What was the first treatment for PTSD

Psychiatry, Psychosomatics & Psychotherapy

Early and comprehensive treatment by a psychiatrist is essential for overcoming PTSD. As a rule, the treatment can be carried out on an outpatient basis. A hospital stay may be necessary, for example, if the patient suffers from severe depressive symptoms in addition to PTSD, an acute psychotic disorder or an acute risk of suicide.

The treatment consists primarily of trauma-focused psychotherapy, if necessary with medical support. The aim is to be in an overall treatment plan

  • to help the person concerned gain control over their unwanted memories,
  • Reduce accompanying symptoms such as anxiety and depression, sleep disorders, concentration problems, etc.,
  • to support the person affected to integrate the trauma as part of the life story and to find new meaning in life, and
  • improve their psychosocial functional level and, in particular, restore their ability to work.

First, the therapist will explain the disease to the patient in detail, if possible with the involvement of the family or other caregivers, and suggest a suitable therapy concept. If the patient is sufficiently stable, he has to deal step by step with his traumatic experiences and the memories associated with them. Together with the therapist, he will work on it and place it in his biography in order to finally be able to put an end to it. This also includes learning strategies to prevent possible relapses.

Above all, cognitive behavioral therapy and EMDR (Eye Movement Desensitization and Reprocessing) have proven to be effective trauma processing methods, as well as other methods:

Prolonged Exposure Therapy (PE)

In Prolonged Exposure Therapy (PE), the so-called exposure is at the center of the treatment: During the therapy hour, the patient imaginatively puts himself back into the traumatic situation and relives the trauma with all the associated unpleasant feelings. The therapy session is taped and patients are given the task of listening to the recording at home every day. With repeated use of this technique, the initially violent emotional reactions subside and the PTSD symptoms fade into the background.

Cognitive Processing Therapy (CPT)

In Cognitive Processing Therapy (CPT) there is also exposure, here in the form of a written homework. At the CPT, however, the focus is on processing so-called dysfunctional cognitions, or, to put it simply, thinking errors. For this purpose, methods of cognitive restructuring (e.g. Socratic dialogue) are used. The aim of this procedure is to modify dysfunctional assessments of cognitive-affective aspects of the trauma (e.g. feelings of guilt or shame).

EMDR therapy

In EMDR therapy, under the guidance of the therapist, the patient makes jerky horizontal eye movements while imagining the traumatic experience. EMDR is just as effective as other cognitive-behavioral approaches. The mechanism of action is unknown.

Narrative Exposure Therapy (NET)

Narrative Exposure Therapy (NET) combines elements of Testimony Therapy with classic behavioral exposure methods. Instead of working on a single experience, the patient is asked to tell their entire life story. The focus is on the detailed report of the trauma. If trauma that has not been processed is addressed, it can be dealt with with the help of an exposure in sensu. The goals of this approach are the habituation to the fear reactions, the reduction of the PTSD symptoms as well as the classification of the trauma in a detailed and consistent life story.

Brief Eclectic Psychotherapy for PTSD (BEPP)

The Brief Eclectic Psychotherapy for PTSD (BEPP) is a multimodal therapeutic approach that includes mainly cognitive-behavioral and psychodynamic elements. BEPP comprises 16 therapy sessions and contains five central elements, namely (1) psychoeducation, (2) exposure, (3 ) Writing tasks and working with memorabilia, (4) attribution of meaning and integration, and (5) a farewell ritual.

There are situations in which trauma-processing procedures can only be used to a limited extent - for example if the patient is in a very poor physical or psychological state of health, or if there is insufficient support in the environment. The basic requirement for starting therapy is minimal patient stability. Life circumstances in which the patient feels safe from further trauma are essential for stabilization. If additional psychological disorders are in the foreground, such as severe depression or substance dependence, these should be treated before starting trauma therapy.

In addition to psychotherapy, the new generation of antidepressants - so-called selective serotonin reuptake inhibitors (SSRI) - can be necessary and helpful. Due to their addiction potential, anti-anxiety (anxiolytic) or calming (sedating) drugs (hypnotics) should generally only be used for a short time.

Supportive treatment options

It is not uncommon for creative approaches such as music therapy or art therapy, as well as movement therapy and other methods to improve posture and movement sequences (Feldenkrais, Qi Gong, occupational therapy) to be integrated into the overall treatment plan.

By means of relaxation techniques (yoga, autogenic training) or the biofeedback process, the patient learns to better control his symptoms.
If necessary, the person concerned receives support as part of the therapy with a professional or social reorientation, coping with grief or problems in the partnership.