PTSD can be thought of as an over-response to a traumatic or life-threatening event that is outside the normal range of daily life stress. It is commonly associated with combat and other military experiences but often presents in private practice as a result of what I refer to as “capital T-traumas”. These may include verbal, physical, emotional or psychological abuse as well as sexual or physical assault.

“Small t-traumas” are what we might normally think of as comparatively insignificant events, such as frequent relocations during childhood, the loss of a caregiver or poor parental emotional reciprocity. Though perhaps commonplace, these “t” traumas can nonetheless impact our emotional wellbeing and our belief system about ourselves (core beliefs) later in life. They are in my opinion under-recognized in the mental health field as influential events.

However, it is the “T” traumas that are more likely to cause PTSD and are often a shared foundational experience for clients who contact me for treatment. A traumatic event of this type can be something that happened to you or something you saw happen to someone else. Witnessing the effects of a violent event can also be traumatic.


It’s normal to have upsetting memories, feel on edge or have trouble sleeping after experiencing trauma. It may initially be hard to perform activities of daily living (ADL’s) such as going to work, school or spending time with people you care about. However, after a few weeks or months, most people start to feel better. If it’s been longer than a few months and you still have symptoms, you may be experiencing PTSD. For some clients, PTSD symptoms may begin to manifest months or even years after the traumatic event, or they may come and go over time.

People who develop PTSD may have both psychological and physical symptoms. Additionally, the disorder often occurs in conjunction with other conditions, such as depression or substance abuse. Indeed, some clients might initially present with other complaints and after being evaluated are discovered to be experiencing symptoms attributable to PTSD; with PTSD causing or exacerbating these other problems. I have found that outcomes are best when treatment is focused first on PTSD before addressing the other subsequent mood or addiction issues, since these other symptoms are often derivatives of PTSD.


Some symptoms of PTSD may be apparent right away while other symptoms may be delayed. The symptoms may last from several months to many years after the causative event and may include the following:

Inability to concentrate, confusion
Agitation, hyperarousal
Fear, anxiety, anger, irritability
Feelings of helplessness
Sadness, depression, apathy
Withdrawal, detachment, dissociation
Avoidance of certain places and situations
Nightmares, flashbacks, sleep problems
Less interest in activities that once were enjoyable
Physiological symptoms such as headaches or stomachaches
In children, acting out during play

Not everyone who experiences or witnesses a life-threatening or traumatic event develops PTSD. After such an experience, most people have commensurate symptoms of acute stress, beginning perhaps with a sense of numbness or shock and later confusion, sadness and anxiety or other symptoms cited above. These signs of acute stress are normal if they are of a relatively short duration and do not cause emotional disruption. It is when symptoms persist or cause functional impairment that a person may be assessed to be experiencing PTSD. It is important to consider therapy if your symptoms last longer than a few months, are upsetting and disrupt your daily life.


If thoughts and feelings from trauma are a disruption, whether or not you meet the technical diagnostic marker for PTSD, therapy can help. Keep in mind that you don’t have to tackle it alone. Therapy can be helpful as you begin to take small steps in your life towards meaningful healing.


Therapists can treat PTSD whether or not they have been through trauma themselves. What’s important is that your therapist understands how you think about your experience so they can teach you the skills you need to manage your symptoms. A supportive therapist will help you to feel like your experience is normal, validate your response to it and encourage your strength of will to seek change.


It’s never too late. Therapy can help even if your trauma happened years ago. Moreover, treatment for PTSD has gotten much better over the years. If you tried therapy before and you’re still having symptoms, it’s a good idea to try again.


It’s normal to feel like you’re not ready for therapy, or to come up with reasons why now isn’t the right time-like you can’t afford it or you’re too busy. But not wanting to think or talk about trauma can be a symptom of PTSD itself. You may never feel truly ready to get help but if you’re having symptoms, it’s better to start therapy now than to wait. The sooner you start, the sooner you can start to feel better.


