Often clients have multiple issues that they present to therapy with. Sometimes it can be difficult to understand how PTSD may be affecting other areas of life and if these other areas of life will change with therapy. In short it might be hard to imagine what recovery from PTSD looks like. “Will my life be better if I do this therapy?” is a valid question for clients to ask us. Research demonstrates that there are significant changes besides symptom reduction when someone does a trauma focussed therapy for PTSD.
Motivation and Change
It can be easy to focus on assisting our clients to reduce their experience of flashbacks, hyper arousal, anxiety, anger, dysregulated emotions, nightmares and other core PTSD symptoms. While these experiences may be motivation for change other important motivators are about the quality of their life. Our clients understanding that the quality of their life can improve beyond symptom reduction is both a great outcome and potentially further motivation for therapy.
Quality of life changes
In a qualitative study examining the quality-of-life improvements following completion of trauma-focused therapy for posttraumatic stress disorder Shannon Kehle-Forbes and colleagues (2024) identified six areas where quality of life changed after trauma focussed therapy for PTSD.
Types of Therapy and Study Design
In this study trauma focused therapies were prolonged exposure (PE) and cognitive processing therapy (CPT). The participants were 60 veterans of mixed gender and racial identity who had received clinical care at veteran affairs clinics in the US. They had attended a minimum of 10 PE sessions or 12 CPT sessions and all had a final session note on file. The authors described that many participants reported improvements in more than one life domain, most often in two areas.
Caveat Emptor
It must also be kept in mind that the participants in this study were all military veterans, and this may be a factor to consider in the generalisability of the themes. The authors did report that there were some studies that included civilian participants that had shown improvements in QoL on self-report measures. Another consideration is that the participants were all therapy “completers”. This means the study doesn’t include the experience of those who discontinued treatment before completion. With these considerations in mind lets look at the life domains that improved with trauma focussed PTSD therapy.
The six areas of improvement in quality of life
The six areas of improvement in quality of life identified by Kehle-Forbes and colleagues (2024) were:
- Full participation in social activities
- Greater emotional intimacy in relationships
- Improvements in parenting
- Expanded engagement in hobbies and community
- Increased occupational commitment and confidence
- More joy in life
The authors provided some example quotes for each area where quality of life had improved after trauma focussed therapy.
Full participation in social activities
“I used to isolate myself a whole lot. I didn’t want to be bothered. I didn’t want to interact with a lot of people, but now I’m interacting with my family again. I have a den way in the back of the house where I would isolate myself. But I’ve come out of that. I’m back up in the front of the house with my family, with my wife and kids, talking with them and stuff.” pg 161
Greater emotional intimacy in relationships
“I’ve been letting my wife in….This time I had a flashback, I told her about it and we worked through it together, and that helped my relationship because then she felt more comfortable with me because I let her in into my touchy, low moment and it helped me feel more connected to her because I realized that she was there for me…” pg 161
Improvements in parenting
“I’m back to playing with my kids. I’m living life. I’m laughing with my kids. I’m going outside and playing with my kids, sports, video games, whatever it was. I’m not yelling as often, I’m not angry as often, my fuse is longer.” pg 161
Increased occupational commitment and confidence
“I think it helped me a lot with my professional relationships because a lot of times, I used humour to avoid serious situations…[therapy] helped me be more, I don’t want to say serious…. The effort involved to have a legitimate conversation about a topic at hand, that has definitely improved. That helped me professionally.” pg 161
Expanded engagement in hobbies and community
“I went to a festival that I had been going to for a few years. But whenever I’d go, I really didn’t have that much fun because I was always focusing on the people and the men…and not wanting to be noticed. I’d be there but really didn’t enjoy it. And this time, I was able to go to this festival and get involved at looking at the arts and crafts and was able to focus on that and not the men around me. And I actually had a nice time”. pg 162
More joy in life
“It made me feel more alive. I was like, ‘Oh my god, I can do this.’ I was like, ‘I haven’t done some of these things in like 10 years. This is awesome.’” pg 161
Why is understanding quality of life change important?
Trauma focussed therapy for PTSD can change more than the symptoms of PTSD. Changes in quality of life after trauma therapy are shown by this study. Therapist discussing these when talking about trauma focussed therapy are likely to be important factors for client engagement with therapy.
In another study examining how clinicians explain trauma focussed therapy Hooyer and team (2024) noted that when participants DID NOT choose a trauma focussed therapy there were some factors associated with this.
These factors included that session discussing therapy choice were often quite brief (i.e., 10–15 min). The treatment descriptions were less detailed and did not allow for deep and time intensive engagement through narratives and storytelling. The sessions were more focused on brief factual information, such as the technical aspects of session meeting times and what would occur in sessions.
When clients DID participate in trauma focussed therapy for PTSD some of the themes evident in the discussion included; questions were used to engage and educate the patient, sharing prior patient success stories was also observed.
Summary
Quality of life is important for all of us, including those with PTSD. Trauma focussed therapies not only reduce PTSD symptoms but also improve quality of life. Something important to include when talking to clients about trauma focussed therapy.
Reference
Kehle-Forbes, S. M., Baier, A. L., Ackland, P. E., Spoont, M., Polusny, M. A., Schnurr, P. P., Galovski, T., & Meis, L. (2025). “It made me feel more alive”: A qualitative analysis of quality of life improvements following completion of trauma-focused therapy for posttraumatic stress disorder. Journal of Traumatic Stress, 38, 158–164. https://doi.org/10.1002/jts.23091
Hooyer, K., Hamblen, J., Kehle-Forbes, S. M., & Larsen, S. E. (2024). “Pitching” posttraumatic stress disorder treatment: A qualitative study of how providers discuss evidence-based psychotherapies with patients. Journal of TraumaticStress,1–12. https://doi.org/10.1002/jts.23058
