What does the recovery journey look like for people with PTSD?

• There is plenty of hope for healing after trauma.
• Trauma treatment can be divided into three levels.
• The first focuses on emotion regulation and symptom management.
• The second level is trauma-focused and involves reprocessing the trauma.
• The third level centers around growth post-trauma.

Dr. Darin Bergen is a clinical psychologist whose job and passion is to help people heal from traumatic experiences and heartbreaking losses. He delves into what this typically involves below:

There are a number of effective treatments for trauma, but there is an important context to understand in trauma treatment. We typically divide treatments into three “levels”—level one is focused on symptom management or emotion regulation, level two is trauma-focused and generally works on reprocessing the traumas, and level three is centered around post-traumatic growth (once the distress has been managed, what kind of life does the person want?). Often, people start level one and progress through level two and on to level three, but this varies.

Level One: Emotion regulation

Level one treatments, as I mentioned are focused on managing the distressing symptoms of PTSD. These are typically focused on coping tools and some common approaches are cognitive behavioral therapy (CBT), skills training in affective and interpersonal regulation (STAIR, a specific kind of CBT developed for survivors of trauma), dialectical behavior therapy (DBT), or acceptance and commitment therapy (ACT).

If someone wanted to do this on their own, they should seek out client workbooks that teach coping skills such as The Relaxation and Stress Reduction Workbook, or The PTSD Workbook. These self-help resources aren’t as comprehensive or in-depth as individual therapy, but can be very helpful. Mindfulness mediation is also very helpful for self-help at this stage and there are tons of apps (Insight Timer, Headspace) and guided meditations on YouTube. There is also an app developed by the VA to help people cope with PTSD called The PTSD Coach that can walk them through coping exercises.

Level Two: Reprocessing Traumatic Memories

Level two trauma treatment, as I mentioned, typically revolves around some form of reprocessing of traumatic memories. The big treatments (per the evidence) in this area are exposure therapy, cognitive processing therapy (CPT) and EMDR. They are newer treatments with good evidence as well, like narrative therapy and emotion-focused trauma therapy.

Level two treatment is harder to approximate on your own. The best resource would be using journaling or writing, to help process the trauma differently than when they think about it in their own mind. The classic resource in this area is Writing to Heal by James Pennebaker.

Level Three: Getting Reacquainted

Level three treatment is much more vague and comes in many forms—any kind of therapy working on clarifying and pursuing the life that the survivor now wants. It’s hard to narrow down treatments in this area because it’s such a broad topic. The same problem exists for self-help—anything in the self-help arena could be helpful for someone looking to grow after they’ve quieted the symptoms.

Any qualified trauma therapist should be able to explain this to prospective clients and I often recommend it as a good way to judge the caliber of a trauma therapist. Do they explain the overview and different treatments, or do they default to one specific treatment in all cases? The second indicates they have limited training.

I do often recommend the book Trauma and Recovery by Judith Herman to clients in treatment for trauma. It is not a quick read and can be very emotional, but it provides an excellent overview of historical perspectives on trauma as well as understanding trauma and its treatment.

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