What is post-traumatic stress disorder (PTSD)?

Post-traumatic stress disorder (PTSD) is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event.

It is natural to feel afraid during and after a traumatic situation. Fear is a part of the body’s “fight-or-flight” response, which helps us avoid or respond to potential danger. People may experience a range of reactions after trauma, and most people recover from initial symptoms over time. Those who continue to experience problems may be diagnosed with PTSD.

Who gets PTSD?

Anyone can develop PTSD at any age. This includes combat veterans and people who have experienced or witnessed a physical or sexual assault, abuse, an accident, a disaster, or other serious events. People who have PTSD may feel stressed or frightened, even when they are not in danger.

Not everyone with PTSD has been through a dangerous event. Sometimes, learning that a friend or family member experienced trauma can cause PTSD.

According to the National Center for PTSD, a program of the U.S. Department of Veterans Affairs, about six out of every 100 people will experience PTSD at some point in their lives. Women are more likely to develop PTSD than men. Certain aspects of the traumatic event and some biological factors (such as genes) may make some people more likely to develop PTSD.

What are the signs and symptoms of PTSD?

Symptoms of PTSD usually begin within 3 months of the traumatic event, but they sometimes emerge later. To meet the criteria for PTSD, a person must have symptoms for longer than 1 month, and the symptoms must be severe enough to interfere with aspects of daily life, such as relationships or work. The symptoms also must be unrelated to medication, substance use, or other illness.

The course of the disorder varies. Some people recover within 6 months, while others have symptoms that last for 1 year or longer. People with PTSD often have co-occurring conditions, such as depression, substance use, or one or more anxiety disorders.

After a dangerous event, it is natural to have some symptoms. For example, some people may feel detached from the experience, as though they are observing things rather than experiencing them. A mental health professional who has experience helping people with PTSD, such as a psychiatrist, psychologist, or clinical social worker, can determine whether symptoms meet the criteria for PTSD.

To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:

• At least one re-experiencing symptom
• At least one avoidance symptom
• At least two arousal and reactivity symptoms
• At least two cognition and mood symptoms

Re-experiencing symptoms include:

• Experiencing flashbacks—reliving the traumatic event, including physical symptoms such as a racing heart or sweating
• Having recurring memories or dreams related to the event
• Having distressing thoughts
• Experiencing physical signs of stress

Thoughts and feelings can trigger these symptoms, as can words, objects, or situations that are reminders of the event.

Avoidance symptoms include:

• Staying away from places, events, or objects that are reminders of the traumatic experience
• Avoiding thoughts or feelings related to the traumatic event

Avoidance symptoms may cause people to change their routines. For example, some people may avoid driving or riding in a car after a serious car accident.

Arousal and reactivity symptoms include:

• Being easily startled
• Feeling tense, on guard, or on edge
• Having difficulty concentrating
• Having difficulty falling asleep or staying asleep
• Feeling irritable and having angry or aggressive outbursts
• Engaging in risky, reckless, or destructive behavior

Arousal symptoms are often constant. They can lead to feelings of stress and anger and may interfere with parts of daily life, such as sleeping, eating, or concentrating.

Cognition and mood symptoms include:

• Having trouble remembering key features of the traumatic event
• Having negative thoughts about oneself or the world
• Having exaggerated feelings of blame directed toward oneself or others
• Having ongoing negative emotions, such as fear, anger, guilt, or shame
• Losing interest in enjoyable activities
• Having feelings of social isolation
• Having difficulty feeling positive emotions, such as happiness or satisfaction

Cognition and mood symptoms can begin or worsen after the traumatic event. They can lead a person to feel detached from friends or family members.

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org. In life-threatening situations, call 911.

How do children and teens react to trauma?

Children and teens can have extreme reactions to trauma, but some of their symptoms may not be the same as those seen in adults. In children younger than age 6, these symptoms can include:

• Wetting the bed after having learned to use the toilet
• Forgetting how to talk or being unable to talk
• Acting out the scary event during playtime
• Being unusually clingy with a parent or other adult

Older children and teens usually show symptoms more like those seen in adults. They also may develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge.

What are the risk factors for PTSD?

Not everyone who lives through a dangerous event develops PTSD—many factors play a part. Some of these factors are present before the trauma; others become important during and after a traumatic event.

Risk factors that may increase the likelihood of developing PTSD include:

• Being exposed to previous traumatic experiences, particularly during childhood
• Getting hurt or seeing people hurt or killed
• Feeling horror, helplessness, or extreme fear
• Having little or no social support after the event
• Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home
• Having a personal or family history of mental illness or substance use

Resilience factors that may reduce the likelihood of developing PTSD include:

• Seeking out support from friends, family, or support groups
• Learning to feel okay with one’s actions in response to a traumatic event
• Having a coping strategy for getting through and learning from the traumatic event
• Being prepared and able to respond to upsetting events as they occur, despite feeling fear

How is PTSD treated?

It is important for anyone with PTSD symptoms to work with a mental health professional who has experience treating PTSD. The main treatments are psychotherapy, medications, or a combination of psychotherapy and medications. A mental health professional can help people find the best treatment plan for their symptoms and needs.

Some people with PTSD, such as those in abusive relationships, may be living through ongoing trauma. In these cases, treatment is usually most effective when it addresses both the traumatic situation and the symptoms of PTSD. People who experience traumatic events or who have PTSD also may experience panic disorder, depression, substance use, or suicidal thoughts. Treatment for these conditions can help with recovery after trauma. Research shows that support from family and friends also can be an important part of recovery.

Psychotherapy

Psychotherapy (sometimes called talk therapy) includes a variety of treatment techniques that mental health professionals use to help people identify and change troubling emotions, thoughts, and behaviors. Psychotherapy can provide support, education, and guidance to people with PTSD and their families. Treatment can take place one on one or in a group and usually lasts 6 to 12 weeks but can last longer.

Some types of psychotherapy target PTSD symptoms, while others focus on social, family, or job-related problems. Effective psychotherapies often emphasize a few key components, including learning skills to help identify triggers and manage symptoms.

One common type of psychotherapy, called cognitive behavioral therapy, can include exposure therapy and cognitive restructuring:

• Exposure therapy helps people learn to manage their fear by gradually exposing them, in a safe way, to the trauma they experienced. As part of exposure therapy, people may think or write about the trauma or visit the place where it happened. This therapy can help people with PTSD reduce symptoms that cause them distress.
• Cognitive restructuring helps people make sense of the traumatic event. Sometimes people remember the event differently from how it happened. They may feel guilt or shame about something that is not their fault. Cognitive restructuring can help people with PTSD think about what happened in a realistic way.

Medications

The U.S. Food and Drug Administration (FDA) has approved two selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant medication, for the treatment of PTSD. SSRIs may help manage PTSD symptoms such as sadness, worry, anger, and feeling emotionally numb. Health care providers may prescribe SSRIs and other medications along with psychotherapy. Some medications may help treat specific PTSD symptoms, such as sleep problems and nightmares.

People should work with their health care providers to find the best medication or combination of medications and the right dose. To find the latest information about medications, talk to a health care provider.

