A Comparison of PTSD treatments, including EMDR Therapy

A Comparison of PTSD treatments, including EMDR

Something I’ll often say in sessions is that having Post Traumatic Stress Disorder (PTSD) is confusing. If it’s not the question of why you’ve been stuck thinking about an event that occurred 20 years ago, then it’s trying to understand why something that reminds you of that event almost always sends you into a panic attack, even if it’s as subtle as a smell or a particular type of car. It can also be a frustrating experience to always feel like you have to be on guard, even in situations where others feel safe. If you get past these confusing questions with the realization that it might be PTSD, usually after talking with your doctor or stumbling across the idea in a book or on the internet, then you’ll likely have more questions about what to do about it. That’s where the journey gets some answers, as research has established some of the most evidenced-based, effective treatments for PTSD. Once you know all the fun acronyms, you’ll feel a bit more ready to take that next step feeling less confused. 

Evidenced-based treatments for PTSD   

The most important starting point for talking about evidenced-based treatments for PTSD is that PTSD treatment works (Schrader, Ross, 2021). Despite how long it’s been since you experienced the original traumatic experience, there is a treatment out there for you. A frequent question I get when working with clients who have PTSD is about time: “But it’s been 10-50 years, does that mean I can’t get better?” Thankfully the answer is no. As long as the therapy you’re receiving is following practices that are understood to be effective when applied to PTSD, you can still heal and reclaim your life from stressful overwhelming events that happened in your past. 

In this post, we’ll compare 3 of the most studied treatments for PTSD that have shown great results in treating PTSD no matter how long it's been. One of the benefits of having a diverse variety of treatments is that you get to pick the right treatment for you. Once you learn about them, you’ll be more equipped to find a therapist who practices the one that you think would fit best with your preferences. The three I’ll be comparing are Cognitive Processing Therapy, Prolonged Exposure, Eye Movement, and Desensitization and Reprocessing. The Veteran Affairs clinical practice guidelines for the treatment of PTSD highlight these three treatments as first-line treatments. The first line means that while these are not the only treatment options for PTSD, they are the first option you should strongly consider. 

Eye Movement Desensitization and Reprocessing (EMDR)

You’ve probably heard of EMDR If you’ve read “The Body Keeps the Score” by Bessel Van der Kolk, which was many people’s introduction to realizing that their childhood may have had a bigger impact on their lives than they thought. EMDR is also featured in Stephanie Foo’s book “What My Bones Know” about her life and recovery from Complex PTSD. Prince Harry filmed part of his EMDR session on his TV show to discuss the impact it had on his unresolved anxiety from his mother’s death. Of the three treatment options outlined, EMDR carries a certain popularity and media appeal. 

The Core of EMDR Therapy

The core of the EMDR perspective is that PTSD symptoms are caused by the memory of distressing, traumatic experiences being inadequately processed. This means that these memories continue to hurt just as much as when the trauma happened originally and that these memories feel more like the present than the past. The goal of EMDR treatment is to stimulate the adaptive ability of our brain to help process the event and related thoughts, feelings, bodily sensations, and images. By using what EMDR calls “bilateral stimulation” or the Eye Movement part of EMDR, it allows your brain to activate its natural ability to process these memories for a reduction in PTSD symptoms, and truly feel like the memory was something that happened to you in the past, unlike feeling like something that continues to happen to you (Shapiro, 2017). A more in-depth explanation of EMDR theory is located on our EMDR services page.

Throughout EMDR treatment, you and your therapist will get a history of the PTSD symptoms you’re facing, and work on preparing you for some of that processing by working to develop relaxation and calming skills you can also use outside of sessions. Then, you’ll work on processing past memories while engaging in bilateral stimulation until those memories are no longer distressing, process current triggers related to the event, and feel prepared for dealing with situations in the future that are currently impacted. 

Cognitive Processing Therapy (CPT)

If you listened to the “10 Sessions” episode on This American Life Podcast in August 2019, then you’ve maybe heard about CPT. As I said, EMDR has the best marketing. Cognitive Processing Therapy is another established treatment model developed in the late 80’s that has been shown to be effective at treating PTSD in a wide variety of cultures, settings, and methods of delivery. CPT focuses on the way PTSD is impacted by negative beliefs about the traumatic experience and how it affects your life afterward. CPT focuses on the way experiencing traumatic situations can change the way you think about the event, about yourself, and about the world. It also emphasizes how traumatic events can change how you feel about trust, safety, power/control, esteem, and intimacy (Resick, Monson, & Chard, 2017).

