Ask the Doc: What Are the Best Treatments For PTSD?

[Editor’s note: This article deals with mental health issues and treatment. If you or someone you know is having a mental health crisis, call 988 National Suicide and Crisis Lifeline and press “1”, or text 838255, or chat with a live counselor for the dedicated Veterans Crisis Line and Military Crisis Line. For Spanish, press “2”.]
Dear Doc,
I think my partner may have post-traumatic stress disorder as a result of what he’s been through in combat. He’s deployed overseas many times over the years, and it’s taken a toll on us when he’s away but now also when he’s home. He gets triggered easily, doesn’t sleep well—and when he does sleep, he can get agitated by horrible nightmares.
He won’t say whether he needs help for PTSD because I think he sees it as a sign of weakness. I don’t agree. What are the best treatments available for PTSD when he decides the time is right to get help?
A Concerned Partner

Dear Concerned,
I understand how your spouse’s behaviors are causing both of you to be on edge. First, let me reassure you that asking for help for this trauma-related condition is a sign of strength. We all can use help from time to time—there are professionals out there who can help, and both of you can benefit from the help and improve the situation at home.
Luckily, there are a variety of treatments that evidence shows successfully treat PTSD. I’ve found just the expert to discuss current treatments. Marija Kelber is a research psychologist with a doctorate in psychology and is team lead at the Defense Health Agency’s Psychological Health Center of Excellence. Here’s her advice.
—
Studies have shown that talk therapies or psychotherapies that focus on helping patients deal with traumatic memories work best. The joint Department of Veterans Affairs-Department of Defense 2023 PTSD clinical practice guideline summary for patients recommends starting with these therapies first because they have the strongest evidence showing they work:
• Cognitive Processing Therapy
• Eye Movement Desensitization and Reprocessing
• Prolonged Exposure

In CPT, patients learn about PTSD and how trauma affects their thoughts, feelings, and understanding of self, others, and the world. They then work with the therapist on changing upsetting thoughts and feelings.
In EMDR, patients remember the trauma while focusing on the movement of the therapist’s hands or a sound that shifts back and forth. The movement or sounds stimulate both halves of the brain. EMDR helps patients change how traumatic memories are experienced and process more information from the past trauma.
PE is focused on confronting fears by approaching traumatic memories gradually. PTSD usually involves avoiding any reminders of trauma; however, that only reinforces one’s fears. By talking about the trauma and facing situations that cause fear, patients can decrease PTSD symptoms and improve their quality of life.
All these therapies involve attending treatment sessions that usually last for 60 minutes for 10–12 weeks. Treatment takes time.
The VA’s National Center for PTSD has short videos on CPT, EMDR, and PE that answer questions, such as the length of time a patient would be in therapy, what they can expect from a particular type of therapy, and its effectiveness. There’s also a booklet for family and friends that discusses topics including PTSD, how to support your loved one, communication, and taking care of yourself.
Talk therapies, however, may not be right for everyone. Other options include medications recommended for the treatment of PTSD such as sertraline (Zoloft), venlafaxine (Effexor SR), and paroxetine (Paxil). Fluoxetine (Prozac) can be prescribed by a health care provider but does not have the same strength of evidence as the other medications for the treatment of PTSD.
Additional manualized psychotherapy treatments include Written Exposure Therapy, Cognitive Behavioral Therapy for PTSD, Present-Centered Therapy, and Mindfulness-based Stress Reduction.
I recommend patients discuss options with their health care provider and choose treatments based on the risks, benefits, side effects, and their preferences.
Providers can consider manualized group therapy or virtual group therapy as an alternative to treatments with stronger evidence based on availability and patient preference. The clinical practice guideline states that the evidence for group therapy for PTSD is insufficient. Although some types of group therapy are better than receiving no treatment, there is no support for one type of group therapy over another.
There is growing interest in biological treatments, such as neurofeedback, and complementary and integrative medicine, and alternative approaches, such as yoga, meditation, and exercise for the treatment of PTSD, but there’s insufficient evidence to make recommendations for or against these other types of treatment, with the exception of Mindfulness-based Stress Reduction.
Thanks for asking this question. If you are concerned your spouse may have PTSD and would like more information, I would encourage your spouse to speak with a provider or chaplain.
—
Concerned,
I hope our expert has answered your PTSD questions with her explanations and resource referrals. Continue to be supportive of your spouse and ask your provider, chaplain, or military and family life counselor about ways to bring up the subject of PTSD in nonjudgmental language. Don’t forget to take care of yourself as well. Mental health is health. Treatment is available, and it’s OK to ask for help.
As always, stay safe out there.

Resources

For anyone experiencing a mental health crisis, needing immediate assistance, or simply wanting to talk, confidential help is available 24/7/365.
There are a variety of treatment options available, and the DHA and VA have many resources available to you. These include:

Kelber Recommendations
Military OneSource, a 24/7 gateway to trusted information for service members and families that provides resources and confidential help. Call 800-342-9667.
Psychological Health Resource Center is available 24/7 for service members, veterans, and family members with questions about psychological health topics. Trained mental health consultants can help you access mental health care and community support resources in your local area. Call 1-866-966-1020, start a live chat, or visit www.health.mil/PHRC.
InTransition has 20 FAQs that are a helpful introduction to the program. You can call 800-424-7877, or 800-748-81111 in Australia, Germany, Italy, Japan, and South Korea only. You can also email the program directly at: dha.ncr.j-9.mbx.inTransition@health.mil.
The Military Health System, Department of Defense, and the VA have many other mental health resources available to any service member, and family or veteran beneficiaries who are struggling with mental health challenges. The Mental Health Hub on health.mil has a complete list of resources for immediate assistance or to make appointments.
To set up a mental health appointment through TRICARE, visit: tricare.mil/MentalHealth.
I recommend these patient- and family-friendly tools to help make a decision about treating PTSD. Providers will find five clinical tools on the hub as well.
For more on who can develop PTSD, its symptoms, treatments, and other facts, read a recent commentary from a DHA public health expert.

Public Outreach

Other critical areas of public outreach are available across the armed services. These include:
• Reviewing the DOD Real Warriors Campaign, the only DOD-DHA public health campaign to decrease stigma associated with mental health care
• Educating and training service members to see signs and reduce suicide risks through the:
o U.S. Army’s Suicide Prevention efforts
o U.S. Air and Space Force’s Ask, Care, Escort program
o U.S. Navy’s Ask, Care, Treat program
• Increasing service members’ knowledge of and comfort in reaching out to help resources via Resources Exist, Asking Can Help program, or REACH from the Defense Suicide Prevention Office
• Encouraging supportive language through DSPO’s Your Words Matter campaign, which calls for the end of stigmatizing or negative language when addressing mental health
• Sharing resources to support service members and their families through the Healthy Relationship program, a free, educational consultation designed to strengthen relationships through a series of personalized coaching sessions tailored to help set goals and strengthen communication skills
• Collaborating with the DOD Educational Agency to support school-age children in talking about their feelings via the Acknowledge, Care, Tell program