Understanding PTSD treatment

What is psychotherapy?

Psychotherapy involves meeting with a trained mental health professional who can help you:

• Identify and understand emotional and relationship problems
• Learn about the situations, thoughts, feelings and behaviors that may be contributing to your problems
• Learn more effective ways to manage stress and solve your problems

Psychotherapy is available in individual, couple, group, and family formats.

Do I need professional help?

It’s normal for people who have experienced trauma to have some challenges adjusting afterwards—this is no cause for shame. Sometimes these challenges are severe, or last more than a few months.

Whether you need help can only be determined by you and a trained healthcare professional. However, you can take the PTSD self-assessment in the PTSD Coach Canada Application to get a sense of how you are doing.

• If you are having serious thoughts about hurting or killing yourself or someone else, please call 911 or go immediately to the nearest hospital emergency room.
• If you are a Canadian Armed Forces (CAF) member during regular working hours and are having thoughts about hurting or killing yourself or someone else call 911 or attend to your closest Care Delivery Unit (CDU).
• If you are a Canadian Armed Forces (CAF) member, a Military or a Royal Canadian Mounted Police (RCMP) Veteran, you can also call the National Suicide and Prevention Support with Crisis Services Canada at all time and toll-free at 1-833-456-4566 or text 45645 (available every day from 16 h to midnight, HE).
• If you are a Canadian Armed Forces (CAF) member, a Military or a Royal Canadian Mounted Police (RCMP) Veteran, you can also call either the Canadian Armed Forces Member Assistance Program (CFMAP) or Veterans Affairs Canada (VAC) Assistance Service 24-hour toll-free line at 1-800-268-7708 or 1-800-567-5803 (TDD).

Remember, you don’t have to wait for an emergency to speak to someone.

Also, these problems are common after a trauma and can signal a need for more support:

• Depression—feeling sad, down, or blue most of the time
• Anxiety—nervousness, worry, tension, being very alert to potential danger most of the time
• Overly watchful, or startling easily in response to loud or unexpected noises
• Intrusive thoughts and memories of traumatic experiences that are very upsetting
• Increased use of alcohol, street drugs, or prescription medications, or using them to cope with problems
• Easily angered, aggressive/violent behavior
• Reckless or aggressive driving
• Sleep problems such as insomnia, nightmares
• Isolating oneself, withdrawing from friends and family
• Changes in appetite, or gaining/losing a lot of weight without trying
• Having trouble working or meeting daily responsibilities
• Having problems in relationships or trouble taking care of family
• Having thoughts about suicide, or of hurting or killing someone else

If you have any of these concerns, you might benefit from talking with a trauma specialist.

Why do people seek psychotherapy?

Some trauma survivors seek psychotherapy because they:

• have trouble with work and relationships
• avoid reminders but find memories around every corner
• feel very nervous or angry, and
• have trouble sleeping

While these symptoms are common in the first month or two after a trauma, if you don’t feel better soon, then you should think about talking to a trauma specialist.

Also, some people find that

• loved ones mean well but can’t help the way they need them to
• loved ones are far away and unavailable, or
• the  things they want to talk about feel too sensitive or private

In these circumstances, talking to an expert can really help.

How can a psychotherapist help me?

Professionals who specialize in working with PTSD can

• help you learn skills to cope better
• offer new perspectives, and
• help you feel more relaxed about talking to people in your daily life, pursuing your goals, and focusing on your future.
• Remember: seeking psychotherapy is a sign of strength, not weakness. Talking to a trauma specialist is a brave step toward recovery, and can strengthen your ability to help yourself.

Is psychotherapy confidential?

Therapy is almost always confidential.

Exceptions to this important rule are made if:

• you disclose that you are planning to kill or harm yourself or someone else
• the therapist learns about a child being abused
• you are Active Duty military (there may be limits to confidentiality)
• in a few other rare situations

Please discuss any concerns you have about confidentiality with your therapist or health care provider.

Will therapy really work?

Research on different kinds of therapy shows that many types of psychotherapy and medications really do work. Plus, some kinds of therapy only take a few months to complete.

Many Canadian Armed Forces members and Veterans find that they get used to talking to a trauma specialist quickly and come to trust them. Trauma specialists are well-trained professionals who are specialized in helping trauma survivors and have helped many.

Remember: you can always see how it goes – you don’t have to commit to anything right away. And if you have a few sessions and don’t think it’s going well, you can talk to the trauma specialist about what you want changed, or ask for a different trauma specialist. Trauma specialists are interested in your recovery and will help you get the support you need.

