Post-Traumatic Stress Disorder Treatment
Post-Traumatic Stress Disorder Treatment
On this page:
- What is post-traumatic stress disorder (PTSD)?
- What are the symptoms of PTSD?
- How does complex, relational or attachment trauma relate to PTSD?
- What role does “exposure” play in the treatment of PTSD?
- Why consider residential treatment for PTSD?
- What benefits does a therapeutic community provide in the treatment of PTSD?
- How does psychiatric treatment in an open setting work?
- How does an integrated treatment team approach work in treating PTSD?
- How does our comprehensive treatment prepare patients to return to a world beyond Riggs?
- How do I inquire about treatment at Riggs?
- Additional resources on PTSD
What is post-traumatic stress disorder (PTSD)?
Post-traumatic stress disorder (PTSD) is the body’s physical and emotional response to extreme stress. That stress is triggered by a life-threatening event-- either a single incident, such as a car accident or sexual assault, or chronic trauma, such as military combat, abuse or chaotic relationships; the most recent version of the DSM (DSM-5) alsorecognizes the stress incurred by first responders or others exposed to extraordinary stressors repetitively, as well as people exposed to the aversive details of traumatic events, particularly violent or accidental experiences of family members. These kinds of trauma can shatter a person’s world. Things that were once safe can become dangerous, and everyday life can become difficult to manage.
What are the symptoms of PTSD?
Common behavioral symptoms include:
- Re-experiencing the trauma (e.g., through flashbacks or nightmares)
- Behaviors aimed at avoiding such distressing thoughts and feelings (e.g., withdrawal)
- Negative cognitions and moods (e.g., a distorted sense of blame or diminished interest in activities)
- Arousal (e.g., sleep disturbances, reckless or self-destructive behaviors or hypervigilance).
PTSD can also be further complicated by co-occurring mood, anxiety, substance use, eating, psychotic spectrum and/or personality disorders. Overwhelming evidence suggests all these disorders can be caused by trauma, not just PTSD.
How does complex, relational or attachment trauma relate to PTSD?
When trauma, such as marked neglect, sexual abuse or physical abuse, occurs in the context of an important relationship, it is often referred to as complex, relational or attachment trauma. Relationships themselves can then become stressful and triggering, which can then pose serious challenges for treatment. PTSD makes people feel and act as if their trauma is still happening or may happen at any moment. If they don’t know or trust that it is not going to happen or understand how they can otherwise manage their fears, they can’t work through their thoughts and feelings productively. PTSD sufferers often find themselves destroying relationships or creating unhealthy ones without understanding the connection between their traumatic past and their present actions. Sometimes, they haven’t even registered the traumatic event(s) or relationship as such, and, further, if someone is suffering from so-called “dissociative” symptoms, even remembering the event might be difficult.
What role does “exposure” play in the treatment of PTSD?
The cornerstone of PTSD treatment is “exposure” to the traumatic experience in manageable sized doses, as, for example, when a traumatized soldier with PTSD is exposed to small bits of his or her trauma in a video game-like virtual reality re-creation of a war zone. Psychodynamic therapy like that done at Riggs also involves a kind of “exposure” to small bits of trauma through the likely if not inevitable re-creation of small bits of traumatic situations in treatment relationships. Opportunities for these exposure experiences arise naturally in the course of work among imperfect humans—like staff and patients.
For example, a patient who was traumatized as a young child by a corrupt caregiver or other authority will likely eventually find some experience at Riggs in which they come up against another experience of what feels like a corrupt caregiver—a nurse who seems too “by the book” and uncaring, a therapist who seems not to protect them or an administrator who is experienced as harsh. Such moments are responded to in two ways. First, they are dealt with on their merits. Is an apology owed? Does a misunderstanding need to be sorted out? Second, they are also viewed as opportunities, that is, as moments when “exposure” to a re-creation of experience with a corrupt authority has reemerged. At these moments the patient has an opportunity to re-work and master their traumatic experience in a different way over time using the relationships and therapeutic resources available at Riggs.
Why consider residential treatment for PTSD?
At the Austen Riggs Center, our goal is to mitigate a person’s traumatic past and help them move toward a healthy future. We treat the individual because there are many ways PTSD manifests and no two experiences are alike. Treatment of PTSD involves helping people understand and cope with their traumatic pasts so they can lead a balanced life. Trauma need not dictate a person’s future.
