Could I Have PTSD or Trauma?

Kimberley: Could I have PTSD or trauma? This is a question that came up a lot following a recent episod e we had with Caitlin Pinciotti, and I'm so happy to have her back to talk about it deeper. Let's go deeper into PTSD , trauma, what it means, who has it, and why we develop it. I'm so happy to have you here, Caitlin. Caitlin: Yes, thank you for having me back. INTRODUCING CAITLIN PINCIOTTI Kimberley: Can you tell us a little bit about you and all the amazing things you do? Caitlin: Of course. I'm an assistant professor in the Psychiatry and Behavioral Sciences Department at Baylor College of Medicine. I also serve as the co-chair for the IOCDF Trauma and PTSD in OCD Special Interest Group. Generally speaking, a lot of my research and clinical work has specifically focused on OCD, PTSD, and trauma, in particular when those things intersect, what that can look like, and how that can impact treatment. I'm happy to be here to talk more specifically about PTSD. WHAT IS PTST VS TRAUMA? Kimberley: Absolutely. What is PTSD? If you want to give us an understanding of what that means, and then also, would you share the contrast of—now you hear more in social media—what PTSD is versus trauma ? Caitlin: Yeah, that's a great question. A lot of people use these words interchangeably in casual conversation, but they are actually referring to two different things. Trauma refers to the experience that someone has that can potentially lead to the development of a disorder called post-traumatic stress disorder. When we talk about these and the definitions we use, trauma can be sort of a controversial word, that depending on who you ask, they might use a different definition. It might be a little bit more liberal or more conservative. I'll just share with you the definition that we use clinically according to the DSM. Trauma would be any sort of experience that involves threatened or actual death, serious injury, or sexual violence, and there are a number of ways that people can experience it. We oftentimes think of directly experiencing trauma. Maybe I was the one who was in the car accident. But there are other ways that people can experience trauma that can have profound effects on them as well, such as witnessing the experience happening to someone else, learning that it happened to a really close loved one, or being exposed to the details of trauma through one's work, such as being a therapist, being a 911 telecommunicator, or anyone who works on the front lines. That's what we mean diagnostically when we talk about trauma. It's an event that fits that criteria. It can include motor vehicle accidents, serious injuries, sexual violence, physical violence, natural disasters, explosions, war, so on and so forth—anytime when the person feels as though their bodily integrity or safety is at risk or harmed in some way. Conversely, PTSD is a mental health condition. That's just one way that people might respond to experiencing trauma. In order to be diagnosed with trauma, the very first criterion is that you have to have experienced trauma. If a person hasn't experienced an event like what I described, then we would look into some other potential diagnoses that might explain what's going on for them, because there are lots of different ways that people can be impacted by trauma beyond just PTSD. PTSD SYMPTOMS AND PTSD DIAGNOSIS Kimberley: Right. What are some of the specific criteria for being diagnosed with PTSD? Caitlin: PTSD is comprised of 20 potential PTSD symptoms , which sounds like a lot, and it is. It can look really different from one person to the next. We break these symptoms down into different clusters to help us understand them a little bit better. There are four overarching clusters of PTSD symptoms. There's re-experiencing, which is the different ways that we might re-experience the trauma in the present moment, such as through really intrusive and vivid memories, flashbacks, nightmares, or feeling really emotionally upset by reminders of the trauma. The second cluster is avoidance. This includes both what we would call internal avoidance and external avoidance. Internal avoidance would be avoiding thinking about the trauma, but also avoiding any of the emotions that might remind someone of the trauma. If I felt extremely powerless at the time of my trauma, then I might go to extreme lengths to avoid ever feeling powerless again in my life. In terms of external avoidance, that's avoiding any cue in our environment that might remind us of the trauma. It could be people, places, different situations, smells, or anything involving the senses. That's avoidance. The third cluster of PTSD symptoms is called negative alterations, cognitions, and mood, which is such a mouthful, but it's basically a long way of saying that after we experience trauma, it's not uncommon for that experience to impact our mood and how we think about ourselves or other people in the world. You'll see some symptoms that can actually feel a little bit like depression, maybe feeling low mood, or an inability to experience positive emotions. But there's also this kind of impact on cognition—an impact on how I view myself and my capabilities, maybe to the extent that I can trust other people or feel that the world is dangerous. Blame is really big here as well. And then the last cluster of symptoms is called hyperarousal. This is basically a scientific word for your body—sort of kicking into