PTSD and Trauma Treatment

When is a reaction to trauma more than a normal stress response?

After an accident, an assault, a disaster, combat or another frightening event, it is normal to have upsetting memories, feel on edge and sleep badly. For most people these reactions ease over a few weeks.

Post-traumatic stress disorder (PTSD) may be diagnosed when symptoms last longer than a month and get in the way of work, school or relationships. Symptoms usually start soon after the event, but they can also appear months or years later, and they may come and go.

Anyone can develop PTSD, at any age. Factors outside a person's control, such as how intense the event was, earlier trauma, and how much support was available afterward, affect who develops it.

What are the symptoms of PTSD?

The VA National Center for PTSD describes four types of symptoms. Everyone experiences them in their own way.

• Reliving the event: unwanted memories, nightmares, or flashbacks in which it feels as if the event is happening again. A sound, smell or news story can set these off.
• Avoiding reminders: staying away from places, people or activities linked to the trauma, or keeping busy so there is no time to think about it.
• More negative thoughts and feelings: guilt, shame, numbness, loss of interest in things you used to enjoy, or a sense that no one can be trusted.
• Feeling keyed up: being constantly alert, startling easily, irritability, trouble concentrating and trouble sleeping.

Why do nightmares and sleep problems come with PTSD?

Nightmares and insomnia are both symptoms of PTSD. Nightmares often replay the event and make it hard to fall back asleep. Some people start to avoid going to bed, and feeling on alert makes restful sleep difficult.

Some people turn to alcohol or other substances to get to sleep. Over time this tends to make sleep quality worse, so tell us if it is part of your picture. We ask without judgment.

We ask about sleep during your evaluation and at follow-up visits. Our page on insomnia and sleep problems explains the habits and therapy approaches used for insomnia. Sleep apnea is also common in people with PTSD, so loud snoring or pauses in breathing may call for a referral to a sleep-medicine clinic.

What happens in a PTSD evaluation here?

Only a mental health provider can diagnose PTSD. Your psychiatric evaluation is with Victor Onodjacha, MSN, PMHNP-BC, and you see him at every follow-up, so you do not have to repeat your story to someone new.

You decide how much detail to share. We need basic information, such as the kind of event and when it happened, but you will not be pushed to describe it step by step. The rest of the conversation covers what you are living with now.

1. 1Current symptomsMemories, sleep, mood, concentration, startle, and what you have been avoiding.
2. 2History and healthMedical conditions, past mental health care, current medications, alcohol and substance use, and family history.
3. 3Related conditionsDepression, substance use and anxiety disorders often occur along with PTSD. We screen for them, sometimes with short questionnaires.
4. 4Impressions and optionsWe tell you what we think is going on, explain the treatment choices, and agree on next steps with you.

What treatments are used for PTSD?

The treatments with the most research support are trauma-focused talk therapies. Trauma-focused means the therapy works directly with the memory of the event or what it means to you. Examples are Cognitive Processing Therapy, Prolonged Exposure and Eye Movement Desensitization and Reprocessing (EMDR).

Medication is another option, alone or combined with therapy. Certain antidepressants, from the SSRI and SNRI classes, are recommended for PTSD symptoms. They can take a few weeks to show an effect, and follow-up visits are used to check your response and any side effects.

Whether medication makes sense is decided after an evaluation and together with you. Not every medication can be prescribed at every kind of visit, some may require an in-person visit, and we explain what applies to you. Our medication management page describes how follow-up works. If you are thinking about stopping a medication, talk with your prescriber first.

What can help between visits?

A few daily habits can support treatment. The National Institute of Mental Health suggests the following:

• Keep regular routines for meals, exercise and sleep.
• Use exercise, mindfulness or other activities that lower stress.
• Spend time with people you trust, and tell them what tends to set off your symptoms.
• Set realistic goals and expect gradual improvement.
• Avoid alcohol and drugs.

How do I start, and what about telehealth and insurance?

Visits are in person at our Sugar Land office in Fort Bend County or by secure video. For telehealth, you must be physically located in Texas, Idaho, Arizona or Maryland at the time of the visit. Choose whichever setting is more comfortable for you.

We accept many major insurance plans and offer self-pay, and we check your coverage before the first visit. See insurance for current details. To begin, fill out the appointment request form or call (346) 855-6216.

DanShalom Behavioral Clinic is not an emergency or crisis service. If you are thinking about suicide or feel unable to stay safe, call or text 988, or call 911. Other options are listed on our crisis resources page.