Treating PTSD: How Cognitive Behavioral Therapy Helps

“In a relatively short period of time, someone can really regain their life.”

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Like many types of anxiety disorders, post-traumatic stress disorder (PTSD) is treatable. Many anxiety disorders, including PTSD, often see improvements with a style of therapy known as cognitive behavioral therapy, or CBT. CBT helps treat PTSD in veterans by tweaking the underlying thoughts that fuel anxiety.

“Cognitive behavioral therapy overall helps one connect their thoughts to their feelings to their behaviors,” says Amanda M. Spray, PhD, psychologist at NYU Langone Health. “This can be very helpful because helping someone to slow down and connect what situation they're in, what thought they had, what feeling that evokes in them, and then what their resulting behavior was, can alone really help someone if they're struggling.”

What Is Cognitive Behavioral Therapy?

CBT is an approach that focuses on your negative thought patterns and how they lead to unwanted behaviors. In particular, a major component of CBT is learning to recognize and reframe your cognitive distortions. This term refers to the faulty thought patterns that can contribute to anxiety, such as jumping to conclusions, seeing only the negatives, blaming everything on yourself, or using black-and-white thinking.

Here's how CBT helps treat PTSD in veterans: Imagine someone having thoughts like “this is all my fault” or “I’m going to get fired if I’m not perfect.” These are cognitive distortions that can escalate feelings of distress. Someone might deal with this anxiety by numbing themselves with substances, or by overworking themselves to be perfect. Recognizing why those thoughts are distorted can alleviate those emotions, and then help you change your behaviors.

Prolonged Exposure Therapy

One subtype of CBT that helps people with PTSD is prolonged exposure therapy. “This is a therapy in which someone [is] guided through exposing themselves to their traumatic event,” says Dr. Spray. This can be particularly effective for veterans who are struggling to deal with PTSD triggers.

Exposing yourself to trauma may sound intimidating or even cruel, but prolonged exposure therapy is a safe environment that guides you through the process. A metaphor for this therapy might be a child who is afraid of the ocean, says Collin Reiff, MD, psychiatrist at NYU Langone Health.

“The child starts to avoid … not just the ocean, but also the beach,” says Dr. Reiff. “What you do is you might first take the child to the parking lot near the beach. Let them see that the parking lot is safe. Then, in time, you'll take them onto the beach, and they'll recognize that the beach is safe.”

You progressively guide the child to feel safe walking along the edge of the water, stepping their toes into the water, and eventually being able to play in the water.

“The goal is that, by the end of treatment, individuals should be able to recall the trauma in the present, with limited distress, so they no longer avoid it,” says Dr. Reiff.

Cognitive Processing Therapy

Another trauma-based subtype of CBT is cognitive processing therapy. This approach helps individuals challenge their negative thoughts or beliefs related to the traumatic event, according to the American Psychological Association.

For example, people often feel some level of guilt after a traumatic event. “This therapy really helps them to go through and process how fair is this guilt that they're experiencing and how can they work through it,” says Dr. Spray.

CBT for PTSD: What to Expect

In general, psychotherapy is an individualized experience. While some may attend therapy for just a few sessions, others may want to attend for years.

CBT is somewhat unique because it has a more defined length. Prolonged exposure therapy may occur over the course of nine to 12 hour-long sessions, and cognitive processing therapy may take about 12 sessions.

“In a relatively short period of time, someone can really regain their life that they feel like sometimes they're starting to really lose,” says Dr. Spray. Learn more about treatment for PTSD in veterans here.