Treatment for PTSD typically begins with a detailed evaluation, and development of a treatment plan that meets the unique needs of the survivor. Generally, PTSD-specific-treatment is begun only when the survivor is safely removed from a crisis situation. For instance, if currently exposed to trauma (such as by ongoing domestic or community violence, abuse, or homelessness), severely depressed or suicidal, experiencing extreme panic or disorganized thinking, or in need of drug or alcohol detoxification, addressing these crisis problems becomes part of the first treatment phase.

The following intervention principles are common in most cases: 

• Educating trauma survivors and their families about how persons get PTSD, how PTSD affects survivors and their loved ones, and other problems that commonly come along with PTSD symptoms. Understanding that PTSD is a medically recognized anxiety disorder that occurs in normal individuals under extremely stressful conditions is essential for effective treatment.
• Examining and resolving strong feelings such as anger, shame, or guilt, which are common among survivors of trauma
• Teaching the survivor to cope with post-traumatic memories, reminders, reactions, and feelings without becoming overwhelmed or emotionally numb. Trauma memories usually do not go away entirely as a result of therapy, but become manageable with new coping skills.

Psychotherapy

Psychotherapeutic treatments include the following:

• Debriefing (i.e., crisis intervention)
• Cognitive Behavioral Therapy
• Group Psychotherapy
• Brief Psychodynamic Psychotherapy
• Eye movement desensitization and reprocessing (EMDR)
• Hypnotherapy

Psychotherapy is generally necessary in the treatment of PTSD, whether it is conducted in individual therapy or in "survivor group" therapy. Survivor groups may be associated with or may refer group members to local community agencies that offer therapy and support for victims of rape, domestic violence, combat, natural disasters, and so on.

The goal of psychotherapy in the treatment of PTSD is to help the person address and manage painful memories until they no longer cause disabling symptoms. This begins after establishing a safe relationship between the client and therapist. The process involves gradually working through the traumatic event and the patient's reactions to it, validating the patient's experiences, repairing damage done to their identity, and dealing with loss.

Cognitive-behavioral therapy (CBT) involves working with cognitions to change emotions, thoughts, and behaviors. Exposure therapy, is one form of CBT unique to trauma treatment which uses careful, repeated, detailed imagining of the trauma (exposure) in a safe, controlled context, to help the survivor face and gain control of the fear and distress that was overwhelming in the trauma. In some cases, trauma memories or reminders can be confronted all at once ("flooding"). For other individuals or traumas it is preferable to work gradually up to the most severe trauma by using relaxation techniques and either starting with less upsetting life stresses or by taking the trauma one piece at a time ("desensitization").

Along with exposure, CBT for trauma includes learning skills for coping with anxiety (such as breathing retraining or biofeedback) and negative thoughts ("cognitive restructuring"), managing anger, preparing for stress reactions ("stress inoculation"), handling future trauma symptoms, as well as addressing urges to use alcohol or drugs when they occur ("relapse prevention"), and communicating and relating effectively with people ("social skills" or marital therapy).

Group treatment is often an ideal therapeutic setting because trauma survivors are able to risk sharing traumatic material with the safety, cohesion, and empathy provided by other survivors. As group members achieve greater understanding and resolution of their trauma, they often feel more confident and able to trust. As they discuss and share coping of trauma-related shame, guilt, rage, fear, doubt, and self-condemnation, they prepare themselves to focus on the present rather than the past. Telling one's story (the "trauma narrative") and directly facing the grief, anxiety, and guilt related to trauma enables many survivors to cope with their symptoms, memories, and other aspects of their lives.

Brief psychodynamic psychotherapy focuses on the emotional conflicts caused by the traumatic event, particularly as they relate to early life experiences. Through the retelling of the traumatic event to a calm, empathic, compassionate and non-judgmental therapist, the survivor achieves a greater sense of self-esteem, develops effective ways of thinking and coping, and more successfully deals with the intense emotions that emerge during therapy. The therapist helps the survivor identify current life situations that set off traumatic memories and worsen PTSD symptoms.

Eye movement desensitization and reprocessing (EMDR) is a specialized form of psychotherapy that is used almost exclusively for treating PTSD and its associated conditions, including depression. EMDR typically is integrated into a conventional psychotherapy regimen and is not used alone to treat PTSD. It involves elements of exposure therapy and cognitive behavioral therapy, combined with techniques (eye movements, hand taps, sounds) which create an alteration of attention back and forth across the person's midline. 

The theory behind EMDR is that stimulated rapid eye movement may help in the psychological processing of trauma. It is thought that the day’s events and our reactions to them are processed during REM sleep . In a controlled EMDR session, moving light is used to induce rapid eye movement.

Because it is a new method of treatment, only a relatively small number of patients have been treated with EMDR for PTSD. However, the EMDR Institute reports that there are more controlled studies of EMDR and its effects than of any other trauma treatment. The EMDR Institute states that an estimated 1,000,000 people had been treated by 1995, with varying degrees of improvement. Some, but not all, studies document improvement after relatively few interventions.

Hypnotherapy involves giving instructions to the patients to induce a state of highly focused attention, a reduced awareness of peripheral stimuli, and a heightened suggestibility. The goal of this treatment is to enhance control over trauma-related emotional distress and hyperarousal symptoms and to facilitate the recollection of details of the traumatic event.

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