How To Change Limiting Beliefs

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Cognitive Models Of Ptsd

Chemtob, Roitblat, Hamada, Carlson, and Twentyman's (1988) hierarchical cognitive action theory extended information-processing theory by proposing that for individuals with PTSD, these fear networks (or threat-response structures ) are at least weakly activated at all times, guiding their interpretation of ambiguous events as potentially dangerous. More recently, Ehlers and Clark (2000) proposed a cognitive model of the persistence of PTSD that can also be viewed as an extension of earlier information-processing theories. This cognitive model suggests that PTSD becomes chronic when traumatized individuals appraise the traumatic event or its sequelae in a way that leads to a sense of serious, current threat (e.g., Nowhere is safe If I think about the trauma, I will go mad ). A second factor proposed by this model as causally related to the persistence of PTSD are changes in autobiographical memory similar to those proposed by earlier information-processing theorists (e.g., strong...

Overview Of Cognitive Therapy For Traumarelated Guilt

The goal of cognitive therapy for trauma-related guilt (CT-TRG) is to help clients achieve an objective and accurate appraisal of their roles in trauma. CT-TRG focuses on correcting thinking errors that can lead trauma survivors to draw faulty conclusions about the importance of the roles they played in traumatic events. We have identified 18 such thinking errors, which are shown in Table 11.1 (Kubany, McCaig, & Laconsay, 2004b).

Cognitive Therapy

Cognitive therapy is based on the notion that emotional dysfunction results from maladaptive or catastrophic interpretations of events (Beck, Rush, Shaw, & Emery, 1979). The relevance of cognitive therapy to ASD and PTSD is underscored by increasing evidence that catastrophic thoughts in the acute phase are predictive of subsequent PTSD (Ehlers et al., 1998b Engelhard et al., 2002). Although it is beyond the scope of this chapter to provide an adequate outline of cognitive therapy (see Beck et al., 1979), it is important to note several points in relation to providing cognitive therapy to individuals with ASD. First, it can be useful to provide cognitive therapy prior to employing exposure because it can be difficult to learn the cognitive therapy techniques if an individual is overly distressed by focusing on traumatic memories. Second, many beliefs that acutely traumatized patients report are based on recent and threatening experiences. Accordingly, their beliefs that they are not...

Tools For Traumarelated Problems

Cognitive-behavioral treatments are built around a set of fundamental helping procedures that target different sets of problems encountered by trauma survivors. These are (1) coping skills training, that focuses on teaching clients to respond effectively to the many situation-specific challenges associated with PTSD and other trauma-related difficulties, and to replace existing maladaptive responses with more effective ones (2) prolonged exposure, that works to reduce conditioned fear responses connected with trauma memories and the stimuli that elicit them (3) cognitive therapy, that assists survivors in modifying ways of thinking that create distress and interfere with recovery and (4) acceptance methods, which recognize that some of the problems of Many cognitive-behavioral approaches also emphasize how important to the recovery process it is to deal with distressing trauma-related appraisals and beliefs. Such beliefs are at the core of the difficulty experienced by clients, and...

The Psychological Perspective of Cognition

The chapter provides an overview of the last thirty years' research in cognitive psychology with special reference to the representation of sensory information on the human mind. The interaction of visual, auditory and linguistic information in memory for understanding instances of the real world scenario has been elucidated in detail. The construction of mental imagery from the visual scenes and interpretation of the unknown scenes with such imagery have also been presented in this chapter. Neuro-physiological evidences to support behavioral models of cognition have been provided throughout the chapter. The chapter ends with a discussion on a new 'model of cognition' that mimics the different mental states and their inter-relationship through reasoning and automated machine learning. The scope of AI in building the proposed model of cognition has also been briefly outlined. The next topic, covered in the chapter, is concerned with cognitive models of memory. It includes the...

