Assessing and Treating PTSD

This article explores what PTSD is, how to identify its symptoms and diagnose it, and what some of the common treatment approaches are. Prefer video? Watch the brief explainer version via the MHA YouTube channel.

Related articles: Epigenetics and Intergenerational Trauma, Case Study: Healing from Trauma as a Soldier, Assessing and Treating Trauma.

Overview of post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a mental health condition that can develop following exposure to a traumatic event or series of events. It is characterised by symptoms that include intrusive thoughts or memories, avoidance of triggers associated with the trauma, negative changes in mood and cognition, and hyperarousal or an exaggerated startle response.

The traumatic event can be a direct personal experience, such as a physical or sexual assault, combat exposure, or a natural disaster. It can also be witnessing or learning about a traumatic event that happened to someone else, such as the sudden death of a loved one, a serious accident, or an act of terrorism.

As a mental health clinician, it is important to screen and assess for PTSD in patients who have experienced a traumatic event. A thorough assessment should include a detailed history of the event, a review of current symptoms, and an evaluation of comorbid conditions. Treatment should be tailored to the individual and may involve a combination of different approaches, including therapy, medication, and supportive interventions. It is also important to address any barriers to treatment, such as stigma or logistical challenges that may prevent patients from accessing care.

What is post-traumatic stress disorder (PTSD)?

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision (DSM-5-TR), posttraumatic stress disorder (PTSD) is a trauma- and stressor-related disorder that is characterised by the development of specific symptoms following exposure to a traumatic event. The DSM-5-TR defines PTSD as the presence of the following four symptom clusters: intrusion symptoms, avoidance symptoms, negative alterations in cognition and mood, and arousal and hyperactivity symptoms; see the next section for a fuller explanation of these.

To receive a diagnosis of PTSD, symptoms must be present for at least one month, cause significant distress or impairment in social, occupational, or other areas of functioning, and not be better explained by other mental health or medical conditions.

What are the symptoms of post-traumatic stress disorder (PTSD)?

As noted above, the DSM-5-TR groups the symptoms of PTSD into four categories: intrusion symptoms, avoidance symptoms, negative alterations in cognition and mood, and arousal and reactivity symptoms.

• Intrusion symptoms: Recurrent, involuntary, and distressing memories, nightmares, or flashbacks related to the traumatic event. This may also include intense psychological distress or physiological reactivity when exposed to cues that resemble the trauma.
• Avoidance symptoms: Avoidance of or efforts to avoid trauma-related stimuli, such as thoughts, feelings, or external reminders. This may involve avoiding people, places, or activities that are associated with the traumatic event.
• Negative alterations in cognition and mood: This category includes persistent negative beliefs or expectations about oneself or the world, persistent negative emotional states, feelings of detachment or estrangement from others, and inability to experience positive emotions.
• Arousal and reactivity symptoms: In this category are irritability, angry outbursts, reckless or self-destructive behaviour, hypervigilance, exaggerated startle response, and difficulty concentrating or sleeping.

The symptoms of PTSD can vary in severity and duration. For some individuals, symptoms may begin immediately after the traumatic event, while for others they may not emerge until weeks, months, or even years later. Symptoms can also fluctuate over time, with some periods of remission and others of exacerbation. Note that the diagnosis of PTSD requires that symptoms last for at least one month and cause significant distress or impairment in social, occupational, or other areas of functioning.

How to diagnose PTSD

The diagnosis of post-traumatic stress disorder (PTSD) involves a comprehensive evaluation by a mental health professional, usually a psychiatrist, psychologist, or licensed therapist. The diagnostic process typically involves the following steps:

• Clinical interview: A clinician will conduct a detailed interview with the patient to gather information about the nature and timing of the traumatic event, as well as the patient’s symptoms and functional impairment.
• Psychological testing: A clinician may use standardised psychological tests or self-report measures to assess the patient’s symptoms and cognitive and emotional functioning.
• Diagnostic criteria: The clinician will use the diagnostic criteria for PTSD as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) to determine whether the patient meets the criteria for the disorder. The DSM-5-TR requires the presence of specific symptom clusters (intrusion, avoidance, negative alterations in cognition and mood, and arousal and reactivity, as noted), along with functional impairment or distress.
• Rule out other conditions: The clinician will rule out other potential causes of the patient’s symptoms, such as medical or neurological conditions, substance use disorders, or other mental health disorders.
• Duration of symptoms: The diagnosis of PTSD requires that symptoms have persisted for at least one month.
• Severity of symptoms: The clinician will evaluate the severity of the patient’s symptoms and the level of functional impairment to determine the appropriate treatment plan.

In summary, the diagnosis of PTSD requires a thorough clinical interview, psychological testing, and a careful evaluation of the DSM-5-TR diagnostic criteria to determine whether the patient’s symptoms meet the criteria for the disorder.

