Understanding PTSD
and PTSD Treatment

www.ptsd.va.gov | February 20181

Table of Contents
PTSD Basics
What is PTSD? (posttraumatic stress disorder)..... 3
What can cause PTSD?.............................................. 4
What are the symptoms of PTSD?........................... 5
How do I know if I have PTSD?............................... 7
What do I do if I have symptoms of PTSD?............ 8

PTSD Treatment
Why get treatment for PTSD?.................................. 9
Common questions about treatment..................... 10
What happens during PTSD treatment? ............. 11
Where can I go to get help?.................................... 14

Laurent G. Taillefer II, US Army (2003–2006)

Get help if you’re in crisis
If you feel like you might hurt yourself orsomeone else:• Call 1-800-273-TALK (1-800-273-8255)
anytime to talk to a crisis counselor.
The call is confide tial (private) and free.
• Chat online with a crisis counselor anytime
at http://www.suicidepreventionlifeline.org/.
You can also call 911 or go to your local
emergency room.

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What is PTSD?
PTSD (posttraumatic stress disorder) is a mental health problem that some people
develop after experiencing or witnessing a life-threatening event, like combat, a natural
disaster, a car accident, or sexual assault.
It’s normal to have upsetting memories, feel on edge, or have trouble sleeping after this typeof event. At first, it m y be hard to do normal daily activities, like go to work, go to school,or spend time with people you care about. But most people start to feel better after a few
weeks or months.
If it’s been longer than a few months and you’re still having symptoms, you may have PTSD.
For some people, PTSD symptoms may start later on, or they may come and go over time.

If thoughts and feelings from a life-threatening event are upsetting you or
causing problems in your life, you may have PTSD.

Here’s the good news: you can get treatment for PTSD — and it works. In this booklet, you’lllearn about types of treatment that are proven to help.
For some people, treatment can get rid of PTSD altogether. For others, it can make symptoms
less intense. Treatment also gives you the tools to manage symptoms so they don’t keep you
from living your life.

PTSD treatment can turn your life around — even if you’ve been struggling for years.

You’re not alone. There’s others out
there that are going through andhave gone through the same typesof things that you are going throughnow. There are people out there that
understand.
— Lee Norris
US Air Force (1993–2010)3

What can cause PTSD?
Any experience that threatens your life or someone else’s can cause PTSD. These typesof events are sometimes called trauma. Types of traumatic events that can cause
PTSD include:u Combat and other military experiencesu Sexual or physical assault
u Learning about the violent or accidental death or injury of a loved oneu Child sexual or physical abuseu Serious accidents, like a car wrecku Natural disasters, like a fire, tornado, hurricane, flood, or earthquau Terrorist attacks

During this kind of event, you may not have any control over what’s happening,and you may feel very afraid. Anyone who has gone through something like thiscan develop PTSD.

Trauma can take many forms.
A traumatic event could be something that happened to you, or something
you saw happen to someone else. Seeing the effects of a horrible or violent
event can also be traumatic — for example, being a first responder after aterrorist attack.

You’re not alone.
Going through a traumatic event is not rare. At least half ofAmericans have had a traumatic event in their lives. Of people
who have had trauma, about 1 in 10 men and 2 in 10 women willdevelop PTSD.
There are some things that make it more likely you’ll develop
PTSD — for example, having very intense or long-lasting trauma,
getting hurt, or having a strong reaction to the event (like shaking,throwing up, or feeling distant from your surroundings).
It’s also more common to develop PTSD after certain types oftrauma, like combat and sexual assault. But there’s no way to know
for sure who will develop PTSD.

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I was awarded a Silver Star
for bravery. You’re not goingto tell me I’m a coward. If
somebody like me has PTSD,
then anybody can have it.
— MAJ Joshua Brandon
US Army (2002–present)Even just falling asleep was
tough. The minute I would
start dozing off I ould geta surge of adrenaline oranxiety, and would wakeup. And even when I did fallasleep, I would wake up withnight terrors or sweats.
— Stacy L. Pearsall
US Air Force (1998–2008)

What are the symptoms of PTSD?
There are 4 types of PTSD symptoms, but they may not be exactly the same foreveryone. Each person experiences symptoms in their own way.

1. Reliving the event
Unwelcome memories about the trauma can come up at any time. They can feelvery real and scary, as if the event is happening again. This is called a flashbac .
You may also have nightmares.
Memories of the trauma can happen because of a trigger — something that
reminds you of the event. For example, seeing a news report about a disastermay trigger someone who lived through a hurricane. Or hearing a car backfi emight bring back memories of gunfi e for a combat Veteran.