Identifying Functional Variables That Interact With Treatments

One empirically supported treatment principle for PTSD is the use of cognitive therapy, whose techniques include identifying dysfunctional cognitions and gathering and evaluating evidence for and against those cognitions. Presumably, examining this evidence will lead the patient to a more realistic and functional set of beliefs and cognitions. If that intervention did not achieve the anticipated results and assuming that the treatment was delivered competently then we are left considering whether there are other important causal factors that could be identified by a functional analysis. In addition to the kinds of analyses already described,

David S Riggs Shawn P Cahill Edna B

Posttraumatic stress disorder (PTSD) is an anxiety disorder that develops in some individuals following exposure to a traumatic event such as combat, sexual or physical assault, a serious accident, or the witnessing of someone being injured or killed (American Psychiatric Association, 1994). The classification of PTSD as an anxiety disorder reflects the longstanding recognition that anxious arousal plays a prominent role in people who experience pathological responses to trauma. However, research and theory into the nature of PTSD have documented that pathological reactions to trauma incorporate many emotions other than anxiety. Accordingly, in addition to reducing trauma-related anxiety and avoidance, treatments for PTSD are expected to modify other negative emotions such as guilt, shame, depression, and general anxiety.

Efficacy Of Exposure Therapy For Ptsd

See Foa & Meadows, 1997 Foa & Rothbaum, 1998 Harvey, Bryant, & Tarrier, 2003). The CBT programs that have been empirically examined include prolonged exposure (PE), stress inoculation training (SIT), cognitive therapy (CT), and eye movement desensitization and reprocessing (EMDR). There are more studies demonstrating the efficacy of exposure therapy (including PE) than of any other treatment for PTSD (Foa & Rothbaum, 1998 Rothbaum, Meadows, Resick, & Foy, 2000), and PE has been shown effective in treating PTSD associated with a wide variety of traumas. When directly compared, PE produces results as good as or better than other CBT approaches (CT, SIT, EMDR) or PE combined with components of the other treatments (see discussion below).

Design in a Best Case Scenario

In most research, the strongest test of the causal hypotheses of a cognitive vulnerability model is provided by a true experimental design. The unique importance of experimental designs is that independent variables are directly manipulated, and extraneous factors, including individual differences that are present prior to the study, are controlled. For example, in clinical trials or therapy-outcome studies, different treatment conditions (e.g., cognitive therapy versus pharmacotherapy) represent the manipulated independent variable(s), and participants with some disorder (e.g., all with major depressive disorder) are randomly assigned to the different treatment groups or conditions. The effects of the randomly assigned independent variables (e.g., treatment conditions) are then assessed on measures of the dependent variables (e.g., scores on depression inventories). In true experimental designs, the experimental control over sources of error permits a relatively strong basis for...

Amy E Street Patricia A Resick

The increased media attention on posttraumatic stress disorder (PTSD) in recent years has highlighted both the scientific advances in this area and remaining questions about the pathology and treatment of PTSD. Among psychotherapeutic interventions, several cognitive-behavioral strategies have demonstrated efficacy (e.g., van Etten & Taylor, 1998). Commonly used cognitive-behavioral therapy (CBT) protocols include, but are not limited to, cognitive processing therapy (CPT Resick & Schnicke, 1993), prolonged exposure (PE Foa, Rothbaum, Riggs, & Murdock, 1991b Foa et al., 1999a), and stress inoculation training (SIT Foa et al., 1991b, 1999a). However, the mechanisms of action in these treatments are not well understood. The relative contributions of cognitive versus behavioral components of treatment have only begun to be explored. Further, the heterogeneity of strategies included under the rubric of cognitive therapy often makes it difficult to evaluate the relative utility of this...

Avoidance Fusion and Pathology

Many of the problematic behaviors seen in PTSD may be the result of unhealthy avoidance strategies, fed by cognitive fusion. Steps taken to avoid experiential states may include directed thinking, rumination, and worry. These cognitive strategies are ways to distract oneself from current experience and the cognitive material associated with emotional content (Wells & Matthews, 1994). Worry and self-analysis seem to provide control over events but, in fact, have been shown to have minimal constructive benefit (Borkovec, Hazlett-Stevens, & Diaz, 1999) and may only serve to complicate psychological struggle. Numbing oneself to emotional responses or engaging in one type of emotional reaction as a way to avoid another (e.g., using anger to avoid hurt), and removing oneself from situations and personal interactions that elicit certain negative thoughts or emotions are all examples of

