4th edition as of August 2026

 

Module Overview

In Module 5, we will discuss matters related to trauma- and stressor-related disorders to include their clinical presentation, epidemiology, comorbidity, etiology, and treatment options. Our discussion will consist of PTSD, acute stress disorder, adjustment disorder, and prolonged grief disorder. Prior to discussing these clinical disorders, we will explain what stressors are, as well as identify common stressors that may lead to a trauma- or stressor-related disorder. Be sure you refer to Modules 1-3 for explanations of key terms (Module 1), an overview of models to explain psychopathology (Module 2), and descriptions of various therapies (Module 3).

 

Module Outline

• • 5.1. Stressors

• • 5.2. Clinical Presentation

• • 5.3. Epidemiology

• • 5.4. Comorbidity

• • 5.5. Etiology

• • 5.6. Treatment

 

Module Learning Outcomes

• Define and identify common stressors.
• Describe how trauma- and stressor-related disorders present.
• Describe the epidemiology of trauma- and stressor-related disorders.
• Describe comorbidity in relation to trauma- and stressor-related disorders.
• Describe the etiology of trauma- and stressor-related disorders.
• Describe treatment options for trauma- and stressor-related disorders.

 

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5.1. Stressors

 

Section Learning Objectives

• Define stressor.
• Identify and describe common stressors.

 

Before we dive into clinical presentations of four of the trauma and stress-related disorders, let’s discuss common events that precipitate a stress-related diagnosis. A stress disorder occurs when an individual has difficulty coping with or adjusting to a recent stressor. Stressors can be any event—either witnessed firsthand, experienced personally, or experienced by a close family member—that increases physical or psychological demands on an individual. These events are significant enough that they pose a threat, whether real or imagined, to the individual. While many people experience similar stressors throughout their lives, only a small percentage of individuals experience significant maladjustment to the event that psychological intervention is warranted.

Among the most studied triggers for trauma-related disorders are combat and physical/sexual assault. Symptoms of combat-related trauma date back to World War I when soldiers would return home with “shell shock” (Figley, 1978). Unfortunately, it was not until after the Vietnam War that significant progress was made in both identifying and treating war-related psychological difficulties (Roy-Byrne et al., 2004). With the more recent wars in Iraq and Afghanistan, attention was again focused on posttraumatic stress disorder (PTSD) symptoms due to the large number of service members returning from deployments and reporting significant trauma symptoms.

Physical assault, and more specifically sexual assault, is another commonly studied traumatic event. Rape, or forced sexual intercourse or other sexual act committed without an individual’s consent, occurs in one out of every five women and one in every 71 men (Black et al., 2011). Unfortunately, this statistic likely underestimates the actual number of cases that occur due to the reluctance of many individuals to report their sexual assault. Of the reported cases, it is estimated that nearly 81% of female and 35% of male rape victims report both acute stress disorder and posttraumatic stress disorder symptoms (Black et al., 2011).

Now that we have discussed a little about some of the most studied traumatic events, we will now examine the clinical presentation of posttraumatic stress disorder, acute stress disorder, adjustment disorder, and prolonged grief disorder.

 

 

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5.2. Clinical Presentation

 

Section Learning Objectives

• Describe how PTSD presents.
• Describe how acute stress disorder presents.
• Describe how adjustment disorder presents.
• Describe how prolonged grief disorder presents.

 

5.2.1. Posttraumatic Stress Disorder

Posttraumatic stress disorder, or more commonly known as PTSD, is identified by the development of physiological, psychological, and emotional symptoms following exposure to a traumatic event. Individuals must have been exposed to a situation where actual or threatened death, sexual violence, or serious injury occurred. Examples of these situations include but are not limited to witnessing a traumatic event as it occurred to someone else; learning about a traumatic event that occurred to a family member or close friend; directly experiencing a traumatic event; or being exposed to repeated events where one experiences an aversive event (e.g., victims of child abuse/neglect, ER physicians in trauma centers, etc.).

It is important to understand that while the presentation of these symptoms varies among individuals, to meet the criteria for a diagnosis of PTSD, individuals need to report symptoms among the four different categories of symptoms.