2. Avoiding things that remind you of the event
You may try to avoid certain people or situations that remind you of the event.
For example, someone who was assaulted on the bus might avoid taking public
transportation. Or a combat Veteran may avoid crowded places like shopping
malls because it feels dangerous to be around so many people.
You may also try to stay busy all the time so you don’t have to talk or think
about the event.
53. Having more negative thoughts and feelings than before
You may feel more negative than you did before the trauma. You might
be sad or numb — and lose interest in things you used to enjoy, likespending time with friends. You may feel that the world is dangerous andyou can’t trust anyone. It may be hard for you to feel or express happiness,or other positive emotions.
You might also feel guilt or shame about the traumatic event itself. For
example, you may wish you had done more to keep it from happening.

4. Feeling on edge
It’s common to feel jittery or “keyed up” — like it’s hard to relax. This iscalled hyperarousal. You might have trouble sleeping or concentrating,or feel like you’re always on the lookout for danger. You may suddenly get
angry and irritable — and if someone surprises you, you mightstartle easily.
You may also act in unhealthy ways, like smoking, abusing drugs andalcohol, or driving aggressively.

The emotional numbness…
will just tear away all of therelationships in your life, youknow, if you don’t learn tounlock them [and] get thoseemotions out.
— Sarah C. Humphries
US Army (1994–2012)

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How do I know if I have PTSD?
The only way to know for sure is to talk to a mental health care provider. He will ask
you about your trauma, your symptoms, and any other problems you have.
If you think you might have PTSD, answer the questions in the screening tool below.

PTSD Screen
Sometimes things happen to people that are unusually or especially frightening,horrible, or traumatic. For example, a serious accident or fi e, a physical or sexualassault or abuse, an earthquake or floo , a war, seeing someone be killed or seriously
injured, or having a loved one die through homicide or suicide.
Have you ever experienced this kind of event?

o Yes

o No

If yes, please answer the questions below. In the past month, have you:p Had nightmares about the event(s) or thought about the event(s)when you didn’t want to?
p Tried hard not to think about the event(s) or went out of your way to
avoid situations that reminded you of the event(s)?
p Been constantly on guard, watchful, or easily startled?
p Felt numb or detached from people, activities, or your surroundings?
p Felt guilty or unable to stop blaming yourself or others for the event(s)or any problems the event(s) may have caused?
If you answered “yes” to 3 or more of these questions, talk to a mental
health care provider to learn more about PTSD and PTSD treatment.
Answering “yes” to 3 or more questions does not mean you have PTSD.
Only a mental health care provider can tell you for sure.

What if the screening tool says I don’t have PTSD?
You may still want to talk to a mental health care provider. If thoughts and feelings fromthe trauma are bothering you, treatment can help — whether or not you have PTSD.
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What do I do if I have symptoms of PTSD?
After a traumatic event, it’s normal to think, act, and feel differently than usual — butmost people start to feel better after a few weeks or months. Talk to a doctor or mental
health care provider (like a psychiatrist, psychologist, or social worker) if your symptoms:
u Last longer than a few months
u Are very upsettingu Disrupt your daily life

Treatment can help — you don’t have to live with your symptoms forever.

What other problems do people with PTSD have?
Many people who have PTSD also have another mental health problem — like
depression, anxiety, alcohol and drug abuse, or thinking about harming themselves
or others. It’s also common to have problems at work, in relationships, or with yourphysical health.
Sometimes, these problems happen because of your PTSD symptoms. For example,
feeling numb and avoiding places can make it hard to have good relationships withyour friends and family.

Getting treatment for PTSD can help with these other problems, too.

I have kicked my alcohol.
I kicked my drugs. And this is allfrom the treatment I have been
given from the PTSD clinic.
— Craig “Stu” Shipley
US Marine Corps (1964–1968)

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Treatment has turned my life
completely around. I’m a lot more
comfortable in my own skin.
— Jeremiah Civil
US Marine Corps (2001–2005)

Why get treatment for PTSD?
Treatment works.
There are many treatment options for PTSD. In this booklet, we’ll tell you about
different talk therapies and medications that are proven to help people with PTSD.
For many people, these treatments can get rid of symptoms altogether. Others findthey have fewer symptoms or feel that their symptoms are less intense.
After treatment, most people feel they have a better quality of life.

It was difficult, t t first time goin , because I didn’t think I really needed it. But once
I got there and spoke with the counselor, I felt better when I left that day. I alreadyfelt better after the first session. — ichelle Rentas, US Army (1992–1995)

When PTSD isn’t treated, it usually doesn’t get better — and it may even get worse.

It’s common to think that your PTSD symptoms will just go away over time. But this isvery unlikely, especially if you’ve had symptoms for longer than a year. Even if you feellike you can handle your symptoms now, they may get worse over time.
Getting treatment can help keep PTSD from causing problems in your relationships,
your career, or your education — so you can live the way you want to.