Cognitivebehavioral Interventions

Along with exposure, cognitive behavioral interventions for trauma include (a) learning skills for coping with anxiety (such as breathing retraining or biofeedback) and negative thoughts (''cognitive restructuring'') Foa et al. 48 reported on the preliminary findings of a therapeutic intervention intended to prevent the development of PTSD in female rape and assault victims. The intervention consisted of four 2-hour sessions. During the first meeting, the therapist introduced the program and gathered information about the subject's symptoms and distorted beliefs related to the disruptive experience they suffered. Also, a list of avoided people and or situations was generated. In the second session, this list was organized into a hierarchy based on the level of anxiety each item produced. The person was trained in relaxation and deep breathing and then asked to recall the experience (imaginal exposure). The therapist led the person to examine the accuracy of his her beliefs through...

The Causes Of The Clinical Effects Of Trauma

Before advocating that FAP can be an ideal treatment for complex PTSD, we first turn to a theory of trauma and its treatment implications. A parsimonious way to understand the complexity of trauma and its effects is to utilize the principles of operant and respondent conditioning. This learning account of PTSD (Hyer, 1994) is based on Mowrer's (1960) two-factor theory. Essentially, this theory contends that symptoms or problematic behavior come from two sources. First, as a result of pairing previously neutral stimuli with a highly aversive event, visceral, autonomic responses are now evoked by these previously neutral stimuli. A simple example might be a woman who was attacked by a dog and who now has aversive emotional responses to being near dogs, hearing dogs, or even anticipating the possibility of running into a dog. This woman's emotional responses to dogs and their related stimuli constitute the first set of problems. Then, because of respondent conditioning, this woman would...

History Of Mental Health Interventions After Disasters

As early as 1983, Mitchell 20 defined debriefing procedures, on the basis of cognitive techniques. His method aimed at treating police officers or firemen who had been exposed to a critical event. Mitchell's method can be applied during the post-immediate period (first week) it follows a seven-step procedure (introduction facts thoughts reactions symptoms education conclusion). Mitchell's approach is mainly cognitive (it helps the patients to gain an exact knowledge of the event) it aims at prevention (lack of knowledge might lead to PTSD) and restoring operational capability. It is not meant to treat and to be applied to victims. Mitchell's debriefing techniques were modified by several authors some established a distinction between didactic, psychological, and therapeutic debriefing others placed debriefing in a ''continuum of care'', and emphasized the importance of coping mechanisms and cognitive structuring. After the San Francisco earthquake in 1989, Armstrong et al. 21...

Cognitive Mechanisms Of

Effects of these events (Warda & Bryant, 1998a). Moreover, ASD participants display cognitive biases for events related to external harm, somatic sensations, and social concerns (Smith & Bryant, 2000). Experimental studies indicate that ASD individuals respond to a hyperventilation task with more dysfunctional interpretations about their reactions than non-ASD individuals (Nixon & Bryant, 2003). There is also evidence that catastrophic appraisals about self in the period after trauma exposure predict subsequent PTSD (Ehlers, Mayou, & Bryant, 1998b Engelhard, van den Hout, Arntz, & McNally, 2002). Relatedly, the nature of attributions about the trauma shortly after the event apparently influences longer-term functioning. Prospective studies indicate that attributing responsibility to another person (Delahanty et al., 1997) and attributions of shame (Andrews, Brewin, Rose, & Kirk, 2000) in the acute phase are associated with later PTSD.

What Is The Evidence For Cbts Effectiveness

A potential limitation of these studies is that the inclusion of all recently distressed trauma survivors raises the possibility that treatment effects may overlap with natural recovery in the initial months after trauma exposure. In an attempt to overcome this problem, other studies have focused on people who meet criteria for ASD because of evidence that most people who do display ASD are at high risk for subsequent PTSD (Bryant, 2003). In an initial study of ASD participants, Bryant and colleagues randomly allocated motor vehicle accident or nonsexual assault survivors with ASD to either CBT or SC (Bryant, Harvey, Dang, Sackville, & Basten, 1998b). Both interventions consisted of five 1.5-hour weekly individual therapy sessions. CBT included education about posttraumatic reactions, relaxation training, cognitive restructuring, and imaginal and in vivo exposure to the traumatic event. The SC condition included trauma education and more general problem-solving skills training in the...