Overcome “Stuck Points: With Cognitive Processing Therapy  

By helping you learn how to identify and challenge negative thoughts that it calls “stuck points” CPT can help you work through thoughts that exacerbate symptoms of PTSD like “the trauma was my fault”, “I should’ve done more to stop it”, or “I can no longer trust anyone”. These thoughts can leave you stuck with feelings of guilt or shame that don’t change in intensity no matter how long it’s been. They can also contribute to symptoms of hypervigilance, or feeling like you always need to be on guard at all times. Throughout CPT treatment, you and your therapist will discuss information to help you understand PTSD, and learn skills that help you notice the impact of your thoughts on your mood, recognize when these thoughts aren’t telling you the whole story, and change these thoughts to help you move forward in recovery. Through this process, you acquire skills that help you outside of PTSD symptoms, since it’s based on Cognitive Behavioral Therapy principles that also apply to how thoughts affect symptoms of depression and anxiety. By learning to use these skills with your therapist, it can help you take a new perspective on the traumatic experience, and “get unstuck” in your recovery from PTSD. 

Prolonged Exposure (PE) 

Prolonged Exposure is more of an action approach to treating PTSD than the other two. You’ll notice I skipped where you might’ve heard about it because you’d have to be a bit of a trauma therapy nerd to have run across this one. Thankfully for this post, I am a trauma therapy nerd.  Just like the other two, PE has a long history of being studied for use to treat PTSD symptoms effectively. PE emphasizes a change in behavior in order to address the key PTSD symptom of avoidance. Avoidance is an understandable coping skill that involves avoiding memories, thoughts, feelings, places, people, sounds, smells, or environments that remind you of the traumatic situation. This may come from the advice you’ve heard like “Just try not to think about it”, or “That was years ago, just move on”. But if avoidance is your main way of coping with the traumatic memories, it can make PTSD symptoms worse and can feel like your life is shrinking as you have to avoid more and more parts of your life to avoid feeling overwhelmed. 

Prolonged Exposure Therapy: Avoiding Avoidance

PE focuses on gradually reducing the different forms of avoidance you might currently use to cope. By confronting these challenges, you can begin to notice a decrease in PTSD symptoms. By talking about the details of the trauma with your therapist, it can help you process associated emotions of fear, anger, or sadness, and gain a sense of mastery and control over the memory. PE gives your brain the opportunity to piece the fragmented memories together by continuing to revisit the story of the traumatic event. Engaging in gradual exposure to non-dangerous activities and situations that you’ve been avoiding, allows your brain to recalibrate and recognize that those avoided activities, memories, or sounds are not as dangerous as they feel, reducing the symptoms of PTSD (Foa, Hembree &Rothbaum, 2007). 

Similarities

Readers will notice that these three share very consistent themes in their approach to PTSD. All of them emphasize learning about PTSD in order to help cut down on the confusion of living with PTSD. All of them emphasize your brain and body’s natural ability to heal and improve when provided the right conditions, which PTSD literature refers to as natural recovery. All of them are roughly about the same length of 8-20 sessions to address PTSD-related symptoms, although they vary based on your specific symptoms and history. All of them are based on the same principles of changing your relationship with the traumatic memory so your brain gets the chance to store the experience correctly in your past so that it no longer feels like the present. Think of it as the mental equivalent of putting away the pile of clothes you have in your room instead of shuffling it to one side of the bed while you sleep on the other side. Once complete, you get to enjoy the whole bed! 

Similarities are great because you know they’re all based on the same effective principles that have been studied over a long period of time. While they each have their own focus, they all work towards the same outcome. It’s kind of like how 3+1, 2+2, and 4+0 all add up to 4, they just have different ways of getting there. But similarities don’t help you make a choice, so let’s get into the differences! 

Differences

Your choices are really going to come down to your preferences and what your therapist has training in delivering. 

EMDR preferences:

EMDR as you work through the traumatic memory internally, with minimal back and forth from your therapist, with the premise that your brain can heal itself, with just a little help. Some people find the benefit to this is that if discussing your traumatic event feels hard in the beginning, it can be easier to get started by not having to emphasize a lot of details. EMDR also does not have much between-session work, only noticing how things change for your understanding of the target issue. EMDR also might be a good fit for you if you really focus on the importance of integrating the mind-body connection. While other therapies focus on thoughts or actions that are different after trauma, EMDR brings a focus on body sensations that you might struggle with after traumatic experiences, such as chronic muscle tension in your shoulders, stomach discomfort when anxious, and other physical symptoms. You also might have a slight preference for EMDR if you’ve heard about it before, most people seem intrigued by the idea of bilateral stimulation and the interestingly weird ability of our brain to self-correct. 

