Bonnie is a fabulous presenter & extremely knowledgeable.
Adult Day Health Care Branch Chief Long, California DepartmentAging

PTSD (Post Traumatic Stress Disorder) and Treatment

I offer two evidence-based treatments for PTSD and associated life problems. Appropriate treatment gives you and your family your lives back. You can return to being successful on the job and at home.

Three clusters of symptoms characterize PTSD:

  • Re-experiencing
  • Avoidance
  • Arousal

Re-experiencing a trauma in dreams, flashbacks, and intrusive thoughts is the most common symptom, but far from the most disruptive. Avoiding thoughts, feelings, activities, people, and places associated with the trauma can lead to isolation. Increased physiological arousal (heart racing, hyperventilating) impairs sleep and concentration, increases irritability and anger, and leads to hyper-vigilance and an increased startle response, all of which can lead to even more isolation, including from those who are closest. The cumulative effect is a destructive spiral of separation that neither creates or allows openings to change, much less cures.

Therapies I Offer for PTSD

The Veterans Administration endorses two research-supported therapies: Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy (PE). These therapies were originally developed and found to be successful with victims of rape. Both are categorized as exposure therapies because they expose the individual to the events related to the trauma in different ways that help rewire reactions to the events.

Cognitive Processing Therapy views PTSD as a problem of recovery that occurs when individuals get “stuck” in habitual ways of thinking about the trauma and how it affects their lives. The way we think about events directly affects how we feel and act. CPT offers new ways to handle distressing thoughts and gain a new understanding of the events. There are four main components to CPT:

  • Education about PTSD symptoms and how treatment can help
  • Awareness of thoughts, feelings, and beliefs about the event
  • Learning how to question and challenge distressing thoughts and beliefs
  • Understanding trauma-related changes in beliefs about safety, trust, control, self-esteem, and intimacy

CPT has been found to be particularly effective when the predominant PTSD symptoms are guilt (e.g., survivor guilt) and shame (e.g., “If only I had…”).

Prolonged Exposure Therapy helps trauma survivors emotionally process their trauma experiences to diminish PTSD and other trauma-related symptoms. PE includes:

  • Education about common reactions to trauma
  • Breathing retraining
  • Repeated real-life exposure to situations that are avoided
  • Repeated imaginal (revisiting and recounting the trauma memory in imagery) exposure

Through repeated exposure and learning tools to manage physiological arousal, the individual learns that memories of the trauma and situations associated with the trauma are not the same as the trauma itself. Anxiety and distress decrease over time, allowing individuals to reclaim their lives. PE has been found to be particularly effective when the predominant PTSD symptom is fear.