The human brain is a very sophisticated computer. However, it has a major flaw – any data that enters into this machine cannot be deleted. Though it might not be a problem in itself, there are thoughts and memories that you do not want in your life but cannot get rid of. This behavior is further amplified in post-traumatic stress disorder (PTSD).

What is PTSD?

PTSD is a psychiatric disorder that results from being subjected to or having witnessed an extremely violent, disturbing, or traumatic event. Victims and survivors of natural disasters, war, sexual assault, rape, and accidents are the most common patients of PTSD. This condition was known as ‘shell shock’ in the First World War; then the term ‘battle fatigue’ was adopted in the Second World War. The term ‘operational exhaustion’ was used in the Vietnam War.  But it does not affect only war veterans.

Of all the treatment approaches for this condition, cognitive behavioural therapy is the most effective one.

What is cognitive behavioural therapy?

Cognitive behavioural therapy (CBT) is a treatment that aims at correcting the relationship between feelings, thoughts, and behaviours. The goal is to note how changing one of these affects the other domains. For example, if the unhelpful thinking of a person is altered, it can result in healthier behaviours and better emotion regulation. The targets of CBT are the current symptoms and problems of the patient. The treatment spans over 12–16 sessions that can be delivered in group or individual formats. 

How does CBT help PTSD?

• Emotional processing theory. This theory was developed by  E.B. Foa and M.J. Kozak. It proposes that people who have been through a traumatic event tend to associate certain unrelated stimuli with the memories of their trauma. These things can then trigger all kinds of responses, from considering the world is dangerous to the numbing of feelings. Emotional processing theory recommends that if these unhealthy associations are somehow altered, the unhealthy and undesired outcomes can be avoided.
• Social cognitive theory. This theory suggests that PTSD results from applying self-made beliefs and ideals to a situation. For example, if someone has the belief that bad things happen to those who deserve them, and then they get raped, they will blame themselves for it. Instead of realising that they were abused, and the bad person is the rapist. According to the social cognitive theory, if these beliefs of the victim can somehow be changed, their perception of reality will be altered, and that will help with the unhealthy thoughts.
  

Effectiveness of cognitive therapy in treating PTSD

CBT is still an emerging treatment and not much data is available about it, and finding accurate estimates of its effectiveness can prove difficult. The best overview of its efficacy comes from the data gathered by StuffThatWorks. 

What research suggests

According to the data gathered and analysed by crowdsourcing AI-powered platform StuffThatWorks.health, CBT is one of the most effective treatments for PTSD. The analysed data gathered from people suffering from the condition that tried CBT as a treatment suggests that the treatment worked:  

• Extremely well in 10% of the patients
• Very well in 39% of the patients
• Fairly well in 34% of the patients

More evidence

The current literature reveals robust evidence that CBT is a safe and effective intervention for both acute and chronic PTSD following a range of traumatic experiences in adults, children, and adolescents. However, nonresponse to CBT by PTSD can be as high as 50%.

How is CBT used to manage PTSD?

The actual process of conducting the therapy differs from doctor to doctor and patient to patient. Some patients need individual assistance, while some prefer participating in group sessions. Most of the time, patients are assigned tasks that they have to complete. These primarily include keeping track of their emotional state between CBT sessions. In later stages, they can also be taught skills and are tasked with practising those skills in their free time. However, the basic concept behind the therapy remains the same, and it can be divided into three parts.

• Re-evaluation of thoughts. One of the first things that therapists do when using CBT to cure PTSD is to encourage the patient to re-evaluate their thought processes and assumptions. This is done to identify the ‘distortions’ (unhealthy patterns) in their thoughts. These include negative thinking that takes over positive thinking, overgeneralising bad outcomes, and the tendency to expect catastrophic results in any given situation. The goal of the therapy is to help the patient remake their concept of traumatic experiences and make them believe that they can cope with things better than they think they can.
• Controlled exposure to memories. Once the patient starts to have a better thinking approach towards their trauma, they are exposed to the memories of the trauma and the emotions they have associated with it. This is done in a controlled manner, and everything is planned ahead of time by the collaboration of the therapist and the patient. The goal of this part of the therapy is to reduce avoidance and eliminate the negative response to the memories the person has. When done properly, it gives the patient a sense of control, predictability, and self-confidence. Seeking escape and avoidance also diminish with time.
• Education on handling trauma. The next step is to educate the patient on how trauma can affect them if they encounter it in the future. This step includes the management of stress and techniques that make it easier for the patient to handle trauma. 

Takeaway

PTSD is a psychiatric disorder that results from exposure to something dangerous, violent, or threatening. This condition was first identified in WWI veterans but can occur in anyone exposed to the said stimuli. It can be treated with medication, but one of the most effective treatments so far is CBT. This therapy aims to replace the patients’ unhealthy thinking patterns with constructive ones and making them realise that facing their memories associated with the trauma and not avoidance, is the way to overcome the condition.

Adam Mulligan did his degree in psychology at the University of Hertfordshire. He is interested in mental health and well-being.