Veterans Affairs | Understanding PTSD Booklet 2016 1

Understanding PTSD

and PTSD Treatment

www.ptsd.va.gov | May 2019
Laurent G. Taillefer II, US Army (2003–2006)

Get help if you’re in crisis 

If you feel like you might hurt yourself or 

someone else:

• Call 1-800-273-TALK (1-800-273-8255) 

anytime to talk to a crisis counselor. 

Press “1” if you are a Veteran. 

The call is confidential (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.

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

2 National Center for PTSD | Understanding PTSD and PTSD Treatment
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 

type of event. At first, it may 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. 

Here’s the good news: you can get treatment for PTSD — and it works. In this booklet, 

you’ll learn 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.

If thoughts and feelings from a life-threatening event are upsetting you 

or causing problems in your life, you may have PTSD. 

You’re not alone. There’s others out 

there that are going through and 

have gone through the same types 

of things that you are going through 

now. 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 types 

of events are sometimes called trauma. Types of traumatic events that can cause 

PTSD include:

u Combat and other military experiences

u Sexual or physical assault

u Learning about the violent or accidental death or injury of a loved one

u Child sexual or physical abuse

u Serious accidents, like a car wreck

u Natural disasters, like a fire, tornado, hurricane, flood, or earthquake

u 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 this 

can 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 a 

terrorist attack.

You’re not alone.

Going through a traumatic event is not rare. At least half of 

Americans have had a traumatic event in their lives. Of people 

who have had trauma, about 1 in 10 men and 2 in 10 women will 

develop 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 of 

trauma, like combat and sexual assault. But there’s no way to know 

for sure who will develop PTSD.

I was awarded a Silver Star 

for bravery. You’re not going 

to tell me I’m a coward. 

If somebody like me has 

PTSD, then anybody can 

have it.

— MAJ Joshua Brandon

US Army (2002–present)

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Even just falling asleep was 

tough. The minute I would 

start dozing off I would get 

a surge of adrenaline or 

anxiety, and would wake 

up. And even when I did 

fall asleep, I would wake up 

with night 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 for 

everyone. Each person experiences symptoms in their own way. 

Reliving the event

Unwelcome memories about the trauma can come up at any time. They can 

feel very real and scary, as if the event is happening again. This is called a 

flashback. 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 disaster 

may trigger someone who lived through a hurricane. Or hearing a car backfire 

might bring back memories of gunfire for a combat Veteran. 

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.

1.

2.

5
The emotional numbness...

will just tear away all of the 

relationships in your life, you 

know, if you don’t learn to 

unlock them [and] get those 

emotions out.

— Sarah C. Humphries

US Army (1994–2012)

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, like spending 

time with friends. You may feel that the world is dangerous and you 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.

Feeling on edge 

It’s common to feel jittery or “keyed up” — like it’s hard to relax. This is called 

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 might startle easily. 

You may also act in unhealthy ways, like smoking, abusing drugs and alcohol, or 

driving aggressively.

4.

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Veterans Affairs | Understanding PTSD Booklet 2015 1

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 fire, a physical or sexual 

assault or abuse, an earthquake or flood, 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.

You may still want to talk to a mental health care provider. If thoughts and feelings from 

the trauma are bothering you, treatment can help — whether or not you have PTSD. 

What if the screening tool says I don’t have PTSD?

7
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 your physical 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 with your 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 all 

from the treatment I have been 

given from the PTSD clinic.

— Craig “Stu” Shipley 

US Marine Corps (1964–1968)

What other problems do people with PTSD have?

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 — but 

most 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 upsetting

u Disrupt your daily life

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

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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 find 

they have fewer symptoms or feel that their symptoms are less intense. 

After treatment, most people feel they have a better quality of life.

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 is 

very unlikely, especially if you’ve had symptoms for longer than a year. Even if you feel 

like 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. 

It was difficult, that first time going, 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 already 

felt better after the first session. — Michelle Rentas, US Army (1992–1995)

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)

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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)
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

Common questions about treatment

u 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, so she can teach you the skills you need to manage your symptoms.

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’s better to get treatment now than to wait. The sooner you get treatment, the 

sooner you can start to feel better. 

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 the 

angles, not just the one perception that you have.

— Reedy Hopkins

US Air Force (1983–2011)

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What happens during PTSD treatment? 

Your therapist or doctor will start by talking with you about your PTSD symptoms and 

your treatment options. Once you’ve chosen a type of treatment, he’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 with 

a therapist once or twice a week, for 50 to 90 minutes. You and your therapist will have 

specific goals and topics 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. 

u Prolonged Exposure Therapy (PE)

People with PTSD often try to avoid things that remind them of the trauma. This can help 

you feel better in the moment, but in the long term it can keep you from recovering 

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. 

She 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, you 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 

intensity of the memory goes away. — Andrew Reeves, US Army (1999–2009)

PTSD therapy helps change your relationship with the trauma. Therapy isn’t 

for erasing your memories. — Dr. Rebecca Liu, Clinical Psychologist

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Horace “Ace” Carter, US Army (1977–1999)

u Cognitive Processing Therapy (CPT)

After a trauma, it’s common to have negative thoughts — like thinking what happened is 

your fault or that the world is very dangerous. CPT helps you learn to identify and change 

these 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 worksheets 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 less upsetting. 

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 sounds 

or movements while you talk about the trauma. This helps your brain work through the 

traumatic 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 from the 

trauma and identify the negative thoughts, emotions, and feelings in your body that go 

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 moving 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 your provider 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 with 

other 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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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 these

chemicals in your brain so you feel better. Sertraline, paroxetine, and fluoxetine 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 start taking medication, you’ll check in with

the doctor often to talk about how the medication is working. You may need to try a few

different medications to find one that works.

Medications can treat PTSD symptoms alone or with therapy — but only therapy treats

the underlying 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 to manage 

your anxiety.

A lot of soldiers will say it’s a weakness to 

go get the help — but in a way you can 

also turn that around and say you know, 

you’re being weak by not going in and 

getting the help.

— Josh Hansen

US Army (2005–2007)

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I wouldn’t have even thought of going into 

treatment had I not had other Veterans tell 

me how it was helping them. Now I want to 

be the person to tell you that it’s worth it. 

— Michelle Fisher

US Air Force (2000–2011)

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 health 

care 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 are some important things to consider: 

u Find a provider who uses PTSD treatments proven to work. 

It’s best if you can find someone who offers 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 anyone who offers these treatments? Many doctors can 

treat PTSD with medication, but it may be hard to find therapists who use the 

other treatments we’ve talked about. If you can’t find a therapist who offers 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.

14 Veterans Affairs | Understanding PTSD Booklet 2015 National Center for PTSD | Understanding PTSD and PTSD Treatment 1
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 that 

you can control your anger, and you can 

control your emotions.

— Bradley Seitz

US Marine Corps (2002–2005)

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)

Veterans Affairs | Understanding PTSD Booklet 2015 151

“Besides my daughter and my 

wife, it’s the best thing that’s 

ever happened to me.”
Arthur Jefferson, US Army (1978–1998 )

For more information and resources 

visit the National Center for PTSD website at:

www.ptsd.va.gov

PTSD treatment can

turn your life around

Find out about PTSD and 

PTSD treatment from Veterans 

who’ve been there.

www.ptsd.va.gov/aboutface 

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