that overdrive feeling of that fight, flight, freeze response. These include symptoms where your body is constantly in a state of feeling like there's danger or threat. This can impact our concentration. It can impact our sleep. We might have angry outbursts because we're feeling really on edge. We may feel as though we have to constantly watch our backs, survey the situation, and make sure that we are definitely going to be prepared and aware if another trauma were to happen. Those are the four overarching symptom clusters. But somebody only actually needs to have at least six of those symptoms to a clinically significant and impairing way. Kimberley: Right. Now, I remember early in my own treatment, a clinician using terms like little T trauma and big T trauma. The example that I was discussing is I grew up on a ranch, a very large ranch. My dad is and was a very successful rancher. Every eight to 10 years, we would have this massive drought where we would completely run out of water and we'd have to have trucks bring in water, and there were dead livestock everywhere. It was very financially stressful. I remember her bringing up this idea of what is a little T trauma and what is a big T trauma—not to say that that's what was assigned to me, but that was the beginning of when I heard this term. WHAT IS BIG T TRAUMA VS LITTLE T TRAUMA? What does it actually mean for someone to say big T trauma versus small T trauma ? Caitlin: Yeah, this is another common term that people are using. I'm glad that there is language to describe this because a lot of times, when I provide the definition that I gave a few minutes ago about what trauma is according to the DSM, people will hear that and think, "Wait a minute, my experience doesn't really fit into that criteria, but I still feel like I've been really impacted by something. Maybe it's even making me experience symptoms that really look and feel a lot like PTSD." Some people can find that really invalidating, like, "Wait a minute, you're saying that what I experienced wasn't traumatizing and it feels like it was traumatizing." Those terms can be used to separate out big T trauma, meaning something that meets the DSM definition that I provided—that really more strict definition of trauma. Whereas little T trauma is a word that we can use to describe these other experiences that don't quite fit that strict criteria but still subjectively felt traumatizing to us and have impacted us in some way. What's interesting is that there's some research that suggests that the extent to which somebody subjectively feels like something was traumatic is actually more predictive of their mental health outcomes than whether or not it meets this strict definition because we see people all the time who experience big T traumas and they might be totally fine afterwards. And then there are people who experience little T traumas and are really struggling. We can use little T trauma to describe things like racial trauma, discrimination, minority stress, the experiences that you described, and even just significant interpersonal losses and things like that. Kimberley: Yeah. Maybe even COVID. For some, it was a capital T trauma, would you say, because they did almost lose their lives or witness someone? Is that correct? Would you say that some others would have interpreted it as a smaller T and then some wouldn't have experienced it as a trauma at all? Caitlin: Yes, I think that's a great example because there are definitely a lot of folks who don't necessarily know someone who became really ill, lost their life, or didn't have that personally happen to them. But there was this looming stress, maybe even related to quarantine and isolation and things like that. WHO GETS PTSD AND TRAUMA? Kimberley: This is really fascinating. I wonder if you could share a little, like, of all the people, what are the factors that you mentioned that increase someone's chances of going on to have PTSD? Who goes on to get PTSD, and who doesn't? How can we predict that? What do we know from the research? Caitlin: This is an interesting question because I think that some people might intuitively think, "Well, somebody experienced this really horrible trauma. Of course, they're going to go on to develop PTSD." We actually know that people on the whole can be pretty resilient even in the face of experiencing pretty horrible tragedies. Our estimates of exposure to what we would call potentially traumatic experiences range from 70% to 90% of the population, and most of us will experience something at some point in our lives that would need that definition—that strict definition of a trauma. Yet, only about 6 to 7% of people will be diagnosed with PTSD at some point in their lives. So there's this huge discrepancy here. There are lots of factors, and of course, we don't have this perfectly nailed down where we can exactly predict, "Okay, this person is going to be fine. This person is going to have PTSD." It's really an interaction of lots of factors. But we know that there are some things that can either provide a buffering effect against PTSD or have the opposite effect, where they might put somebody at greater risk. One of the biggest things that's come up in research is social support or the lack thereof, so that when people have really great social support after their trauma, whether it's after a sexual assault or they've come home from combat, that can really buffer against the likelihood