Understanding PTSD
Post-traumatic stress disorder (PTSD) develops after experiencing or witnessing a traumatic event. While many people recover naturally with time, some develop persistent symptoms that last months or years. PTSD is not a sign of weakness — it reflects how the brain processes overwhelming experiences.
Core PTSD symptoms include re-experiencing (flashbacks, nightmares, intrusive memories), avoidance (of reminders, places, or people associated with the trauma), negative changes in mood and cognition (guilt, shame, detachment, difficulty remembering details), and hyperarousal (heightened startle, difficulty sleeping, irritability, difficulty concentrating). Symptoms must persist for more than one month and cause significant distress or functional impairment.
- Re-experiencing: flashbacks, nightmares, intrusive thoughts
- Avoidance: staying away from reminders of the trauma
- Negative mood/cognition: guilt, shame, detachment, memory gaps
- Hyperarousal: irritability, sleep problems, exaggerated startle
- Symptoms persist beyond one month and impair daily functioning
Related: Psychiatry → · Dr. Jitendra Knowledge Hub → · ICHD-3 Topic →
Treatment approaches for PTSD
Evidence-based PTSD treatment typically involves trauma-focused psychotherapy as the primary intervention. Trauma-focused CBT, including Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE), has the strongest evidence base. These therapies help process traumatic memories, challenge unhelpful beliefs about the trauma, and gradually reduce avoidance behaviors.
For severe PTSD or when symptoms are too intense for trauma-focused work, stabilisation comes first — addressing sleep, managing acute distress, and building coping resources before moving to trauma processing. Medication (SSRIs such as sertraline or paroxetine) may be recommended alongside psychotherapy, particularly when depression or anxiety is co-occurring. Dr. Shrestha follows a phased approach, progressing at the patient’s pace.
| Phase | Focus | Approach |
|---|---|---|
| Stabilisation | Safety, sleep, coping skills | Psychoeducation, CBT techniques, medication if needed |
| Trauma processing | Addressing traumatic memories | Trauma-focused CBT, CPT, or prolonged exposure |
| Reconnection | Rebuilding life and relationships | Ongoing support, relapse prevention |
What to expect at evaluation
The initial evaluation for PTSD takes 45–60 minutes and includes a thorough assessment of the traumatic event(s), symptom pattern, duration, severity, and impact on daily life. Dr. Shrestha will also assess for co-occurring conditions (depression, substance use, dissociation) and screen for safety concerns.
Treatment recommendations are made collaboratively, with attention to your readiness for trauma-focused work. You will not be pressured to discuss trauma details before you feel prepared. Bring a brief summary of your concerns and any previous treatment records to your first appointment.
- 45–60 minute comprehensive PTSD evaluation
- Assessment of trauma history, symptoms, and co-occurring conditions
- No pressure to discuss trauma details before readiness
- Collaborative treatment planning with phased approach
- Bring medication list and prior records if available