Cognitive Schema Models

As previously noted, Beck (1967) proposed the first cognitive theory of depression. Beck argued that dysfunctional cognitions, such as cognitive errors, are important causal elements for depression. However, this theory goes beyond cognitive errors and suggests that deeper cognitive structures are also involved in precipitating depression. Specifically, Beck contended that there are three layers of cognition involved in the causes of depression. First, automatic thoughts are the recurring, intrusive, and negative thoughts that occur in depressed individuals. Second, underlying these automatic thoughts are irrational cognitions or beliefs, sometimes referred to as conditionals. These beliefs tend to take the form of if-then beliefs that are negative in nature. For example, a depressive conditional belief might be, If I don't get the job I applied for, then I am stupid. Third, automatic thoughts and irrational beliefs are a function of a deeper depressive self-schema that organizes...

Initial Evaluation Of The Patient With Substance Use Disorders

Obtaining a substance use history is essential when evaluating all patients with HIV AIDS. Some clinicians may have negative feelings about working with patients who exhibit self-destructive behaviors such as substance abuse and dependence. It is important to be aware of these feelings and realize that patients respond better when a working alliance can be established by approaching them in a nonthreatening and nonjudgmental manner. It is also important to reassure the patient that the information they provide will be kept confidential to those outside of the treatment

Guiding Conceptualization Of Guilt

We have conceptualized and obtained empirical support for guilt as a multidimensional construct comprised of negative affect and four guilt-related beliefs or cognitions (1) perceived responsibility, (2) perceived insufficient justification for actions taken, (3) perceived violation of values, and (4) perceived foreseeability and preventability of negative outcomes (which are often distorted by hindsight bias Fischhoff, 1975 Kubany & Watson, 2003a). In a two-factor analysis of the TRGI, all negative affect items loaded on a Distress factor, and all cognitive items loaded on a Cognitions factor (Kubany et al., 1996). Guilt is defined phenomenologically as an unpleasant feeling accompanied by a belief (or beliefs) that one should have thought, felt, or acted differently (Kubany & Watson, 2003a). This definition has guided our theoretical work on guilt (e.g., Kubany & Watson, 2003b Kubany et al., 1995), our guilt assessment research (e.g., Kubany et al., 1996), and our development of a...

Depressogenesis of Cognitive Mechanisms

All individuals encounter stress and negative emotions in their lives, but not all experience depression as a result of this stress and emotion. However, when individuals who have negative cognitive structures that are connected to negative affective structures encounter these experiences, not only will they experience negative emotions, but these negative emotions will also activate a variety of maladaptive cognitions about the self the experience of negative affect thus brings the negative self-schema online. Life stress, or negative events, that are cognitively interpreted in terms of one's own inadequacy and inferiority thus turn a normal negative affective state into depression (Teasdale, 1988). We are reminded in this regard of Freud's differentiation between mourning and melancholia In mourning the person's response to a loss is this is terrible, whereas in melancholia the person's response to this loss is I am terrible. Therefore, the vulnerability function, or depressogenesis...

Severe Mental Illness And Hiv Risk

They are less likely to seek care or testing and counseling. It is difficult to engage depressed patients in treatment because they are preoccupied with negative ideas and low mood. Once involved in treatment, extra effort must be employed to maintain their engagement, because depression leads to low motivation and energy. This can be partially overcome through the use of incremental goals and rewards (Treisman and Angelino, 2004). Because depression causes decreased memory and concentration, patients have a more difficult time with medication adherence. Visual cues and memory aids may help improve adherence, and social support can improve morale and adherence. It is therefore necessary to treat depression concomitantly with HIV AIDS if providers wish to succeed in viral suppression. Major depressive disorder is covered in further detail in Chapter 9 of this book.

