Post-Traumatic Stress Disorder, or PTSD, is estimated to affect more than 3.5% of the U.S. population, and this disorder can happen to anyone. If you think you have PTSD, a PTSD psychiatrist can help you reach a diagnosis and there are many treatments available including EMDR, which is a type of psychotherapy that many people are unaware exists. Let’s take a look at PTSD, EDMR and other treatment options.
What Is PTSD & What Causes It?
PTSD is a mental health disorder that affects people who have either experienced a traumatic event or witnessed a traumatic event. Soldiers often will suffer from PTSD because of their combat experiences. In fact, PTSD was sometimes called combat fatigue or shell shock, and while it is common for soldiers to experience PTSD, many other traumatic events can trigger this disorder.
For instance, if you have been the victim of violent crime, such as rape or assault or witnessed a violent crime, this can cause PTSD. Victims of abuse (physical, sexual or mental abuse) can suffer from PTSD. A car accident or another type of accident or a near-death experience can cause PTSD, even if it was a loved one who was near death or in an accident. A person who lost a loved one to suicide or a long-term illness also can experience PTSD.
Additionally, others might experience PTSD. For instance, police officers or firefighters that repeatedly are exposed to violent crimes or severe trauma, such as car accidents, might experience PTSD.
In general, the American Psychiatric Association defines PTSD as a disorder caused by either experiencing or witnessing a traumatic event or series of traumatic events. In addition to witnessing or experiencing trauma, the person must be experiencing intrusion-related symptoms, such as suffering from flashbacks, experiencing recurrent dreams related to the trauma or perhaps experiencing frequent involuntary memories of the event. For children, they may engage in repetitive play that mimics various aspects of trauma.
Additionally, the criterion for PTSD includes avoidance. This means the person might avoid any places or people that remind them of the event or perhaps try to block out the memories or their feelings regarding the trauma.
People with PTSD also experience altered moods and reactivity. For instance, they might have difficulty expressing any positive feelings and instead focus on feelings of negativity. They might even have trouble remembering details about the trauma itself, which is known as dissociative amnesia, which is an amnesia that is not caused by factors such as a head injury or drug use.
We also find that PTSD sufferers experience heightened reactivity. For instance, they might be hypervigilant, constantly checking doors and windows. They might have outbursts of anger or physical violence that seem out of proportion. They often experience difficulty with sleep and general concentration or even engage in reckless behavior.
In order to reach a diagnosis, these issues must last for at least one month and cause a significant disruption in your daily functioning and relationships. This could be problems at home or at work that can not be attributed to another physical condition or substances such as medication or alcohol. Your PTSD psychiatrist should conduct a thorough evaluation to ensure a proper diagnosis and once we’ve reached a diagnosis of PTSD, psychiatrists will start looking at treatment options.
What Is EMDR & How Can It Help?
While there are many treatments for PTSD, one that I find particularly interesting is known as Eye Movement Desensitization and Reprocessing (EMDR). This treatment was designed to help those with traumatic memories, and it requires no medication nor extensive treatment to be effective.
There are several steps or phases in the process of EMDR, including:
Phase 1: History, Evaluation & Planning
During the first session, your PTSD psychiatrist or psychologist will take a detailed history and identify the traumatic memories associated with your PTSD as well as taking a look at what current situations trigger a negative response. Once we’ve evaluated the source or sources of your trauma, we can begin to focus on planning effective treatment.
Keep in mind, if you don’t meet the full criteria for PTSD, EMDR may still be a successful treatment option for your anxiety and stress. Some studies show anxiety and depression may be reduced using EMDR techniques.
Phase 2: Preparation
In this phase, your PTSD psychiatrist, psychologist or therapist, will provide you with some tools to help you handle emotional distress. These tools will be useful during your actual EMDR sessions, but also can help you handle stress and anxiety in general, especially during the times in between an EMDR session.
Phases 3-6: The Desensitization Phases
In Phase 3, we identify a specific trigger memory that we want to address. For those with single traumas, that experience (car accident, rape, death of a loved one, etc.) will be the memory we target. For people with multiple traumas, we might select a specific incident, such as a particular moment of abuse that was especially traumatic or typical of the general type of trauma you experienced.
In Phases 4-6, we undergo the desensitization process. The patient will focus on the memory, and we use special eye movements where your therapist moves their fingers in your line of sight, and you follow the movement with just your eyes. Your therapist then will introduce more pleasant thoughts as you continue to move your eyes and follow hand movements, although a therapist often uses a different rhythm or type of hand movement when introducing positive thoughts.
