Trauma and PTSD treatment

Most people go through at least one traumatic event — an assault, a serious accident, combat, a disaster, the sudden loss of someone close. The VA's National Center for PTSD explains that it is normal to have upsetting memories, feel on edge or have trouble sleeping afterward. When those reactions last more than a month and disrupt daily life, it may be PTSD. Symptoms fall into four groups:

• Reliving the event: unwanted memories, nightmares, or flashbacks that feel as if it is happening again
• Avoidance: staying away from places, people, conversations or thoughts that remind you of what happened
• Negative changes in thinking and mood: guilt, shame, numbness, losing interest in things, or feeling the world is completely dangerous
• Feeling keyed up (hyperarousal): being jumpy, always on guard, irritable, unable to concentrate or sleep

Trauma can also show up as depression, panic, heavy drinking or chronic pain. Childhood trauma and repeated trauma can affect relationships and self-image in ways that take longer to work through.

Symptoms sometimes appear months or even years after the event, triggered by a new loss, a retirement, a news story or an anniversary. NIMH notes that PTSD can develop at any age and that not everyone with PTSD went through a dangerous event themselves — learning that a loved one was harmed can be enough. Whatever your story, a delayed reaction is not a sign of weakness, and it is still treatable.

You do not have to tell your whole story at the first visit. During a psychiatric evaluation we ask enough to understand what you are dealing with now — symptoms, sleep, safety, alcohol and substance use, and any past treatment — and you set the pace for the details. We often use the PCL-5, a 20-item checklist developed by the National Center for PTSD, to measure symptoms and follow change over time.

We also look for conditions that often occur with PTSD, especially depression, anxiety and panic, and traumatic brain injury in people with blast or head-injury history.

Trauma-focused psychotherapy has the strongest evidence. The VA/DoD and American Psychological Association guidelines both recommend three in particular:

• Cognitive processing therapy (CPT) — learning to examine and change stuck beliefs about the trauma, such as self-blame
• Prolonged exposure (PE) — gradually and safely approaching memories and situations you have been avoiding
• EMDR — eye movement desensitization and reprocessing, which pairs recalling the memory with guided eye movements

Our therapists can provide trauma-informed therapy in New City and Middletown. When a specific protocol such as CPT, PE or EMDR is the best fit and is not available in-house at the time, we refer you to a trained clinician and keep managing your medication here.

Medication. Sertraline and paroxetine are the two medications FDA-approved for PTSD. Venlafaxine and fluoxetine are also commonly used. For trauma-related nightmares, prazosin — originally a blood-pressure medicine — is sometimes prescribed off-label; research results have been mixed, so we discuss the evidence with you first. We generally avoid benzodiazepines for PTSD, as the VA/DoD guideline advises.

Weeks 1–2: evaluation, PCL-5 baseline, safety planning if needed, and a plan for sleep. If medication is part of the plan, we start at a low dose.

Weeks 3–8: trauma-focused therapy usually runs weekly for about 8 to 16 sessions, according to the National Center for PTSD. It is normal to feel worse briefly when you begin facing memories; we check in more often during this stretch. Medication follow-ups are every two to four weeks.

Weeks 8–12: we repeat the PCL-5 and review what has changed — nightmares, avoidance, startle, sleep. If progress is limited, we adjust medication, try a different therapy approach, or look again at co-occurring depression or substance use.

Poor sleep is one of the most common and exhausting parts of PTSD. Beyond medication, we look at sleep routines, alcohol use (which many people rely on to fall asleep but which worsens nightmares and early waking), and whether insomnia-focused therapy would help. Improving sleep often makes it easier to take part in trauma-focused therapy.

Trauma affects the people around you, too. Partners and family members may feel shut out or walk on eggshells. With your permission, a family member can join part of a visit to learn about PTSD and how to help without pushing. The National Center for PTSD also has guidance written specifically for families. If at any point you are thinking about harming yourself, call or text 988 — veterans can press 1 for the Veterans Crisis Line.

TMS is not FDA-cleared for PTSD. Its use for PTSD is off-label, and the research is promising but still emerging. When someone has both PTSD and major depression, TMS may be considered for the depression, which is an FDA-cleared use, and some patients report broader benefit. We explain this honestly on our TMS for PTSD page, and any TMS treatment takes place at our New City office.

Our Middletown office serves Orange County communities connected to Stewart Air National Guard Base and West Point, and we see service members, veterans, military families, police officers, firefighters and EMTs from across Orange County. We understand that shift work, deployments and a culture of "pushing through" can delay getting help, and we offer evening and Saturday appointments plus video follow-ups.

We accept TRICARE East through Humana Military. If you get care through the VA and want to know whether VA Community Care could cover a visit with us, please ask us — we will check what applies to you. The VA National Center for PTSD (ptsd.va.gov) also has free self-help tools and apps that work well alongside treatment.