How can I find help for PTSD?

If you’re not sure where to get help, a health care provider can refer you to a licensed mental health professional, such as a psychiatrist or psychologist with experience treating PTSD. Find tips to help prepare for and get the most out of your visit and information about getting help.

Here are some things you can do to help yourself while in treatment:

• Talk with your health care provider about treatment options and follow your treatment plan.
• Engage in exercise, mindfulness, or other activities that help reduce stress.
• Try to maintain routines for meals, exercise, and sleep.
• Set realistic goals and focus on what you can manage.
• Spend time with trusted friends or relatives and tell them about things that may trigger symptoms.
• Expect your symptoms to improve gradually, not immediately.
• Avoid the use of alcohol or drugs.

How can I help a friend or relative who has PTSD?

If you know someone who may be experiencing PTSD, the most important thing you can do is to help that person get the right diagnosis and treatment. Some people may need help making an appointment with their health care provider; others may benefit from having someone accompany them to their health care visits.

If a close friend or relative is diagnosed with PTSD, you can encourage them to follow their treatment plan. If their symptoms do not get better after 6 to 8 weeks, you can encourage them to talk to their health care provider. You also can:

• Offer emotional support, understanding, patience, and encouragement.
• Learn about PTSD so you can understand what your friend is experiencing.
• Listen carefully. Pay attention to the person’s feelings and the situations that may trigger PTSD symptoms.
• Share positive distractions, such as walks, outings, and other activities.

Making the decision to get treatment for PTSD can be difficult. If you have PTSD, you may want to avoid talking about it. But there are treatments that work. Learn why it is important to get help for PTSD and tips to help you deal with concerns about stigma or barriers to care.

Why Is It Important to Seek Care for PTSD?

You deserve treatment. There are PTSD treatments that work. You can learn how to keep PTSD from hurting your relationships or causing problems at work or school. You can enjoy your life. Learn from Veterans who talk about living with PTSD and how treatment turned their lives around: AboutFace.

"Getting better" means different things for different people. In many cases, PTSD treatment can get rid of your symptoms. For other people, symptoms may be less intense or happen less often. After treatment you will have learned skills to better cope with symptoms. People who get treatment improve their quality of life.

Treatment can also help you:

• Make sense of traumatic event(s)
• Learn skills to better handle negative thoughts and feelings
• Reconnect with people you care about
• Set goals for activities, like work or school, that you can handle

Why Wait?

It's common for people to think health issues will resolve on their own, or that "it's not bad enough" to need treatment. Or you may think it makes sense to wait for the "right time" to get help. These are examples of barriers, or things that might stop you from seeking help for PTSD. Part of PTSD is avoiding thinking about the trauma. So, it makes sense that people with PTSD may want to avoid getting treatment if it means talking about those events. Research points out important reasons to get treatment as soon as you can:

Early treatment is better

Symptoms of PTSD may get worse. Dealing with them now might help stop symptoms from getting worse in the future and lead to a better quality of life for you.

It's never too late to get PTSD treatment

Treatment can help even if your trauma happened years ago. And treatment for PTSD has gotten much better over the years. If you tried treatment before and you're still having symptoms, it's a good idea to try again or try a different treatment.

PTSD symptoms can affect those you love

PTSD symptoms can get in the way of your family life. You may find that you pull away from loved ones, are not able to get along with people, or that you are angry, irritated or aggressive. Getting help for your PTSD can help improve your relationships.

PTSD can be related to other health problems

PTSD symptoms can affect physical health problems. For example, a few studies have shown a relationship between PTSD and heart trouble. By getting help for your PTSD, you could also improve your physical health.

What Is Stigma?

Stigma is when you feel judged because of some personal quality or trait. You may feel stigma because of negative things people say about mental health problems. An example of stigma related to PTSD is a belief that people with PTSD are dangerous or unstable, which is not true.

You may try to hide problems or avoid seeking care because of stigma. You may start to feel that you deserve to be treated badly because of your symptoms. If you have PTSD, you are not alone. Mental health concerns are just as common as physical health concerns. The best thing you can do for yourself is to take control and get help.

How Is PTSD Different for Service Members or Veterans?

When you are in the military, there are other things that may get in the way of seeking help. Military members may worry that talking about PTSD with doctors, other service members, or commanding officers will hurt their career. You may think if people in your unit learn you have PTSD, they will see you as weak, or not trust you to be able to protect them. Or you may feel that your medical records will be opened for other people to see.

Being afraid that seeking treatment will damage your career leads you to avoid getting help at a time when you need it most. Many don't get help until their return from deployment, or when their family tells them there is a problem. But you don't have to wait.

You may think that avoiding your PTSD is critical to keeping your job. If your PTSD symptoms are getting in the way of doing your duties, it is better to deal with them before they hurt your military career or other aspects of your life. Rather than creating a problem, PTSD treatment helps you solve problems.

If you have PTSD, you have treatment options. There are talk therapies and medications that have been shown to work in multiple studies. Learn how to compare the best options and work with your provider to make the best choices for yourself.

What Treatments Are Effective?

Research tells us that for the average patient, trauma-focused psychotherapies are the most effective treatment for PTSD. Antidepressant medications or other psychotherapies that do not focus on trauma are also recommended for PTSD.

Even among the most strongly recommended PTSD treatments, how well a particular treatment works can vary from one person to the next. At this time, there is no scientific way to know which PTSD treatment will work best for you as an individual.

What Is Shared Decision Making?

You will need to work together with your provider to choose a treatment that makes sense to you and suits your needs. This is called shared decision making. During this process, your provider will give you information about the pros and cons of different PTSD treatments. Don't be afraid to ask questions or tell your provider about your goals and preferences. You can have say in which treatment you receive. Ultimately, you and your provider can arrive at a decision that you both agree on.

If you are starting PTSD treatment or want to try something new, you have options. Some mental health providers offer talk therapy and others prescribe medication. There are also some who can do both for PTSD treatment. Learn about the different training for mental health providers who treat PTSD.

There are many types of professionals who provide evidence-based psychotherapy and medication to people who have experienced trauma. The information below reviews the most common types of licensed mental health providers—also called psychiatric care providers—and generally explains their education, training, and services offered.

Mental health professionals can have different training, credentials, or licenses. Providers can also offer different services, based upon their expertise. If you are looking for a particular type of treatment (like medications) or expert focus, the license and specialized training of the mental health provider is important. Your health insurance provider may also allow you to see only certain types of mental health professionals. Check your policy for details.

Who Is Licensed to Provide Psychotherapy for PTSD?

The mental health professionals below provide psychotherapy for PTSD, and in most states, are not licensed to prescribe medications.

Psychologists

Licensed clinical psychologists focus on mental health assessment and treatment. They have a doctoral degree (e.g., PhD, PsyD, EdD) from 4 or more years of graduate training in clinical or counseling psychology. To be licensed to practice, psychologists must have another 1 to 2 years of supervised clinical experience. Psychologists have the title of "doctor" because of their doctoral degree, but in most states they cannot prescribe medicine.

