This is a very difficult question toanswer, because everyone is different, everyone’s story is different, andeveryone’s trauma is “stuck” in a unique way.
But clients have a right to know howlong things might take. So to show I’m not avoiding the question altogether, I’lltalk about it a little bit.
First of all, many people have spent many years suffering. It’s natural to want a quick fix, and our society specializes in quick. Unfortunately, it’s more difficult to do that with therapy than with other things. That said, trauma therapy used to take many years, and with more modern and powerful therapies, it usually doesn’t. Trauma therapy length depends on a number of factors, so let’s start there.
What influences how long it takes?
What are the factors?
There are many factors that go intodetermining this; before our first session, I don’t know any of them, and someof them we’ll never know, or at least not until afterwards. The good news is that there is an afterwards. Some things that influence how long it takesto get there:
Your goals
Some people want a deep healing of their symptoms, others are satisfied with some significant changes that help them in their everyday life; sometimes people just want to be well enough to function in a job or a relationship. This part depends on you.
The type and severity of the trauma
If we’re just working on a single event that happened when you were an adult, then it could be fairly short—possibly between 1-3 months. The research on childhood trauma recommends 15-30 months, but I’ve had clients who were satisfied with what they accomplished sooner, sometimes much sooner. But no matter what, we can’t know how it will go until we get started.
How “stuck” is the trauma?
If you’ve read my pages on PTSD, you know that the symptoms we see are natural and reasonable responses to threat. However, the threat is now over. (If it’s not over, trauma therapy might not be exactly the right thing, or it might not work so well.) So the body seems stuck in a place where it responds as if the trauma is still going on. We don’t know why. We just know that there are some things that might help get it unstuck. If we can do that, the healing process will proceed naturally, although that takes some time. We can’t know exactly how much time, but we do know that it seems to continue even after therapy is completed, if the therapy was effective.
Resources
There are other factors that make a difference. We don’t know what they all are, by any means. We know that having one trauma often makes it more difficult to recover from a second one. Also, we know that having social resources (good relationships with some family and friends) helps. There are other things that make a difference, too. (see my blog on Resources)
How soon will we know?
Not right away. Sometimes we’ll know a little bit after a fewsessions, sometimes it will take longer to determine. It takes what it takes. But I’m not interested in dragging things outunnecessarily—the suffering has lasted long enough.
Here’s my suggestion. Let’s give it a chance. Let’s have a few sessions together. The first thing that should happen is thatyou should start feeling more comfortable in our session. If that doesn’t happen by the third session,we’re probably not a good fit. By thenwe will have started the first phase of trauma treatment—what I callresourcing. We’ll work on that for awhile, finding and using the tools that seem to work best for you. When that’s finished and we start into themiddle part of treatment, then we will begin to know more about how your systemis responding to the things we do. Then,of course, we’ll keep adjusting as we go along, based on what we find out andwhat your goals are.
Here’s my promise to you: I’ll always be open about my opinion and my reasons for it. I’ll also try not to speculate too much when I don’t know. That’s my professional commitment to being open with my clients about what we’re doing. You’re always in charge.
If you’re in or near Colorado Springs, you can contact me by calling 719-377-4577 or emailing [email protected]
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While most but not all traumatized people experience short term symptoms, the majority do not develop ongoing (chronic) PTSD. Not everyone with PTSD has been through a dangerous event. Some experiences, like the sudden, unexpected death of a loved one, can also cause PTSD. Symptoms usually begin early, within 3 months of the traumatic incident, but sometimes they begin years afterward. Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic.
A doctor who has experience helping people with mental illnesses, such as a psychiatrist or psychologist, can diagnose 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:
- Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
- Bad dreams
- Frightening thoughts
Re-experiencing symptoms may cause problems in a person’s everyday routine. The symptoms can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing symptoms.
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
Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.
Arousal and reactivity symptoms include:
- Being easily startled
- Feeling tense or “on edge”
- Having difficulty sleeping
- Having angry outbursts
Arousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic events. These symptoms can make the person feel stressed and angry. They may make it hard to do daily tasks, such as sleeping, eating, or concentrating.
Cognition and mood symptoms include:
- Trouble remembering key features of the traumatic event
- Negative thoughts about oneself or the world
- Distorted feelings like guilt or blame
- Loss of interest in enjoyable activities
Cognition and mood symptoms can begin or worsen after the traumatic event, but are not due to injury or substance use. These symptoms can make the person feel alienated or detached from friends or family members.
