After experiencing a traumatic event, the last thing most people want to do is revisit the circumstances that remind them of what happened. But for those who develop mental health conditions from trauma, like post-traumatic stress disorder (PTSD), acute stress disorder (ASD), and depression, returning to those circumstances under the guidance of a therapist may help in the recovery process.
Psychological trauma is an emotional response to a terrible, life-altering or potentially life-threatening event, such as a serious accident, assault, or natural disaster, according to the American Psychological Association (APA). And many people can experience a variety of intense physical and mental symptoms following such an event — people may feel fearful, agitated, or numb, and have difficulty sleeping, concentrating, or remembering aspects of the trauma, among other concerns, notes the National Institutes of Health.
These feelings are all part of a natural reaction that, for many people, subsides within a few weeks or months of the incident, but other people may feel stuck in feelings such as guilt or fear that the world will never be safe again, says Arianna Galligher, licensed independent social worker supervisor, an associate director of the STAR Trauma Recovery Center and director of Gabbe Health and Well-Being Program at The Ohio State University College of Medicine in Columbus.
A variety of therapies exist to help people suffering from the lingering effects of a traumatic event, and most treatment options, Galligher says, involve helping patients reprocess and reconceptualize what happened so they can live fulfilling lives in the future.
Why Recovering From Trauma Is Tough for Some People
It’s not clear why some people experience lasting mental health symptoms months or even years after a traumatic event, but research does shed some light on circumstances that can make recovery more difficult.
People who feel physically or emotionally isolated may be more likely to develop longer-lasting symptoms following trauma than those who do feel supported and connected to their community, according to a recent study. And financial insecurity, perhaps caused by the loss of a job or a divorce, can worsen trauma-recovery outcomes, according to another recent study.
Past exposure to other traumatic events, especially to childhood trauma, is considered a particularly critical risk factor for developing PTSD or depression after trauma, according to a review of 22 World Health Organization (WHO) surveys. Genetic factors and an individual’s general predisposition to mental health challenges may also contribute, although more recent research suggests that environmental factors are more important than biological factors in determining whether an individual will develop a condition like PTSD.
When to Seek Help for Trauma Recovery
Because PTSD is considered a disorder of having feelings and symptoms associated with trauma long after the traumatic event occurred, patients will not receive this diagnosis unless their symptoms have lasted for more than a month, explains Norah Feeny, PhD, a professor of psychology at Case Western Reserve University in Cleveland, where she studies the efficacy of treatments for PTSD. But this does not mean that you should put off treatment for symptoms you believe are tied to a traumatic experience. Many patients, Dr. Feeny says, wait far too long, sometimes living with debilitating symptoms for years before they seek help.
Experts like Feeny and Rene Hen, PhD, a professor of neuroscience at Columbia University in New York City, recommend seeking treatment if you feel unable to return to your day-to-day activities more than a few weeks after a traumatic experience has occurred.
Some patients, Feeny says, may put off seeking help because they do not think their symptoms are serious enough to warrant attention. But a recent review found that seeking therapy soon after a traumatic event could help at-risk individuals avoid more serious mental health symptoms.
It’s also important to note, Feeny says, that while trauma is most often associated with PTSD, it can trigger symptoms of other mental health conditions, especially depression. And it’s usually not an either/or scenario — about 50 percent of people who develop PTSD will also develop depression, Feeny says.
Regardless of whether a clinician ultimately makes a diagnosis like PTSD or depression, Feeny says, the treatment for mental health symptoms associated with a traumatic event will be fairly similar. Here’s what to expect if you’re seeking mental health treatment after a trauma.
Common Treatment Options for Trauma
While there are multiple options for the treatment of PTSD and trauma-related mental health symptoms, like cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR), among others, all types of therapy generally focus on targeting what is believed to be the key symptom that keeps patients stuck in the disorder: avoidance.
“[Avoidance] makes people feel better in the moment, but we think it maintains their PTSD,” says Barbara Rothbaum, PhD, director of the Trauma and Anxiety Recovery Program at Emory University School of Medicine in Atlanta. And if PTSD is reinforced by avoidance, then the treatment is helping people confront the trauma and their memory of it, she explains.
