PTSD: National Center for PTSD
What Is PTSD?To receive a PTSD diagnosis, a person must have experienced a trauma. In addition, he or she must exhibit symptoms in the following four clusters for at least a month, with noted decreases in functioning:
- Intrusion symptoms. Intrusive memories of traumatic events can come back at any time via any number of reminders or "triggers" (e.g., sounds, smells, visual cues). These reminders commonly cause emotional (e.g., fear, anger) and/or physical (e.g., racing heartbeat) reactions. In extreme situations, "flashbacks" of the event may occur. This happens when the person feels as though he or she is actually back at the time and place of the traumatic event(s).
- Avoidance symptoms. Because remembering traumatic events is so distressing, those with PTSD may try to avoid people, places, activities, thoughts, and feelings that remind them of the traumatic event(s).
- Negative alterations in cognitions and mood. These changes can take the form of emotional numbing or having difficulty feeling; forgetfulness; estrangement from others; or negative views of oneself and the world. For instance, a person may find it hard to express emotions or may detach from his or her emotions. He or she may use substances or activities to feel numb. Someone may find it difficult to remember pieces of the traumatic event or the entire event, whether he or she wants to remember or not. The person may stop feeling excitement or interest in activities or things for which he or she used to have interest.
- Alterations in arousal and reactivity. A person with PTSD may respond by frequently being overly alert, "keyed up" or jittery, overly attuned to danger, or quick to get agitated or react aggressively to others. Anger may be his or her response to feeling threatened even when not really in danger.
Who Will Get PTSD?Not everyone who experiences a traumatic event will develop PTSD. Most people recover naturally. In general, the more severe or intense the traumatic event that an individual experiences, the greater the likelihood that person will develop PTSD. Additionally, the likelihood of developing PTSD may increase following combat or sexual assault.
Other factors that make developing PTSD more likely include having:
- An earlier life-threatening event or traumatic event
- Another mental health problem
- Little support from family and friends
- A serious injury during the event
- Recent loss of a close friend or loved one, especially if it was unexpected
- Additional stressful life changes
- High alcohol usage
- Less education
The best estimates for the rates of PTSD in the general population indicate around 6-7% of Americans will experience PTSD at some point during their lifetime3. Military Veterans show higher rates; about 8-35% of Veterans will experience PTSD. Different sub-populations of Veterans are more likely to have higher rates, including those with higher combat exposure4.
How Is PTSD Treated?Because clergy members may be the first to identify possible PTSD, they are a critical link to getting Service members and Veterans into evidence-based PTSD treatment. Therefore it is important that clergy who work with trauma survivors have an understanding of what types of mental health treatments are available within the VA system.
There's no single treatment that will work for every person with PTSD. In general, people who receive an evidence-based treatment (a treatment proven to work in multiple research studies) for PTSD show a noticeable improvement in their symptoms, and many no longer have PTSD. There are two main types of treatment supported by the VA/DoD Clinical Practice Guideline5: psychotherapy (also called talk therapy or counseling) and medication.
- Trauma-focused cognitive behavioral therapy (CBT) is a psychotherapy that uses a variety of techniques to help change negative thoughts and unhelpful behaviors related to traumatic event(s). There are many different types of trauma-focused CBT. Thousands of VA providers nationwide have been trained in two types of CBT: Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE). CPT and PE are available in every major VA facility.
- Eye Movement Desensitization & Reprocessing (EMDR) is a psychotherapy that helps patients process and make sense of traumatic event(s). It involves thinking about the traumatic event(s) while paying attention to a back-and-forth movement or sound (like a finger shifting from side to side, a light, or a tone). EMDR is available in some VA facilities.
- Stress Inoculation Training (SIT) teaches patients skills for handling stressful situations. It is less widely available than other evidence-based psychotherapy options, but it is also effective.
- Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are antidepressant medications that restore the balance of naturally occurring chemicals in your brain.