"Trauma" gets thrown around a lot these days. What is it, really, and why do we need more awareness? What are the long term impacts on individuals?

Trauma is defined as exposure to a life-threatening injury or event that overwhelms one’s ability to cope. Examples of trauma include domestic or sexual violence, childhood abuse, pregnancy loss, combat, car accidents, mass shootings, or physical violence. And trauma does not need to include physical assault to inflict serious harm. Some types of verbal abuse, including threats against one’s life, are characterized as trauma. While difficult life experiences like breakups or job loss are distressing – and certainly merit seeking professional help – they are not clinically defined as trauma despite what we might see on social media.

An astounding 83% of Americans will experience a trauma and about 20% of them will go on to develop PTSD. Risk factors for PTSD include the type of trauma, the number of traumas/stressors one experiences, and the presence (or not) of a support system. Symptoms of PTSD can include intrusive thoughts, flashbacks, hypervigilance, avoidance of "triggers", and self-blame. PTSD often worsens physical conditions including chronic pain, migraines, and GI issues. PTSD can also develop years after a trauma.

People often think about military veterans when they think of PTSD, but the traumas most likely to cause PTSD are actually rape and domestic violence. About 86% of all PTSD cases are actually in civilians.

The power of CPT has been around for a while, can you share more about the model's background?

‍One of the categories of PTSD symptoms is negative cognitions. Many trauma survivors often experience shame, guilt, and thoughts of self-blame after the trauma, such as "It's my fault that the trauma happened." These thoughts keep survivors stuck in a ruminating cycle about their trauma, which distresses them and causes avoidance. Cognitive processing therapy (CPT) is a type of cognitive behavioral therapy designed to examine such thoughts, or “stuck points." It is specifically designed for PTSD patients to help survivors process their thoughts and feelings safely. It is structured and skills-based, with the goal that survivors think and feel differently about themselves, others and the world by the end of the therapy. CPT generally only takes 10-12 sessions to complete, and leads to lasting recovery. It's been around for decades and has over 50 randomized controlled trials demonstrating its effectiveness.

For these reasons, CPT is a first-line treatment for PTSD and is recommended in all treatment guidelines including that of the National Center for PTSD. Studies show that CPT leads to a positive response in up to 90% of patients and has the highest success rates and symptom improvement when compared with other trauma therapies. CPT is so effective that it is recommended over FDA-approved medications like sertraline or paroxetine for PTSD. It also works across different trauma populations, which makes it a gold standard for PTSD.

Do you have any advice for payers who want to implement specialized care for this chronic and costly population?

We know from decades of research that PTSD doesn't effectively respond to general supportive talk therapy - in fact, that is not considered a treatment in any of the treatment guidelines. Oftentimes, outpatient therapy settings approach PTSD as a chronic illness where the best they can do is symptom management and harm reduction, because many clinics aren't able to offer the specialized treatment that leads to lasting recovery.

Health plans are beginning to recognize the urgency and importance of getting trauma survivors the right treatment both to ensure they're on the road to healing and to reduce healthcare dollars on treatment that doesn't work. My recommendation is that insurance partners continue to understand the overall burden of healthcare costs for PTSD, the evidence-based treatment models designed for the condition, and the clinical outcomes measures that accurately assess improvement. When payors are willing to partner with a treatment program like Nema that offers effective care for true recovery, everyone wins.

What is your hope for the future of trauma and PTSD patient care?

‍My hope for the future of trauma & PTSD care is that survivors from all walks of life achieve lasting healing. There is a long way to go, because only about 20% of trauma survivors actually receive any treatment.

Many people still think about trauma & PTSD as a scarlet letter: once you experience it, there is no way back to a good or "normal" life. If we bring more awareness to PTSD and its treatments, we can help fight these myths. And through our work providing outstanding care at Nema, we are well on our way to helping millions of survivors reach the lasting peace they deserve.