Dr. Charles A. Fontana

To understand the impact of psychotherapy on PTSD, one can turn to the theory of Classical Conditioning. The pairing of a unconditioned stimulus (like a bell sound) with a conditioned stimulus (like food) can produce an autonomic (involuntary) response (such as salivating in dogs) as was discovered by Pavlov in the 19th century. In PTSD a person has experienced a traumatic event (unconditioned stimulus) and there was an unconditioned response (such as fear, hypervigilance, avoidance, fight/flight and panic as is often seen as symptoms of PTSD. The unconditioned stimulus in this case is a trauma which is any event that can potentially cause loss of life or loss of bodily integrity. Emotional trauma can also be a strong UCS as such experiences can cause physical symptoms and problems and functional issues in their own right. The conditioned stimulus in most persons with PTSD are the reminders (the smell's, sights, persons, sounds, experiences) that in any way trigger the unconditioned response as they are tied in with the initial trauma.

Therapy seeks to remove the control of the conditioned stimuli (trigger events or experiences) over the conditioned responses (symptoms of PTSD) by helping the individual disconnect the memories, smells, sights, persons or experiences that are tied to the trauma response and thus give the individual back control over their bodies and responses to the triggers.

Such therapies began with Systematic desensitization which works to get a person into a relaxed state while imaging the triggers of the traumatic memories and working to change the person's autonomic responses to them.

Later, researchers found that one could access these triggers or conditioned responses through the use of eye movements. And in Eye Movement Desensitization and Reprocessing (EMDR) which works to help reduce the conditioned response and the symptoms of PTSD so one can function without interference of them. This is similar to Accelerated Resolution Therapy or ART which also uses eye movement to help the person to reduce the conditioned responses or symptoms.

As PTSD can cause anxiety, depressed mood and and poor attention span, I once was testing a middle aged person for memory loss as she had signs of this that I suspected were connected with anxiety. She came to me complaining about memory loss and underwent ART while I was testing her. Her memory scores came out well within normal limits and she reported a marked improvement in memory functioning.

Most people with PTSD complain of high levels of vigilance and anxiety as well as panic attacks and phobias. By decreasing the influence of triggers to traumatic responses, they are able to gain more control over their lives and in so doing begin to see their traumatic events as no longer a defining moment or life ruining experience but as something that just happened and taught them new things and made them feel more effective.

Other therapies have involved the use of hypnosis as well as cognitive behavior methods that work with the person to "redefine" their traumatic experiences and therefore the power they have over them.

All of these are powerful tools in helping persons to overcome their traumatic experiences.

The principles of behavior modification which are central to behavior therapy involve the use of positive reinforcement, time out and overcorrection to name a few things involved. These are useful at all ages. But I have always known that the younger a child is, the more the actual
therapy is done by the educated caretaker or parent. A 5-year-old can be seen if the practitioner is comfortable using behavior therapy with the parents'' involvement and willingness to apply the principles on a day to day basis. Thus, the therapy is for the parents in order to help them help the child.
It is, of course, important to get a good diagnostic look at the child and family system so that one can be sure that the problem is behavioral, not medical or psychiatric before doing any behavior therapy.

Meeting people outside may mean a lot of different things. But I will assume that you prefer not to leave your home. IF this is the case, I would suspect that you are having more anxiety than usual in dealing with the stressors of going out. These can include the COVID pandemic, which places a lot more pressure and risk on us when we go out. It can also be a sign of
medical issues such as allergies. Many who have been in accidents or have had violence done to them, who have been traumatized will develop a fear of leaving their homes as well at least for a period of time.

Whatever the case, if anxiety and fear are the reasons, then one needs to seek a provider that is familiar with such problems. Your medical provider can prescribe medications that may help alleviate these problems although oftentimes, the results are short acting. Most find it best to seek medical and therapeutic assistance in dealing with such anxiety. A cognitive
behavior therapist who is experienced with anxiety conditions can help you to develop strategies for managing and conquering your fears and get back to living a fuller life.

Legally, I cannot advise on medication usage as I am a psychologist and not a medical provider. The prescribing provider should answer all questions about potential side effects from your medication. You can also look at the side effect list from the pharmacist or online for any medication to find out whether it has been found to cause any confusion or lack of concentration or memory. I have worked with many people on benzodiazepines which are controlled substances and have never heard of major cognitive problems if taken as ordered. Selective Serotonin Reuptake Inhibitors are often used as well for anxiety as a more long term assist and I haven't heard of such problems with them either. However, everyone is different and every body breaks down medication and processes it differently so you need to do your homework and get advice from the person who prescribed it. Often when there are problems, they can adjust dosage and solve them quickly. And don't forget to get a therapist to help you work on calming techniques, methods of coping with anxiety and managing stress. Best of luck

There are many causes for depressive symptoms, that usually come out to situational versus dispositional or brain chemistry causes. The thing to remember is that the brain always interacts with and can change with changes in our situation and environment. So we can't just say its nature or nurture when melancholy or sadness can often be the result of the loss of a loved one and could be nothing more than grief.

The question of whether or not it will persist has to do with those factors including your family history, how many relatives have struggled with depressive symptoms with no apparent environmental cause and how much this has happened in your life before. A mental health professional will take a history to help determine to what extent this is situational. Whether it is an ongoing clinical depression or not, there is always hope. If it is a clinical depression, there is always help best with a combination of medication and therapy. I've seen many people do well with just medication and some do well with just therapy. But keep in mind that the therapy needs to focus on specific tasks and skills that help to alleviate the symptoms, while the medication has to be manageable by your body. There is always hope.

You can always call the therapist and discuss whether they prefer to use non-directive methods or more specific cognitive behavioral therapies. Those tend to be more directive and often involve homework and skill building. I tend to prefer to do both, depending on where the person is at and what is needed.