And she said, ‘You’re not afraid that it will affect your career?’ And I said, ‘No, it doesn’t
matter how it affects my career because I can’t go on living the way I’m living…’— Reedy Hopkins, US Air Force (1983–2011)9

Common questions about treatmentu Can a therapist really understand what I’ve been through?
Therapists can treat your PTSD whether or not they have been through trauma themselves.
What’s important is that your therapist understands how you think about your experience, sothey can teach you the skills you need to manage your symptoms.

When you can walk through it with a trained
professional — and that doesn’t mean your buddy
or your buddies that went through it with you —they have a way of making you look at it from all theangles, not just the one perception that you have.
— Reedy Hopkins
US Air Force (1983–2011)u Is it ever too late to get treatment for PTSD?
It’s never too late. Treatment can help even if your trauma happened years ago. And
treatment for PTSD has gotten much better over the years. If you tried treatment before
and you’re still having symptoms, it’s a good idea to try again.

u What if I don’t feel ready for treatment?
It’s normal to feel like you’re not ready for treatment, 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 talk or
think about the trauma can actually be a symptom of PTSD.
You may never feel truly ready to get help for PTSD — but if you’re having symptoms, it’sbetter to get treatment now than to wait. The sooner you get treatment, the sooner
you can start to feel better.

Getting ready for treatment is like, how do I know I’m ready to get in better shape? How do
I know I’m ready to be a better father? How do I know I’m ready to be a better person?
If you’re feeling pain, you’re ready for treatment. — Dr. Ron Acierno, Clinical Psychologist
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What happens during PTSD treatment?
Your therapist or doctor will start by talking with you about your PTSD symptoms andyour treatment options. Once you’ve chosen a type of treatment, they’ll explain what will
happen, how it will help you feel better, and why it works. Remember, you can always
ask questions about your treatment.
Both trauma-focused psychotherapies and medication are proven to treat PTSD.

Trauma-focused Psychotherapies
Trauma-focused psychotherapies are the most highly recommended treatment for PTSD.
“Trauma-focused” means that the treatment focuses on the memory of the traumatic
event or its meaning. In this booklet, we’ll tell you about 3 of the most effective traumafocused psychotherapies for PTSD. In each of these psychotherapies, you’ll meet witha therapist once or twice a week, for 50 to 90 minutes. You and your therapist will havespecific goals and opics to cover during each session. Treatment usually lasts for 3 to 4
months. Then, if you still have symptoms, you and your therapist can talk about other ways
to manage them.

PTSD therapy helps change your relationship with the trauma. Therapy isn’t forerasing your memories. — Dr. Rebecca Liu, Clinical Psychologist

u Prolonged Exposure Therapy (PE)People with PTSD often try to avoid things that remind them of the trauma. Thiscan help you feel better in the moment, but in the long term it can keep you fromrecovering from PTSD.
In PE, you expose yourself to the thoughts, feelings, and situations that you’ve been
avoiding. It sounds scary, but facing things you’re afraid of in a safe way can help you
learn that you don’t need to avoid reminders of the trauma.

What happens during PE? Your therapist will ask you to talk about your trauma
over and over. This will help you get more control of your thoughts and feelings
about the trauma so you don’t need to be afraid of your memories.
They will also help you work up to doing the things you’ve been avoiding. For
example, let’s say you avoid driving because it reminds you of an accident. At first, ou
might just sit in the car and practice staying calm with breathing exercises. Gradually,
you’ll work towards driving without being upset by memories of your trauma.

I learned with the Prolonged Exposure, by re-living some of the most scariest
moments of my life when I was in Iraq, you learn that it’s there, but the intensityof the memory goes away. — Andrew Reeves, US Army (1999–2009)11

u Cognitive Processing Therapy (CPT)
After a trauma, it’s common to have negative thoughts — like thinking what happened isyour fault or that the world is very dangerous. CPT helps you learn to identify and changethese thoughts. Changing how you think about the trauma can help change how you feel.

What happens during CPT? You’ll talk with your therapist and fill out orksheets
about the negative thoughts and beliefs that are upsetting you. Then your therapist
will help you challenge those thoughts and think about your trauma in a way that’s lessupsetting.

u Eye Movement Desensitization and Reprocessing (EMDR)
People with PTSD react negatively to the memory of their traumas. EMDR can help you
process these upsetting memories, thoughts, and feelings. You’ll focus on specific soundor movements while you talk about the trauma. This helps your brain work through thetraumatic memories. Over time, you can change how you react to memories of your trauma.

What happens during EMDR? Your therapist will ask you to choose a memory fromthe trauma and identify the negative thoughts, emotions, and feelings in your body thatgo with it.
You’ll think about this memory while you pay attention to a sound (like a beeping tone)
or a movement (like your therapist’s finger m ving back and forth). Once the memory
becomes less upsetting, you’ll work on adding a positive thought.

