Spotlight: Posttraumatic Stress Disorder Treatment

Recovery and Resilience

Research tells us that the most common response to trauma is resilience and recovery. Following a traumatic stressor, even amidst intense trauma reactions, a natural recovery process begins. Recovery is not instantaneous but a slow and gradual process that occurs as the person navigates their trauma reactions and continues to progress their life.

Most people recover from trauma on their own and do not experience long-term difficulties or impaired functioning. Data indicates that within the U.S., 60% of men and 50% of women will experience at least one traumatic stressor in their lifetime. However, only about 6% of U.S. adults will develop PTSD at some point.

Risk Factors for Developing PTSD

The question often arises: Why do some people develop PTSD following a trauma when others do not? When we consider the potential impact of trauma, it’s not only about the event (what happened), but the person who experienced the event (who it happened to).

Research has identified some factors that may increase the risk of developing PTSD:

• Pre-trauma risk factors: Elements of personal history that increase PTSD risk, such as existing mental health conditions at the time of trauma as well as a history of previous trauma.
• Trauma risk factors: Aspects specific to the traumatic event itself. Certain types of traumas, such as sexual assault or combat exposure, are more commonly associated with PTSD.
• Post-trauma risk factors: Circumstances following trauma exposure, such as limited social support or negative social interactions, including blaming the survivor or questioning the validity of the trauma.

These risk factors act as barriers to the natural recovery process. Instead of progressing through their trauma reactions and adjusting, individuals may become stuck and unable to move forward. Consequently, trauma reactions may persist and evolve into chronic symptoms of PTSD.

Understanding PTSD Symptoms

PTSD develops following exposure to a traumatic stressor, triggering a range of symptoms associated with that trauma.

Re-experiencing symptoms refer to how the trauma continues to intrude on a person’s current experiences. These intrusions may involve:

• Unwanted thoughts and images about the trauma: These can be cued (triggered by environmental reminders) or un-cued (appearing out of the blue).
• Emotional and physiological reactivity: Reactions triggered by reminders such as sights, sounds, smells, places, objects, or activities associated with the trauma.

For instance, an assault survivor encountering a person with characteristics like the perpetrator (e.g., same height, build, eye and hair color) might experience intense emotional and physiological reactions. Re-experiencing symptoms can make individuals feel out of control, as they struggle to understand why they continue reliving aspects of the trauma despite efforts to move past it.

Avoidance symptoms occur in two forms:

• Avoidance of internal reminders: Memories, thoughts, and feelings linked to the trauma.
• Avoidance of external reminders: People, places, and things associated with the trauma.

Avoidance is often the best way a person has learned to cope with their PTSD symptoms. Many individuals with PTSD discover that although avoidance reduces their anxiety in the moment, their anxiety gets stronger over time. Thus, they must use avoidance even more to keep their anxiety at a level that feels tolerable, resulting in their world becoming smaller and smaller as their avoidance increases.  

Negative thoughts and emotions are another aspect of PTSD. Trauma exposure can lead to strong negative emotions like sadness, guilt, and anger. An individual might view themselves and others differently, often in extreme ways. Examples include:

“The trauma was my fault.”

“I am incompetent and make bad choices.”

“People are not trustworthy.”                                                                                                                                                   “The world is extremely dangerous.”

Furthermore, some individuals experience numbness, become disconnected from others, and lose interest in previously enjoyable activities.

Increased arousal often involves a person experiencing a chronic sense of needing to be ready to react if something bad happens. Hypervigilance involves enhanced concerns for safety that typically result in the person feeling “on guard” or “on edge.” An exaggerated startle response, or being “jumpy,” may occur in response to loud unexpected noises or if suddenly surprised. Increased arousal can also result to sleep difficulties, poor concentration, and being easily angered.

The Role of Evidence-Based Treatment & Best Practice Guidelines

The term “evidence-based” refers to treatments backed by scientific research. These treatments have undergone extensive studies to affirm their effectiveness. Results are objectively evaluated and published in peer-reviewed scientific journals, ensuring well-designed, correctly implemented studies with reliable and valid outcomes.

