PTSD & Trauma Recovery Protocol

Safety first: PTSD recovery requires feeling safe - stable housing, remove from abusive situations, safety planning if ongoing threat, therapy relationship must feel safe

Trauma therapy modalities (choose 1-2): EMDR (Eye Movement Desensitization and Reprocessing) - bilateral stimulation while processing trauma memories (gold standard, 8+ sessions with trained therapist, 70-80% success rate), CPT (Cognitive Processing Therapy) - changes trauma-related thoughts, SE (Somatic Experiencing - Peter Levine) - releases trauma stored in body through body awareness, IFS (Internal Family Systems) - work with trauma "parts", PE (Prolonged Exposure) - gradual exposure to trauma memories (effective but difficult)

EMDR: 8-12 sessions with certified EMDR therapist - eye movements or bilateral taps while recalling trauma, reprocesses memory from limbic (emotional) to prefrontal cortex (rational), reduces emotional charge

Somatic therapy: SE, Sensorimotor Psychotherapy - trauma stored in body (hypervigilance, freeze response, muscular tension). Body-based approaches release without re-traumatizing (safer than talk therapy for some)

Neurofeedback: Trains brain to regulate (reduce hyperarousal, increase calm). 20-40 sessions. Alpha-theta training for PTSD. Evidence-based

MDMA-assisted therapy: Breakthrough - Phase 3 trials show 67% PTSD remission with 3 MDMA sessions + therapy vs 33% placebo. FDA-approved 2024 for PTSD. MDMA allows trauma processing without overwhelming fear. 125mg MDMA + 8-hour therapy session, 3 sessions spaced 3-4 weeks. Must be done with trained therapists, legal only in clinical settings post-approval

Psilocybin-assisted therapy: Emerging for trauma (less studied than MDMA for PTSD but shows promise). 25mg psilocybin + therapy session. Allows new perspective on trauma

Ketamine-assisted therapy: IV or IM ketamine + therapy for PTSD (dissociative state allows trauma processing without re-traumatization). Series of 6 sessions. Some trauma therapists now offer

Internal Family Systems (IFS): Work with trauma "parts" (inner child, protector parts, exiles). Gentle, non-re-traumatizing. Developed by Richard Schwartz

Yoga: Trauma-sensitive yoga (not regular yoga - triggers can occur). Reconnects with body, regulates nervous system. Bessel van der Kolk's research shows yoga improves PTSD

MBSR/Meditation: Mindfulness-Based Stress Reduction, meditation (reduces hypervigilance, improves emotion regulation). Loving-kindness meditation for self-compassion

Breathwork: Trauma dysregulates breathing (hyperventilation or breath-holding). Diaphragmatic breathing, coherent breathing (5-6 breaths/min), vagal stimulation

Vagal nerve stimulation: Cold water face immersion, gargling, singing, humming (activates vagus, shifts from sympathetic to parasympathetic, calms hyperarousal)

Exercise: Regular aerobic exercise (reduces hyperarousal, burns cortisol, improves sleep). But not excessive (overtraining increases cortisol)

Trauma-informed support groups: Connection with other survivors reduces isolation, normalizes experience, builds community

Omega-3: 2-3g EPA/DHA (reduces inflammation, supports brain healing)

Vitamin D: Optimize 60-80 ng/ml (low D associated with PTSD severity)

Magnesium: 400-800mg (calming, reduces hyperarousal)

Ashwagandha: 600mg 2x/day (reduces cortisol, anxiety, supports HPA axis recovery)

L-theanine: 200-400mg as needed (calm without sedation)

CBD: 25-100mg 2x/day (reduces anxiety, improves sleep, non-intoxicating)

Sleep optimization: PTSD disrupts sleep (nightmares, hypervigilance) - sleep hygiene, darkness, white noise, weighted blanket (proprioceptive input calming), prazosin 1-5mg (alpha-blocker Rx that reduces nightmares - very effective), imagery rehearsal therapy for nightmares

Avoid: Alcohol (many PTSD patients self-medicate but worsens long-term, impairs processing, increases risk), benzodiazepines (interfere with trauma processing, addictive, worsen PTSD long-term despite short-term relief - avoid), re-traumatization (avoid graphic media, triggers until processed)

Grounding techniques: For flashbacks/dissociation - 5-4-3-2-1 sensory grounding (5 things see, 4 hear, 3 feel, 2 smell, 1 taste), ice on skin, strong smell (peppermint), bilateral stimulation (butterfly hug), name present reality ("I'm in 2026, I'm safe, that was then, this is now")

HPA axis support: Chronic trauma dysregulates stress axis - adaptogenic herbs (ashwagandha, rhodiola), reduce stress, therapy, meditation

Medication: SSRIs (Zoloft, Paxil) FDA-approved for PTSD (modest benefit 30-40% improvement, don't address root cause but can reduce symptoms while doing therapy). Prazosin for nightmares (very effective). Avoid benzos long-term

Safe relationships: Trauma often involves betrayal, abuse - safe, supportive relationships are healing (therapy relationship, support groups, trusted friends/family)

Timeline: Trauma recovery takes time (months-years), not linear (setbacks common), need patience and self-compassion