of developing PTSD. The reverse is true as well when people don't have social support. We saw this, for example, after the Vietnam War, where a lot of veterans came home and really were mistreated by a lot of people. Unfortunately, that's a risk factor for developing PTSD. But there are other things too, like coping. Not necessarily using one particular coping skill, but rather having a variety of coping strategies that somebody can use flexibly, even something like humor. We see this as a resilience factor. Obviously, there are times when using humor can serve as a distraction or avoidance, and there are times when it can be really adaptive too. Obviously, of course, genetics that people may have a predisposition in general towards having mental health concerns. Sex, we know that people assigned female at birth have a higher likelihood of developing PTSD after trauma. And then there are things that may be specific to the experience itself, so the type of trauma. Sexual assault is unfortunately a really big risk factor for developing PTSD, whereas there are other trauma types where fewer people go on to develop PTSD from those. And then there's something that we call peritraumatic fear, and that just means the fear that you were experiencing at the time that the event was happening. In the moment that the trauma was happening to me, how scared was I? How much did I feel like I might lose my life? People who experience more of that fear at the time of the event are more likely to go on and develop PTSD. But it's pretty interesting too, because, as with everything, there isn't just this binary, like you either have it or you don't have it. I want to normalize this too for anyone who might be listening and maybe has recently experienced something really horrible and is struggling with some of these symptoms that we talked about. It doesn't necessarily mean that you have PTSD or that you're going to continue to have PTSD. Most people, about 50 to 65%, will experience mild to moderate post-traumatic stress symptoms after the event that will just gradually go away on their own. We call that a resilience trajectory. We also have about 10 to 15% of people who have what we call a recovery trajectory, where maybe right away they did have a spike in post-traumatic stress symptoms, right away in that first month or so. But after a year, again, it's resolved itself. And then we have two trajectories that go on to describe people who will have PTSD. That would be a chronic trajectory where somebody would have this elevation in symptoms after the trauma that persists. That's usually about 15 to 20% of people. And then less likely is what we call a delayed trajectory. This is about only 5 to 10% of people who may have had really mild symptoms right away or perhaps no symptoms at all. And then, after about six to 12 months, it might just all of a sudden skyrocket for whatever reason. IT IS OCD OR AM I IN DENIAL? Kimberley: Right. So interesting. I was actually wondering what you often hear about people who, especially as someone who treats OCD and anxiety disorders, often questioning whether there was a trauma they had forgotten. Like, did I repress or am I in denial of a trauma? What can you share statistically about that? Caitlin: Yeah, that's a really great question. It's definitely more of a controversial topic in the field, not because people don't have the experience of having these recovered memories, but rather because of what we know about how memory works and how fragile it can be, that as clinicians, we have to be really careful that we're not, in our efforts to help someone, inadvertently constructing a false memory. I would say that most of the time, this delayed trajectory of PTSD symptoms is less so about the person not remembering the event, but more so like they just have continued on with their life and are probably suppressing, avoiding, and doing all sorts of things that are maybe keeping it at bay temporarily. And then there may be, in a lot of cases, some big life event that may bring it up, or perhaps another traumatic experience or something like that. WHAT IF I HAVE REPEATED TRAUMAS? Kimberley: Yeah. I was going to ask that as well, as I was wondering. Let's say you've been through a trauma. You recovered on that trajectory you talked about. Are you more likely to then go on to have PTSD if you repeat different events, or do we not have research to back that up? Caitlin: That's a great question. I'm not sure specifically about, depending on which trajectory you were initially on, how that increases the likelihood later on. I can say that repeated exposure to trauma in general is associated with a greater likelihood of PTSD. I would say that, probably regardless of how quickly your symptoms onset, if at all initially, experiencing more and more trauma is going to increase the likelihood of PTSD. WHO CAN DIAGNOSE PTSD AND TRAUMA? Kimberley: Right. Amazing. Thank you for sharing that. I know that was very in-depth, but I think it helps us to really understand the complexity and the way that it can play out. Who can make these diagnoses? I know, as I mentioned to you before, even my daughter has said she found herself on some magazine website that was having her do some online tests to determine whether there was trauma. It seems to be everywhere, these online tests. Can you get diagnosed through an online test? Would you recommend that or not? Who can we trust to make these