          5.2.1.1. Category 1: Recurrent experiences. The first category involves recurrent experiences of the traumatic event, which can occur via dissociative reactions such as flashbacks; recurrent, involuntary, and intrusive distressing memories; or even recurrent distressing dreams (APA, 2022, pgs. 301-2). These recurrent experiences must be specific to the traumatic event or the moments immediately following to meet the criteria for PTSD. Regardless of the method, the recurrent experiences can last several seconds or extend for several days. They are often initiated by physical sensations similar to those experienced during the traumatic events or environmental triggers such as a specific location. Because of these triggers, individuals with PTSD are known to avoid stimuli (i.e., activities, objects, people, etc.) associated with the traumatic event. One or more of the intrusion symptoms must be present.

          5.2.1.2. Category 2: Avoidance of stimuli. The second category involves avoidance of stimuli related to the traumatic event and either one or both of the following must be present. First, individuals with PTSD may be observed trying to avoid the distressing thoughts, memories, and/or feelings related to the memories of the traumatic event. Second, they may prevent these memories from occurring by avoiding physical stimuli such as locations, individuals, activities, or even specific situations that trigger the memory of the traumatic event.

          5.2.1.3. Category 3: Negative alterations in cognition or mood. The third category experienced by individuals with PTSD is negative alterations in cognition or mood and at least two of the symptoms described below must be present. This is often reported as difficulty remembering an important aspect of the traumatic event. It should be noted that this amnesia is not due to a head injury, loss of consciousness, or substances, but rather, due to the traumatic nature of the event. The impaired memory may also lead individuals to have false beliefs about the causes of the traumatic event, often blaming themselves or others. An overall persistent negative state, including a generalized negative belief about oneself or others is also reported by those with PTSD. Similar to those with depression, individuals with PTSD may report a reduced interest in participating in previously enjoyable activities, as well as the desire to engage with others socially. They also report not being able to experience positive emotions.

          5.2.1.4. Category 4: Alterations in arousal and reactivity. The fourth and final category is alterations in arousal and reactivity and at least two of the symptoms described below must be present. Because of the negative mood and increased irritability, individuals with PTSD may be quick-tempered and act out aggressively, both verbally and physically. While these aggressive responses may be provoked, they are also sometimes unprovoked. It is believed these behaviors occur due to the heightened sensitivity to potential threats, especially if the threat is similar to their traumatic event. More specifically, individuals with PTSD have a heightened startle response and easily jump or respond to unexpected noises just as a telephone ringing or a car backfiring. They also experience significant sleep disturbances, with difficulty falling asleep, as well as staying asleep due to nightmares; engage in reckless or self-destructive behavior, and have problems concentrating.

Although somewhat obvious, these symptoms likely cause significant distress in social, occupational, and other (i.e., romantic, personal) areas of functioning. Duration of symptoms is also important, as PTSD cannot be diagnosed unless symptoms have been present for at least one month. If symptoms have not been present for a month, the individual may meet criteria for acute stress disorder (see below).

 

5.2.2. Acute Stress Disorder

Acute stress disorder is very similar to PTSD except for the fact that symptoms must be present from 3 days to 1 month following exposure to one or more traumatic events. If the symptoms are present after one month, the individual would then meet the criteria for PTSD. Additionally, if symptoms present immediately following the traumatic event but resolve by day 3, an individual would not meet the criteria for acute stress disorder.

Symptoms of acute stress disorder follow that of PTSD with a few exceptions. PTSD requires symptoms within each of the four categories discussed above; however, acute stress disorder requires that the individual experience nine symptoms across five different categories (intrusion symptoms, negative mood, dissociative symptoms, avoidance symptoms, and arousal symptoms; note that in total, there are 14 symptoms across these five categories). For example, an individual may experience several arousal and reactivity symptoms such as sleep issues, concentration issues, and hypervigilance, but does not experience issues regarding negative mood. Regardless of the category of the symptoms, so long as nine symptoms are present and the symptoms cause significant distress or impairment in social, occupational, and other functioning, an individual will meet the criteria for acute stress disorder.