FAP and Empirical Support

Research findings suggest that FAP can improve interpersonal functioning (Callahan, Summers, & Weidman, 2003 Kohlenberg, Kanter, Bolling, Parker, & Tsai, 2002). Kohlenberg et al. (2002) compared FAP-enhanced cognitive therapy (FECT) with cognitive therapy (CT) for the treatment of depression. Their findings suggested that FECT was more effective than CT

Integrating Cbt And Ipt In

This similarity in therapist behavior supports the feasibility of a merged intervention. We have successfully integrated behavioral and cognitive techniques in two other IPT projects, one targeting bipolar disorder (Frank, Swartz, & Kupfer, 2000) and one that addresses comorbid panic and depression (Cyranowski et al., 2004). Thus, in developing CGT, we began with standard grief-focused IPT and developed some CBT-informed modifications, drawing especially upon Foa's approach to PTSD (Jaycox, Zoellner, & Foa, 2002 Zoellner, Fitzgibbons, & Foa, 2001). The CGT therapist does utilize IPT facilitative, supportive, cognitive, and behavioral techniques. These core IPT therapeutic techniques, as outlined in the Weissman et al. (2000) manual, include nondirective exploration, encouragement and acceptance of affect, helping the patient generate suppressed and or avoided affect, and clarification and communication analysis. Directive behavioral change techniques are also outlined and include...

Case Example Illustrating Common Obstacles

Cognitive Therapy for PTSD TABLE 5.1. CPT Session by Session 2. Continue cognitive therapy regarding stuck points Below is a list of questions to be used in helping you challenge your maladaptive or problematic beliefs. Not all questions will be appropriate for the belief you choose to challenge. Answer as many questions as you can for the belief you have chosen to challenge below.

Development of the QUEST assessment tool

From a psychological perspective, satisfaction is a subjective reaction, that is, a state of pleasantness, well being or gratification (Chaplin, 1985). According to Linder-Pelz (1982), satisfaction is a positive attitude it is an affect that is the result of social psychological determinants including perceptions, evaluations and comparisons. Based on the theory and the research conducted in rehabilitation, Simon and Patrick (1997) define consumer satisfaction as a level of pleasantness, well being or gratification felt in reaction to a total specified experience or its components. In his comprehensive review article on patient satisfaction with rehabilitation services, Keith (1998) explains that satisfaction is comprised of affective components that reflect positive or negative feelings as well as cognitive components that are concerned with what is important and how it is evaluated. He maintains that if the factors that influence a patient's opinion cannot be identified then the...

Contingent Responding

Shaping is used by the therapist to identify and reinforce approximations of an effective target behavior toward the goal of gradually strengthening and widening the individual's repertoire. In other words, shaping rewards improvement rather than a preestablished absolute level of performance (Masters, Burish, Hollon, & Rimm, 1987). Shaping is an essential part of therapy with survivor couples. It is our experience that many of these couples lack skills that are necessary for communication and validation it is not so much an issue of not wanting to communicate with or validate a partner, it is more an issue of not having the skills to do so. Self-disclosure of feelings is often a behavior we want to shape in survivors of trauma. For example, we might reinforce a survivor's disclosure that she is not sure what she is feeling as a beginning step in the process of sharing emotions. The behavior of disclosing uncertainty is closer to the desired behavior of sharing her feelings than the...

Mental Health Response to Terrorism and Disaster

Conducted an open trial of a cognitive-behavioral therapy delivered between 1 and 34 months (median 10 months) postattack with survivors who had developed PTSD. Ninety-one patients who met criteria for PTSD resulting from the bombing received 2-78 sessions (with a mean of 8) of a treatment that combined imaginal exposure with cognitive therapy 37 of survivors were treated in five or less sessions. Seventy-eight patients demonstrated significant pre-post improvement on standardized measures of symptoms, with an effect size for improvement in PTSD symptoms of 2.47, a magnitude of change comparable to, or larger than, controlled trials of cognitive-behavioral therapy for PTSD.

