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Frontline Psych with Doc Bender: Treatment Options for PTSD

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Army medical experts say it’s normal and adaptive for soldiers to experience heightened fear responses following combat duty. But if the occurrences don’t subside within a few months, they could signal a level of posttraumatic stress disorder that requires professional treatment. (U.S. Army photo by Tech. Sgt. Jeremy Lock)

Dr. James Bender is a former Army psychologist who deployed to Iraq as the brigade psychologist for the 1st Cavalry Division 4th Brigade Combat Team out of Fort Hood, Texas. During his deployment, he traveled through Southern Iraq, from Basra to Baghdad. He writes a monthly post for the DCoE Blog on psychological health concerns related to deployment and being in the military.

Posttraumatic Stress Disorder, or PTSD, can occur after someone experiences or sees a traumatic event. However, treatments for PTSD exist and work for most people. The sooner you receive treatment, the sooner you can learn skills to manage PTSD symptoms — many of which significantly worsen a person’s quality of life and ability to function over time.

The two main types of treatments available for PTSD include psychotherapy (e.g., prolonged exposure therapy or cognitive processing therapy) and medication (e.g., selective serotonin reuptake inhibitors).

Prolonged Exposure Therapy
This treatment focuses on the body’s physical stress reaction (racing heartbeat, sweating, nervous feelings, etc.) along with ways to control this reaction. You and your therapist will identify situations where you feel these reactions inappropriately such as in crowded shopping malls or at the rifle range. You’ll then expose yourself to these stressful environments armed with skills that help you relax and manage distress. With time and practice, stress-related reactions will diminish, and you’ll be able to function better in everyday life. There are two reasons why this works. First, you learn how to consciously control your reactions to stressful memories, a skill that comes in handy in many situations. Second, as you become more exposed to stressful conditions, your body will naturally start to change its reaction.

Cognitive Processing Therapy
You’ll examine thoughts and feelings related to the traumatic event and how it changed your thinking. For example, many people with combat experience may start to think that the world in general is a bad place. This thought will understandably lead to negative moods and attitudes toward the world, yourself and others. The goal is to replace this faulty thought with another, more realistic thought, like “certain parts of the world and certain people are bad, but there are a lot of good places and good people in the world. Right now, I’m in a good place.” This works because there’s a very strong connection between your thoughts and moods. When you identify and challenge thoughts and feelings associated with poor moods, the moods will usually change.

Selective Serotonin Reuptake Inhibitors
These are in a class of medications initially used to treat depression but two medications in this class are approved by the Food and Drug Administration for PTSD (Paxil and Zoloft). These medications work by allowing your brain to use a certain neurotransmitter called serotonin more effectively. Serotonin has been linked to anxiety, which is a core symptom of PTSD.

So, which treatment is best? That really depends. Some people respond very well to one treatment and not well to others. Some people use a combination of medication and psychotherapy. Medications usually have to be taken for a year or longer while therapy usually lasts eight to 12 sessions with one session per week. The main points to remember are that treatment works and you have options.

For more on PTSD treatment and how it can help you or someone you know, view resources below. Thanks for reading, and stay safe.

Treatment Resources:


Comments (6)

  • corine w smith np @durham va. 05 Sep

    does the veteran need education prior to the use of the ap and how do we facilitate that for our veteran's in a timely fashion..thank you
  • Dr. Bender 05 Sep

    @Corine, The PTSD Coach can be a stand-alone educational tool that does not require any training to use. It can also be used in conjunction with treatment. Instructions are shown on the screen and most people have no trouble navigating it by themselves. You can download it for free on iPhone or Android at: http://t2health.org/apps/ptsd-coach.
  • Lakeesha 05 Sep

    I would get counseling, but since I have PTSD from sexual assault and I do not want my chain of command to know my personal business, I have to go without counseling. I don't want to have to report it on my security clearance. If I was "lucky" enough to have PTSD from combat, I could go get as much help as I wanted. But since I do not want to have to talk to some investigator about how I was repeatedly violated against my will, I will go without. The argument that the DoD has that it's better to get counseling and to have to report if rather than have an "incident" and lose your clearance altogether is a specious one. From day one in the military, I have been taught to suck it up and drive on. Therefore, in order to have some control over my sanity and my privacy, I will suck it up. In order to not have to endure delays getting my final clearance approved because I answer "yes" to Question 21, I will suck it up. In order to not be flagged as a potential threat to national security, I will suck it up. Because I love my job more than myself. Why can't you guys understand that?
  • Dr. Bender 05 Sep

    @Lakeesha, First off, I’m very sorry about your assault. No one should have to go through something like that. I do encourage you to get help. Sexual assault affects different people in different ways, but it can affect you in ways you don’t want it to. Treatment can help you recover in positive ways. The VA has a section on their website that may be useful to you at www.ptsd.va.gov/public/pages/military-sexual-trauma-general.asp. It’s a common belief that any sort of mental health treatment will jeopardize a security clearance. This is simply not true. When I served in the Army at Ft Benning, I did security reviews for people with mental health backgrounds and the vast majority of cases were approved. In my experience, denying a security clearance due to mental health treatment was the exception, not the rule. Right now, there are special ops service members and pilots who are taking medications for mental illness and actively undergoing therapy. They still function well and have their TS clearances. The military definitely values toughness and the ability to “drive on” despite injury, mental or physical. Recently, the military has started to change its stance on that. But it takes a while for directives to trickle down from the Pentagon to the unit level. Progress is being made and mental health providers will keep confidentiality in most situations. If you have concerns, you can make an appointment and have a very frank talk about confidentiality with your doctor before treatment starts. You can also ask to be “Tri-Cared out,” meaning your doctor writes a referral for you to see a civilian provider in the community. Also, Military OneSource offers free counseling services that are completely separate from the military and your chain of command. To learn more, visit the Military OneSource website at www.militaryonesource.mil or call 800-342-9647. Lastly, chaplains can be a great source of comfort and have very strict rules that maintain confidentiality. A chaplain would not report the situation you described to your command or anyone else.
  • David Riley,LCSW 01 Apr

    It seems that a third research supported therapy, EMDR,  that has been accepted by the  army was not included. I have found this effective and efficient for soldiers and for my own trauma/anxiety symptoms. This treatment has an added benefit of being effective without needing to disclose details of the trauma being addressed.
  • Dr. James Bender 04 Apr

    @David, There is a lot of evidence showing EMDR's effectiveness. EMDR has gained widespread acceptance as an effective treatment for PTSD in the VA and other facilities.


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