Clinical social workers

The purpose of social work is to enhance human well-being by helping people meet basic human needs. Licensed social workers also focus on diagnosis and treatment, and specialize in areas such as mental health, aging, of family and children. Most licensed social workers have a master's degree from 2 years of graduate training (e.g., MSW) or a doctoral degree in social work (e.g., DSW or PhD).

Licensed professional mental health counselors

Mental health professionals who obtain a master's degree in counseling, psychology, or marriage and family therapy may be licensed to provide individual and/or group counseling. These counselors must meet requirements that vary by state. Some examples include:

• Licensed Marriage and Family Therapist (LMFT)
• Licensed Professional Counselor (LPC)

Who Is Licensed to Provide Medications for PTSD?

Working with a specialist who commonly sees patients with PTSD is ideal. However, in addition to the mental health providers listed below, primary care physicians, physician's assistants and mental health clinical pharmacy specialists are usually qualified to prescribe medications for PTSD.

Psychiatrists

Psychiatrists have either a Doctor of Allopathic Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree in addition to specialized training in the diagnosis and treatment of mental health problems. Since they are medical doctors, psychiatrists can prescribe medicine. Some may also provide psychotherapy.

Psychiatric nurses or nurse practitioners

Psychiatric mental health nurses (PMHN) can have different levels of training. Most are registered nurses (RN) with additional training in psychiatry or psychology. Psychiatric mental health advanced practice registered nurses (PMH-APRN) have a graduate degree. Psychiatric nurse practitioners are registered nurse practitioners with specialized training in the diagnosis and treatment of mental health problems. In most states, psychiatric nurses and psychiatric nurse practitioners can prescribe medicine.

Anyone who has PTSD deserves the best treatment available. Whether you are a Veteran or someone who experienced a non-military trauma—when you get care in VA, at a Vet Center, or in the community, you need to feel sure that it's working for you.

Signs of Quality PTSD Care

Below are 4 signs of quality care to guide you through treatment. You can refer to them if you are in treatment, especially if you are not happy with your progress or before you begin to work with a provider. The signs don't all have to be present for you to know the treatment you are getting is high-quality. But each will improve your chances of getting the care you deserve.

You're involved in your care

If you have ever been diagnosed with a medical condition, your provider probably told you the treatment options, and you worked together—perhaps with your family as well—to decide on the care that was right for you. Why would your PTSD care be any different?

In the best case, your provider talks with you about the effective treatments that are available for PTSD—both psychotherapy (talk therapy) and medication (drug therapy). Together you can then discuss what matters most to you, what your goals are, and which treatments match up with your likes and dislikes.

For example, if you are OK with the idea of talking about your trauma with a therapist, trauma-focused talk therapy would be a good fit. If you know that you'll forget to take medications on a steady basis, drug therapy might not be the best choice for you.

Once treatment starts, you should stay an active player in your care. Depending on the treatment, that could mean doing some work on your own between appointments or taking your medication as directed.

You follow a proven treatment

There are a LOT of treatments available for PTSD, but evidence-based treatment has the best chance of working. Evidence-based treatments—both talk therapy and drug therapy—are treatments that have been proven to work for many people in multiple high-quality research studies.

Among evidence-based treatments, one type stands out: trauma-focused psychotherapy. It is the most effective PTSD treatment. "Trauma-focused" means that the treatment centers on the memory of the trauma or its meaning. There are different types of trauma-focused psychotherapy. Some names you might hear are:

• Prolonged Exposure (PE)
• Cognitive Processing Therapy (CPT)
• Eye Movement Desensitization and Reprocessing (EMDR)
• Written Exposure Therapy (WET)

Medication—drug therapy—also treats the symptoms of PTSD well. The evidence-based medications that have been shown to work best are: sertraline (Zoloft), paroxetine (Paxil), fluoxetine (Prozac) and venlafaxine (Effexor). If you choose medication to treat PTSD symptoms, you'll need to keep taking it for it to keep working.

There are other treatments available. If you are happy with a treatment not listed here, there is no need to change it. Sometimes people may choose a treatment that does not have a strong evidence base, and that treatment may be helpful.

Important note: There is one type of treatment that does not help with PTSD symptoms and can in fact be harmful - benzodiazepines—or "benzos." Some names you may have heard are: alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan) and temazepam (Restoril). Benzos are sometimes prescribed for short-term use to treat extreme anxiety, panic or sleep problems.

In the long-term, though, benzos can be addictive, cause other mental health problems, and make talk therapy less effective. If you are taking benzos for PTSD, work with your provider when making a plan to stop. There are other treatments that are safer and more effective.

Your progress is measured

Without checking your blood pressure or your weight, how would you know if your high blood pressure (hypertension) treatment or diet was working? It's the same with PTSD.

With the best PTSD treatment, your provider will monitor (or track) how you are doing. One way to do this is to have you fill out a brief questionnaire to measure your progress from time to time. Your provider will review the results with you and discuss what they mean for your treatment. If you are not seeing the results you want, you and your provider can talk about other treatment options to try.

You are improving

We have treatment options that have been shown to work, but there's not just one treatment that works for everyone. That means you have a choice about which treatment is best for you. Just as your preferences matter, so does your sense of how well you are doing. Even if the other signs of good PTSD care aren't part of your experience, if you feel you are making progress, stick with your treatment. You can always consider more or different treatment at another time if you feel the progress stops or you want to try another option.

Remember

Quality care for PTSD can take many forms. Seeking out these signs of good care in your PTSD treatment can keep you on the road to feeling better.

The treatments that work best for PTSD are trauma-focused psychotherapies (or, talk therapies). "Trauma-focused" means that the therapy focuses on your memory of the traumatic event or what it means to you. There are other talk therapies that do not focus on your trauma. Learn about the research for different talk therapies and what you can expect in treatment.

Most of the therapies below last for 3 to 4 months. Then, if you still have symptoms, you and your therapist can talk about ways to manage them using skills you learned in treatment.

Trauma-Focused Talk Therapies for PTSD

• Cognitive Processing Therapy (CPT)
  CPT teaches you how change the upsetting thoughts and feelings you have had since your trauma.
• Prolonged Exposure (PE)
  PE teaches you to gradually approach trauma-related memories, feelings and situations that you have been avoiding since your trauma.
• Eye Movement Desensitization and Reprocessing (EMDR)
  EMDR helps you process and make sense of your trauma while paying attention to a back-and-forth movement or sound (like a finger waving side to side, a light, or a tone).
• Written Exposure Therapy (WET)
  WET helps you find new ways to think about your trauma and its meaning through writing assignments you complete during sessions. This is a brief, 5-session therapy.

Other Talk Therapies for PTSD

• Stress Inoculation Training (SIT)
  SIT teaches coping skills to help you find new ways to manage PTSD symptoms or other stress in your life.
• Present-Centered Therapy (PCT)
  PCT focuses on learning how to deal with current life problems related to your traumatic experience or PTSD symptoms in ways that are adaptive.

Which PTSD Treatment Is Best for You?

No one treatment is right for everyone. You can read about different treatments, hear advice from people who have been through these treatments, and watch videos of providers explaining how the treatments work. You can also build a chart to compare the treatments you like the most and print a personalized summary that lists your symptoms, treatment preferences, and questions to share with your provider.