CPT preferences:

CPT really helps you practice the skills to identify the impact of your thoughts on your mood so that they become second nature. These skills are helpful for not only PTSD but for addressing related symptoms of depression and anxiety as they relate to negative thoughts you might have. CPT does have between-session work, where you practice applying the skills identified in the session and discuss how it went with your therapist. Identifying your stuck points and slowly working through them provides a nice little bit of satisfaction like checking off items on a to-do list while your life slowly improves. While there is some discussion of details of the traumatic event, CPT mostly focuses on your thoughts about the event, meaning there’s not as much detail required as in Prolonged Exposure, but clients often find benefit from verbally working through the relevant details. EMDR and CPT both work towards processing the experience, but preferences depend on if you would want to do that internally (EMDR), or externally, with a therapist and through the skills you’ll learn (CPT). If you’ve experienced Cognitive Behavioral Therapy in the past, it may be easier for you to engage in CPT since it’s based on similar principles. CPT is also the only one of the three that has a self-help book version, which I covered in a previous blog post here. 

PE preferences:

If the symptom of PTSD you struggle with the most is avoidance, then PE may be a good fit for you. It can help you make a plan for how to slowly reduce avoidance to grow your confidence in facing traumatic memories and triggers. PE does involve working through the traumatic event in detail both with your therapist and in between sessions by yourself. This can be some client’s preference as it feels good to face a fear you’ve been avoiding for your entire life. PE also involves between session assignments of exposing yourself to previously avoided and feared environments. Research has shown that exposure is one of the most effective tools at addressing anxiety disorders, so concepts in PE can extend well to other anxiety disorders. 

Making your choice

If you’re like me, you’ll have gotten a bit excited about the different therapy treatment options for PTSD that we’ve gone through (as evidenced by my writing and your reading 2500 words on trauma treatments). It means so much to go from thinking that these symptoms are something you’re stuck living with to having some hope for change. You don’t deserve to be stuck unfairly suffering and struggling after experiencing something you never deserved to happen. What you might be able to see more clearly now is there are ways forward. There’s not a bad choice to make out of these three, and if you find that one isn’t working for you, it’s nice to have backup options. Like most things, there’s not a one-size-fits-all treatment for everyone, so listening to your preferences is a good starting point to help you decide! 

If you have an interest in seeing if EMDR or CPT is a good fit for you, I am trained in both of these approaches and would be honored by the opportunity to work with you in your recovery and reclaiming of your story. 

Learn More About EMDR Therapy and other PTSD Treatments Available in North Richland Hills, TX by Reaching Out Today.

Living with PTSD can be a challenging and confusing experience, often filled with lingering memories and heightened reactions to seemingly mundane triggers. However, the journey to healing and understanding begins with exploring the most effective, evidence-based treatments available. At Luxx Therapy n North Richland Hills, TX, individuals have access to a range of PTSD treatments, including the well-regarded Eye Movement Desensitization and Reprocessing (EMDR) therapy. This therapy, alongside other methods like Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE), offers diverse approaches to suit different needs and preferences. Each therapy, with its unique focus, aims to help you process traumatic memories, confront and reduce avoidance behaviors, and change your relationship with the traumatic experience. Understanding that there's no one-size-fits-all solution, it's crucial to find a therapy that resonates with your personal journey. If you're considering EMDR or CPT as potential options for your path to recovery, don’t hesitate to reach out to a trained professional in North Richland Hills, TX. Take that important step towards reclaiming your life from the overwhelming grip of past traumas. Your story deserves to be heard and healed.

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OTHER MENTAL HEALTH SERVICES AVAILABLE AT LUXX THERAPY

In addition to EMDR Therapy, we offer a wide range of services at Luxx Therapy geared towards meeting you where you are in your mental health journey including Therapy for Anxiety, Therapy for Depression, Trauma Therapy, and Couples Therapy. We will walk the path to understanding and healing with you whether you are in need of Individual Counseling, Couples Counseling, or Family Therapy! Reach out to us today.

References:

Schrader C, Ross A. A Review of PTSD and Current Treatment Strategies. Mo Med. 2021 Nov-Dec;118(6):546-551. PMID: 34924624; PMCID: PMC8672952.

Shapiro, F. (2017). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures (3nd ed.). Guilford Press.

Resick, P. A., Monson, C. M., & Chard, K. M. (2017). Cognitive processing therapy for PTSD: A comprehensive manual. The Guilford Press.

Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences: Therapist guide. Oxford University Press. https://doi.org/10.1093/med:psych/9780195308501.001.0001