**4.6 Psychological interventions**

Psychological treatments for PTSD are mainly in the form of cognitive-behavioral therapy. Cognitive processing therapy, trauma-focused cognitive behavioral therapy, and long-term exposure are largely within the framework of cognitive and behavioral therapy. Among the Cognitive Behavioral Therapies, especially Exposure Therapy and Systematic Desensitization techniques are successful in trauma treatment. In both techniques, it is aimed to desensitize the person and gradually reduce the traumatic effects by enabling the person to face the images and situations related to the trauma in a systematic and controlled manner.

Interpersonal psychotherapy was also found to be promising in recent research. Interpersonal psychotherapy is a form of attachment-based therapy. The patient is shown his / her own needs, and the support he/she needs. The client is taught how to get the support he/she needs from those around him/her. Thus, he/she will be able to recognize the attachment needs that have become active due to the trauma and will be able to provide appropriate social support for himself/herself.

During the traumatic event, the individual is exposed to intense fear and anxiety. The traumatic event cannot be processed by the brain as it should. The traumatic memory, which cannot be processed adequately and appropriately, disturbs the individual over time. Eye Movement Desensitization and Reprocessing (EMDR), developed by Shapiro and used in the treatment of PTSD, activates both halves of the brain through two-way eye stimulation and ensures healthy processing of the traumatic memory. With the EMDR method, the traumatic memory with high emotional intensity for the individual loses its vitality and the individual's hypersensitivity disappears.

#### **4.7 Neuromodulation interventions**

Neuro-modulatory treatments are viable treatment options for many psychiatric disorders. After U.S. Food and Drug Administration (FDA) approval of transcranial magnetic stimulation (TMS) as an option for treating depression, researchers also tried to use repetitive transcranial magnetic stimulation (rTMS) for depressive symptoms of PTSD [62]. rTMS and transcranial direct current stimulation (tDCS) are frequently employed as adjunctive options to pharmacotherapy for the treatment of several psychiatric disorders including PTSD. Several studies also investigated the potential of rTMS and tDCS in the treatment of PTSD to decrease the overactivity of the amygdala. The results of the studies revealed that both high-frequency and low-frequency rTMS can significantly reduce PTSD symptoms. rTMS may, therefore, be an effective add-on treatment option for treatmentresistant PTSD [63].

Deep TMS is a drug-free and non-surgical intervention, it does not require anesthesia. During the application, the patient is awake and conscious. The target area in the brain is physically stimulated by sending magnetic pulses under the skull with a mechanism placed in the skull. Thus, neurons working with electrical activity are activated by magnetic stimulation. It has been reported that recalling traumatic memories with activation and talking about it in the presence of an expert significantly reduces the burden of trauma.

The treatment method, which is based on the electrical processing of the data of the brain and bodywork and presenting it as feedback to the person, is called neurobiofeedback training. Thus, the patient learns to consciously control his/her own brain activity and bodily functions, such as breathing, muscle tension, and heart rate. Promising results are obtained in PTSD with the use of neurobiofeedback together with pharmacotherapy and psychotherapies.