Phase 7: Closure
After we’ve completed a session, we evaluate whether or not the specific target memory was processed during the desensitization phases. If not, the therapist will provide the patient with some techniques to help them handle anxiety and stress between the sessions. The goal of the closure section of the session is also to help the patient feel more peaceful, less anxious and more optimistic about the next session and the future in general. Often the sessions are spaced very closely together, so that the patient can work through the issues as quickly as possible.
Phase 8: Re-Evaluation
This actually will be the first component of your next session as your therapist evaluates the success of the previous treatment or treatments. If you have completed all of your sessions, this re-evaluation appointment might be a follow-up appointment scheduled several weeks after finishing your desensitization treatments.
The advantages of EMDR include the success rate, ranging from 70% up to more than 95% in some studies. Typically, patients with a single trauma experience faster and more permanent success. If you have experienced multiple traumas, it can take a few more sessions to achieve successful remission of PTSD symptoms. Additionally, no medication is needed, and the entire process can be handled very quickly, providing you with quick relief from your PTSD symptoms. EMDR also seems to yield permanent results for most patients.
Of course, in some cases, especially for those who experienced multiple traumas, such as years of abuse or perhaps just several traumatic episodes, it can be helpful to use additional therapies, and there are several options to consider.
What Other Types Of Treatments Can A PTSD Psychiatrist Provide?
There are several additional options to help reduce or eliminate symptoms of PTSD. Cognitive Processing Therapy (CPT) can be an option. With this type of therapy, you address negative thoughts about the trauma or about yourself, and this includes talk therapy as well as writing about your trauma.
Typically, CPT begins with a person writing a detailed account of the trauma and reading it aloud to their therapist. The therapist’s office serves as a safe space so that the patient can face their emotions and also perhaps identify issues associated with their interpretations of the events. For instance, an abuse victim might write out several examples about why they, the victim, are to blame, and the therapist can begin to redirect these thoughts and help them look at the trauma from a more detached perspective.
With CPT, the therapist also provides their patients with an assortment of strategies to help them deal with issues related to PTSD. People with PTSD often struggle with issues related to self-esteem, safety, power/control, intimacy and trust. Finding ways to redirect negative thoughts about these issues can be very helpful.
Prolonged Exposure (PE) therapy also has shown some success, and, again, this targets those negative feelings and thoughts. With PE, you undergo talk therapy where you discuss traumatic events in detail and process your emotions regarding these events and use different breathing techniques to help you manage your anxiety.
Additionally, with PE, the therapist will give you some homework to help you begin to expose yourself to situations or people that might generate fear and anxiety. This homework begins with smaller, less stressful assignments and is known as in vivo exposure.
For example, with PTSD from a car accident, a person might be fearful of allowing another person to drive while they are a passenger, as this can feel like a lack of control. With in vivo exposure, you might begin by just sitting in the passenger seat with someone in the driver’s seat. Then, you might allow that person to drive around the block. Gradually, you could increase the time as you begin to feel more comfortable, utilizing the breathing techniques and other tools you learned in therapy.
Finding A Psychiatrist for PTSD
A PTSD psychiatrist is a professional that provides you with a solid diagnosis. My goal as a psychiatrist is to identify all of the issues troubling a patient, which might include identifying PTSD as well as any co-occurring mental health disorders. Additionally, as a medical doctor, I also consider any medical conditions that might need to be addressed to achieve a happier, healthier life.
Typically, a PTSD psychiatrist can provide you with a diagnosis and any medications that you might need, and some might provide EMDR treatments. In some cases, your PTSD psychiatrist might refer you to a therapist or psychologist for EMDR or other types of therapy.
In my practice, I offer comprehensive telepsychiatry services, so we can meet virtually from wherever you might live. My offices are in Thousand Oaks, but as a virtual psychiatrist, I can provide services to patients throughout Southern California and beyond.
If you are suffering from PTSD or severe anxiety related to a single trauma or multiple traumas, don’t hesitate to get in touch with me or another PTSD psychiatrist as soon as possible. PTSD is a treatable disease, and we can provide you with options that will help you live a happier, successful life.
Dr Jesalva is a psychiatrist. He is in private practice in Thousand Oaks, CA since 1989. He successfully treats very challenging patients with varying co-occurring disorders with medications.