It is natural to have some of these symptoms for a few weeks after a dangerous event. When the symptoms last more than a month, seriously affect one’s ability to function, and are not due to substance use, medical illness, or anything except the event itself, they might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months. PTSD is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.
Do children react differently than adults?
Children and teens can have extreme reactions to trauma, but some of their symptoms may not be the same as adults. Symptoms sometimes seen in very young children (less than 6 years old), these symptoms can include:
- Wetting the bed after having learned to use the toilet
- Forgetting how to 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 are more likely to show symptoms similar to those seen in adults. They may also 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.
Diagnosis
To diagnose post-traumatic stress disorder, your doctor will likely:
- Perform a physical exam to check for medical problems that may be causing your symptoms
- Do a psychological evaluation that includes a discussion of your signs and symptoms and the event or events that led up to them
- Use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association
Diagnosis of PTSD requires exposure to an event that involved the actual or possible threat of death, violence or serious injury. Your exposure can happen in one or more of these ways:
- You directly experienced the traumatic event
- You witnessed, in person, the traumatic event occurring to others
- You learned someone close to you experienced or was threatened by the traumatic event
- You are repeatedly exposed to graphic details of traumatic events (for example, if you are a first responder to the scene of traumatic events)
You may have PTSD if the problems you experience after this exposure continue for more than a month and cause significant problems in your ability to function in social and work settings and negatively impact relationships.
Treatment
Post-traumatic stress disorder treatment can help you regain a sense of control over your life. The primary treatment is psychotherapy, but can also include medication. Combining these treatments can help improve your symptoms by:
- Teaching you skills to address your symptoms
- Helping you think better about yourself, others and the world
- Learning ways to cope if any symptoms arise again
- Treating other problems often related to traumatic experiences, such as depression, anxiety, or misuse of alcohol or drugs
You don’t have to try to handle the burden of PTSD on your own.
Psychotherapy
Several types of psychotherapy, also called talk therapy, may be used to treat children and adults with PTSD. Some types of psychotherapy used in PTSD treatment include:
- Cognitive therapy. This type of talk therapy helps you recognize the ways of thinking (cognitive patterns) that are keeping you stuck — for example, negative beliefs about yourself and the risk of traumatic things happening again. For PTSD, cognitive therapy often is used along with exposure therapy.
- Exposure therapy. This behavioral therapy helps you safely face both situations and memories that you find frightening so that you can learn to cope with them effectively. Exposure therapy can be particularly helpful for flashbacks and nightmares. One approach uses virtual reality programs that allow you to re-enter the setting in which you experienced trauma.
- Eye movement desensitization and reprocessing (EMDR). EMDR combines exposure therapy with a series of guided eye movements that help you process traumatic memories and change how you react to them.
Your therapist can help you develop stress management skills to help you better handle stressful situations and cope with stress in your life.
All these approaches can help you gain control of lasting fear after a traumatic event. You and your mental health professional can discuss what type of therapy or combination of therapies may best meet your needs.
You may try individual therapy, group therapy or both. Group therapy can offer a way to connect with others going through similar experiences.
Medications
Several types of medications can help improve symptoms of PTSD:
- Antidepressants. These medications can help symptoms of depression and anxiety. They can also help improve sleep problems and concentration. The selective serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) and paroxetine (Paxil) are approved by the Food and Drug Administration (FDA) for PTSD treatment.
- Anti-anxiety medications. These drugs can relieve severe anxiety and related problems. Some anti-anxiety medications have the potential for abuse, so they are generally used only for a short time.
- Prazosin. While several studies indicated that prazosin (Minipress) may reduce or suppress nightmares in some people with PTSD, a more recent study showed no benefit over placebo. But participants in the recent study differed from others in ways that potentially could impact the results. Individuals who are considering prazosin should speak with a doctor to determine whether or not their particular situation might merit a trial of this drug.
You and your doctor can work together to figure out the best medication, with the fewest side effects, for your symptoms and situation. You may see an improvement in your mood and other symptoms within a few weeks.
Tell your doctor about any side effects or problems with medications. You may need to try more than one or a combination of medications, or your doctor may need to adjust your dosage or medication schedule before finding the right fit for you.
Coping and support
If stress and other problems caused by a traumatic event affect your life, see your doctor or mental health professional. You can also take these actions as you continue with treatment for post-traumatic stress disorder:
- Follow your treatment plan. Although it may take a while to feel benefits from therapy or medications, treatment can be effective, and most people do recover. Remind yourself that it takes time. Following your treatment plan and routinely communicating with your mental health professional will help move you forward.