Clinical practice guidelines, also referred to as “best practice” guidelines, are essential resources to aid providers in their clinical decision-making process. These guidelines provide information based on systematic review of scientific findings and reflect the best evidence available at time of publication. They enhance the provision of high-quality care and ensure clients receive the treatment they need to effectively reduce their symptoms.

The American Psychological Association (APA), the Department of Veterans Affairs/Department of Defense (VA/DOD), and the International Society of Traumatic Stress Studies (ISTSS) recommend trauma-focused therapies as the primary treatment options for PTSD. Specifically, these organizations have highly recommended Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy (PE) as the first-line treatments for PTSD for the past several decades, as these therapies have evidenced a greater reduction in PTSD symptoms and longer lasting improvement than medications or comparative therapies such as EMDR or Brainspotting. Written Exposure Therapy (WET) is also recognized and recommended as brief, evidence-based treatment for PTSD.

Now, let’s learn a bit more about these highly effective trauma-focused therapies…

Trauma-Focused Psychotherapies:

“Trauma-focused” simply means that therapy will focus on your memory of the trauma or the meaning of the trauma. These therapies explore certain thoughts, emotions, or behaviors that have become challenging or problematic for you since the trauma. They use different methods to help you process the trauma and better understand its impact on your life.

These are primarily individual psychotherapies, meaning you would be meeting one-on-one with a therapist in person or via tele-health.  These are all time-limited treatments that may involve one or multiple sessions each week as collaboratively decided by you and your therapist. Thus, these treatments may be completed within two to three weeks or up to three to four months.

PE and CPT include daily homework that you will progress between sessions. As noted, therapy often involves learning skills to address your PTSD symptoms. These skills are like any other skill - they require practice to become proficient and fully benefit from them.

A potential risk of trauma-focused therapy is the possibility of some level of discomfort when approaching trauma reminders. This may include thinking, writing, or talking about the trauma and its impact, or approaching situations and activities in real life that you typically avoid. This discomfort is typically short-term, as most individuals start feeling better as therapy progresses

Cognitive Processing Therapy (CPT):

• Goal: Modify unhelpful, negative thoughts and beliefs related to trauma.
• Techniques: Exploring trauma's meaning, identifying and challenging extreme thoughts, generating balanced views, and optional written narratives.

Cognitive Processing Therapy (CPT) aims to modify unhelpful, negative thoughts and beliefs related to trauma. Trauma disrupts basic beliefs, leading to extreme negative thoughts and emotions. CPT helps you develop skills to objectively challenge these thoughts, fostering balanced views and reducing negative emotions.

CPT involves writing and discussing why the trauma occurred and how it altered views of yourself, others, and the world. Over the course of therapy, you learn skills to identify unhelpful thoughts, challenge their accuracy or extremity due to trauma, and generate balanced, helpful thoughts, resulting in less intense negative emotions.

Prolonged Exposure Therapy (PE):

• Goal: Encourages you to approach trauma reminders safely, reducing distress and reinforcing that these reminders are not inherently dangerous.
• Techniques: Imaginal exposure (visualizing and narrating trauma memory) and in-vivo exposure (gradually approaching trauma reminders in real life).

Prolonged Exposure (PE) helps you learn that trauma reminders are not dangerous, facilitating decreased distress and reclaiming aspects of your life lost to avoidance. Through imaginal and in-vivo exposures, PE provides new learning opportunities and helps manage anxiety through approach rather than avoidance, reinforcing the safety of previously feared situations.

Imaginal exposure involves repeatedly visualizing the trauma memory and narrating it aloud during therapy sessions. This process is recorded, and individuals listen to the recording daily as part of their homework. This technique you helps gain control over thoughts and feelings about the trauma.

In-vivo exposure involves deliberately encountering trauma reminders, such as people, places, activities, and objects typically avoided. Collaborating with your therapist, you will develop a list of these reminders and work on them through daily homework. In-vivo exposure helps you reclaim aspects of life previously lost to avoidance.

These techniques facilitate new learning opportunities: understanding trauma reminders as separate from the trauma itself, managing distress through approach rather than avoidance, and recognizing the safety of previously feared situations.

