PTSD Treatment: How to Support Clients Dealing With Trauma

Imagine going through a traumatic experience like a car accident, earthquake, or explosion.

That would be bad enough, wouldn’t it?

Now imagine reliving the experience, again and again, each day like a terrible nightmare. That really would be devastating, and it happens to many people around the world.

Unfortunately, some people who experience trauma develop post-traumatic stress disorder (van der Kolk, 2000). They need plenty of support and treatment when this happens.

You will learn more about post-traumatic stress disorder (PTSD), trauma, and the availability of treatments and resources in this article. Then you will be in a much better position to help your clients experiencing PTSD and trauma.

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PTSD and Trauma: A Psychological Explanation

To understand this correlation, we start with a very brief history of PTSD.

1. Brief historical background

Historically, PTSD was known as ‘shell shock’ in World War I (Myers, 1915). Mention of the disorder first appeared in The Lancet, with soldiers documented as having various symptoms affecting their nervous system (Myers, 1915).

In World War II, it was referred to as ‘combat fatigue’ and believed to be related to long deployments (Marlowe, 2001).

2. Types of trauma

Trauma can be overwhelming for a person in psychological terms (Neria, Nandi, & Galea, 2008). A car accident, robbery, kidnap, torture, brutal attack, rape, witnessing death or a serious injury, war, and natural disaster can be classified as traumatic events (Kessler et al., 2014).

Traumatic events are quite common. By the age of 16, most people have experienced at least one traumatic event (Copeland, Keeler, Angold, & Costello, 2007). Psychological trauma, including onetime events, multiple occasions, and long-term repeated events, affects everyone differently (Bonanno, 2004).

3. Relationship between PTSD and trauma

PTSD and trauma are closely related and often discussed relative to each other (van der Kolk, 2000).

Like other mental health conditions, PTSD does not discriminate between age, gender, ethnicity, or culture. Nevertheless, higher rates have been found in some populations (Beals et al., 2013) and lower rates in others (Creamer, Burgess, & McFarlane, 2001).

PTSD comes with a complex set of symptoms, including somatic, cognitive, affective, and behavioral, that are the effects of psychological trauma (van der Kolk, McFarlane, & Weisaeth, 1996).

4. Etiology of PTSD

There are several pre-existing individual and societal risk factors associated with PTSD.

Gender, age at trauma, lower levels of education, lower socioeconomic status, pre-existing trauma, adverse childhood experiences, marital status, poor social support, and initial severity of the reaction to the trauma are some factors (Kroll, 2003; Stein, Walker, & Hazen, 1997; Sareen, 2014).

Genetic research has also suggested a relationship between the development of PTSD and specific genes (Zhao et al., 2017) and receptor proteins (Miller, Wolf, Logue, & Baldwin, 2013).

5. Criteria symptoms for PTSD

The criteria for PTSD are intrusive thoughts, nightmares, and flashbacks of past traumatic events; avoidance of reminders of trauma; hypervigilance; and sleep disturbance (American Psychiatric Association, 2013). These can lead to considerable social, occupational, and interpersonal dysfunction (Bryant, Friedman, Spiegel, Ursano, & Strain, 2011).

For a person to be diagnosed with PTSD, the symptoms must last for more than a month and cause significant distress or problems in the individual’s daily functioning (American Psychiatric Association, 2013).

6 Possible PTSD Treatment Options and Paths

PTSD has several possible treatment pathways.

Treatment preferences are related to the method used for treatment and efficacy (Schwartzkopff, Gutermann, Steil, & Müller-Engelmann, 2021).

1. Cognitive-Behavioral Therapy (CBT)

Cognitive-Behavioral Therapy (CBT) is perhaps one of the most preferred therapeutic treatment choices for PTSD. An extensive evidence base shows its effectiveness (Monson & Shnaider, 2014). It can be planned for an individual or group format (Warman, Grant, Sullivan, Caroff, & Beck, 2005).

Trauma-focused CBT directly addresses memories, thoughts, and feelings related to the traumatic event (Monson & Shnaider, 2014).