diagnoses? Caitlin: That's a great question. I would not recommend using something like an online test or even a self-report questionnaire to help you figure out if you have PTSD. Now, it can give you a sense of the specific areas that I might be struggling with that I could then share with a licensed provider, who can then make the diagnosis . But if you were to just find a quiz online and take it, and it says you have PTSD, that would not be something that we would consider to be valid or reliable in any way. I would recommend talking with a psychologist, a psychiatrist, any sort of general practitioner, an MD, or maybe even someone's primary care physician. Definitely, if you can get in touch with a licensed provider who specializes in PTSD and can really be sure that that's what's going on for you. Now, TikTok and all these things exist out there. As with anything on the internet, it can be used for good and it can also be very harmful. I think it just comes down to gathering information that may be helpful but then passing it on to someone who can sift through the misinformation and give you a clearer answer. Kimberley: Yeah. Thank you for that. I think, as someone myself who's had their own mental journey, I do remember during different phases of my own recovery where our brains just don't make sense. I had an eating disorder—a very bad eating disorder—and my brain just couldn't see clearly in some areas, and me being so frustrated with that. I know lots of people with, let's say, panic disorder feel the same way or health anxiety, their condition feels so confusing and makes no sense that in the moment of being grief-stricken by this and also very confused, it's pretty easy to start wondering, "Could this have been a trauma or is this PTSD? This doesn't make sense. Why am I having this mental health issue?" Especially if it's not something that was genetically set up in your family. I'm wondering if you can speak to the listeners who may have dabbled in thinking maybe there is a trauma, a big T, a little T, or PTSD. Can you speak to how someone might navigate that? Caitlin: Most definitely. I'll validate too that it's really complex. We use the DSM to help us understand these different diagnoses, but there's so much overlap. Panic disorder—obviously, panic attacks are the hallmark feature of panic disorder, but people can have panic attacks in PTSD as well. People with eating disorders might have issues with their self-image and their self-esteem. That can happen in PTSD as well, as I mentioned, even with mood disorders. There are symptoms in PTSD that sure look and sound a lot like depression. If it feels confusing, "Well, wait a minute, I have this symptom. What does it belong to? What does it mean?" We do really have this very imperfect and overlapping classification system that we use. That being said, it's a legit question to ask if somebody feels like, as you were saying, "I've been struggling with these symptoms, but it really feels like there's something more here." When we diagnose PTSD, we go through all of the 20 symptoms, some of which I referenced earlier. For each symptom, we'll ask about when that symptom started for the person relative to trauma and whether or not it's related to trauma in some sort of way, if there's some content there to work with. For example, somebody maybe wasn't having any issues with their mood whatsoever, and then they experienced trauma, and all of a sudden, it was just really hard for them to get out of bed. Well, that could potentially be a symptom of PTSD because it started after the trauma. One thing that I hear a lot, because unfortunately, childhood trauma is really common, when I ask folks about this, they'll say, "I don't know. The trauma happened when I was so young that I don't even remember who I was before this person that I am now, who's really struggling." In that case, people usually have a pretty good insight into this. Like, do you think that this is related in any way? Or maybe, if you have any recollection, you had a little bit of this experience and this symptom initially, and it got worse after the trauma. That, again, could potentially indicate that that's a symptom of PTSD. I would say for those folks who are listening, who are struggling with things like panic attacks, difficulty with eating, mood, whatever it might be, even OCD, which we talked about recently, really checking in with yourself about how and if those symptoms are related to your trauma. If they are, then find someone that you trust that you can talk to about it. Hopefully, a therapist who can help you piece this apart. It could still be maybe the disorder you thought it was, maybe it is panic disorder, maybe it is OCD, maybe it is an eating disorder that's still informed by trauma in some way or impacted in some way, which would be important to be able to process in treatment. Or it could just be PTSD entirely. And then that would be really important to know because that would significantly change what the treatment approach would be. Kimberley: Yeah. It's so true of so many disorders. You could have social anxiety and panic attacks because of social anxiety, and a mental health professional will help you to determine what's the primary, like, "Oh, you have social anxiety and social interactions are causing you to have panic," and that can sort of help. I think as clinicians, we're constantly ruling out disorders using our professional hat to do