It’s important to do this in a therapeutic way, Dr. Rothbaum says, to address the thoughts or memories in which the patient has become stuck. A typical situation, she says, might be a veteran whose vehicle was hit by an explosive device, killing the veteran’s friend. The veteran may believe that the accident was his or her fault, because they were driving.
“Most of us believe our stories rather than the facts,” Rothbaum says. “If the story was, ‘Rivera died and it’s my fault’, and it’s so painful the person can’t even go there, they can’t think about it differently. By going over and over it, and getting over the initial distress, their story might change — ‘It sucks that Rivera died, but I did everything I could.’”
Here’s a breakdown of various trauma-recovery treatment options, so you can speak with your doctor to decide which one is right for you, if you’ve suffered from trauma and are experiencing lasting mental health symptoms.
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy is a form of talk therapy that focuses on identifying unhelpful patterns of thought, and replacing them with more effective coping mechanisms and problem solving skills, according to the APA. It can be helpful in the treatment of PTSD and mental health concerns following trauma, including these two types of CBT, in particular:
Prolonged Exposure Therapy (PE)
According to the APA, prolonged exposure therapy is among the most strongly recommended treatment approaches for individuals diagnosed with PTSD. The therapy typically takes place over the course of several months, during which a therapist will guide the patient through exercises where they imagine the traumatic experience in detail. The patients may also be assigned “homework” in which they confront fear triggers outside of therapy. Patients will be taught breathing and emotional regulation techniques throughout the course of treatment, notes the APA. And some research has found that prolonged exposure therapy and cognitive behavioral therapy may be superior to other modalities in the treatment of PTSD and trauma.
Cognitive Processing Therapy (CPT)
Cognitive processing therapy (CPT) teaches patients to challenge and modify their beliefs about a traumatic event. In this form of therapy, per the APA, the patient may be asked to make a detailed account of their experience, while the therapist asks questions to challenge patterns of thought, like guilt or self-blame, as they arise. Evidence suggests that trauma-focused CBT may be especially effective as an early intervention following traumatic experiences, according to the aforementioned recent review.
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR is a form of therapy in which a therapist will ask the patient to recount a traumatic experience while simultaneously engaged in an activity designed to stimulate both halves of the brain, usually a movement of the eyes from one side to the other, per the APA. The thinking is this bilateral stimulation changes the way memories are stored in the brain, which may result in a reduction of symptoms associated with traumatic memories, notes the APA. Other stimuli, such as tapping the arms or playing tones from a speaker, may also be used. One recent systematic review identified potential benefits in applying EMDR to a variety of mental health conditions, but also pointed to a need for more rigorous research into its efficacy.
Medication
Three selective serotonin reuptake inhibitors (SSRIs) and one selective serotonin-norepinephrine reuptake inhibitor (SNRI) have been approved by the U.S. Food and Drug Administration (FDA) for use in the treatment of PTSD, according to the APA. The organization’s most recent guidelines for the treatment of PTSD, last updated in 2017, don’t take a position on whether medication is preferable to therapy, or vice versa, for the treatment of PTSD. According to the guidelines, there’s not enough scientific research comparing the two options to determine which approach is most effective.
Rothbaum explains that everyone reacts to these treatment protocols differently. When she first used EMDR in her practice, Rothbaum recalls working at an inpatient center where there was too little time for a full course of PE. The first patient she administered EMDR to had an eating disorder, and experienced an almost immediate reduction in distress. But in her clinical experience, Rothbaum later found EMDR less effective with people addicted to cocaine, because they weren’t able to follow her fingers during eye-movement exercises.
Individuals should work with their therapist to determine which course of action is best for their particular care, Rothbaum says.
Summary
Exposure to terrifying, life-threatening events can cause a severe, but natural, stress response in many people. In some cases, mental health symptoms may continue to interfere with one's daily activities long after a traumatic event. Clinicians generally recommend seeking treatment sooner rather than later — within a few weeks, if the distress triggered by the event has not subsided enough to resume normal activities.
For people seeking therapy for trauma, the most commonly recommended forms of treatment include prolonged exposure therapy, cognitive behavioral therapy, and eye movement desensitization and reprocessing. Medications may also be used to treat symptoms associated with trauma, but the APA holds that current research regarding whether therapy or medication is more effective for trauma remains inconclusive.
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