From the Guidelines
Remission from trauma symptoms means a significant reduction or absence of symptoms related to trauma, such as those experienced in post-traumatic stress disorder (PTSD), allowing the person to function better in daily life. This state occurs when intrusive memories, flashbacks, nightmares, hypervigilance, avoidance behaviors, and emotional numbness substantially decrease or disappear. Remission can be partial, where some symptoms improve while others persist at a lower intensity, or complete, where symptoms are largely absent.
Key Points to Consider
- Treatment approaches that help achieve remission include trauma-focused psychotherapies like Cognitive Processing Therapy (CPT) and Eye Movement Desensitization and Reprocessing (EMDR), typically delivered in 12-16 weekly sessions 1.
- Medications such as SSRIs (sertraline 50-200mg daily or paroxetine 20-60mg daily) may be prescribed for 6-12 months or longer, as recommended by the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline 1.
- The guideline also recommends against the use of benzodiazepines, cannabis, or cannabis-derived products due to their potential to worsen symptoms or lead to dependency 1.
- Regular follow-up care is crucial as trauma symptoms can sometimes return during periods of stress, and early intervention can prevent full relapse.
- Remission doesn't necessarily mean the trauma is forgotten, but rather that the person has processed the experience in a way that allows them to move forward without being controlled by symptoms.
Important Considerations for Treatment
- The choice of treatment should be based on the individual's specific needs and circumstances, taking into account the severity of symptoms, co-occurring conditions, and personal preferences.
- Secure video teleconferencing can be an effective way to deliver recommended psychotherapy, especially when in-person sessions are not feasible 1.
- Providers should prioritize evidence-based, patient-centered care and shared decision making to optimize individuals’ health outcomes and quality of life 1.
From the Research
Definition of Remission from Trauma Symptoms
Remission from trauma symptoms refers to the reduction or disappearance of post-traumatic stress disorder (PTSD) symptoms over time. According to 2, most trauma survivors will recover over time without intervention, but a significant minority will develop chronic PTSD, which is unlikely to remit without intervention.
Factors Influencing Remission
Several factors can influence remission from trauma symptoms, including:
- The type of treatment received, such as trauma-focused psychotherapies like prolonged exposure (PE), cognitive processing therapy (CPT), and eye movement desensitization and reprocessing (EMDR) 2, 3
- The use of medications, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin/norepinephrine reuptake inhibitors (SNRIs) 4
- The individual's response to treatment, with some people experiencing significant reductions in symptoms and others experiencing little to no improvement 3, 5
Treatment Options for Achieving Remission
Various treatment options are available to help individuals achieve remission from trauma symptoms, including:
- Trauma-focused cognitive behavioral therapy (TF-CBT) 5
- EMDR 3, 5
- PE 2
- CPT 2
- Cognitive therapy 2
- Combination of pharmacotherapy and psychotherapy 2
Cultural Considerations
When treating PTSD across cultures, it is essential to consider the cultural adaptations of trauma-focused cognitive behavioral therapies. A systematic review of cultural adaptations of trauma-focused CBTs found that there are inconsistencies in how these therapies are adapted, and a systematic approach to transportation would enable greater investigation into the necessity and efficacy of such adaptations 6.