Common treatment approaches for PTSD

Post-traumatic stress disorder can be treated effectively with various evidence-based treatment approaches. The following are some common ones:

• Cognitive-behavioural therapy (CBT): CBT is a psychotherapeutic approach that aims to help individuals identify and change negative or distorted patterns of thinking and behaviour that contribute to PTSD symptoms. CBT for PTSD often includes exposure therapy, in which the patient is gradually exposed to trauma-related stimuli to reduce avoidance and decrease fear.
• Eye movement desensitisation and reprocessing (EMDR): EMDR is a therapy that uses eye movements or other forms of bilateral stimulation to help individuals process traumatic memories and reduce associated distress. EMDR involves a structured protocol and is based on a theoretical framework that posits that bilateral stimulation enhances information processing (related reading: EMDR: What the Research Shows).
• Pharmacotherapy: Certain medications, such as selective serotonin reuptake inhibitors (SSRIs) and other antidepressants, can be effective in reducing specific PTSD symptoms, such as anxiety and depression.
• Mindfulness-based therapies: Mindfulness-based interventions, such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), can help individuals increase awareness and acceptance of present-moment experiences and reduce avoidance of trauma-related stimuli.
• Psychodynamic therapy: Psychodynamic therapy focuses on helping individuals explore and process underlying emotional conflicts and attachment patterns that contribute to PTSD symptoms.
• Group therapy: Group therapy for PTSD involves working with a therapist and a small group of individuals with PTSD. The group can provide social support, validation, and normalisation of PTSD symptoms, and it can help individuals build coping skills and increase their sense of self-efficacy.
• Family therapy: Family therapy can help individuals with PTSD and their family members understand and address the impact of PTSD on family dynamics and relationships. Family therapy can also help family members develop effective communication and problem-solving skills.
• Psychedelic-assisted therapies. Evidence for the therapeutic benefits of psychedelic-assisted therapies can best be described as emerging, but promising. To date, psilocybin and MDMA have been the most well studied substances.

In general, the most effective treatment for PTSD is likely to be a combination of different approaches tailored to the individual’s specific symptoms and needs. The choice of treatment will depend on the severity of the symptoms, the individual’s preferences and goals, and the clinician’s expertise and experience.

PTSD and trauma courses

Parts of this article were adapted from Mental Health Academy’s trauma course, Working with Trauma. This 3-hour course briefly defines Acute Stress Disorder (ASD) and Post-traumatic Stress Disorder (PTSD), examines assessment tools for trauma, explains the neurobiology of trauma, and describes the chief psychotherapeutic interventions for working with traumatised clients.

Other PTSD and trauma courses you may be interested in:

• Emotionally Focused Individual Therapy (EFIT) for Trauma: Dancing Tango and Reshaping Self
• Diagnosing Trauma-Related Disorders
• The Traumatic Effects of Disasters
• Principles of Trauma-informed Practice
• The Treatment of Trauma and the Internal Family Systems Model
• Understanding the Link Between Trauma and Addiction
• Counselling Trauma Affected Clients with Diverse Abilities
• Non-Combat Post-Traumatic Stress Disorder (PTSD) in Veterans: A Focus on Non-Combat Military-Related Trauma
• Case Studies in Trauma
• Systemic Oppression and Traumatic Stress: Evidence-based Social Justice Interventions for Clinicians
• Using Play to Provide Multicultural Trauma Treatment to Adolescents and Kids
• Intimate Partner Violence Solution-Focused Trauma Care
• First Do No Harm: The Need for Trauma-Sensitive Mindfulness

Note: Mental Health Academy members can access 500+ CPD/OPD courses, including those listed above, for less than $1/day. If you are not currently a member, click here to learn more and join.

Key takeaways

• PTSD is a mental health condition characterised by symptoms that include intrusive thoughts or memories, avoidance of triggers associated with the trauma, negative changes in mood and cognition, and hyperarousal or an exaggerated startle response.
• To receive a diagnosis of PTSD, symptoms must be present for at least one month, cause significant distress or impairment in social, occupational or other areas of functioning, and not be better explained by other mental health or medical conditions.
• The symptoms of PTSD can be grouped into four categories: intrusion symptoms, avoidance symptoms, negative alterations in cognition and mood, and arousal and reactivity symptoms.
• The diagnosis of PTSD requires a comprehensive evaluation by a mental health professional, including a detailed interview, psychological testing, and a careful evaluation of DSM-5-TR diagnostic criteria.
• Effective treatments for PTSD may include cognitive-behavioural therapy, eye movement desensitization and reprocessing, pharmacotherapy, mindfulness-based therapies, psychodynamic therapy, group therapy, and family therapy.