The best treatments for PTSD are trauma-focused talk therapies. These treatments help you process—or work through—your traumatic experience. Learn about Cognitive Processing Therapy (CPT), which teaches you to examine and change negative thoughts.

What Type of Treatment Is This?

Cognitive Processing Therapy (CPT) is one specific type of Cognitive Behavioral Therapy. It is a 12-session psychotherapy for PTSD. CPT teaches you how to evaluate and change the upsetting thoughts you have had since your trauma. By changing your thoughts, you can change how you feel.

How Does It Work?

Trauma can change the way you think about yourself and the world. You may believe you are to blame for what happened or that the world is a dangerous place. These kinds of thoughts keep you stuck in your PTSD and cause you to miss out on things you used to enjoy. CPT teaches you a new way to handle these upsetting thoughts. In CPT, you will learn skills that can help you decide whether there are more helpful ways to think about your trauma. You will learn how to examine whether the facts support your thought or do not support your thought. And ultimately, you can decide whether or not it makes sense to take a new perspective.

What Can I Expect?

Your provider will start off by giving you an overview of the treatment. Together, you will review some information about PTSD in order to help you better understand your symptoms. Your provider probably will ask about the type of trauma you experienced, but you will not need to go into great detail right away. Your provider will also ask you to do some writing about how your trauma has affected you. Over the next several sessions, you will talk about any negative or unhelpful thoughts you have been having about the trauma, and you will work together to learn to consider other ways of thinking about the situation. You will use worksheets in session and at home that help you learn this strategy. CPT can also include writing about the details of your trauma (although sometimes this can be skipped). This may sound difficult at first, but you may be more able to cope with emotions like anger, sadness and guilt by talking it over with your therapist. Towards the end of therapy, you and your therapist will focus on some specific areas of your life that may have been affected by the trauma, including your sense of safety, trust, control, self-esteem, and intimacy.

Is It Effective?

Yes, trauma-focused psychotherapy (including Cognitive Processing Therapy) is one of the most effective types of treatment for PTSD.

How Long Does Treatment Last?

CPT usually takes 12 weekly sessions, so treatment lasts about 3 months. Sessions are 60 to 90 minutes each. You may start to feel better after a few sessions. And the benefits of CPT often last long after your final session with your provider.

What Are the Risks?

The risks of doing CPT are mild to moderate discomfort when talking or writing about trauma-related memories or beliefs. These feelings are usually brief and people tend to feel better as they keep doing CPT. Most people who complete CPT find that the benefits outweigh any initial discomfort.

Group or Individual?

CPT can be done individually, where you meet one-to-one with a provider. CPT can also be done in a group with one or two providers and about 6-10 other people who also have PTSD.

Will I Talk in Detail about My Trauma?

Around your 3rd session, you may be asked to write about the details of your trauma. This writing assignment will be done at home. You will read this written trauma account out loud in your next session. If you are in group CPT, you will read through your written trauma account with a provider--but not in front of the whole group. There is also another type of CPT that does not ask you to write about the details of your trauma.

Will I Have Homework?

Yes, you will do some writing and complete worksheets between sessions. Take home worksheets help you practice in real life the skills you learn in the therapist's office. Most people find that the more effort and energy they put into these assignments, the more they get out of CPT.

The best treatments for PTSD are trauma-focused talk therapies. These treatments help you process—or work through—your traumatic experience. Learn about Prolonged Exposure (PE), which teaches you not to be afraid of the memory of your trauma or other trauma reminders.

What Type of Treatment Is This?

Prolonged Exposure (PE) is a psychotherapy—or talk therapy— for PTSD. It is one specific type of Cognitive Behavioral Therapy. PE teaches you to gradually approach trauma-related memories, feelings, and situations that you have been avoiding since your trauma. By confronting these challenges, you can actually decrease your PTSD symptoms.

How Does It Work?

People with PTSD often try to avoid anything that reminds them of the trauma. This can help you feel better in the moment, but not in the long term. Avoiding these feelings and situations actually keeps you from recovering from PTSD. PE works by helping you face your fears. By talking about the details of the trauma and by confronting safe situations that you have been avoiding, you can decrease your PTSD symptoms and regain more control of your life.

What Can I Expect?

Your provider will start by giving you an overview of treatment and getting to know more about your past experiences. You will also learn a breathing technique to help you manage anxiety. Around your second session, you will work with your provider to make a list of people, places, or activities that you have stayed away from since your trauma. Over the course of therapy, you will work through your list step-by-step, practicing in vivo exposure. This means that you will gradually confront these situations. With time, you will find that you can feel comfortable in these situations--and you will not need to avoid them anymore. After a few sessions, you will begin to talk through the details of your trauma with your provider. This is called imaginal exposure. Talking about the trauma can help with emotions like fear, anger, and sadness. You will listen to recordings of your imaginal exposure between sessions. By confronting the details of the trauma in therapy, you will find that you have fewer unwanted memories at other times.

Is It Effective?

Yes, trauma-focused psychotherapy (including Prolonged Exposure) is one of the most effective types of treatment for PTSD.

How Long Does Treatment Last?

PE usually takes 8-15 weekly sessions, so treatment lasts about 3 months. Sessions are 1.5 hours each. You may start to feel better after a few sessions. And the benefits of PE often last long after your final session with your provider.

What Are the Risks?

The risks of doing PE are mild to moderate discomfort when engaging in new activities and when talking about trauma related memories. These feelings are usually brief and people tend to feel better as they keep doing PE. There is also a slight risk that someone could listen to a therapy session without your permission if the recording was not secure. You and your provider can discuss ways to secure your personal information related to this program. Most people who complete PE find that the benefits outweigh any initial discomfort.

Group or Individual?

PE is an individual therapy. You will meet one-to-one with your provider for each session.

Will I Talk in Detail about My Trauma?

Yes, around your 3rd session, you will start talking in detail about your trauma. Your provider will guide you through it, keep track of your anxiety level as you talk, and make sure you take things at your own pace. You will listen to a recording of this part of your session at home between sessions.

Will I Have Homework?

Yes, you will practice doing some of the things you have avoided since your trauma. You will start with activities that are manageable for you, and you will work up to activities that are more challenging. You will also listen to a recording of your therapy sessions, including your imaginal exposure recording. Practicing these skills between sessions helps you get the most out of PE.

The best treatments for PTSD are trauma-focused talk therapies. These treatments help you process—or work through—your traumatic experience. Learn about Eye Movement Desensitization and Reprocessing (EMDR), which helps you think about the trauma in a different way.

What Type of Treatment Is This?

Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapy—or talk therapy—for PTSD. EMDR can help you process upsetting memories, thoughts, and feelings related to the trauma. By processing these experiences, you can get relief from PTSD symptoms.

How Does It Work?

After trauma, people with PTSD often have trouble making sense of what happened to them. EMDR helps you process the trauma, which can allow you to start to heal. In EMDR, you will pay attention to a back-and-forth movement or sound while you call to mind the upsetting memory until shifts occur in the way that you experience that memory and more information from the past is processed. Although EMDR is an effective treatment for PTSD, there is disagreement about how it works. Some research shows that the back and forth movement is an important part of treatment, but other research shows the opposite.