The client is requested to focus and confront the traumatic experience in a session by thinking about the trauma in greater detail. This helps to identify unhelpful thinking patterns and distortions and replace these with realistic thoughts (Malkinson, 2010). It increases the ability to cope by reducing escape and avoidance behaviors through exposure in a controlled manner (Hawley, Rector, & Laposa, 2016).

2. Eye movement desensitization and reprocessing (EMDR)

Eye movement desensitization and reprocessing (EMDR) therapy was initially developed in 1987 to treat PTSD (Shapiro, 2007) and has shown to be clinically effective in children and adults (Chen et al., 2018).

Unprocessed memories contain emotions, thoughts, beliefs, and physical sensations that occurred during the event (Shapiro, 1995). When memories are triggered, these stored disturbances cause the symptoms of PTSD or other disorders (Aranda, Ronquillo, & Calvillo, 2015).

EMDR is based on the idea that symptoms of PTSD result from past disturbing experiences that continue to cause distress because the memory was not adequately processed (Shapiro, 1995).

EMDR therapy focuses on the memory and how it is stored, reducing and eliminating the problematic symptoms (Shapiro, 2014).

The therapy incorporates the use of eye movements and other forms of rhythmic left–right (bilateral) stimulation, such as with tones or taps (Shapiro, 2007). When clients focus on the trauma memory and simultaneously experience bilateral stimulation, the vividness and emotion are reduced (Shapiro, 1995).

3. Narrative Exposure Therapy (NET)

Narrative Exposure Therapy (NET) is another treatment for PTSD that may be more complex due to political, cultural, or social influences (Elbert & Schauer, 2002; Schauer, Neuner, & Elbert, 2011).

NET is currently included in the suggested interventions for treating PTSD in adults individually and in a group setting (Schauer et al., 2011).

A person’s narrative influences how they perceive their experiences. Framing life around the traumatic experiences leads to a feeling of persistent trauma and distress (Elbert & Schauer, 2002; Schauer et al., 2011).

The treatment focuses on imaginary trauma exposure and reorganizing memories (Schnyder et al., 2015). The therapist and client work to create the client’s timeline in sessions, and the client receives the written narrative as a testimony of their life at the end of treatment sessions (Schnyder et al., 2015).

4. Prolonged Exposure Therapy

Prolonged Exposure Therapy, developed by Professor Edna Foa from the University of Pennsylvania, teaches individuals to approach their trauma-related memories, feelings, and situations (Watkins, Sprang, & Rothbaum, 2018). Clients learn that trauma-related memories and cues are not dangerous and should not be avoided (Foa & Rothbaum, 1998).

By facing what has been avoided, a person can decrease symptoms of PTSD. Both imaginal and in vivo exposure are used at the pace dictated by the patient (Eftekhari, Stines, & Zoellner, 2006).

This treatment is recommended for PTSD (Rauch, Eftekhari, & Ruzek, 2012).

5. Medications

There is no single medication solely for the treatment of PTSD. As the condition presents with both anxiety and depression, the best medication depends on the primary symptoms experienced (Marken & Munro, 2000).

Selective serotonin reuptake inhibitors can be helpful in managing these symptoms (Marken & Munro, 2000).

Serotonin-norepinephrine reuptake inhibitors (SNRIs) are often used to treat depression (Fasipe, 2019). Research has found venlafaxine, a SNRI, to be most effective with PTSD patients (Davidson et al., 2006).

6. Psychedelic-assisted therapy

A controversial therapy, highlighting a significant paradigm shift for the treatment of PTSD, involves the use of psychedelic drugs (Doblin, 2002; Pilecki, Luoma, Bathje, Rhea, & Narloch, 2021). These drugs alter perception and consciousness, producing auditory and visual hallucinations (Morgan, 2020).

Psychedelic drugs such as MDMA are a potential breakthrough in the treatment of severe PTSD (Mitchell et al., 2021). They help to regulate the severe symptoms of the disorder, especially dissociative states (Frewen & Lanius, 2006). This treatment allows the patient to build trust in the therapeutic relationship (Mitchell et al., 2021).