that. I think you're right. Speak to a professional and have them do our assessment to help you pass that apart. Because I think in general, any mental health disorder will make you feel like something doesn't feel right, and that's the nature of any disorder. Caitlin: Right. The good news, too, is that, within reason, some of the treatment techniques that we have can be used more broadly. Interoceptive exposures, we can use that for people who have panic disorder, just people who struggle with panic attacks, or maybe people who have OCD or GAD and just feel really sensitive to those sensations in their body that suggest that they might be anxious. Same thing with behavioral activation. We use that for depression, and that can really easily be added to any treatment, whether it's treatment for PTSD or something else. You're exactly right, getting clarity on what's going on for folks, and then what are some of these techniques that might be most helpful for these symptoms? PTSD AND TRAUMA TREATMENT Kimberley: Yeah. Thank you. You perfectly segue this into the next question, which is, can you describe the treatment or give us names of the treatment for this comparison of trauma versus PTSD? Are they the same treatments? Does it matter whether it's a big T trauma or a little T trauma? Can you give us some idea of the treatments for these struggles? Caitlin: Definitely. Most of the evidence-based treatments that exist are specifically for PTSD. Obviously, they touch on trauma, of course, as the reason why somebody has PTSD and where all of these symptoms stem from. But there aren't as many treatments that are, let's say, specifically for trauma, at least not in terms of a standardized way of working through that. If somebody's experienced trauma and they don't have PTSD, and let's say they don't have any diagnoses, but they are still impacted by this experience, just doing behavioral therapy or whatever treatment feels like a good fit for what somebody is trying to work through might be sufficient. And then we have these evidence-based treatments that have been shown to really target PTSD symptoms and help reduce them. A few years back, I think it was 2017, the American Psychological Association reviewed all of the research on PTSD treatments. They reviewed it using lots of different criteria for what it means to feel better after treatment beyond just reducing PTSD symptoms, but also looking at other things too, like mood and suicidality and things like that. They essentially created this list of treatments that they rank orders in different tiers, depending on how effective they were shown to be. In the top tier are four treatments. There's cognitive behavioral therapy just broadly, cognitive therapy also broadly, and then the two specialized treatments are prolonged exposure (PE) and cognitive processing therapy or CPT. I can talk a little bit more about those two if you'd like. In the second tier are things like acceptance and commitment therapy, EMDR—these treatments that people may have used themselves and have found really effective, and they are effective. They're just maybe a little bit less effective for fewer people, if that makes any sense. It's not to say that EMDR doesn't work, but rather that there's just more of an evidence base for things like PE and CPT. DIFFERENCE BETWEEN PTSD AND TRAUMA TREATMENTS Kimberley: Great. To speak to those two top-tier treatments, can you compare and contrast them for someone just so that they feel they understand the difference? Caitlin: Yeah. If I had a whiteboard, I would just draw out the CBT triangle, but hopefully, folks listening know that in the CBT triangle, you have your emotions, your behaviors, and your thoughts, and all these things are constantly interacting with one another. We could say, just on a really simplified level, that when we are seeking treatment for PTSD, we want our emotions to be different. We want to feel less emotionally impacted by the trauma that we've experienced. PE and CPT are both under the umbrella of cognitive behavioral therapy, so they both use that triangle. They just get at it a different way. PE starts with the behaviors, knowing that the thoughts and emotions come along for the ride. CPT starts with the thoughts, knowing that the behaviors and the emotions come along for the ride. Now, they're both extremely effective at reducing PTSD symptoms. They've done head-to-head comparisons. They're both great. You're not going to find one that's significantly better than another, but you might find one that feels like a better fit for what you're currently struggling with. Cognitive processing therapy , again, starting with the thoughts, cognitive processing, basically involves-- I almost think of this as looking at our thoughts and our beliefs about things and examining them from different lenses. I always picture plucking an apple from a tree. Like, okay, this is a belief that I developed from my trauma. This was really adaptive for me at the time because this belief told me that I can't trust anyone and I have to always watch my back. Boy, did that help me when I was in combat and I was always watching my back and making sure I was safe. But as I look at it from these different angles, I might realize, well, I'm not in combat anymore, and I'm living in a pretty safe environment with safe people. So maybe this belief doesn't really serve me anymore. You work with your therapist to identify what we call