 

 

5.2.3. Adjustment Disorder

Adjustment disorder is the least intense of the three disorders discussed so far in this module. An adjustment disorder occurs following an identifiable stressor that happened within the past 3 months. This stressor can be a single event (loss of job, death of a family member) or a series of multiple stressors (cancer treatment, divorce/child custody issues).

Unlike PTSD and acute stress disorder, adjustment disorder does not have a set of specific symptoms an individual must meet for diagnosis. Rather, whatever symptoms the individual is experiencing must be related to the stressor and must be significant enough to impair social, occupational, or other important areas of functioning and causes marked distress “…that is out of proportion to the severity or intensity of the stressor” (APA, 2022, pg. 319).

It should be noted that there are modifiers associated with adjustment disorder. Due to the variety of behavioral and emotional symptoms that can be present with an adjustment disorder, clinicians are expected to classify a patient’s adjustment disorder as one of the following: with depressed mood, with anxiety, with mixed anxiety and depressed mood, with disturbance of conduct, with mixed disturbance of emotions and conduct, or unspecified if the behaviors do not meet criteria for one of the aforementioned categories. Based on the individual’s presenting symptoms, the clinician will determine which category best classifies the patient’s condition. These modifiers are also important when choosing treatment options for patients.

 

5.2.4. Prolonged Grief Disorder

The DSM-5 included a condition for further study called persistent complex bereavement disorder. In 2018, a proposal was submitted to include this category in the main text of the manual and after careful review of the literature and approval of the criteria, it was accepted in the second half of 2019 and added as a new diagnostic entity called prolonged grief disorder. Prolonged grief disorder is defined as an intense yearning/longing and/or preoccupation with thoughts or memories of the deceased who died at least 12 months ago. The individual will present with at least three symptoms to include feeling as though part of oneself has died, disbelief about the death, emotional numbness, feeling that life is meaningless, intense loneliness, problems engaging with friends or pursuing interests, intense emotional pain, and avoiding reminders that the person has died.

Individuals with prolonged grief disorder often hold maladaptive cognitions about the self, feel guilt about the death, and hold negative views about life goals and expectancy. Harmful health behaviors due to decreased self-care and concern are also reported. They may also experience hallucinations about the deceased, feel bitter an angry be restless, blame others for the death, and see a reduction in the quantity and quality of sleep (APA, 2022).

 

 

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5.3. Epidemiology

 

Section Learning Objectives

• Describe the epidemiology of PTSD.
• Describe the epidemiology of acute stress disorder.
• Describe the epidemiology of adjustment disorders.
• Describe the epidemiology of prolonged grief disorder.

 

5.3.1. PTSD

The national lifetime prevalence rate for PTSD using DSM-IV criteria is 6.8% for U.S. adults and 5.0% to 8.1% for U.S. adolescents. There are currently no definitive, comprehensive population-based data using DSM-5 though studies are beginning to emerge (APA, 2022). It should not come as a surprise that the rates of PTSD are higher among veterans and others who work in fields with high traumatic experiences (i.e., firefighters, police, EMTs, emergency room providers). In fact, PTSD rates for combat veterans are estimated to be as high as 30% (NcNally, 2012). Between one-third and one-half of all PTSD cases consist of rape survivors, military combat and captivity, and ethnically or politically motivated genocide (APA, 2022).

Concerning gender, PTSD is more prevalent among females (8% to 11%) than males (4.1% to 5.4%), likely due to their higher occurrence of exposure to traumatic experiences such as childhood sexual abuse, rape, domestic abuse, and other forms of interpersonal violence. Women also experience PTSD for a longer duration. (APA, 2022). Gender differences are not found in populations where both males and females are exposed to significant stressors suggesting that both genders are equally predisposed to developing PTSD. Prevalence rates vary slightly across cultural groups, which may reflect differences in exposure to traumatic events. More specifically, prevalence rates of PTSD are highest for African Americans, followed by Latinx Americans and European Americans, and lowest for Asian Americans (Hinton & Lewis-Fernandez, 2011). According to the DSM-5-TR, there are higher rates of PTSD among Latinx, African-Americans, and American Indians compared to whites, and likely due to exposure to past adversity and racism and discrimination (APA, 2022).