Unfortunately, you can’t bring a box of pills to your client’s next session. Psychedelic-assisted psychotherapy is regulated and therapists must gain extensive approved and accredited training and certification.

Read more about this in our article Is Psychedelic-Assisted Therapy Effective? 6 Research Findings.

[Reviewer’s comments:

Yoga therapy as well as Internal Family Systems could also be used as treatment options. Both have been found more effective than CBT according to The Body Keeps The Score by Bessel van der Kolk.]

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How to Help Clients With PTSD and Trauma

Clients with trauma and PTSD will require focused help with their therapeutic needs. The following are guidelines for helping PTSD clients.

1. Assure your client that they are not to blame

Clients who have gone through trauma and may be experiencing PTSD often feel they are to blame (Bub & Lommen, 2017). This usually leaves them with tremendous guilt, especially survivor guilt and blame (Murray, Pethania, & Medin, 2021).

It is important to state to the client explicitly that they are not to blame, and the therapy will help them eventually see that.

2. Do not avoid talking about trauma for fear of re-traumatizing

PTSD is a disorder that creates and maintains avoidance (Lancaster, Teeters, Gros, & Back, 2016). You may fear causing distress and re-traumatizing the client by talking about their past trauma and upsetting them. Understandably, you want to make your clients feel happy and soothe them. Exposing them to the past trauma in a controlled and safe manner can help them undo the trauma.

3. Use creative therapy to work through trauma

Creative therapies can be used alongside or as a precursor to other therapies (Schouten, de Niet, Knipscheer, Kleber, & Hutschemaekers, 2014).

Working through trauma with art can help clients process painful, traumatic experiences without speaking about them, which might be too overwhelming. Some clients might find writing things down helpful.

4. Measure progress of symptoms

It is essential to chart the progress of your client’s symptoms with a brief assessment tool.

The Impact of Event Scale-Revised (Weiss, 2007) can be used for PTSD symptoms. It provides different sub-scores for hyperarousal, avoidance, and intrusion.

Track the severity of symptoms at baseline, intermediate stage, and end of the sessions to monitor the scores and look for improvements with the chosen intervention.

Using CBT to Heal Trauma: A Guide

There are many variations in how a therapist may perform trauma-focused CBT.

This is what the stages of therapy may look like.

1. Assessment of symptoms

The first step is to assess the client through interviews to gather information on their trauma, triggers, and symptoms. This will provide the best treatment plan for them.

2. The rationale for treatment

Next, give the client an in-depth analytical overview of their PTSD symptoms and easy-to-follow analogies to allow them to understand their trauma.

3. Eliminate thought suppression

Tell your client not to suppress their thoughts but to allow them to arise automatically. This will eliminate avoidance of distressing thoughts and allow them to address their fears.

4. Psychoeducation

Psychoeducation will help clients understand more about PTSD, how the brain reacts to trauma and exposure, and why their traumatic memories have not been processed (Bremner, 2006).

5. Relaxation methods

Make use of relaxation methods to help clients reduce stress. You may include breathing exercises, guided imagery, and muscle relaxation.

6. Cognitive restructuring

Your client will now be asked to relive their trauma under safe conditions. Target specific areas and ask them to describe the event at a moment-by-moment detail, as if they were reliving the experience. This step will support them in processing memories.

7. Identifying triggers

At this stage, ask your client to identify harmful triggers that have resurfaced as intrusive memories of negative thoughts. You will support them to distinguish the triggers, learn how they are not associated with the event, and learn how to separate the concepts.

8. Imagery techniques

Imagery techniques are helpful in changing the meaning of a memory (Arntz, 2012). Ask your client to view the image from a different perspective. This technique will support your clients to increase their insight to allow information to be processed more effectively.

2 Helpful Worksheets for Adults & Youth

Worksheets can help you gain more information about your client’s trauma and how it affects them.

1. Understanding PTSD triggers

This worksheet from Mylemarks allows your client to identify triggers that lead to anxiety. The client has to identify three triggers and notice the changes when that happens. It can be used with adolescents and adults, individuals and groups.

