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How to write a PTSD treatment plan

Here’s what you need to know, plus a treatment plan example.

Post-traumatic stress disorder can significantly impair someone’s quality of life. As research on PTSD evolves, therapists have more and more evidence-based treatments to help improve their clients’ well-being, from trauma-focused cognitive behavioral therapy (TF-CBT) and acceptance and commitment therapy (ACT) to eye movement desensitization and reprocessing (EMDR) and prolonged exposure therapy (PE). 

But writing a PTSD treatment plan can be challenging, especially given the potential severity of the condition. Understanding PTSD diagnostic criteria and common elements of a treatment plan is the best place to start. Below, learn more about how to write a PTSD treatment plan for your clients.

DSM-5 diagnostic criteria for PSTD

Diagnosing post-traumatic stress disorder requires certain criteria, which are outlined in the DSM-5. The following criteria apply to people ages six and older:

A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

1. Directly experiencing the traumatic event(s).

2. Witnessing, in person, the event(s) as it occurred to others.

3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.

4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.


B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:

1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.

2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note: In children, there may be frightening dreams without recognizable content.

3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play.

4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).


C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:

1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

2. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).


D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia, and not to other factors such as head injury, alcohol, or drugs).

2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).

3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.

4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).

5. Markedly diminished interest or participation in significant activities.

6. Feelings of detachment or estrangement from others.

7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).


E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

1. Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.

2. Reckless or self-destructive behavior.

3. Hypervigilance.

4. Exaggerated startle response.

5. Problems with concentration.

6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).


F. Duration of the disturbance (Criteria B, C, D and E) is more than 1 month.


G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.


H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.


Specify whether:

With dissociative symptoms: The individual’s symptoms meet the criteria for posttraumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following:

  1. Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly).
  2. Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted). Note: To use this subtype, the dissociative symptoms must not be attributable to the physiological effects of a substance (e.g., blackouts, behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).

Specify whether:

With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).

What to include in a PTSD treatment plan

Key components covered in a PTSD treatment plan depend on both the presenting concerns a client comes to therapy with, their goals for treatment, and how their PTSD symptoms are presenting (in other words, the DSM-5 criteria they’ve met to warrant the diagnosis). 

All treatment plans should include a goal, objective, and intervention. You should also incorporate evaluation criteria to help you assess whether your client is improving. PTSD treatment may also include a safety plan to implement in an emergency.

Treatment is never one-size-fits-all, but typically, therapists include at least one goal and objective from each diagnostic criteria your client experiences. Your interventions should be based on psychological evidence and your clinical training.

Depending on the specific case you’re working with, you may include components that address the following aspects of PTSD.

Symptom management

Because PTSD symptoms can disrupt a person’s life, you may create goals and objectives around reducing them. This may include reducing flashbacks or anxiety or improving sleep. 

Self-esteem building

PTSD may negatively impact the affected person’s sense of self-worth. Your goals may include practicing self-compassion or reframing negative thoughts the client has about themselves.

Exposure

PTSD makes it difficult for clients to think about traumatic memories, which may lead to avoidance. You may develop goals based on helping the client gradually process these memories and confront their fears in everyday life.

Emotion regulation

PTSD can result in emotional outbursts or overall difficulty self-regulating. You may decide to create goals to identify triggers so clients can prepare for them or develop healthy coping mechanisms for uncomfortable emotions. 

Relationship improvement

PTSD can also cause issues in a client’s relationships. Treatment goals may include relationship-focused steps like healthier communication or boundary setting.

PTSD treatment plan example

Every client and case is different, but following certain themes can help ensure you develop the best possible plan to support clients who have experienced trauma. Below, find a sample treatment plan for PTSD.

Case example:

Maria is a 34-year-old teacher who experienced a car accident two years ago. Since the accident, she has recurrent intrusive memories of the crash, often triggered by loud noises or driving past the site. She avoids driving altogether and refuses invitations to events requiring travel. Maria frequently feels intense fear and panic when reminded of the accident and believes, “I can’t trust myself or anyone else on the road,” she says. She struggles with a sense of guilt, thinking, “I should have prevented the crash.” These symptoms have significantly impacted her daily life, leaving her feeling isolated and unable to engage in activities she once enjoyed.

Maria would benefit from the outlined treatment plan to process the trauma, reduce avoidance, and rebuild a sense of safety and self-trust.

Goal 1: Reduce the intensity and frequency of intrusive memories and psychological distress

  • Objective 1.1: Be able to identify 2-3 triggers that prompt intrusive memories or flashbacks
  • Intervention 1.1: Guide the client in keeping a ‘trigger journal’ to document situations, environments, or sensations that prompt flashbacks
  • Objective 1.2: Practice grounding techniques (specifically the 5-4-3-2-1 method) independently at least 3x/week
  • Intervention 1.2: Teach and demonstrate the 5-4-3-2-1 method in session


Goal 2: Reduce avoidance behaviors and increase engagement with life

  • Objective 2.1: Gradually engage in activities previously avoided (i.e. at local coffee shop) using exposure hierarchy developed in therapy over next month
  • Intervention 2.1: Develop an individualized exposure hierarchy together, starting with less distressing situations
  • Objective 2.2: Identify and challenge thoughts related to avoidance (i.e. “I can’t handle this situation”), using cognitive restructuring techniques.
  • Intervention 2.2: Teach cognitive restructuring by identifying avoidance-related automatic thoughts and examining their validity


Goal 3: Enhance emotional regulation skills to reduce emotional distress

  • Objective 3.1: Apply one new distress tolerance skill (i.e. self-soothing) each week through DBT strategies
  • Intervention 3.1: Introduce specific DBT distress tolerance skills and practice in session 


Goal 4: Challenge and reframe negative beliefs about self, others, and the world

  • Objective 4.1: Use cognitive restructuring to identify and challenge 1-2 distorted beliefs this week (i.e. “I am bad,” “The world is dangerous”)
  • Intervention 4.1: Use Socratic questioning to explore and challenge distorted beliefs
  • Objective 4.2: Create and incorporate 1-2 balanced and adaptive beliefs, such as “I am capable of healing” or “some people can be trusted”
  • Intervention 4.2: Use guided imagery to envision a future shaped by adaptive beliefs

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