PTSD Treatment Options – How to Find a Good Trauma Therapist

Hi everyone. I’m Emma McAdam, and I’m a  licensed marriage and family therapist.   And I make mental-health education videos.  And I’ve made a lot of videos about trauma   and trauma treatment. And so I get asked in a  lot of emails this question: How can I find a  
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therapist who does trauma treatment like you? And  it’s a great question, not because I’m the world’s   best trauma therapist, that is not the case, but  because when it comes to therapy, it’s really good   to be an informed consumer. There are hundreds of  different types of therapy, and every therapist is  
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different in how they approach issues. So  whether you’ve never tried therapy before   or you’ve worked with other therapists in  the past and you want something different,   learning about different treatment  modalities can be really helpful.  
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So first, what is trauma? Trauma is  any experience that was overwhelming,   threatening, that caused pain, distress, or  fear to the point where you felt helpless.   It can include assault and abuse and witnessing  tragedy. It could include frightening medical  
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experiences, near-death experiences, or  a severe loss. But basically when your   response to these situations interferes with  your life, you might receive a diagnosis of PTSD.   Or, if the abuse was ongoing for long periods of  time, you might get a diagnosis of complex PTSD.  
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And symptoms include nightmares; feeling tense or  anxious all the time; being jumpy; feeling numb   or detached; feeling exhausted and depressed;  struggling in relationships, sleep, and and work.   So while almost all therapists have some skills  in treating depression, anxiety, and trauma,  
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because these are such universal problems, not  all therapists specialize in trauma treatment.   So that means that most therapists have at  least a handful of tools to treat trauma,   but some therapists have a lot of skills and  interventions and resources and experience to  
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help you out. And that’s not exclusive to trauma.  The more specific you can get with your diagnosis,   the more specific you can get in finding a  therapist who has interventions tailored to   your needs. Okay. So what are the trauma treatment  options out there, and how do you find a therapist  
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who uses them? There’s a gazillion ways to do  therapy, but I’m going to highlight the ways that   are research-backed, meaning they have a strong  body of consistent evidence that these treatments   are effective. So the first approach to treating  PTSD is cognitive therapy. And this is called  
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a top-down approach. So it includes cognitive  behavior therapy, cognitive processing therapy,   and prolonged exposure. Cognitive approaches focus  on talking about your trauma, changing how you   think about it, and changing behaviors that might  be making it worse. So for example, you would  
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tell your trauma story, and your therapist would  notice that you blame yourself for your abuse,   and then they would help you to challenge that  type of thinking and replace it with something   healthier, like placing the responsibility on the  abuser and forgiving yourself. Now, CBT has a lot  
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of research for a couple of reasons: it’s been  around for a long time and it can be standardized.   They can, they can put it in a manual and say,  “Oh, in session one, do this. In session two,   do this. And then they can measure outcomes.  Most therapists include some form of talking  
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and examining thinking patterns as a part of  therapy, but with a CBT therapist they may have a   very clear set of instructions for you. Prolonged  exposure is another type of cognitive therapy.   It’s essentially exposure therapy. You talk about  your trauma over and over until it’s no longer as  
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scary for you. Essentially, you teach your brain  that you can face your trauma and be okay. Now,   cognitive approaches have been around for a  long time, and they have a lot of research   behind them. One study at Kaiser showed that  even just the simple act of a doctor saying,  
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“I see that you have a history of trauma or abuse.  I’m sorry that happened to you. Would you like to   talk about it?” and then just listening – just  that simple act of addressing trauma without any   specific interventions – this decreased the  physical symptoms of trauma in a significant  
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way. So I I don’t mean to minimize the  effectiveness of talk therapy with trauma,   but I think that I and many other therapists  find that trauma treatment benefits from a   really well-rounded approach. And cognitive  therapies focus on thoughts and memories,  
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but they don’t do much to address the physical  reactions of trauma. Cognitive therapy can also   be really uncomfortable, and in some cases, you  know, re-traumatize the participant by having them   talk about trauma without the skills to calm their  body down. Now, that being said, cognitive therapy  
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is still an effective approach. According to the  VA, around 53% of people who do cognitive therapy   no longer have PTSD after three months of  treatment. EMDR is another great approach to   treating trauma. It’s got a lot of research behind  it. It incorporates body-based soothing with  
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cognitive work while also including eye movement  and bilateral movement as a part of the treatment.   EMDR stands for eye movement desensitization and  reprocessing. So basically, scientists found out   that when we have bilateral movement –  so that’s moving your eyes back and forth  
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or patting your legs one and then the other –  that it stimulates the part of the brain that   processes memories. And this is similar to what  happens in REM sleep, rapid eye movement sleep,   because when you dream, your eyes move  back and forth. And this is a critical time  
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when your brain processes memories without too  much emotion so that it can file them away.   So with EMDR and somatic approaches there isn’t  nearly as much of a focus on retelling the   trauma story or challenging thoughts or homework  assignments. And according to the VA, around 53%  
