Untangling Trauma and Its Treatment
18 years ago this coming September, I was a newly minted college graduate with a full time job in mental health, and plans to attend graduate school in a couple of years. On September 11th, 2001, life as I knew it fundamentally changed, abruptly and permanently, as it did for people all across the United States and abroad. Two months later, I attended my first Association for Behavioral and Cognitive Therapies (ABCT) conference in Philadelphia, PA, where there was a somewhat urgent focus on Post Traumatic Stress Disorder (PTSD). It was there that I first began to learn the fundamentals that would shape my understanding of trauma, and my practice treating it.
- There are very few things therapists can do in the immediate aftermath of a trauma that will help: The most widely practiced intervention delivered by therapists right after a trauma is called Psychological First Aid (PFA). It’s a common sense approach that focuses on making sure survivors’ immediate physical and psychological needs are met, triaging people who might need emergency intervention, and providing a means for individuals to seek services later on, if needed. A large analysis of data from 1990-2010 found that there was no real evidence supporting PFA’s effectiveness in preventing PTSD, but that expert consensus seemed to agree that it was a helpful treatment, and at the very least, not harmful.
- There are some things that well-meaning therapists can do in the immediate aftermath of a trauma that can hurt: It was at the aforementioned conference that I first came across the term Critical Incident Stress Debriefing (CISD). This involves, immediately following a trauma, either as an individual or within a group, going through a 7 step model where the traumatic incident is reviewed in detail, and psychoeducation is provided, among other interventions. Research shows that individuals who undergo CISD do not have lower rates of PTSD, and may actually be more likely to develop PTSD than those who do not. In the aftermath of a trauma, we all feel helpless; it’s important that in our rush to allay our own feelings of helplessness, that we do not inadvertently do harm to others.
- Most people who are exposed to a trauma, and have no psychological intervention at all, will not go on to develop PTSD: There are some incidents (like mass violence) where this is not the case, but in general, immediately after a trauma, everyone experiences PTSD like symptoms which will abate over time. These can include difficulty sleeping, flashbacks, nightmares, and increased startle response, among other symptoms. These are normal and expected reactions – think of it as your nervous system slowly coming back to baseline following a threat. At some point around 3-6 months, most people recover, and some do not. Those who do not, will go on to develop PTSD.
- PTSD is a treatable psychological condition: While we still might not completely understand how to prevent PTSD, or why some people go on to develop it while others will not, there are several psychological treatments that have demonstrated effectiveness in treating PTSD – Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), and Trauma Focused Cognitive Therapy (TF-CBT). These treatments have several elements in common, including decreasing avoidant behaviors, and exposure to the trauma itself, where the trauma is remembered and recounted within the therapy space, so that the trauma memories cease to be living, breathing nightmares, and become reintegrated along with the rest of a person’s memories. When looking for treatment, it’s very important to seek an evidence based treatment, delivered by a trained provider.