism is that many patients stop doing PE before their course is over because they find it too distressing. As many as half of patients drop out of PE therapy.18 Patients who also have a diagnosis of depression are 9x more likely to drop out of PE than others, and about half of people with PTSD also have depression.20 One study even found that 10% of patients got worse. Another criticism is that the studies that assess the effectiveness of PE are poorly designed.18 Dr. Bessel van der Kolk, director of Boston’s renowned Trauma Center, has criticized PE. He says that trauma does not need to be relived in order to be healed, and in fact, the parts of the brain that “went offline” during a traumatic experience also “go offline” when people re-experience their trauma.18 Therefore, PE might distress PTSD patients without helping their brains rewire in order to properly process the trauma.
Pharmacotherapy means using medication as a treatment. Most people who have PTSD also have another mental disorder, such as depression.21 This makes it hard to do research on which medications are effective for PTSD, because different PTSD patients might have different co-occuring mental disorders. There are only two medications that are approved by the Food and Drug Administration (FDA) for treating PTSD: Zoloft and Paxil. Both of them are a type of antidepressant called selective serotonin reuptake inhibitors (SSRI).22 SSRIs have been shown to have only small benefits for treating PTSD.21 For more information about SSRIs, you can read this article.
Some other types of medication are prescribed “off-label” for PTSD, meaning doctors prescribe them even though they are not approved by the FDA for treating PTSD. Some examples of medications used off-label for PTSD are antipsychotic drugs and benzodiazepines (a type of anti-anxiety medication).23 The risks of these drugs seem to outweigh the benefits since there is no solid evidence that antipsychotics help, and they can have serious side effects.21 Also, research suggests that benzodiazepines might actually make things worse for PTSD patients.22 For more information on antipsychotic medications being prescribed off-label, you can read this article.
Recently, researchers have been investigating whether drugs like MDMA (ecstasy) or psilocybin (“magic mushrooms”) could be treatments for PTSD. The drugs are being tested as a way to assist PTSD patients during therapy. The idea is that the drugs will help reduce the fear reactions common in PTSD, in order for patients to be able to talk about their experiences without being overwhelmed with fear.24 These drugs should not be taken outside of a clinical setting as a “DIY” treatment for PTSD since the risks and benefits are not yet known. Clinical studies testing the effects of these drugs are currently underway.
The Bottom Line
The road to recovery from trauma and PTSD is not a simple one. The mental and social effects of trauma can stay with a person for years, and one specific therapy may not work for everyone. Luckily, there are several types of effective therapy that you can choose from and try.
For help finding mental health counseling or therapy near you, you can check out this site by Psychology Today. You can search the website for therapists in your area, as well as search for those who practice whichever type of therapy you are interested in.
All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.
The National Center for Health Research is a nonprofit, nonpartisan research, education and advocacy organization that analyzes and explains the latest medical research and speaks out on policies and programs. We do not accept funding from pharmaceutical companies or medical device manufacturers. Find out how you can support us here.
- American Psychiatric Association. What is posttraumatic stress disorder? https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd. Updated January 2020.
- Vogt DS, King DW, King LA. Risk pathways for PTSD. Handbook of PTSD: Science and Practice. 2007 May 29:99-115.
- Van der Kolk BA, Van der Hart O, Burbridge J. Approaches to the treatment of PTSD. 1995. In Hobfoll, S & de Vries, M (Eds.), Extreme stress and communities: Impact and intervention (NATO Asi Series. Series D, Behavioural and Social Sciences, Vol 80). Norwell, MA: Kluwer Academic.
- National Institute of Mental Health. Post-Traumatic Stress Disorder. https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml. Updated May 2019.
- Draucker CB, Martsolf DS, Ross R, Cook CB, Stidham AW, Mweemba P. The essence of healing from sexual violence: A qualitative metasynthesis. Research in Nursing & Health. 2009; 32(4):366-78.
- Resick PA, Nishith P, Weaver TL, Astin MC, Feuer CA. A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of Consulting and Clinical Psychology. 2002; 70(4):867.
- Bass JK, Annan J, McIvor Murray S, Kaysen D, Griffiths S, Cetinoglu T, Wachter K, Murray LK, Bolton PA. Controlled trial of psychotherapy for Congolese survivors of sexual violence. New England Journal of Medicine. 2013; 368(23):2182-91.