Your therapist will start by talking with you about your PTSD symptoms and your treatment options. Once you have chosen a specific modality, they will explain the likely course of therapy, how it works and how it can help you to feel better. Remember, you can always ask questions about your treatment.


Ideally, the victim of trauma should receive supportive therapy at the earliest possible time. Clients benefit from the support of their family members, friends and mental health professionals. The most important element of any treatment plan is to create a sense of safety.


A therapist that specializes in working individually with victims of trauma can help them talk about the event. The client may also be encouraged to write about it. The therapist may use behavior modification techniques and cognitive therapy to alleviate fears and worries. Family therapy can be helpful as you begin to treat PTSD or conditions that derive from it.


A central feature of PTSD is its effect on social relationships. Trauma can impact groups of people, not just individuals. Family systems and even whole generations may feel the results of psychological trauma. Because of the social nature of its effects, post-trauma treatment must address an individual’s relationship to others. Family therapy is an important component of a multimodal approach to PTSD treatment. Family therapy provides opportunities for social support, social reintegration and interpersonal learning. Since not all clients are appropriate for exposure-based treatments, improved interpersonal coping skills is beneficial to many PTSD clients. A skilled family therapist can help family members provide support for the client and deal with their own feelings.


The cognitive behavioral approach is shown to be helpful in treating some PTSD symptoms. There is robust evidence that CBT is a safe and effective intervention for both acute and chronic PTSD following a range of traumatic experiences in adults, children, and adolescents. CBT has been validated and used across many cultures, and has been used successfully by therapists following extensive training in various settings. CBT has even been found to have a preventive role, increasing resiliency and decreasing the onset of certain symptoms. The effects of CBT have been mediated mostly by the change in maladaptive cognitive distortions associated with PTSD. Many studies also report physiological, functional neuroimaging, and electroencephalographic (measurement of electrical activity in the brain) changes correlating with response to CBT.


Since many victims of trauma have a difficult time relaxing, therapeutic training to promote relaxation may be helpful. Physiological symptoms of PTSD manifest as increased arousal and reactivity seen as anger outburst, irritability or reckless behavior with no concern for consequences. Also common is hypervigilance, sleep disturbance and problems with focus. In seeking the most beneficial treatment for PTSD, consideration must be given to the anxiety response. Relaxation techniques are shown to help address the physiological manifestations of prolonged anxiety and stress. It is not hard to learn relaxation techniques and its benefits can be appreciated in a relatively short period of time.


An active exercise program can be an excellent way to relieve stress. Cardiovascular exercise can yield physical, emotional and cognitive benefits and is especially helpful in managing symptoms of depression and anxiety, which are often comorbid with PTSD. Less physically demanding exercise may also be helpful. Yoga, for example, may help clients with PTSD focus on the present, reduce rumination and combat negative thinking patterns.


The brains of people experiencing PTSD process “threats” differently, in part because the balance of chemicals called neurotransmitters has become dysregulated. PTSD often causes a person’s sympathetic nervous system to respond hyperactively, leading to an easily triggered “fight or flight” reaction. This can render a person to feel jumpy and on-edge. Constantly trying to quiet this response can lead to feeling emotionally cold, removed and fatigued.

Antidepressant medications can help relieve symptoms of depression and anxiety and reduce nightmares and flashbacks. They may also encourage improved overall sleep. They can help a person to stop thinking about and reacting to what happened and create a more positive outlook on life. Several types of drugs affect the chemistry in the brain related to fear and anxiety. Providers will usually start with medications that affect the serotonin or norepinephrine (SSRIs and SNRIs) neurotransmitters. There are other medications sometimes used “off-label” if a person has not experienced benefits from traditional methods.

Though medications may be helpful, therapy is a proven treatment for PTSD and its many symptoms. However PTSD might be impacting your life, I encourage you to reach out. As Rainer Maria Rilke once wrote: “No feeling is final.”

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