Immersion in our treatment program helps patients who do have PTSD:
- understand thoughts, feelings and behaviors
- focus on the meaning of symptoms
- work through the experience of trauma in moments of “exposure” or re-creation of the traumatic situation within a tapestry of relationships and supports
- come to grips with the emotional impact of having this kind of disorder, including the potential benefits—and risks—of a medication regimen
- develop better emotional regulation and the ability to tolerate previously overwhelming feelings
- learn from their relationships, past and present
- communicate in words instead of behavior
- make better life choices, based on their increased understanding of themselves and their motivations
- understand that their behaviors affect others
- discover a life more worth living
What benefits does a therapeutic community provide in the treatment of PTSD?
Exploring Different Roles with the Clinical Staff and the Therapeutic Community
At the Austen Riggs Center we have substantial clinical expertise and experience working with patients who have PTSD. Our treatment program is intensive, including four times weekly psychodynamic psychotherapy within a therapeutic community. The psychotherapists are all doctors (MDs, DOs, PhDs and PsyDs) who recognize the specific treatment dilemmas involved in working with someone with PTSD. Our psychiatrists are well versed in the use of medications that are effective in targeting symptoms of PTSD.
Patients have rich opportunities to learn about themselves within the therapeutic community. Through experiences in the therapeutic community they learn how others affect them and how they affect others, and they are often able to shed unproductive roles. As a result of successful treatment at Riggs patients develop a better understanding of the meanings of their symptoms, and learn to recognize signs of strain and discomfort in ways that allow them to develop greater confidence and more adaptive coping skills. The goal of this comprehensive approach is to help patients develop ways of facing their future with greater competence and integrity.
How does psychiatric treatment in an open setting work?
Beyond PTSD -- Exploring the Open Setting
One of the distinguishing features of the Austen Riggs Center is the open setting--our way of saying patients have complete freedom, but in return take up responsibility for their safety. There are no locked units or physical restraints and no privilege system. All admissions are voluntary. That means that after being carefully assessed as potentially suitable for the open setting both prior to and during a face-to-face preadmissions consultation, patients must decide whether to accept an offer of admission. But with freedom comes responsibility. Patients learn what it means to take responsibility for their behavior and for the decisions they make. There is ample opportunity for staff input and recommendations, but also an emphasis on developing a partnership between patients and staff that keeps in mind the patients’ developmental needs and goals.
How does an integrated treatment team approach work in treating PTSD?
An Integrated, Multidisciplinary Treatment Team Works with the Patient
Each patient works with a multidisciplinary team that develops with them a treatment plan. Members of the team include doctoral level psychotherapists, at least one psychopharmacologist (who may also be the therapist to some patients), team nurses and a substance use disorder counselor. A therapeutic community staff member helps patients find their way into the formal groups and informal, leisurely activities within the therapeutic community program. A team social worker provides liaison contact with the patient’s family, arranges family meetings, provides family therapy with the patient’s therapist if indicated, and works with the patient on practical issues such as getting a driver’s license, applying to school, preparing for job interviews, and making discharge plans when the patient is ready to transition to life outside Riggs. The same multidisciplinary team of clinicians generally works with a patient throughout their entire treatment at Riggs. For patients suffering with PTSD, this model can be particularly helpful as they can use the multiple resources and perspectives available to them to gain clarity on how and why they may be reacting to triggers. This can be difficult to do when working alone with a therapist on an outpatient basis.
How does our comprehensive treatment prepare patients to return to a world beyond Riggs?
Patients Can Take On New Roles and Responsibilities During Their Stay
As patients move through our treatment program, this they may take on new responsibilities, learn new skills, and build confidence by accepting a position of leadership within the patient community. All these efforts are designed to enable the individual develop greater skills and more adaptive functioning in preparation for the transition to life after dischargefrom Riggs. As patients progress, they may step down in level of care, increasing their involvement in the world beyond Riggs as they taper their participation in the therapeutic community of Riggs.
Additional resources on PTSD
- What is Post-Traumatic Stress Disorder: A Brief Overview by Dr. Christina Biedermann
- How the Austen Riggs Center Treats PTSD
- How is PTSD Diagnosed?
- Does the Past Matter?
- Reconsidering “Untold Stories, Hidden Wounds: War Trauma and Its Treatment”
- Dr. Stephen Xenakis Speaks at the 2012 Fall Conference on PTSD and Moral Injury