- Resick PA, Williams LF, Suvak MK, Monson CM, Gradus JL. Long-term outcomes of cognitive–behavioral treatments for posttraumatic stress disorder among female rape survivors. Journal of Consulting and Clinical Psychology. 2012; 80(2):201.
- Psych Central. An Overview of Dialectical Behavior Therapy. https://psychcentral.com/lib/an-overview-of-dialectical-behavior-therapy/. Updated May 2020.
- Bohus M, Kleindienst N, Hahn C, Müller-Engelmann M, Ludäscher P, Steil R, Fydrich T, Kuehner C, Resick PA, Stiglmayr C, Schmahl C. Dialectical Behavior Therapy for Posttraumatic Stress Disorder (DBT-PTSD) Compared With Cognitive Processing Therapy (CPT) in Complex Presentations of PTSD in Women Survivors of Childhood Abuse: A Randomized Clinical Trial. JAMA Psychiatry. 2020.
- American Psychological Association. Eye Movement Desensitization and Reprocessing (EMDR) Therapy. https://www.apa.org/ptsd-guideline/treatments/eye-movement-reprocessing. Updated July 2017.
- Cuijpers P, Veen SC, Sijbrandij M, Yoder W, Cristea IA. Eye movement desensitization and reprocessing for mental health problems: a systematic review and meta-analysis. Cognitive Behaviour Therapy. 2020; 49(3):165-80.
- van der Kolk BA, Spinazzola J, Blaustein ME, Hopper JW, Hopper EK, Korn DL, Simpson WB. A randomized clinical trial of eye movement desensitization and reprocessing (EMDR), fluoxetine, and pill placebo in the treatment of posttraumatic stress disorder: treatment effects and long-term maintenance. Journal of Clinical Psychiatry. 2007; 68(1):37.
- Leitch ML, Vanslyke J, Allen M. Somatic experiencing treatment with social service workers following Hurricanes Katrina and Rita. Social Work. 2009; 54(1):9-18.
- Brom D, Stokar Y, Lawi C, Nuriel‐Porat V, Ziv Y, Lerner K, Ross G. Somatic experiencing for posttraumatic stress disorder: a randomized controlled outcome study. Journal of Traumatic Stress. 2017; 30(3):304-12.
- Parker C, Doctor RM, Selvam R. Somatic therapy treatment effects with tsunami survivors. Traumatology. 2008; 14(3):103-9.
- American Psychological Association. Prolonged Exposure (PE). https://www.apa.org/ptsd-guideline/treatments/prolonged-exposure. Updated June 2020.
- Morris DJ. Trauma Post Trauma. https://slate.com/technology/2015/07/prolonged-exposure-therapy-for-ptsd-the-vas-treatment-has-dangerous-side-effects.html. July 2015
- Newhouse E. VA Therapists Help Vets Wrestle With Moral Injuries. https://www.psychologytoday.com/us/blog/invisible-wounds/201512/va-therapists-help-vets-wrestle-moral-injuries. December 2015.
- Markowitz JC, Petkova E, Neria Y, Van Meter PE, Zhao Y, Hembree E, Lovell K, Biyanova T, Marshall RD. Is exposure necessary? A randomized clinical trial of interpersonal psychotherapy for PTSD. American Journal of Psychiatry. 2015; 172(5):430-40.
- Abdallah CG, Averill LA, Akiki TJ, Raza M, Averill CL, Gomaa H, Adikey A, Krystal JH. The neurobiology and pharmacotherapy of posttraumatic stress disorder. Annual Review of Pharmacology and Toxicology. 2019; 59:171-89.
- Westfall NC, Nemeroff CB. State-of-the-art prevention and treatment of PTSD: pharmacotherapy, psychotherapy, and nonpharmacological somatic therapies. Psychiatric Annals. 2016; 46(9):533-49.
- Puetz TW, Youngstedt SD, Herring MP. Effects of pharmacotherapy on combat-related PTSD, anxiety, and depression: a systematic review and meta-regression analysis. PloS One. 2015; 10(5):e0126529.
- Mahmood H. Comparative effects of MDMA and Psilocybin on Depression and PTSD. https://www.lakeforest.edu/live/news/10166-comparative-effects-of-mdma-and-psilocybin-on.