What Can I Expect?

During the first stage, you will learn about physical and emotional reactions to trauma. You and your provider will discuss how ready you are to focus on your trauma memories in therapy. To prepare, you will learn some new coping skills. Next, you will identify the "target", or the upsetting memory you want to focus on--including any negative thoughts, feelings and bodily sensations related to the memory. You will hold the memory in your mind while also paying attention to a back-and-forth movement or sound (like your provider's moving finger, a flashing light, or a tone that beeps in one ear at a time) until your distress goes down. This will last for about 30 seconds at a time, and then you will talk about what the exercise was like for you. Eventually, you will focus on a positive belief and feeling while you hold the memory in your mind. Towards the end of treatment, your provider will re-assess your symptoms to see if you need to process other targets.

Is It Effective?

Yes, trauma-focused psychotherapy (including Eye Movement Desensitization and Reprocessing) is one of the most effective types of treatment for PTSD.

What Are the Risks?

You may feel uncomfortable when focusing on trauma-related memories or beliefs. These feelings are usually brief and people tend to feel better as they keep doing EMDR. Most people who complete EMDR find that the benefits outweigh any initial discomfort.

Group or Individual?

EMDR is an individual therapy. You will meet one-to-one with your provider for each session.

Will I Talk in Detail about My Trauma?

No, in most cases you will not be asked to talk about the details of your trauma out loud. But you will be asked to think about your trauma in session.

Will I Have Homework?

No, EMDR does not require you to complete homework or practice assignments between sessions.

How Long Does Treatment Last?

About 1-3 months of weekly 50-90 minute sessions. But, many people start to notice improvement after a few sessions. And the benefits of EMDR can last long after your final session with your provider.

The best treatments for PTSD are trauma-focused talk therapies. These treatments help you process—or work through—your traumatic experience. Learn about Written Exposure Therapy (WET), where you focus on writing about your trauma to find new ways to think about its meaning.

What Type of Treatment Is This?

Written Exposure Therapy (WET) is a brief, 5-session psychotherapy—or talk therapy—for PTSD. WET can help you find new ways to think about a traumatic experience and what it means to you. Writing about what you were thinking and feeling during the event and then talking with your provider about the writing session can help you get relief from PTSD symptoms.

How Does It Work?

When you have PTSD, it's common to feel that the traumatic experience you went through is too difficult or stressful to manage. You likely avoid reminders (like people or situations) from the event, feeling a sense of danger. WET can help you learn to experience a trauma memory with less emotional distress, knowing that you can tolerate negative feelings as you remember the event. Writing about the event can also help you be more comfortable with physical responses, like a rapid heartbeat or sweating. And talking with your provider about your writing sessions can help you develop new ways of thinking about the event and what it means to you.

What Can I Expect?

In WET, there are 5 sessions that have 30 minutes of writing about your trauma, called your trauma narrative. You will start the first session by learning about PTSD symptoms and common reactions to trauma. Then, your therapist will instruct you on how to complete the first 30-minute writing exercise. Your provider will then check in with you about your experience while writing. For the remaining therapy sessions, your provider will offer instructions for each 30-minute writing exercise and then talk with you when the trauma narrative is complete. Over time you will learn to manage thoughts and feelings about the event and find new meanings that help reduce your PTSD symptoms.

Is It Effective?

Yes, WET is a therapy supported by research. Currently, there are not as many studies on WET as the number of those supporting other trauma-focused psychotherapies, like Cognitive Processing Therapy (CPT), Prolonged Exposure (PE) or Eye Movement Desensitization and Reprocessing (EMDR). What we know from research thus far is that WET is effective in reducing PTSD symptoms. This symptom improvement takes fewer sessions than some of the other treatments, and those who start WET are more likely to complete the therapy.

More research is underway to learn about WET for people who experience different types of trauma and to understand other factors that may affect treatment. WET may be a good option if these other trauma-focused talk therapies are not available to you, or the idea of writing a trauma narrative is of interest to you.

How Long Does Treatment Last?

WET includes 5 sessions that last about 50 minutes. Typically, you have 1 session a week, for a total of 5 weeks.

What Are the Risks?

You may feel uncomfortable writing about your trauma and talking about your problems or PTSD symptoms. These feelings are usually brief and people tend to feel better as they keep doing WET. Most people who complete WET find that the benefits outweigh any initial discomfort.

Group or Individual?

WET is done individually, where you meet 1-to-1 with a provider.

Will I Talk in Detail About My Trauma?

You will write in detail about your traumatic event during each session. WET will help you to better understand how your PTSD symptoms may be related to your thoughts and feelings about the trauma, and how distress reduces with time and danger from a past event does not carry over to the memory of it happening.

Will I Have Homework?

There are no homework assignments between sessions in WET.

The treatments that work best for PTSD focus on the trauma you experienced. You may prefer a treatment that does not have this focus. The research support is not as strong for these therapies, but they do help you work through your reactions to the trauma and PTSD symptoms. Learn about Stress Inoculation Training (SIT), which teaches you skills and techniques to manage stress and reduce anxiety.

What Type of Treatment Is This?

Stress Inoculation Training (SIT) is a psychotherapy—or talk therapy—for PTSD. It is one specific type of cognitive behavioral therapy. By teaching you coping skills, SIT can help you find new ways to deal with PTSD symptoms. These skills can also help you manage other stressful situations or events in your life.

How Does It Work?

People with PTSD are often under a lot of stress and may have a hard time coping with their symptoms. SIT teaches you skills to react differently to stressful situations and to manage your PTSD symptoms. You will consider how different situations, thoughts, and behaviors could be making it hard for you to deal with your PTSD symptoms. With your provider, you will learn how to develop more helpful ways of coping. With practice, you will become more confident in your ability to use the coping skills to manage your PTSD symptoms.

What Can I Expect?

During the first phase of SIT you will learn about PTSD symptoms and identify the sources of your stress. You will talk about your usual ways of coping with PTSD symptoms. You will also learn how to keep track of your stress level. The next phase involves learning and practicing new problem-solving strategies and coping skills that can help you relax your body and your breathing, stop upsetting thoughts, and stay in the moment. You will practice each skill in session, and then at home on your own. You also discuss whether you can change any of the things in your life causing you stress—or at least change how you react to them. Towards the end of treatment, you will review your progress and make a plan for how to handle stressful situations that could come up in the future.

Is It Effective?

Yes, SIT is a therapy supported by research. The evidence for this therapy is not as strong as research supporting trauma-focused psychotherapies like Cognitive Processing Therapy (CPT), Prolonged Exposure (PE) or Eye Movement Desensitization and Reprocessing (EMDR). However, SIT may be a good option if trauma-focused psychotherapy is not of interest or available to you.

How Long Does Treatment Last?

About 3 months of weekly 60-90 minute sessions. You may decide to meet with your provider less often (for example, every other week) towards the end of treatment. Many people notice improvement after a few sessions.

What Are the Risks?

