Online PTSD and trauma treatment
in California.

PTSD, acute stress response, and complex trauma

Not all trauma responses are the same, and the distinctions matter clinically.

PTSD develops after exposure to actual or threatened death, serious injury, or sexual violence — either directly, as a witness, by learning it happened to someone close, or through repeated indirect exposure. It involves four symptom clusters: intrusion (flashbacks, nightmares), avoidance, negative alterations in mood and cognition, and hyperarousal.

Acute stress disorder involves similar symptoms within three days to one month after a traumatic event. When symptoms persist beyond one month, the diagnosis shifts to PTSD.

Complex PTSD arises from prolonged, repeated trauma — childhood abuse, captivity, domestic violence — and involves the core PTSD symptoms plus significant disturbances in self-perception, emotional regulation, and relationships. It is not formally in the DSM-5 but is clinically recognized and increasingly well-described.

What the evaluation looks like

A trauma-informed evaluation does not require you to recount your trauma in detail. You do not need to relive what happened in order to get help. What the evaluation covers:

• Current symptoms — intrusion, avoidance, hypervigilance, emotional numbing, sleep disruption
• Functional impact — how symptoms are affecting work, relationships, and daily life
• Timeline — when symptoms started, what preceded them
• Prior treatment — therapy, medication, and what helped or didn't
• Safety — current thoughts of self-harm or suicide are assessed at every evaluation
• Co-occurring conditions — depression, anxiety, substance use, and other conditions frequently co-occur with PTSD

You set the pace. The evaluation is structured but not forced.

Preparing for your PTSD evaluation

You don't need to prepare a trauma narrative. The evaluation is not a retelling of what happened — it focuses on how your nervous system and daily functioning have been affected, not on the specifics of the event itself.

What's useful to think about before the appointment: how long you've been experiencing your current symptoms, which symptoms are most disruptive (sleep, concentration, avoidance, emotional reactivity), what you've already tried (therapy, medication, self-directed approaches), and any current medications or medical history that might be relevant.

If you're currently working with a therapist, note who they are and what approach they're using. If you've tried medications before, any information about what they were and how they went is helpful. Prior records are not required and you don't need to track them down before the appointment.

Safety is assessed at every evaluation. If you have current thoughts of self-harm, that gets addressed directly. The evaluation doesn't require you to be in crisis to be valid, and it doesn't require you to be perfectly stable to be helpful.

Medication for PTSD

Two SSRIs are FDA-approved for PTSD: sertraline (Zoloft) and paroxetine (Paxil). Both reduce the core PTSD symptom clusters. Sertraline is typically preferred due to its tolerability profile. Venlafaxine (Effexor) and mirtazapine have evidence for PTSD even without formal FDA approval for the indication.

Prazosin — an alpha-1 blocker originally developed for blood pressure — has evidence for reducing trauma-related nightmares and is often added specifically for sleep disturbance and nightmare frequency.

Medication addresses symptom severity. It reduces the intensity and frequency of intrusions, hyperarousal, and sleep disruption. For many patients, this reduction makes it possible to engage more effectively with therapy. Medication alone does not process or resolve trauma — that requires trauma-focused therapy.

The role of trauma-focused therapy

The treatments with the strongest evidence for PTSD are trauma-focused therapies: EMDR (Eye Movement Desensitization and Reprocessing), CPT (Cognitive Processing Therapy), and Prolonged Exposure (PE). These are specific, structured treatments — not general supportive therapy.

Umbrella Mental Health provides the psychiatric and medication management component of care. If you're not currently working with a trauma-focused therapist, a referral can be coordinated. Many patients start medication first to reduce symptom intensity enough to engage with the therapy work.

Insurance and cost

Accepted plans: Aetna, Anthem Blue Cross California, Carelon Behavioral Health, Cigna, Optum, Oxford, Quest Behavioral Health, and UnitedHealthcare. Out-of-network and self-pay options may be available. See insurance details or call (323) 970-2625 with questions about your specific plan.

What ongoing psychiatric care looks like for PTSD

After the initial evaluation, follow-up appointments are 30 minutes. Frequency depends on where you are in treatment. When a medication is being established, monthly visits are typical. Once symptoms are stable, appointments extend to every two to three months.

At each follow-up, the provider tracks how the medication is affecting symptoms — specifically intrusions, hyperarousal, sleep, and overall functioning. PTSD often fluctuates with life circumstances. A significant stressor, a relationship rupture, or an anniversary reaction can shift the clinical picture. These changes are addressed at appointments, not between them.

If you're working with a trauma therapist, the psychiatric and therapy components can coordinate. Some patients start medication to stabilize symptoms enough to engage with trauma-focused therapy more effectively. Others use medication as ongoing support while therapy proceeds on its own timeline. Neither approach is wrong — the right sequence depends on severity, access to therapy, and what you've tried before.

What psychiatric medication does — and what it doesn't

Medication reduces the biological force of PTSD symptoms. It lowers the intensity and frequency of intrusions. It moderates hyperarousal. For many patients, it makes sleep more possible and emotional reactivity more manageable. These are meaningful changes in daily functioning, not minor adjustments.

What it doesn't do: process the trauma. The memory doesn't disappear. The meaning of what happened doesn't change. That work belongs to trauma-focused therapy — EMDR, CPT, Prolonged Exposure. Medication creates a lower floor of functioning that makes that work more possible.

Some patients benefit significantly from medication alone, particularly when trauma-focused therapy isn't accessible or when symptoms are severe enough to require stabilization first. The evaluation determines what makes sense for your specific presentation. That conversation happens at the first appointment.

A note on timing: the SSRIs used for PTSD take several weeks to reach their full effect. Most patients don't see the full benefit until 4 to 8 weeks in. Prazosin for nightmares tends to work more quickly — sometimes within the first week. Managing expectations about the timeline is part of what the first and second appointments cover. If medication isn't producing the expected change after an adequate trial, that's a clinical data point, not a dead end — it informs what to try next.