 

5.3.2. Acute Stress Disorder

The prevalence rate for acute stress disorder varies across the country and by traumatic event. Accurate prevalence rates for acute stress disorder are difficult to determine as patients must seek treatment within 30 days of the traumatic event. Despite that, it is estimated that anywhere between 7-30% of individuals experiencing a traumatic event will develop acute stress disorder (National Center for PTSD). While acute stress disorder is not a good predictor of who will develop PTSD, approximately 50% of those with acute stress disorder do eventually develop PTSD (Bryant, 2010; Bryant, Friedman, Speigel, Ursano, & Strain, 2010).

As with PTSD, acute stress disorder is more common in females than males; however, unlike PTSD, there may be some neurobiological differences in the stress response, gender differences in the emotional and cognitive processing of trauma, and sociocultural factors that contribute to females developing acute stress disorder more often than males (APA, 2022). With that said, the increased exposure to traumatic events among females may also be a strong reason why women are more likely to develop acute stress disorder.

 

5.3.3. Adjustment Disorder

Adjustment disorders are relatively common as they describe individuals who are having difficulty adjusting to life after a significant stressor. In psychiatric hospitals in the U.S., Australia, Canada, and Israel, adjustment disorders accounted for roughly 50% of the admissions in the 1990s. It is estimated that anywhere from 5-20% of individuals in outpatient mental health treatment facilities have an adjustment disorder as their principal diagnosis. Adjustment disorder has been found to be higher in women than men (APA, 2022).

 

5.3.4. Prolonged Grief Disorder

According to Rosner, Comtesse, Vogel, and Doering (2021) the prevalence of prolonged grief disorder is 1.2% in the general population. Among bereaved people the prevalence of developing prolonged grief disorder was 3.3%. The study also compared the ICD-11 conceptualization of prolonged grief disorder and found the prevalence using its criteria to be 1.5%. In another study, ICD-11 prolonged grief disorder prevalence ranged from 1.5 to 15.3% in bereaved adults and 9.9–11.4% in national samples (Nafarieh, et al., 2025).

 

 

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5.4. Comorbidity

 

Section Learning Objectives

• Describe the comorbidity of PTSD.
• Describe the comorbidity of acute stress disorder.
• Describe the comorbidity of adjustment disorder.
• Describe the comorbidity of prolonged grief disorder.

 

5.4.1. PTSD

Given the traumatic nature of the disorder, it should not be surprising that there is a high comorbidity rate between PTSD and other psychological disorders. Individuals with PTSD are more likely than those without PTSD to report clinically significant levels of depressive, bipolar, anxiety, or substance abuse-related symptoms (APA, 2022). There is also a strong relationship between PTSD and major neurocognitive disorders, which may be due to the overlapping symptoms between these disorders (Neurocognitive Disorders will be covered in Module 14).

 

5.4.2. Acute Stress Disorder

Because 30 days after the traumatic event, acute stress disorder becomes PTSD (or the symptoms remit), the comorbidity of acute stress disorder with other psychological disorders has not been studied. While acute stress disorder and PTSD cannot be comorbid disorders, several studies have explored the relationship between the disorders to identify individuals most at risk for developing PTSD. The literature indicates roughly 80% of motor vehicle accident survivors, as well as assault victims, who met the criteria for acute stress disorder went on to develop PTSD (Brewin, Andrews, Rose, & Kirk, 1999; Bryant & Harvey, 1998; Harvey & Bryant, 1998). While some researchers indicated acute stress disorder is a good predictor of PTSD, others argue further research between the two and confounding variables should be explored to establish more consistent findings.

 

5.4.3. Adjustment Disorder

Unlike most of the disorders we have reviewed thus far, adjustment disorders have a high comorbidity rate with various other medical conditions (APA, 2022). Often following a critical or terminal medical diagnosis, an individual will meet the criteria for adjustment disorder as they process the news about their health and the impact their new medical diagnosis will have on their life. Other psychological disorders are also diagnosed with adjustment disorder; however, symptoms of adjustment disorder must be met independently of the other psychological condition. For example, an individual with adjustment disorder with depressive mood must not meet the criteria for a major depressive episode; otherwise, the diagnosis of MDD should be made over adjustment disorder. As the DSM-5-TR says, “adjustment disorders are common accompaniments of medical illness and may be the major psychological response to a medical condition” (APA, 2022).