Early Intervention Contexts Involving Continued Threat

Interventions designed for the treatment of PTSD are almost always applied under conditions of relative safety, in which threat of continued harm is minimal. In some environments (e.g., war zones, terrorist threat situations), however, these conditions do not apply. Realistic threats of ongoing exposure to continued attacks may form part of the environment in which traumatic stress reactions must be managed. Shalev et al. (2003) described modifications in delivery of cognitive-behavioral treatment for terrorism-related PTSD in Israel, designed to reflect these changed circumstances. During in vivo exposure assignments, survivors were encouraged to expose themselves to situations that were clearly safe, but not to those widely considered dangerous and avoided by most of the populace (e.g., city centers where repeated bombings had occurred). Their appropriate avoidance was characterized as positive safety behaviors and their goal as achieving normal fear. Cognitive therapy was applied...

Manifestations of Attention

This initial section of the chapter provides a framework for inquiry into the attention process by combining concepts and methods of the cognitive science disciplines of cognitive psychology and neurobiology. The first question deals with the goals of the individual's processing system that are met by attention, and the second question deals with the set of problems to be solved by attentional operations if they are to benefit the life of the individual. Three goals of the attention process were stated accurate and fast judgments of objects and ideas and the sustaining of desired mental processing. Attention was said to meet these three goals with three corresponding manifestations of attention simple selection, preparation, and maintenance. Common to all three manifestations of attention is the selective property, but the duration of selection is typically more prolonged in the manifestations of attentional preparation and attentional maintenance.

Who Quality Of Life Assessment

WHO defines Quality of Life as an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It is a broad ranging concept affected in a complex way by the person's physical health, psychological state, personal beliefs, social relationships and their relationship to salient features of their environment. Spirituality religion personal beliefs (1 facet) Spirituality religion personal beliefs (1 items)

Swedish Health Related Quality Of Life Survey

Likert Survey Healthy Lifestyle

The Swedish Health related Quality of Life Survey (SWED-QUAL) was developed by Brorsson et al. from the measures used in the US Medical Outcomes Study (MOS). The questionnaire, which is designed to measure health related quality of life, consists of 70 items, of which 63 forms two single-item and 11 multiitem dimension scales of Likert type physical functioning (7 items), mobility (1 item), satisfaction with physical ability (1 item), role limitations due to physical health (3 items), pain (6 items), emotional well-being positive affect (i.e. positive feelings 6 items), emotional wellbeing negative affect (i.e. negative feelings 6 items), role limitations due to emotional health (3 items), sleep problems (7 items), satisfaction with family life (relations with parents, siblings, children etc. 4 items), relation to partner (6 items), sexual functioning (4 items) and general health perception (9 items).

Specific Mechanisms Potentially Contributing To The Pathophysiology Of Ptsd

There may be consequences of increased catecholamine levels in the acute aftermath of a trauma in promoting the consolidation of the traumatic memory. Indeed, adrenergic activation in the presence of low cortisol has been shown to facilitate ''learning'' in animals 45 . If this was the neurohumoral state of an individual during and in the immediate aftermath of a traumatic exposure, the event would not only be strongly encoded in memory, but associated with extreme subjective distress. This level of distress, in turn, would set the stage for the occurrence of perceptual and cognitive distortions in the acute aftermath of the event, particularly regarding the estimation of danger and subjective assessment of ability to respond effectively to the threat. Such altered beliefs would serve to further inhibit recovery by leading to a failure to quell fearful recollections. The repeated experience of the trauma memory with its associated fear response, as may occur at the time of an...

Demersion Factors Of Individual Difference

Intelligence and development A cognitive theory. Oxford Blackwell. Cooper, L. A. (1975). Mental rotation of random two-dimensional forms. Cognitive Psychology, 7, 20-43. Hunt, E., Lunneborg, C., & Lewis, J. (1975). What does it mean to be high verbal Cognitive Psychology, 7, 194-227. Neisser, U. (1967). Cognitive psychology. New York Appleton-Century-Crofts.