2. Simple CBT

This simple CBT worksheet explains the CBT model, clarifying the process of automatic thoughts, and how problems occur. The worksheet allows clients to reflect on their reactions to a given situation.

This sheet is suitable for adolescents and adults. It is helpful for individual and group sessions too.

A Look at Trauma Psychoeducation: 2 Worksheets

These two worksheets can assist with psychoeducation for those traumatised.

1. Autonomic nervous system

Psychoeducation is often used to deal with trauma (Wessely et al., 2008).

Psychoeducation has been described as psychological first aid (Gray, Litz, & Papa, 2006).

The autonomic nervous system regulates the body systems outside of voluntary control (McCorry, 2007). This worksheet helps clients understand the uncontrollable intrusion, avoidance, and hyperarousal symptoms they may experience.

2. The traumatized brain

Alterations of brain processing in normal and traumatic material are responsible for the intrusive nature of memories in conditions such as PTSD (Brewin, Dalgleish, & Joseph, 1996). This handout simply explains the changes in memory thought to occur in PTSD.

A Note on Group Therapy for Clients With PTSD

If your client is seeking treatment for PTSD, you may wish to help them decide whether to opt for individual or group therapy. There have been mixed opinions on group therapy versus individual therapy (Sloan, Unger, & Beck, 2016).

The following points may help your clients make the right decision.

1. Validation of the problem

Clients can see others in the group experiencing sleep, appetite, cognitive, anger, and emotional problems. This helps clients to validate the same experiences.

2. Helping others

The ability to help others can promote your client’s self-esteem, confidence, and self-belief in coping with and managing PTSD symptoms.

3. Social support

Group therapy can help people living with PTSD overcome the negative impact of trauma. Clients will feel they are not alone and can form a supportive network.

4. Limitations of personal attention from the therapist

A disadvantage of group therapy is that the attention from the facilitator is divided among the participants. Some clients may feel they need more attention that can only be received through individual focus rather than a group format.

5. Confidentiality

Individuals with PTSD may experience feelings of mistrust and paranoia and have skewed judgments about the intentions of others (Freeman et al., 2013). They may be reluctant to open up and share their experiences with others in a group. This will need to be considered when deciding on which modality of intervention to take.

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Resources From PositivePsychology.com

There are several helpful resources that can help you support clients who have PTSD or other trauma.

17 Validated positive CBT tools for practitioners

This science-based and fully referenced set of 17 positive CBT tools for practitioners is available for purchase on our website and covers many resilience topics.

There are tools on strength spotting, optimism, coping, emotional avoidance, and growth mindset, to name a few.

They are valuable in assisting clients who may experience trauma, PTSD, and any other emotional difficulties and setbacks in life. When used regularly with clients who have had negative life experiences, these tools can help them see setbacks as opportunities for growth through a changed perspective.

Growing Stronger From Trauma

This is a free worksheet that will help clients identify their strengths following trauma. It is vital that clients can see the positives to move forward with their lives.

Breath Awareness

Relaxation exercises, including breathing work, can help minimize feelings of stress. This free simple breathing exercise can help clients relax and reduce hyperarousal from their trauma symptoms.

A Take-Home Message

It is inevitable that trauma will come to us at least once, if not more than once, throughout life (Copeland et al., 2007). It is even more unfortunate that some of us will develop PTSD when the trauma does not resolve.

Gone are the days when PTSD was considered ‘shell shock’ and ‘combat trauma’ (Myers, 1915; Marlowe, 2001).

Thankfully, it is now recognized as a set of symptoms belonging to a formal anxiety disorder that can be debilitating (American Psychiatric Association, 2013) and affect anyone, although some people are more susceptible. All is not lost, for some excellent treatment options and pathways are now available.

This article has been very informative about trauma, PTSD, and treatment pathways. We hope you enjoyed reading it as much as we enjoyed writing it for you.

The worksheets, psychoeducation, and information on whether to use individual or group sessions will hopefully inform your work with clients who have been traumatized. You can now support them in making wise changes and moving forward again in life.

We hope you enjoyed reading this article. For more information, don’t forget to download our three Positive CBT Exercises for free.