 

5.4.4. Prolonged Grief Disorder

Prolonged grief disorder is commonly comorbid with MDD, PTSD if the death occurred in violent or accidental circumstances, substance use disorders, and separation anxiety disorder.

 

 

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5.5. Etiology

 

Section Learning Objectives

• Describe the biological causes of trauma- and stressor-related disorders.
• Describe the cognitive causes of trauma- and stressor-related disorders.
• Describe the social causes of trauma- and stressor-related disorders.
• Describe the sociocultural causes of trauma- and stressor-related disorders.

 

5.5.1. Biological

HPA axis. One theory for the development of trauma and stress-related disorders focuses on dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis plays a central role in the body’s response to stress by coordinating physiological reactions that prepare the individual to respond to perceived threats. During a stressful or traumatic event, the amygdala senses potential danger and activates the HPA axis, releasing stress hormones epinephrine and cortisol. The increase of epinephrine causes physiological changes such as increased blood pressure, increased heart rate, increased alertness, and increased muscle tension, and energy availability to support the body’s “fight-or-flight” response. Once the threat has passed, cortisol is responsible for regulating the stress response and returning the body to homeostasis (McEwen, 2007).

Researchers examining individuals with PTSD suggest that symptoms may be related to dysregulation within the stress response rather than simply an overactive stress response. Individuals with PTSD often demonstrate increased amygdala reactivity in stressful situations, reduced regulation from the prefrontal cortex, and alterations in the HPA axis functioning (Pitman et al., 2012; Sherin & Nemeroff, 2011). Additionally, individuals with PTSD may show a diminished fear extinction, suggesting they have difficulty learning that previously threatening situations are no longer dangerous (Lokshina et al., 2023; Quinones et al., 2020). These findings may explain why individuals with PTSD experience hypervigilance, exaggerated startle responses and persistent reactions to trauma-related reminders (Schmidt, Kaltwasser, & Wotjak, 2013).

 

5.5.2. Cognitive

Preexisting conditions such as depression and anxiety may increase an individual’s risk of developing PTSD or other trauma- and stress-related disorders following a traumatic event. Cognitive theorists suggest that individuals who engage in persistent rumination or repeatedly dwell on the traumatic event may have greater difficulty processing the experience, thus increasing the likelihood that stress-related symptoms will develop (Ehlers & Clark, 2000; Lancaster et al., 2016). In addition, negative beliefs about oneself, others, and the environment may also contribute to PTSD symptoms. For example, individuals who identify life events as “out of their control” report more severe stress symptoms than those who feel as though they have some control over their lives (Catanesi et al., 2013).

 

5.5.3. Social

Although many factors contribute to the development of PTSD, strong social and family support have been identified as one of the most important protective factors. More specifically, individuals who receive emotional support, validation, and practical assistance from family, friends, or their community following a traumatic event are less likely to develop chronic PTSD symptoms. Conversely, individuals who receive blame, criticism, or social isolate after a traumatic event report poorer psychological outcome. For example, survivors of sexual assault who report supportive responses from friends and family members, typically experience fewer PTSD symptoms than those who experience negative or unsupportive reactions (Dworkin et al., 2019; Ozer et al., 2003).

 

5.5.4. Sociocultural

Rates of PTSD vary across different cultural, racial and ethnic groups. These differences are influenced by many factors including increased exposure to traumatic events, socioeconomic stressors, discrimination, access to mental health care and cultural interpretations of traumatic events. For example, Hispanic Americans have routinely been identified as a cultural group that experiences a higher rate of PTSD (Kaczkurkin et al., 2016; Perilla et al., 2002; Pole et al., 2001).

Women are approximately twice as likely as men to develop PTSD following trauma exposure. The difference in symptom presentation is thought to result from several factors, including greater exposure to interpersonal violence, differences in biological stress responses, and differences in emotional processing of traumatic events. With that said, among military and first responders who experience similar types of trauma, gender differences in PTSD are often smaller, suggesting that the nature of the traumatic experience may also play a role in development of symptoms (Olff, 2017; Street et al., 2009).