Written Exposure Therapy (WET):

• Goal: Provide effective trauma treatment through structured written exposure.
• Techniques: Time-limited writing assignments about the trauma

Written Exposure Therapy (WET) offers effective trauma treatment through structured written exposure, focusing on exploring trauma memories and their meanings.

You will be asked to write about a specific traumatic event in detail during the therapy session, including your thoughts and feelings at the time the trauma occurred. Your therapist reviews the writing and helps you process the experience, exploring how the trauma has impacted your life. By approaching the trauma memory through writing, you can learn to experience it with less emotional distress and reduce your avoidance of trauma reminders.

Couples Therapy for Individuals with PTSD:

Cognitive Behavioral Conjoint Therapy (CBCT) for PTSD is an evidence-based treatment that focuses on improving the lives of individuals suffering from post-traumatic stress disorder and their loved ones. This therapy integrates cognitive-behavioral approaches with conjoint therapy techniques to address the symptoms of PTSD within the context of a close relationship. By facilitating communication, enhancing understanding, and fostering mutual support, CBCT helps both partners develop skills to manage stress and improve their relationship dynamics. At Upward, we offer CBCT to help couples navigate the challenges of PTSD together, promoting healing and resilience in a supportive and collaborative environment.

Why Consider PTSD Treatment at Upward Behavioral Health?

Choosing Upward Behavioral Health for PTSD treatment ensures access to gold-standard therapies like CPT, PE, and WET, which are not commonly available through community providers. Our team of psychologists proudly adheres to the best practice guidelines offered by the American Psychological Association (APA)’s 2025 Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in adults.

Studies indicate that therapist competence and adherence to protocols are crucial for positive outcomes. Therapists formally trained in these protocols demonstrate better treatment fidelity and client results. At Upward Behavioral Health, our psychologists specialize in Cognitive Processing Therapy (CPT), Prolonged Exposure Therapy (PE), and Written Exposure Therapy (WET). Our therapists have been formally trained, certified as proficient, and have substantial experience in delivering one or more of these leading PTSD treatments.

Many of our psychologists have experience providing clinical training and consultation in these therapies at a local, national, and international level. Dr. Megan Keyes served as an expert consultant with National Center for PTSD’s Prolonged Exposure Therapy (PE) training program for 16 years. As adjunct faculty with Brown School at Washington University in St. Louis, she teaches Cognitive Processing Therapy (CPT) to master’s-level graduate students as well as licensed clinical social workers. Dr. Courtney Worley is a national CPT trainer and consultant. She is also an international consultant for Written Exposure Therapy (WET) and has published in this area. Dr. Susan Rathmell and Dr. Misti Norton have trained and provided clinical supervision to innumerable graduate psychology students and trainees in CPT and PE over the past decade.

Research tells us that 80% of individuals with PTSD have at least one co-morbid mental health diagnosis. Our therapists are trained in the leading, evidence-based therapies for many of the most common co-occurring conditions experienced by individuals with PTSD including depression, insomnia, OCD, and couples therapy for partners experiencing relationship distress. Dr. Worley and Dr. Norton have both achieved a Diplomate in Behavioral Sleep Medicine, and each has specialized training in the treatment of trauma-related nightmares.

We practice measurement-based care, assessing symptoms of PTSD and comorbid conditions weekly through self-report measures. This data-driven approach allows us to monitor progress and address barriers collaboratively, if necessary, thus optimizing your treatment experience and outcomes.

We are proud to now offer massed CPT, PE, and WET, in which therapy sessions occur at least three times per week or more. Emerging research indicates that the increased frequency of treatment delivery results in individuals getting better, faster. This accelerated format increases access to these high-quality therapies for busy professionals, students, or anyone with a limited time frame to participate in treatment.

Although we are an out-of-network practice, we provide superbills for insurance reimbursement applications. We also partner with CareFund, which provides affordable financing for healthcare.

How to Get Started

Recovery from PTSD is not just possible, it is highly probable when choosing a therapy that has been proven to be effective.

If you are interested in CPT, PE, or WET, please schedule a free 15-minute consultation by contacting us at (205) 983-4063, info@upwardbehavioralhealth.com, or via our website.