How can I decide which treatment is right for me?
The online PTSD Treatment Decision Aid (https://www.ptsd.va.gov/apps/decisionaid/) is a great
way to learn about your options and consider which treatment is right for you. You can watch
videos of providers explaining how treatments work, then build a personalized comparison
chart of the treatments that appeal to you. You can share a printout of the chart with yourprovider as you decide together which treatment best meets your needs.

What about support
groups?
In a support group, you talk about
your day-to-day problems withother people who have had similar
experiences. They can be a good
addition to PTSD treatment, or
something you can do after you’ve
gotten treatment — but they won’t
treat your PTSD.
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Horace “Ace” Carter, US Army (1977–1999) I

A lot of soldiers will say it’s a weakness togo get the help — but in a way you canalso turn that around and say you know,
you’re being weak by not going in andgetting the help.
— Josh Hansen
US Army (2005–2007)

Medication
When you have PTSD, you may not have enough of certain chemicals in your brain that
help you manage stress. SSRIs (selective serotonin reuptake inhibitors) and SNRIs (selective
norepinephrine reuptake inhibitors) are medications that can help raise the level of thesechemicals in your brain so you feel better. Sertraline and paroxetine are SSRIs that work for PTSD.
Venlafaxine is an SNRI that is effective.
Before starting to take medication to treat PTSD, you’ll talk to a psychiatrist (a doctor who
specializes in mental health). When you first sta t taking medication, you’ll check in with thedoctor often to talk about how the medication is working. You may need to try a few different
medications to find one that orks.
Medications can treat PTSD symptoms alone or with therapy — but only therapy treats theunderlying cause of your symptoms. If you treat your PTSD symptoms only with medication,
you’ll need to keep taking it for it to keep working.

What about benzodiazepines?
Some doctors may prescribe a type of anxiety medication called benzodiazepines(or benzos) — but benzodiazepines aren’t a good treatment for PTSD. They can be
addictive, cause other mental health problems, and make PTSD therapy less effective.
If you’ve been taking benzodiazepines for a long time, talk to your doctor about making
a plan to stop. Ask about PTSD treatments that are proven to work and other ways tomanage your anxiety.

13Where can I go to get help?
If you’re a Veteran, check with the VA about whether you can get treatment there. Visit
http://www.va.gov/directory/guide/PTSD.asp to find a VA PTSD program near you.
If you’re looking for care outside the VA, ask your doctor for a referral to a mental healthcare provider who specializes in PTSD treatment, or visit https://findtreatment.samhsa.gov/
to search for providers in your area. When choosing a mental health care provider, here aresome important things to consider:u Find a provider who uses PTSD treatments proven to work.
It’s best if you can find someone who o ers one of the treatments we’ve talked about
in this booklet, since these treatments have strong evidence showing that they work.
Many mental health centers in hospital or university systems offer these treatments.

What if I can’t find a yone who offers these treatments? Many doctors cantreat PTSD with medication, but it may be hard to find therapists who use the othe
treatments we’ve talked about. If you can’t find a therapist who o ers CPT, PE, or
EMDR, ask about trauma-focused cognitive behavioral therapy. General cognitive
behavioral therapy can also be a good alternative.

u Find out what your insurance will cover.
If you have health insurance, check to see what mental health services are covered.

u Find someone who is a good fit for you
You and your therapist or doctor will work closely together, so it’s important that you
feel comfortable asking questions and talking about problems in your life. It’s always
okay to look for a different therapist or doctor if you’re not happy with the person
you’re seeing.

I wouldn’t have even thought of going into
treatment had I not had other Veterans tellme how it was helping them. Now I want tobe the person to tell you that it’s worth it.
— Michelle Fisher
US Air Force (2000–2011)14

Veterans Affairs | Understanding P SD Booklet 2015

My treatment has been a blessing to me
and my family. It’s hard to put into words
just how you feel after you know thatyou can control your anger, and you cancontrol your emotions.
— Bradley Seitz
US Marine Corps (2002–2005)“Besides my daughter andmy wife, it’s the best thingthat’s ever happened to me.”I can carry on with my life and not feel so much guilt, so much anger and resentment.
Besides my daughter and my wife, it’s the best thing that’s ever happened to me.
— Joe Duarte, US Army (2002–2008)
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PTSD treatment canturn your life around

Arthur Jefferson, US Army (1978–1998 )For more information and resources
Find out about PTSD
and PTSD treatment from
Veterans who’ve been there.
www.ptsd.va.gov/aboutface

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visit the National Center for PTSD website at:www.ptsd.va.gov