stuck points, which are these really deep-seated beliefs that somebody has about themselves, other people, or the world that either developed from trauma or were reinforced by trauma, because sometimes people will say, "Well, I've never trusted people. I've always been in an environment where things weren't safe." And then there we go, the trauma happened, and it just proved me right. Cognitive processing therapy helps people work through these stuck points and come up with alternative perspectives on these thoughts. Prolonged exposure is a lot more similar to what I imagine lots of the folks listening may have done with exposure therapy generally, or exposure and response prevention for OCD. Again, we're starting with the behavior, knowing that if we target the behavior first, that's going to change our cognitions, and it's going to change our emotions. PE involves two different types of exposure. The first one being in vivo exposure, which is really similar to just any sort of ERP exposure where you expose yourself to something in the environment that triggers a thought about the trauma or some sort of emotional reaction. You do those over and over again until they feel like no big deal to you, you feel really awesome about yourself, and you can conquer the world because you can. And with your therapist, you do an imaginal exposure, which is where, in a really safe environment, you talk through the experience of your trauma and what happened to you. You do this actually in a unique way to really engage with that memory because, as we talked about, that internal avoidance is so common in people with PTSD. This imaginal exposure would be describing the experience in the present tense, painting a picture as though it was a film that was playing out right in front of our eyes, and really digging into the details of, what am I feeling in the moment that this trauma is happening? What am I hearing? What am I sensing? And doing that imaginal exposure, again, with your therapist in a really safe space until it doesn't have an impact on you anymore. I always say this to people when they start PE with me: I know that this may sound nuts right now. But a lot of people who do PE will get to a point where they'll look at me and say, "I'm so bored telling this story again. I've told this story so many times. It doesn't even bring up this emotional response for me anymore." That feels really unlikely for people who are just starting out in treatment and are so impacted by this memory, and they do everything in their power to avoid it. But people can and very much do get to a place where they feel like they've conquered this memory and it doesn't control them anymore. That's how PE and CPT work. Again, they both eventually target the same thing. It's just sort of, which route do you go? COMPLIMENTARY PTSD TREATMENTS Kimberley: Right. Amazing. Thank you. From my experience too, and actually, this is a question, not a statement—my experience, some people who I'm close with or clients who have been through PTSD treatment also then had to develop some coping skills, mindfulness skills, compassion skills, or maybe sometimes even DBT skills to get them across the finish line. Has that been your experience? What is your feedback from a more scientific perspective? Caitlin: Yeah, it really depends on the person. There are also combinations of these treatments. There's a combined DBT and PE protocol out there for folks who do need a little bit more of those skills. Some people do feel like they would benefit from having some of these coping skills, maybe upfront or throughout the course of treatment. But they've also done research where they've started with that skill-building before they go into PE or CPT, compared to people who go right in. Actually, what they often find is that starting with skill building, sometimes it's just colluding with avoidance, and it just lengthens the amount of time that somebody needs before they start to feel better. I'm glad you asked this question because it's so common for people with PTSD to feel like, "I can't. I can't do this thing. I can't feel this thing. I can't talk about this thing." And they really can. Sometimes if we allow people to really challenge those "I can't" beliefs, then they'll realize, "I really thought that I was going to need all this extra support or I was going to need this or this, and I was able to just move right through this treatment." Now, of course, again, that's not the case for everyone. There are some folks who maybe have much more severe PTSD, maybe have some different comorbidities like personality disorders or something else where it might be helpful to involve some of that, or people who had really chronic exposure to, say, childhood trauma. But far and away, people are often much better able to jump right into some of these treatments than they think they are. HOW TO FIND A PTSD TRAUMA THERAPIST Kimberley: Thank you for sharing that. I think that's super helpful for us to feel hopeful at the end. One more question before you tell us about you and some of the amazing things that you're doing. Where might people go? As we know, with OCD and health anxiety, we want a specialist to be helping us, ideally. I've noticed as a consumer that everybody and their Psychology Today platform says they treat trauma. I'm wondering how we might pass through that and find treatment providers who are skilled in this area. How might they find a trained