PTSD treatments that work

The good news is that there are several effective treatments for PTSD, including:

(From American Psychological Association - Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD))

Four psychotherapeutic interventions are strongly recommended, all of which are variations of cognitive behavioral therapy (CBT) and are trauma-focused:

• Cognitive Behavioral Therapy (CBT) focuses on changing patterns of behaviors, thoughts and feelings that lead to difficulties in functioning.
• Cognitive Processing Therapy (CPT) focuses on thoughts developed as a result of the trauma and helps the person learn how to modify and challenge unhelpful thoughts related to the trauma.
• Cognitive Therapy (CT) entails analyzing distorted thinking and reshaping beliefs and thoughts in relation to the trauma that have been interfering with daily life.
• Prolonged Exposure (PE) therapy teaches individuals to gradually approach trauma-related memories, feelings and situations and learn that the trauma-related memories and cues are not dangerous and do not need to be avoided.

Three psychotherapies are also recommended although less strongly:

• Brief Eclectic Psychotherapy (BEP) combines CBT techniques with psychodynamic strategies and focuses on changing the emotions of shame and guilt.
• Eye Movement Desensitization and Reprocessing Therapy (EMDR) encourages the person to briefly focus on the trauma memory while simultaneously experiencing bilateral stimulation (typically eye movements), which is associated with a reduction in the vividness and emotion associated with the trauma memories.
• Narrative Exposure (NET) helps individuals establish a coherent life narrative in which to contextualize traumatic experiences.

Medications:

Four medications received a conditional recommendation for use in the treatment of PTSD: sertraline (Zoloft), paroxetine (Paxil), fluoxetine (Prozac), and venlafaxine (Effexor). Currently only the Selective Serotonin Reuptake Inhibitors (SSRIs) sertraline (Zoloft) and paroxetine (Paxil) are FDA- approved for the treatment of PTSD. While SSRIs are typically the first class of medications used in PTSD treatment, exceptions may occur for based upon individual histories of side effects, response, comorbidities, and personal preferences.

Treatment may include either or both of these approaches (psychotherapy and medication). If you have PTSD, you can look for a therapist who uses one of these approaches. If you are a Canadian Armed Forces member or a Veteran, you should have no problem getting assistance finding someone to provide one of these kinds of treatment.

For more information about treatment, contact Veterans Affairs Canada or call: 1-866-522-2122 | 1-833-921-0071 (TDD).

For Canadian Armed Forces members, the main providers of mental health services are located within the Canadian Forces Health Services Centre.

How do I find a trauma specialist?

To find a trauma specialist, you can:

• Ask your doctor for a referral.
• Ask friends and family you trust for names
• Contact community and professional organizations
• If you are a Veteran, you can also visit or call Veterans Affairs Canada for a list of VAC registered service providers in your area.
  • Veterans Affairs also provides specialized treatment services to eligible Veterans through a network of Operational Stress Injury Clinics across Canada.
  • If you are a Canadian Armed Forces member, contact a Canadian Forces Health Services Centre.
  • Every Canadian Armed Forces medical clinic offers two levels of mental health care: Psychosocial and specialized mental health programs.
  • The Psychosocial Program provides first line services that Canadian Armed Forces members may directly access on their own at any time.

How much does psychotherapy cost?

Get informed as to the different options available to you.

Try not to worry about how much therapy will cost, until you have details. Think of therapy as an investment in your health and well-being. It helps you live a happier fuller life.

If you are a Veteran, you can contact Veterans Affairs Canada and ask for the treatment benefits available to you.

If you are a Canadian Armed Forces member, services at Canadian Forces Health Services Centres are provided at no cost to the member.

I want psychotherapy but I work all day

If you need flexible appointments so you don’t miss work, look for a mental health practitioner who can accommodate your schedule. Many professionals offer availability in the evening. Also, most employers will understand and help you take care of your health, whether it’s physical or emotional.

Often, people can work out a flexible schedule with their boss to free up time for appointments during the day.

Transportation to appointments

Some people have problems getting to and from appointments. If this is an issue for you, consider these options:

• Public transportation
• Ask for a ride from a friend, family member, or neighbor
• Borrow a vehicle from a friend, family member, or neighbor
• For Veterans and other Veterans Affairs Canada (VAC) clients, VAC may reimburse certain health-related travel costs when Veterans must travel to attend an authorized medical appointment. You can contact Veterans Affairs Canada and ask for the treatment benefits available to you.
• The VAC Network of Operational Stress Injury (OSI) Clinics offers tele-mental health services for those living in remote areas.
• For Canadian Armed Forces personnel, health-related travel costs outside your area of responsibility (AOR) will be covered by the Canadian Armed Forces Health Services Centre making the referral.