You may feel uncomfortable talking about your problems or PTSD symptoms. These feelings are usually brief, and people tend to feel better as they keep doing SIT. Most people who complete SIT find that the benefits outweigh any initial discomfort.

Group or Individual?

SIT is often done in a group with one or two providers and other people who also have PTSD. SIT can also be done individually, where you meet one-to-one with a provider.

Will I Talk in Detail About My Trauma?

No, SIT does not require you to talk in detail about the trauma. In fact, you may be asked not to mention any details of your trauma at all.

Will I Have Homework?

Yes, you will practice using stress management skills learned in therapy.

The treatments that work best for PTSD focus on the trauma you experienced. You may prefer a treatment that does not have this focus. The research support is not as strong for these therapies, but they do help you work through your reactions to the trauma and PTSD symptoms. Learn about Present-Centered Therapy (PCT), which teaches you how to deal with current life problems related to your trauma or PTSD.

What Type of Treatment Is This?

Present-Centered Therapy (PCT) is a psychotherapy—or talk therapy—for PTSD. PCT can help you learn how to respond to current life problems related to your trauma or PTSD symptoms by problem-solving. By learning about PTSD symptoms and how they may affect your current emotions and problems in your life you can think about ways of reacting that draw upon your strengths.

How Does It Work?

When you have PTSD, the symptoms can affect how you feel about and react to relationships and problems in your daily life. By learning how to identify the ways in which your PTSD symptoms may impact your feelings and actions, you can learn new ways to respond. Learning to problem-solve can help you feel more in control and have confidence in your ability to face problems in your daily life.

What Can I Expect?

In PCT, you will start by learning about PTSD symptoms and common reactions to trauma. Then, you will talk with your provider about topics that are important to you, such as problems and concerns you have during the week. You will learn to problem-solve challenges you have in relationships and in your daily life that are related to your PTSD symptoms. Over time you will learn to identify problems that come up and develop new ideas about how to respond in ways that create hope and draw upon your strengths.

Is It Effective?

Yes, PCT is a therapy supported by research. The evidence for this therapy is not as strong as research supporting trauma-focused psychotherapies, like Cognitive Processing Therapy (CPT), Prolonged Exposure (PE) or Eye Movement Desensitization and Reprocessing (EMDR). However, PCT may be a good option if trauma-focused psychotherapy is not of interest or available to you.

How Long Does Treatment Last?

The number and length of PCT sessions may vary. For individual format, the number of sessions tends to be 10 to 12 weekly meetings, lasting 60 to 90 minutes each. In group-delivered format, there may be more sessions, from 3 to 8 months, meeting once a week.

What Are the Risks?

You may feel uncomfortable talking about your problems or PTSD symptoms. These feelings are usually brief and people tend to feel better as they keep doing PCT. Most people who complete PCT find that the benefits outweigh any initial discomfort.

Group or Individual?

PCT can be done individually, where you meet 1-to-1 with a provider. PCT can also be done in a group format with 1 or 2 providers and about 6-8 other people who also have PTSD.

Will I Talk in Detail About My Trauma?

PCT is not a trauma-focused psychotherapy, which means the therapy does not focus on your traumatic event. You will have the opportunity to talk about your trauma in the first session if you want to, but this is not required. PCT will help you to better understand how your PTSD symptoms may be related to current problems you are dealing with, and to develop ways of responding that work better for you.

Will I Have Homework?

In PCT, you will be encouraged to use a daily diary to note issues and problems that concern you between sessions.

There are 4 medications recommended to treat PTSD symptoms. These medications are also used to treat depression. When used for PTSD, they can reduce PTSD symptoms. Learn more about the recommended medications for PTSD.

What Type of Treatment Is This?

SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) are types of antidepressant medication. Medications have 2 names: a brand name (for example, Zoloft) and a generic name (for example, sertraline). There are 4 SSRIs/SNRIs that are recommended for PTSD:

• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Fluoxetine (Prozac)
• Venlafaxine (Effexor)

There are other types of antidepressant medications, but these four medications listed above are the ones that are most effective for PTSD.

Are There Other Medication Options for PTSD?

There are other medications that may be helpful, although the evidence behind them is not as strong as for SSRIs and SNRIs (listed above). These include:

• Nefazodone (Serzone)
  A serotonin reuptake inhibitor (SRI) that works by changing the levels and activity of naturally occurring chemical signals in the brain.
• Imipramine (Tofranil)
  A tricyclic antidepressant (TCA) which acts by altering naturally occurring chemicals which help brain cells communicate and can lift mood.
• Phenelzine (Nardil)
  A monoamine oxidase inhibitor (MAOI) which inactivates a naturally occurring enzyme which breaks down the neurotransmitters serotonin, norepinephrine and dopamine.

How Does It Work?

PTSD may be related to changes in the brain that are linked to our ability to manage stress. People with PTSD appear to have different amounts of certain chemicals (called neurotransmitters) in the brain than people without PTSD. The 4 recommended SSRIs and SNRIs are believed to treat PTSD by putting these brain chemicals back in balance.

What Can I Expect?

To receive medications for PTSD, you will need to meet with a provider who can prescribe these medications to you. Many different types of providers, including your family provider and even some nurses and physician assistants, can prescribe antidepressant medications for PTSD. You and your provider can work together to decide which antidepressant medication may be best for you.

In general, the 4 different SSRIs and SNRIs listed above appear to work equally well for PTSD. Once you fill your prescription, you will begin taking a pill at regular time(s) each day. It may take a few weeks before you notice the effects of the medication. It is important to continue to take it even if you do not notice changes right away. You will meet with your provider every few months or so. Your provider will monitor your response to the medication (including side effects) and change your dose, if needed.

Is It Effective?

Yes, certain SSRIs and SNRIs are some of the most effective treatments for PTSD. Not all SSRIs and SNRIs are effective for PTSD.

What Are the Risks?

The risks of taking SSRIs and SNRIs are mild to moderate side effects such as upset stomach, sweating, headache, and dizziness. Some people have sexual side effects, such as decreased desire to have sex or difficulty having an orgasm. Some side effects are short-term, though others may last as long as you are taking the medication.

Group or Individual?

You will attend regular 1-on-1 visits with the provider who prescribes you the medication.

Will I Talk in Detail about My Trauma?

No, you will not need to talk about the details of your trauma. However, your provider may ask for some basic information about your trauma—like the type of trauma and when it happened—when you first meet.

Will I Have Homework?

No, you will just need to take your medication as prescribed.

How Long Does Treatment Last?

You may start to feel better in about 4-6 weeks. You will need to keep taking the medication to keep getting the benefits.

Certain medications may be used to treat PTSD symptoms. Some PTSD symptoms are related to sleep problems or anxiety. A doctor may give you benzodiazepines—or "benzos"—for sleep or anxiety symptoms. Benzos are not recommended for PTSD. Learn about the long-term side effects of benzos and better treatment options.

What Are Benzodiazepines?

Benzodiazepines—also known as "benzos"—are a group of anti-anxiety medications that make people feel calm, relaxed, or sleepy. They are recommended for short-term treatment of severe anxiety, panic, or insomnia. They are also used to treat or prevent seizures.