professional? Caitlin: I'm glad you mentioned that about Psychology Today. That's the advice that I give people when they're using Psychology Today, or really any sort of platform. If this person is saying that they treat everything under the sun, then it's probably not a person that you want to link up with for something really specialized because it's-- what is the saying? "Jack of all trades, master of none." And I start to get suspicious even that this person even does evidence-based treatment for trauma and PTSD when they've listed a thousand things. It's definitely a red flag to consider for those who are listening and maybe have had this experience. In terms of finding a therapist, if folks are interested in PE or CPT, there's actually directories of therapists who've been trained and certified in those modalities. You can find them on-- I'm trying to think of the exact website. If you Google "Prolonged Exposure providers," something will come up, I believe it's through Penn. You can do the same for cognitive processing therapy. If you Google, I think it's like "CPT provider roster," you'll get a whole list of providers as well. Now, just because somebody isn't on there doesn't mean that they haven't been trained in these things. There's just a certification process that some people go through, and then they can get added to this list. If your provider says, "I'm trained in PE, I'm trained in CPT," I would probably trust that person that, for one thing, they even know what those things are, and I'd be willing to give them a shot. Also, and I know we mentioned this on the last episode too, for anyone listening who might have PTSD and OCD , I've compiled a list of providers on my website—providers who are trained to treat both OCD and PTSD. I have that broken down by state and then a couple of international providers as well. My website is www.cmpinciotti.com. In terms of broad resources beyond finding a provider, there are lots of organizations that have put out some really great content about PTSD—videos, handouts, blogs, articles, all sorts of things. I think the biggest place that I send people is the National Center for PTSD. This is technically run through the Veterans Administration, but anyone can use these resources. They're not only for veterans. It's very, very helpful. I'd recommend people who want more information to go there. You can also find things on the Anxiety and Depression Association of America, the National Institute of Mental Health, the National Alliance on Mental Illness, and so on. And then, of course, I mentioned the Trauma and PTSD in OCD Special Interest Group that I co-chair, that folks can sign up for that too, and we send out materials through there as well. Kimberley: Amazing. I am so grateful for you because I think we've covered so much in a way that feels pretty easily digestible, helps put things in perspective, and hopefully answers a lot of questions that people may be having but didn't feel brave enough to ask. Where can people find out more about you? You've already listed your website. Is there any other thing you want to tell us about the work that you're doing so that we can support you? Caitlin: On my website, in addition to the treatment provider directory, I also have some handouts and worksheets. Again, these are specific to co-occurring OCD and PTSD. That might be helpful for some folks. I also usually list on there different studies that are ongoing. I have two right now that are ongoing that I can-- oh, actually, I have three—I lied to you when I said two—that people can participate in if they're interested. There's one study that we'll be wrapping up at the end of December. That's about OCD and trauma. People can email OCDTraumaStudy@bcm.edu for more information. We also have a study that's specific to LGBTQIA+ people with OCD that also covers some things related to trauma and minority stress in that study. If folks are interested in participating in that, they can email me at PrideOCD@bcm.edu. And the last one, and I'll plug this one the most, that if folks are like, "Well, I want to participate in a study, but I don't know which of those," or "I only really have a few minutes of my time," we have a really, really brief survey, and we're trying to get a representation of folks with OCD from all over the country. For anyone who's listening and who has OCD and is willing to participate, it's a 10-minute survey. You can email me at NationalOCDSurvey@bcm.edu. All of these cover the topic of trauma and PTSD within them as well. Kimberley: Thank you. I'm so grateful for you. You've come on twice in one month, and I can't thank you enough. I do value your time, but I so value as well your expertise in this area and your kindness in discussing some really difficult topics. Thank you. Caitlin: No, I appreciate it. Thanks for having me on. I hope that folks who are listening can feel a little bit more hopeful about what the future can hold for them. PTSD & TRAUMA LINKS AND RESOURCES Find a PE provider: https://www.med.upenn.edu/ctsa/find_pe_therapist.html Find a CPT provider: https://cptforptsd.com/cpt-provider-roster/ For educational resources on PTSD: https://www.ptsd.va.gov/ To participate in a brief, 10-minute national survey on OCD: NationalOCDSurvey@bcm.edu To participate in the OCD/Trauma Overlap Study (closing at the end of December): OCDTraumaStudy@bcm.eduTo participate in a study for LGBTQIA+ people with OCD: PrideOCD@bcm.edu