 

 

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5.6. Treatment

 

Section Learning Objectives

• Describe the treatment approach of the psychological debriefing.
• Describe the treatment approach of exposure therapy.
• Describe the treatment approach of CBT.
• Describe the treatment approach of Eye Movement Desensitization and Reprocessing (EMDR).
• Describe the use of psychopharmacological treatment.

 

5.6.1. Psychological Debriefing

One way to negate the potential development of PTSD symptoms is through psychological debriefing. Psychological debriefing is considered a type of crisis intervention that encourages individuals to discuss and process their thoughts and emotions shortly after experiencing a traumatic event. While traditional psychological debriefing often involved structured discussions in which individuals were asked to describe the event, their emotional reaction, and identify coping strategies and available support, more modern approaches suggest immediate processing of the traumatic event may interfere with natural recovery and increase distress (Roberts et al., 2019). As a result, current guidelines recommend Psychological First Aid (PFA), an early intervention that promotes safety, meeting immediate needs, providing social support, and monitoring symptoms. Unlike psychological debriefing, PFA does not require individuals to discuss the traumatic event and has become the preferred early intervention post traumatic events (Forbes et al., 2020).

 

5.6.2. Exposure Therapy

While exposure therapy is predominately used in anxiety disorders, it has also shown great success in treating PTSD-related symptoms as it helps individuals extinguish fears associated with the traumatic event. Exposure therapy helps individuals gradually confront trauma-related memories, thoughts, feelings, and situations that they have been avoiding due to trauma-related fear (Foa et al., 2019).

One type of exposure is imaginal exposure, in which the individual repeatedly recalls and describes the traumatic experience in a safe, controlled environment. As treatment progresses, the individual asked to discuss the event in increasing detail, providing more information regarding their thoughts and feelings at each step of the event. Another approach is in vivo exposure, where the individual is encouraged to gradually confront safe situations, places, or objects that remind the individual of the trauma. This can be done through videos, virtual reality, images, or even physical/tangible objects related to the traumatic event that induces a heightened arousal response. Throughout treatment, the individual is prompted to engage in coping strategies to manage anxiety and physiological symptoms, while learning that the trauma reminders do not signal current danger.

Exposure therapy is typically done in a gradual process, beginning with less distressing trauma reminders and progressing to more challenging ones as the individual’s ability to cope with psychological and physiological responses. Although some early forms of exposure therapy used flooding, where individuals were immediately exposed to their most feared memories/situations, this approach has been replaced with Prolonged Exposures (PE), which combines repeated imaginal exposure to the traumatic memory with gradual in vivo exposure to safe, but avoided trauma experiences. Through repeated exposures of gradual intensity, individuals learn that their trauma-related memories are distressing but not dangerous, thus reducing avoidance and PTSD symptoms (Foa et al., 2019; Forbes et al., 2020).

 

5.6.3. Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy, as discussed in the mood disorders chapter, has been proven to be an effective form of treatment for trauma/stress-related disorders. It is believed that this type of treatment is effective in reducing trauma-related symptoms due to its ability to identify and challenge the negative cognitions surrounding the traumatic event, and replace them with positive, more adaptive cognitions (Foa et al., 2019).

Trauma-focused cognitive-behavioral therapy (TF-CBT) is an adaptation of CBT specifically designed to treat children and adolescents who have experienced trauma. TF-CBT incorporates cognitive-behavioral techniques with trauma-sensitive care (Cohen et al., 2017). The treatment model is commonly summarized via the acronym PRACTICE:

• P: Psycho-education about the traumatic event. This includes discussion about the event itself, as well as typical emotional and/or behavioral responses to the event.
• R: Relaxation Training. Teaching the patient how to engage in various types of relaxation techniques such as deep breathing and progressive muscle relaxation.
• A: Affect. Discussing ways for the patient to effectively express their emotions/fears related to the traumatic event.
• C: Correcting negative or maladaptive thoughts.
• T: Trauma Narrative. This involves having the patient relive the traumatic event (verbally or written), including as many specific details as possible.
• I: In vivo exposure (see above).
• C: Co-joint family session. This provides the patient with strong social support and a sense of security. It also allows family members to learn about the treatment so that they are able to assist the patient if necessary.
• E: Enhancing Security. Patients are encouraged to practice the coping strategies they learn in TF-CBT to prepare for when they experience these triggers out in the real world, as well as any future challenges that may come their way.

