Which Trauma Treatment Is Right For You?
Two evidence-based treatments that may help you manage your trauma reactions.
Posted Jun 25, 2020
There are a lot of different types of trauma therapies out there, and of them, EMDR (Eye Movement Desensitization Record) is probably the most well known. But today I wanted to talk about some lesser-known treatments that have a stronger evidence-base around them. These are treatments that I and many of my colleagues frequently use to treat in private practice and with veterans at the VA Hospital. These two treatments are Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE).
Although both treat PTSD quite effectively and show improvements in various areas (Jeffreys et al., 2014), the way they go about targeting PTSD symptoms is slightly different. Whereas CPT focuses on the changes in mood/behavior that result from the trauma, PE focuses a bit more on the avoidance symptoms that came as a result of the trauma.
It should be noted that regardless of what treatment you choose, there are similar mechanisms of change: exposure to the experience (in some shape or form), exposure to the fear, and exposure to the anxiety. It is through thought, imaginal, and/or in vivo exposures that you learn...
- Anxiety doesn’t last forever.
- Your thoughts about your anxiety aren’t always 100% accurate.
- Avoidance only makes your anxiety worse in the long run.
Knowing some of these common factors, let's take a moment to talk about Cognitive Processing Therapy, which was developed by Patricia Resnick and her colleagues. This treatment is based on Cognitive Behavioral Therapy and was designed to be 12 weeks (if done adherently to the protocol) and focuses on helping you restructure your thoughts and belief systems that changed as a result of your trauma. The thoughts focused on usually revolve around one of these five main areas:
- Difficulty trusting others
- Needing to be in control / have power
- Having low self-esteem
- Difficulty being intimate
- Not feeling safe
Prolonged Exposure, on the other hand, was developed by Edna Foa and colleagues and was designed to be a 10-12 week protocol (if done adherently). Unlike CPT that focuses on restructuring the beliefs you developed as a result of your trauma, PE focuses on continued gradual exposures to reminders of the trauma. Although doing so also changes your thoughts, it uses the exposures as the primary mechanism of change.
So for example, if going to a crowded place like a movie is a 100 on your anxiety scale and riding on a public transportation bus is a 30, I might start out having you go on the bus until you notice your anxiety levels get cut in half. Then as you gain mastery in that area, I would suggest you go up the list until you learn that the thing that makes you anxious won't make you anxious forever.
Just like a wave, the anxiety will build, peak, and ultimately fall. The goal of therapy is to help make you the best surfer imaginable so that you learn how to surf that anxiety all the way to the end rather than let it crash over you.
Regardless of the trauma treatment chosen, I often share this analogy to provide a framework for what therapy will look like. I ask my client to think of the last time they got in a car accident. I bet that after the car accident, you were pretty scared and probably weary of your surroundings, of other cars, constantly scanning, and replaying the situation blaming yourself.
Then I ask, what do you think would happen if you never got back in the car? What do you think would happen if, because of your anxiety and tension, you just chose never to get back in your car? I bet your anxiety would probably increase in the long run. Given I'm in Los Angeles and mostly see clients in the area, most of us drivers got back in the car (unless, of course, your trauma was some sort of car accident). Usually what happens after getting back in the car after a few weeks or months have passed is that the scanning and thoughts slowly fade. They fade because you constantly get back in the car.
That is the same process by which trauma treatment works. CPT might target your beliefs that developed after the car accident, like "I'm a bad driver" or "Driving is never safe," while PE might involve having you focus on steps to getting back into the car. It may get worse before it gets better, but in order to get to the other side, you have to fight through the discomfort and the fear to regain a new sense of normalcy. It may not be the same normalcy you once had, but it's a new normal. And therapy is about helping you find what that normal looks like.
In conclusion, keep getting back in the car. It may not feel comfortable initially, but it can get better.
To find a therapist, please visit the Psychology Today Therapy Directory.
Jeffreys, M. D., Reinfeld, C., Nair, P. V., Garcia, H. A., Mata-Galan, E., & Rentz, T. O. (2014). Evaluating treatment of posttraumatic stress disorder with cognitive processing therapy and prolonged exposure therapy in a VHA specialty clinic. Journal of anxiety disorders, 28(1), 108-114.