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of people who do EMDR no longer have PTSD after  three months of treatment. Okay. The next type of   therapy, this next group of therapies incorporates  a much more body-based approach or a bottom-up   approach to healing trauma, and it includes  somatic experiencing, sensory motor therapy,  
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and polyvagal approaches to trauma treatment.  So these approaches focus on the body and the   nervous system and how they get stuck in a trauma  response, and they teach people skills to soothe   the body and turn off the fight/flight/freeze  response and to activate their nervous system and  
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work through the physical tension of trauma. And  it’s based off of the work of Bessel van der Kolk,   Peter Levine, Stephen Porges, Pat Ogden, Deb Dana,  and others. And it’s gaining a lot of momentum,   and the research behind its effectiveness is  growing. Interventions include things like yoga,  
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learning nervous system calming skills, gaining  a greater awareness of your body’s reactions,   and working with your body to restore a sense of  calm. And I teach a bunch of these skills in my   free course, Grounding Skills for Anxiety, Stress,  and PTSD. So if you’d like to learn some of them,  
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just check out the link in the description. When  someone asks me how to find a trauma therapist who   does trauma work the way I do, this approach is  one that I’m drawn to the most. Now, I understand   a lot of cognitive work. I’ve read books or  attended trainings on most of the approaches.  
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And for me, the body-based approach really  adds a lot to the cognitive work that many   people have already tried. Somatic  experiencing is also a newer approach,   so there’s less research behind it, but studies  are promising. Some smaller studies have found  
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that 67% of people experience a reduction of  PTSD symptoms, and a meta-analysis of 16 studies   found overall positive effects  of somatic experiencing therapy   on PTSD symptoms. Okay. Another type of therapy  is narrative therapy. And this is often used in  
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a small-group setting. It’s another approach  that has been used with good results. And   basically you just get a group of people together  to talk about and work through their experiences.   People explore their narrative or their  interpretation of traumatic events with  
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other people, and they create a new story around  their humanity. And it has a lot of good evidence.   Medication is another option to treat PTSD, and it  can be combined with therapy. Antidepressants like   Prozac, Paxil, Effexor, and Zoloft can be helpful  at treating overall symptoms. And basically,  
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medication helps to quiet the alarm system that  seems to be constantly stuck in the on position.   According to the VA, medication is  effective for 42% percent of people. Also,   prazosin can help with nightmares, and anxiety  medications can help with the anxiety symptoms.  
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Medication does come with the possibility of  side effects, and the benefits may go away if you   stop taking the medication. Now, I don’t think  that there is one approach to trauma treatment   that is best for everyone, so you may need to try  a few different things to find out what works for  
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you. Also, a combination of approaches may be  best. Many therapists will integrate a cognitive   approach with body-soothing skills while also  encouraging you to work with a doctor to explore   medical treatments as well. Regardless of which  approach you want to try, it’s important to find  
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a therapist who is experienced. So let me show  you one way I recommend doing that. So if you   go to psychologytoday.com (not a sponsor), their  therapist finder tool has some great filters. So   you just start by entering your location, and then  you can select trauma-focused EMDR or somatic, and  
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then you can see a list of the providers in your  area. You can also filter by gender, religion,   by the insurance they take, and a bunch of other  characteristics. Now, just because someone says   they’re trauma-informed or they practice a certain  modality doesn’t mean they’re certified in it.  
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So for someone to be EMDR certified, they need to  have done something like 40 hours of training and   50 plus hours of supervised practice. So look  for a certified provider whenever possible.   To become a certified somatic experiencing  practitioner you have to do eight training  
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modules of four to six days in length spaced  out over two and a half to three years, so   this is really different from someone who’s just  trauma informed or has a different certificate.   There are a ton of other approaches to  trauma treatment that are gaining popularity,  
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but they they just don’t have  as much research behind them.   These include brain spotting, neurofeedback,  mindfulness, acceptance and commitment therapy,   tapping. And there’s a lot of other things that  you can try that may help, but they don’t have as  
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much evidence behind them. And so other other  interventions include things like journaling,   dancing, exercise, improving your overall  mental health, certain nutritional approaches,   and sharing your story with compassionate  people. All these things can be really helpful;  
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they’re just not necessarily meeting that gold  standard of evidence-based treatment. Now, for   all we know, these may work. But the further you  get away from research, the less we know about how   the treatment will affect you. I’m pretty cautious  about recommending treatment without rigorous  
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evidence, but I do encourage people to try a few  things until they find something that works for   them. So there you have it: a handful of different  approaches to treating trauma. I hope this helps   you choose a treatment option that works for  you. Thank you for watching, and take care.