I’m embarrassed to go for psychotherapy

Some people feel ashamed to need help or ask for help. But think about this:

• We are not alone in this world. People are here to help you now, just as you’ve helped others in the past.
• Did you know that people who accept help after a stressful time do better than those who don’t get support?
• You may think that asking for help means that you’re not normal, but it’s normal, and common, to have difficulties after a trauma, including sleep problems, increased anger, depression, anxiety, and substance use problems.
• Seeking  psychotherapy doesn’t mean you are not functional. In fact, most people experiencing PTSD can continue their usual routines while recovering.
• If you feel guilty about taking the time and money for psychotherapy, remember: you will be better able to be there for your family and your work once you are feeling better.
• If you don’t feel better and it’s been months, or years, since your trauma, talking to a trauma specialist may help so that problems don’t become chronic or more severe.
• Going for psychotherapy does not mean you are weak. It takes courage to ask for help.  You are actively taking charge of your life and improving your ability to help yourself. 

Who can help me?

There are many experts who can help you if you seek care.

You can read more here about the roles and duties of primary care physicians, social workers, psychologists, psychiatrists, and pastoral counselors/chaplains.

What does a primary care physician do?

A primary care physician is a medical doctor (MD). They can treat common medical problems, and may also be trained to recognize and help with common psychological problems, such as depression and anxiety.

A primary care physician can help you with:

• Medical attention
• A prescription to help with depression or sleep problems
• A referral to a psychologist, social worker, or psychiatrist

You can find a primary care physician:

• Through the public health care
• In the Canadian military
• Through people you know

What does a social worker do?

In most Canadian provinces, a Bachelor degree in Social Work is the minimum requirement for entry in the profession. Some social workers have a Master’s or Doctoral degree. Their services may include psychotherapy. They work with individuals, couples, families, and groups. You can find a social worker in Operational Stress Injury (OSI) Clinics and on the list of Veterans Affairs Canada (VAC) registered service providers.

A social worker can help you with:

• Practical challenges like finding employment, housing, and government benefits
• Problems like depression, anxiety, PTSD, and substance use
• Family and relationship difficulties
• Finding resources in your community

Social workers cannot prescribe medications.

You can find a social worker:

• Through a medical doctor’s referral in the public health care system or private self-referral
• Through people you know
• In the Canadian military
• Through the VAC network of Operational Stress Injury (OSI) Clinics
• Through VAC registered service providers

What does a psychologist do?

Psychologists have a Ph.D. or Psy.D. in psychology. A doctoral degree is the minimum requirement for entry in the profession. Psychologists can provide assessment and psychotherapy. They work with individuals, couples, families and groups. You can find a psychologist in Operational Stress Injury (OSI) Clinics and on the list of Veterans Affairs Canada (VAC) registered service providers.

A psychologist can help you with:

• Psychological and neuropsychological assessment
• Mental health problems and mental illnesses
• Family and relationship difficulties

In Canada, psychologists cannot prescribe medications.

You can find a psychologist:

• Through a medical doctor’s referral in the public health care system or private self-referral
• Through people you know
• In the Canadian military
• Through the Veterans Affairs Canada (VAC) Network of Operational Stress Injury (OSI) Clinics
• Through the list of Veterans Affairs Canada (VAC) registered service providers

What does a psychiatrist do?

A psychiatrist is a medical doctor (MD) with specialized training in psychiatry. They mostly treat patients with medications that can ease symptoms of depression, anxiety, or PTSD, or help with sleep or other problems associated with mental health issues.

A psychiatrist can help you with:

• Medications for mental health problems like depression, anxiety, PTSD and severe mental illnesses
• In some cases, psychotherapy

You can find a psychiatrist:

• Through a medical doctor’s referral
• Through people you know
• In the Canadian military
• Through the VAC network of Operational Stress Injury (OSI) Clinics
• Through VAC registered service providers

What does a pastoral counselor or chaplain do?

A pastoral counselor or chaplain is a member of the clergy who:

• Provides spiritual support and guidance
• Conducts religious services in the field
• Offers support in emergency situations

Chaplains help people regardless of their faith and religious beliefs, and offer spiritual counseling and support. They are not trained to provide psychotherapy, but can advise you to consult a specialist like a psychologist, psychiatrist, or social worker.

If you are looking for spiritual guidance, a pastoral counselor or chaplain is a good place to start.