- Learn about PTSD. This knowledge can help you understand what you’re feeling, and then you can develop coping strategies to help you respond effectively.
- Take care of yourself. Get enough rest, eat a healthy diet, exercise and take time to relax. Try to reduce or avoid caffeine and nicotine, which can worsen anxiety.
- Don’t self-medicate. Turning to alcohol or drugs to numb your feelings isn’t healthy, even though it may be a tempting way to cope. It can lead to more problems down the road, interfere with effective treatments and prevent real healing.
- Break the cycle. When you feel anxious, take a brisk walk or jump into a hobby to re-focus.
- Stay connected. Spend time with supportive and caring people — family, friends, faith leaders or others. You don’t have to talk about what happened if you don’t want to. Just sharing time with loved ones can offer healing and comfort.
- Consider a support group. Ask your mental health professional for help finding a support group, or contact veterans’ organizations or your community’s social services system. Or look for local support groups in an online directory.
When someone you love has PTSD
The person you love may seem like a different person than you knew before the trauma — angry and irritable, for example, or withdrawn and depressed. PTSD can significantly strain the emotional and mental health of loved ones and friends.
Hearing about the trauma that led to your loved one’s PTSD may be painful for you and even cause you to relive difficult events. You may find yourself avoiding his or her attempts to talk about the trauma or feeling hopeless that your loved one will get better. At the same time, you may feel guilty that you can’t fix your loved one or hurry up the process of healing.
Remember that you can’t change someone. However, you can:
- Learn about PTSD. This can help you understand what your loved one is going through.
- Recognize that avoidance and withdrawal are part of the disorder. If your loved one resists your help, allow space and let your loved one know that you’re available when he or she is ready to accept your help.
- Offer to attend medical appointments. If your loved one is willing, attending appointments can help you understand and assist with treatment.
- Be willing to listen. Let your loved one know you’re willing to listen, but you understand if he or she doesn’t want to talk. Try not to force your loved one to talk about the trauma until he or she is ready.
- Encourage participation. Plan opportunities for activities with family and friends. Celebrate good events.
- Make your own health a priority. Take care of yourself by eating healthy, being physically active and getting enough rest. Take time alone or with friends, doing activities that help you recharge.
- Seek help if you need it. If you have difficulty coping, talk with your doctor. He or she may refer you to a therapist who can help you work through your stress.
- Stay safe. Plan a safe place for yourself and your children if your loved one becomes violent or abusive.
Preparing for your appointment
If you think you may have post-traumatic stress disorder, make an appointment with your doctor or a mental health professional. Here’s some information to help you prepare for your appointment, and what to expect.
Take a trusted family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you.
What you can do
Before your appointment, make a list of:
- Any symptoms you’ve been experiencing, and for how long.
- Key personal information, especially events or experiences — even in your distant past — that have made you feel intense fear, helplessness or horror. It will help your doctor to know if there are memories you can’t directly access without feeling an overwhelming need to push them out of your mind.
- Things you have stopped doing or are avoiding because of your stress.
- Your medical information, including other physical or mental health conditions with which you’ve been diagnosed. Also include any medications or supplements you’re taking, and the dosages.
- Questions to ask so that you can make the most of your appointment.
Some basic questions to ask your doctor or mental health professional may include:
- What do you believe is causing my symptoms?
- Are there any other possible causes?
- How will you determine my diagnosis?
- Is my condition likely temporary or long term?
- What treatments do you recommend for this disorder?
- I have other health problems. How best can I manage these together with PTSD?
- How soon do you expect my symptoms to improve?
- Does PTSD increase my risk of other mental health problems?
- Do you recommend any changes at home, work or school to encourage recovery?
- Would it help my recovery to tell my teachers or co-workers about my diagnosis?
- Are there any printed materials on PTSD that I can have? What websites do you recommend?
Don’t hesitate to ask any other questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask:
- What symptoms are concerning to you or your loved ones?
- When did you or your loved ones first notice your symptoms?
- Have you ever experienced or witnessed a traumatic event?
- Do you have disturbing thoughts, memories or nightmares of the trauma you experienced?
- Do you avoid certain people, places or situations that remind you of the traumatic experience?
- Have you been having any problems at school, work or in your personal relationships?
- Have you ever thought about harming yourself or others?
- Do you drink alcohol or use recreational drugs? How often?
- Have you been treated for other psychiatric symptoms or mental illness in the past? If yes, what type of therapy was most helpful?