Some commonly used benzodiazepines are: alprazolam (Xanax®), clonazepam (Klonopin®), diazepam (Valium®), lorazepam (Ativan®) and temazepam (Restoril®).

What Problems Arise from Long-Term Use of Benzodiazepines for PTSD?

Benzodiazepines provide short-term relief from distressing feelings but can become a problem in the long run. You can become dependent on the medication and end up feeling like you cannot face stressful situations without it.

If you use benzodiazepines to escape reminders of your trauma, you never truly learn to manage your stress. This makes it harder to recover from PTSD. Effective treatments for PTSD, like talk therapy, help you stop avoiding distressing situations and memories. And, the most effective talk therapies for PTSD, trauma-focused psychotherapies, focus on the memory of the traumatic event or its meaning.

If you take benzodiazepines for a long period of time you can become physically dependent. This means you would go into "withdrawal" without the medication. In withdrawal, cravings can be constant and intense. At this point it is hard to stop taking the medication. Efforts to obtain the medication to stop the withdrawal symptoms can get in the way of other things like work and family. It can also be dangerous if done suddenly, without the help of a health care provider.

There are other problems with benzodiazepine use that you should know about:

• Accidental overdose. Taking benzodiazepines and alcohol, street drugs, strong pain medication (opioids) or other sedatives at the same time can be fatal.
• Mood problems. Benzodiazepine use can create problems with depression, irritability and anger.
• Trouble with thinking and memory. Benzodiazepines can lead to poor attention, confusion and fogginess. Use of benzodiazepines is linked to dementia and Alzheimer's disease.
• Slow reaction time. People taking benzodiazepines have more car accidents and falls, which can result in fractures and other injuries.
• Breathing problems. Benzodiazepines make chronic obstructive pulmonary disease (COPD) and sleep apnea worse.
• Pregnancy risks. Women who are pregnant or planning to become pregnant should be aware of possible risks of benzodiazepine use on their newborn. These children may be born early, have a low birth weight or experience symptoms of withdrawal.

How Do You Decrease Benzodiazepine Use?

You should not stop benzodiazepines suddenly. It's safer to decrease the amount taken slowly, called tapering. The taper usually takes 4 to 6 months but can take longer in people who have been taking benzodiazepines for a long time. When you are ready to start tapering, talk to your provider.

Tapering slowly helps reduce uncomfortable withdrawal symptoms. There are also some medications that can help with the discomfort. Coping skills such as deep breathing, relaxation, mindfulness or exercise can reduce symptoms. Getting help from family and friends or joining a support group can also help.

What Are Better Options for Treating PTSD?

There are many effective treatment options. Trauma-focused therapy and some antidepressants work best. Talk with your provider about which options are best for you.

What Is Life Like After Reducing Benzodiazepines?

Research shows that many people who slowly stop benzodiazepines can stay off them and feel better. You may notice more alertness, better coordination and improved memory and mood. Once off of benzodiazepines, you can get a treatment for PTSD that has better, more lasting benefits.

Mindfulness means noticing and paying attention to what is going on in the present moment. It also means not making judgment. Learn how mindfulness might help you cope with stress or difficult emotions.

What Is Mindfulness?

Mindfulness is a way of thinking and focusing that can help you become more aware of your present experiences. Practicing mindfulness can be as simple as noticing the taste of a mint on your tongue. There are some things you might do every day without even thinking about them, like brushing your teeth in the morning. Mindfulness involves paying attention to the feelings and sensations of these experiences.

While researchers have not yet studied the effects of mindfulness practice in helping trauma survivors diagnosed with PTSD, research has shown mindfulness to be helpful with other anxiety problems. It has also been shown to help with symptoms of PTSD, such as avoidance and hyperarousal. If you have gone through trauma, you may want to learn what mindfulness is and how it might be helpful to you.

Mindfulness practice has two key parts:

• Paying attention to and being aware of the present moment
• Accepting or being willing to experience your thoughts and feelings without judging them

For example, focusing on the inhale and exhale of your breathing is one way to concentrate on the present moment. Mindfulness involves allowing your thoughts and feelings to pass without either clinging to them or pushing them away. You just let them take their natural course. While practicing mindfulness, you may become distracted by your thoughts and that is okay. The process is about being willing to notice where your thoughts take you, and then bringing your attention back to the present.

How Can Mindfulness Help Reduce Trauma Reactions?

Mindfulness might increase your ability to cope with difficult emotions, such as anxiety and depression. Practicing mindfulness can help you to be more focused and aware of the present moment while also being more willing to experience the difficult emotions that sometimes come up after trauma. For example, mindfulness practice might help you to notice your thoughts and feelings more and to be able to just let them go, without labeling them as "good" or "bad" and without acting on them by avoiding or behaving impulsively.

Mindfulness is a practice, a continual process. Although it may be hard to do at first, regular mindfulness practice can help you notice your thoughts and learn to take a step back from them. Mindfulness practice can also help you develop more compassion toward yourself and others. You may be less likely to sit in judgment of your thoughts, feelings, and actions. You may become less critical of yourself. Using mindfulness can help you become more aware and gentle in response to your trauma reactions. This is an important step in recovery.

Cognitive Processing Therapy and Prolonged Exposure have been shown to be the most effective treatments for PTSD. In both of these treatments, you are asked to write or talk about trauma with the guidance of your therapist. Mindfulness can prepare you for these treatments by giving you skills and confidence that you can handle your feelings. As you learn to be mindful, you learn to observe what is happening in your body and your mind. You can learn to be more willing to cope with difficult thoughts and feelings in a healthy way. This will help you keep going when you are asked to think and talk about your trauma in treatment. In this way you may get even more out of the PTSD treatment.

There are several types of therapy that use mindfulness practices. These therapies have been used to treat problems that often affect people with PTSD, such as anxiety, depression, and substance use. The therapies may target specific problems such as:

• Difficult feelings and stress in daily living
• The stress of physical health problems, such as chronic pain
• Negative thinking patterns that can lead to repeated episodes of depression
• Trouble working towards your goals in life
• Urges to use drugs or alcohol

Summing It Up

Mindfulness practices may be of benefit to trauma survivors. Research findings show that mindfulness can help with problems and symptoms often experienced by survivors. Mindfulness could be used by itself or together with standard treatments proven effective for PTSD. Learn more about specific PTSD treatments that work.

Support from others who understand your trauma and PTSD symptoms may help your recovery. Peer support groups are not treatment for PTSD but may help you feel connected to others. Learn about the benefits of peer support groups and how you can find one.

Peer support groups are a place where you can discuss day-to-day problems with other people who have been through trauma. Support groups have not been shown to reduce PTSD symptoms, but they can help you feel better in other ways. Because they can give you a sense of connection to other people, a peer support group could be a great addition to your treatment. Support groups can also help family members or friends who are caring for someone with PTSD.

Remember, if you are suffering from PTSD, is it important that you get treatment for PTSD as well. An evidence-based treatment provides the best chance of recovery from PTSD.

What Are Peer Support Groups Like?