 

5.6.4. Eye Movement Desensitization and Reprocessing (EMDR)

EMDR was developed by psychologist Francine Shapiro in the late 1980s as a treatment for trauma-related symptoms. EMDR combines elements of cognitive-behavioral therapy, exposure-based approaches, and bilateral stimulation—such as guided eye movements, tapping, and auditory tones. The goal of EMDR is to help individuals process distressing traumatic memories and develop more adaptive beliefs about the traumatic experiences (Shapiro, 2018).

While the exact mechanisms responsible for EMDR’s effectiveness remain debated, some researchers argue the bilateral stimulation may assist with memory processing and emotion regulation, while others argue that the exposure and cognitive restructuring components are responsible for success (Lee & Cuijpers, 2013). Regardless, clinical trials and meta-analyses indicate that EMDR is effective in reducing PTSD symptoms.

The standard EMDR protocol consists of eight phases:

1. Patient History and Treatment Planning – Identify trauma symptoms and potential barriers to treatment.
2. Preparation – Psychoeducation of trauma and treatment.
3. Assessment – Careful and detailed evaluation of the traumatic event. Patient identifies images, cognitions, and emotions related to the traumatic event, as well as trauma-related physiological symptoms.
4. Desensitization and Reprocessing – Holding the trauma image, cognition, and emotion in mind, while simultaneously assessing their physiological symptoms, the patient must track the clinician’s finger movement for approximately 20 seconds. At this time, the patient must “blank it out” and let go of the memory.
5. Installation of Positive Cognitions – Once the negative image, cognition, and emotions are reduced, the patient must hold onto a positive image or thought while again tracking the clinician’s finger movement for approximately 20 seconds.
6. Body Scan – Patient must identify any lingering bodily sensations while again tracking the clinician’s fingers for a third time to discard any remaining trauma symptoms.
7. Closure – Patient is provided with positive coping strategies and relaxation techniques to assist with any recurrent cognitions or emotions related to the traumatic experience.
8. Reevaluation – Clinician assesses if treatment goals were met. If not, schedules another treatment session and identifies remaining symptoms.

 

Research comparing EMDR with other trauma-focused treatments has generally found that EMDR is effective in reducing PTSD symptoms, consistent with treatment outcomes of TF-CBT and prolonged exposure therapy (Bisson et al., 2019; Lewis et al., 2020). Because of these research findings, EMDR is recommended for treatment of PTSD by several professional organizations (NICE, 2018; WHO, 2013). For more on NICE’s PTSD guidance (2018) as it relates to EMDR, please see Sections 1.6.18 to 1.6.20.

 

5.6.5. Psychopharmacological Treatment

While psychopharmacological interventions have been shown to provide some relief with PTSD symptoms, particularly symptoms related to anxiety, depression, and sleep disturbances, most research indicates that trauma-focused psychotherapies remain among the most effective treatments for PTSD. While the psychotherapies target core PTSD symptoms, medications may be useful for individuals who do not respond to psychotherapy or prefer medication-based treatment (VA/DoD, 2023).

Among the most common types of medications used to treat PTSD symptoms are selective serotonin reuptake inhibitors (SSRIs), which increase the amount of serotonin available to neurotransmitters. The SSRIs sertraline and paroxetine are the only medications approved by the US Food and Drug Administration (FDA) specifically for treatment of PTSD. Additionally, the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine has demonstrated some effectiveness in reducing PTSD symptoms (VA/DoD, 2023). Medications such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are also recommended as second-line treatments, as they have reported greater side effects and safety concerns.

 

 

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Module Recap

In Module 5, we discussed trauma- and stressor-related disorders to include PTSD, acute stress disorder, adjustment disorder, and prolonged stress disorder. We defined what stressors were and then explained how these disorders present. In addition, we clarified the epidemiology, comorbidity, and etiology of each disorder. Finally, we discussed potential treatment options for trauma- and stressor-related disorders. Our discussion in Module 6 moves to dissociative disorders.

 

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End Module 5

4th edition as of August 2026