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Transcript of PTSD
Cognitive Behavioural Therapy technique.
James G. Taylor (1897–1973) first used Exposure therapy
to treat anxiety.
Includes: Systematic desensitization, flooding, implosive therapy, prolonged exposure therapy, in vivo exposure therapy, and
imaginal exposure therapy.
Eye movement desensitization, reprocessing therapy.
Popular, yet controversial.
Type of Exposure Therapy - Flooding.
Cognitive Processing Therapy
A manualized derivative of CBT
Patient writes out impact statement, repeatedly reads & focuses on it, while working safety, control, trust, empowerment and intimacy
Gain understanding of & modify meaning attributed to traumatic event. Also works to create trust empowerment, and control
Decrease pattern of avoidance (stuck points)
Focus is on identifying automatic thoughts
Brief Dynamic Therapy
aim is to understand the individual who experienced the event and how their environment interferes with normal psychological processing and integration of the trauma
Jonathan, 23 year old homosexual student.
Physically assaulted by 3 teenagers.
Called derogatory names.
Constantly replays memories in his mind.
Even the smell of cologne can trigger him.
Avoids that area in town entirely.
Can't concentrate, lack of interest, feelings of depression, anxiousness.
Feels ashamed and insecure
Post Traumatic Stress Disorder
Group Music Therapy
In Vivo Exposure Therapy
: Systematic Desensitization and Flooding.
: therapists begin with the most anxiety inducing situation
: hierarchy of stimulus from least anxiety provoking to most anxiety provoking.
Virtual Reality Exposure Therapy
Works by, “present[ing] fear-relevant visual, auditory, tactile, and/or proprioceptive stimuli via a computer-generated virtual environment produced through motion-sensitive instruments worn by the patient.” (Meyer, Morissette, Motraghi & Seim, 2014, p. 197).
Aims to normalize feelings of anxiety and lower arousal in the presence of certain triggers.
Works towards habituation, and ultimately extinction.
Increase competence and decrease the belief that the world is dangerous.
Concerns: it can re-traumatize patients by raising arousal levels of anxiety and fear.
Higher drop-out rates because of symptom exacerbation OR quick symptom
Simulation in artificially created environment
The therapist monitors the patient's reaction and anxiety levels
Gradual exposure to feared environment.
Overrides symptoms of avoidance, gives sense of control
Sensory stimuli facilitates emotional processing.
Invented by psychologist Thomas Stampfl in 1967
Single trauma incidents
Reducing comorbid issues ie: anger, guilt, negative
health perceptions, and depression
Repeatedly confront trauma related-stimuli without the occurrence of feared consequences
lessens emotional activation
evidence that disconfirms dysfunctional cognitions
specifically related to self-competence and control
Client focuses on the stress causing event from their memory & simultaneously watches an alternative stimulus ie: the therapist’s finger
One session focuses on past memories, another on present disturbances and future actions to help alleviate future symptoms
Post Traumatic Stress Disorder
1. Exposure to actual or threatened death, serious injury, or sexual violence.
2. Intrusion symptoms associated with the traumatic event(s).
3. Persistent avoidance of stimuli associated with the traumatic event(s).
4. Negative alterations in cognitions and mood associated with the traumatic event(s).
5. Marked alterations in arousal and reactivity associated with the traumatic event(s).
6. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.
7. Disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
8. Disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
Session 1: Education about PTSD, overview of & rationale for treatment, impact statement
Session 2: Discuss impact statement, link relationship between thoughts, behaviors, and emotions
Session 3: Write detailed description of traumatic event
Session 4: Reads statement to therapist, cognitive therapy approaches used
Sessions 5-6: Challenge distorted thoughts
Sessions 7-12: Practice challenging thoughts
Final session: New beliefs
Post Traumatic stress disorder occurs when:
(a) an individual
experiences a traumatic event
(b) reacts with intense fear
helplessness, or horror
(c) develops particular symptoms that
persist for at least a month
Clients participate in musical activities, such as:
Singing, playing instruments, rhythmic exercises, improvising, composing, imagery, and listening
Goal: Personal development and social interaction all while producing an enviornment where the client feels safe and comfortable
developed for survivors of single traumatic events (tragic bereavement, assault, surgery)
3 phases of treatment:
the initial phase: work on building a strong therapeutic relationship, attuned to clients symptoms
the middle phase: focus on intrusive thoughts, clarify sequence of events that led to trauma and its aftermath
the final phase:encouraged to continue working on issues
main goal: help a person gain confidence in their ability to cope with anxiety and fear
3 Phase Intervention
educate client about stress
2. Skill Acquisition and Rehearsal
coping skills are taught and practiced
3. Application and Follow Though
client applies a variety of coping skills across increasing levels of stressors
The important part:
Nationally considered the first line of treatment for those with PTSD Chow, et al. (2004).
Baca et al (2014), reports that CPT reduces overall symptoms of PTSD
p > 0.001, n = 271, ES =0.92!
The overall symptoms included: hyperarousal, avoidance, numbness, and reexperiencing.
taps on specific acupuncture points with positive voice affirmations neutralize emotions associated with traumatic experience
clears emotional block that can bring mind and body back to balance
variant of Roger Callahan Thought Field therapy-> energy psychology
(Flint, Lammers& Mitnick,2006)
Manualized therapy leaves little room for adjustments from patient to patient
12 session program may be too short for some patients
Band of Brothers
Captain Winter's Flashback
So, what do you think is the most effective?
Has been shown to reduce depression by numerous studies
Appears to be effective for PTSD patients who have not sufficiently responded to CBT
Good for the depression symptoms of PTSD, but does not appear to efficiently address the other symptoms