Peer support groups are led by someone like you who has been through a trauma. Groups often meet in person, but many groups also provide online (Internet) support.

Sharing your story with others may help you feel more comfortable talking about your trauma. Or it may help to listen to other people talk about their experiences with a similar trauma. Peer support groups can help you cope with memories of the trauma or other parts of your life that you are having trouble dealing with as a result of the event. You may learn to deal with emotions such as anger, shame, guilt, and fear if you open up to others who understand.

When you connect with other people it can help you feel better. You can work together with others to get better at talking about your PTSD or learning how to ask for help when you need it. You might even share some of the materials from this website to help others.

What Are the Benefits of Joining a Peer Support Group?

Joining a peer support group can help you to feel better in any number of ways, such as:

• Knowing that others are going through something similar
• Learning tips on how to handle day-to-day challenges
• Meeting new friends or connecting to others who understand you
• Learning how to talk about things that bother you or how to ask for help
• Learning to trust other people
• Hearing about helpful new perspectives from others

Peer support groups can be an important part of dealing with PTSD, but they are not a substitute for effective treatment for PTSD. If you have problems after a trauma that last more than a short time, you should get professional help.

You may find a dog can lift your mood and be a good companion. There is not enough research to know if dogs help treat PTSD and symptoms. Learn about service dogs and emotional support dogs.

Owning a dog can lift your mood or help you feel less stressed. Dogs can help people feel better by providing companionship. All dog owners, including those who have posttraumatic stress disorder (PTSD) can experience these benefits.

Currently, there is not enough research to know if dogs help treat PTSD and its symptoms. Evidence-based therapies and medications for PTSD are supported by clinical research. We encourage you to learn more about these treatments because it is difficult to draw strong conclusions from the few studies on dogs and PTSD that have been done.

What Are the Emotional Benefits of Having a Dog?

Dogs can make great pets. Having a dog as a pet can benefit anyone who likes dogs, including people with PTSD. For example, dogs:

• Help bring out feelings of love.
• Are good companions.
• Take orders well when trained. This can be very comfortable for a Service member or Veteran who was used to giving orders in the military.
• Are fun and can help reduce stress.
• Are a good reason to get out of the house, spend time outdoors, and meet new people.

Recovering from PTSD

Recovering from PTSD is a process. Evidence-based treatments for PTSD help people do things they have been avoiding because of their PTSD, such as standing close to a stranger or going into a building without scanning it for danger first. Evidence-based treatments can also help people feel better. Dogs can help you deal with some parts of living with PTSD, but they are not a substitute for effective PTSD treatment.

Although people with PTSD who have a service dog for a physical disability or emotional support dog may feel comforted by the animal, there is some chance they may continue to believe that they cannot do certain things on their own. For example, if the dog keeps strangers from coming too close, the owner will not have a chance to learn that they can handle this situation without the dog. Becoming dependent on a dog can get in the way of the recovery process for PTSD. Based on what we know from research, evidence-based treatment provides the best chance of recovery from PTSD.

Service Dogs and Emotional Support Dogs

Service dogs

A service dog is a dog trained to do specific tasks for a person that the person cannot do because of a disability. Service dogs can pick things up, guide a person with vision problems, or help someone who falls or loses balance easily. For example, a service dog can help a blind person walk down the street or get dangerous things out of the way when someone is having a seizure.

Protecting someone, giving emotional support, or being a companion do not qualify a dog to be a service animal. To be a service dog, a dog must go through training. Usually the dog is trained to:

• Do things that are different from natural dog behavior
• Do things that the handler (dog owner) cannot do because of a disability
• Learn to work with the handler in ways that help manage the handler's disability

Because the handler depends on the service dog's help, service dogs are allowed in most public places the handler goes. This is the case even if it is somewhere pet dogs usually cannot go, like restaurants or on airplanes. But there are a few exceptions. For example, service dogs can be asked to leave if they are not behaving well.

Emotional support dogs

An emotional support animal is a pet that helps an owner with a mental health condition. Emotional support dogs help owners feel better by giving friendship and companionship. These dogs are also called comfort dogs or support dogs.

An emotional support dog does not need special training. Generally, a regular pet can be an emotional support dog if a mental health provider writes a letter saying that the owner has a mental health condition or disability and needs the dog's help for emotional support.

In most states, emotional support dogs do not have special permission to go to all public places like service dogs do. But, emotional support dogs are sometimes allowed special consideration. For example, the owner may be able to get permission to have an emotional support pet in a house or apartment that does not normally allow dogs. Or, the owner may be able to get permission to fly on a plane together with the dog.

To get special permissions, the dog owner needs to show a provider's letter to the landlord or airline. Sometimes, the landlord or airline will also want to see information about the provider, such as a copy of their professional license.

What Do I Need to Know about Dogs and PTSD?

Pets, service animals, and emotional support dogs need owners who can provide for them. Dogs require constant attention and care. It is a good idea to discuss getting a dog with your doctor or family before making the decision. If you have PTSD and are worried that it may be hard for you to provide a safe, caring home for a dog, it may be good to wait until after you get treatment for your PTSD and feel better.

You may already have a dog that helps you feel better or do things you would not otherwise do. But learning more about evidence-based PTSD treatments is important. Unlike people who have service dogs because they have permanent disabilities (like blindness or seizure disorders), people with PTSD can get better with treatment.

If you are looking for a service dog or emotional support dog, we recommend you carefully research any organizations you contact. You should only get a dog if you are confident it is well trained. The organization should be able to answer any questions you have.

If you are experiencing symptoms of PTSD, treatment can turn your life around. PTSD treatment allows you to take control of your life. It can improve sleep and relationships, reduce substance use, and help you learn coping skills. No matter how PTSD is affecting your life, treatment can help you get back to doing the things you enjoy.

“The great thing about mental health treatment is that we work with patients to individualize their care so that they can return to the life they want,” says Dr. Lisa-Ann Cuccurullo, a clinical psychologist at the National Center for PTSD.

“We know that trauma-focused psychotherapies, or talk therapy that focuses on the memory of a traumatic event or its meaning, are the most effective treatments for PTSD, but within those treatments there is room to focus on the individual's needs and wants. There is life after PTSD treatment.”

A Return to Activities and Routines

One of the most common symptoms of PTSD is avoidance. This may mean avoiding people or places that remind you of trauma. It could mean using drugs or alcohol to avoid memories, or to try and relax. Sometimes it means avoiding crowds, traffic, unfamiliar situations, or any number of things that may interfere with your day-to-day life.

Through PTSD treatment, it is possible to address and resolve avoidance, allowing you to return to your routines or activities that you enjoy, or start new ones. Treatments like:

• Prolonged Exposure (PE) help you safely approach the things you’ve been avoiding since your trauma.
• Cognitive Processing Therapy (CPT) helps you examine and challenge your beliefs—about the trauma, yourself, or your surroundings—and balance them in a positive, realistic way.

Effective therapy is not one size fits all; you can work with your health care team to find the best treatment for you. Every VA medical center in the country will have a provider trained in at least one of the most recommended treatment programs for PTSD, including PE and CPT. Find a program or mental health care professional near you.