Functional Problems In Ptsd

Let us consider an analysis of symptoms 5 and 6 from criterion C as target behaviors feeling of detachment or estrangement from others, and restricted range of affect. These behaviors are part of the numbing phenomena said to characterize PTSD. Presumably the numbing is functionally useful to the patient in that it is an avoidance strategy whose purpose is to control otherwise highly negative feelings. Without disagreeing that these numbing responses are adaptive in the short run, let us further hypothesize about how these target behaviors might arise and be maintained in a way that could lead to an improved outcome if addressed from a functional perspective. The analysis might begin with an explanation of what would lead to a feeling of closeness the opposite of estrangement and restricted affect. The therapist might begin by taking a behavioral history of the patient's close relationships and find that they were characterized by shared expressions of feelings, wants, and needs, and...

Specific Treatment Modalities

Psychosocial treatments with the potential for broad applicability across several dual-diagnosis populations have also been developed. With the exception of cognitive therapy, most originated in the addiction literature but have demonstrated some efficacy in treating both disorders when adapted specifically for dually diagnosed populations. Below, we briefly describe several of the more common psychosocial interventions studied in populations with co-occurring SUDs and psychiatric disorders. Cognitive-behavioral therapy (CBT), developed by Beck, Rush, Shaw, and Emery (1979), has been adapted for the treatment of substance abuse (Beck, Wright, Newman, & Liese, 1993). When adapted to specific dually diagnosed populations (e.g., PTSD), additional techniques include the identification of cognitive distortions associated with both disorders (e.g., getting high now as a reward for having been deprived in the past), identifying meanings of substance use in the context of PTSD (e.g., as...

Assessment Of Cognitions

An extensive review of potential measurements to use to assess cognitions is beyond the scope of this chapter. However, a few measures deserve mention for those readers who are seeking appropriate assessment instruments that are sensitive to changes in cognition anticipated over the course of treatment. Among the commonly used measures of cognition are the Trauma and Attachment Belief Scale (TABS Pearlman, 2003), the Personal Beliefs and Reactions Scale (PBRS Mechanic & Resick, 1993), the World Assump The TABS is an 84-item measure that identifies disruption in several dimensions that impact interpersonal relationships, including Safety, Trust, Esteem, Intimacy, and Control. Similarly, the PBRS is a 55-item measure developed for use with sexual assault survivors to assess eight dimensions of Safety, Trust, Power, Esteem, Intimacy, Negative Rape Beliefs, Self-Blame, and Undoing (i.e., trying to deny or alter the event as a method of assimilation). Three subscales of the PBRS are...

Commentary

An overanxious, fearful handler can impart negative feelings to the animals being manipulated. Regardless of the species being restrained, if the animal becomes overexcited and fearful, the stress can alter physiologic parameters and influence experimental results. It is best in such circumstances to stop the procedure, allow the animal to relax and recover, and begin again the following day or at least several hours later.

Social Vulnerability

This social vulnerability is present even in the pathological reactions to disasters. Among the risk factors for post-traumatic stress disorder most often identified in the USA are female sex Hispanic ethnicity 32 personal and family history of psychiatric disorders experiences with previous traumas, especially during childhood poor social stability low intelligence neurotic traits low self-esteem negative beliefs about oneself and the world and an external locus of control 33 . Curiously enough, there is a preventing factor which is political activism.

Description of PE

The first session of PE is devoted to laying the groundwork for the program. The therapist provides a description of the treatment and each of the procedures that will be used. The therapist also provides the client with a model for understanding the persistence of PTSD symptoms. The model emphasizes the role of avoidance and negative beliefs about the world and the self in impeding recovery and thus maintaining PTSD symptoms (Foa & Riggs, 1993 Foa & Rothbuam, 1998). Following the overall rationale for the treatment and a general description of the PE procedures, the therapist collects information about the patient's traumatic experience, using a semistructured interview format to elicit details about the trauma and the patient's reactions during and after the trauma. (This information may also be collected in a less structured format.) At the end of the session, the patients is trained to use controlled breathing to manage anxiety. Setting a pattern for all sessions, this session...

Emotion

The intensity of emotional experience and appropriate expression of emotion are strongly associated with the quality of psychological adjustment. Conflicts over anger and guilt, and the display of intense emotional reactions commonly accompany substance use. These disruptive emotions may either presage substance use or emerge following drug use onset. Not uncommonly, consumption of psychoactive substances is motivated by a need to ameliorate negative affective states such as anger, depression, and fear. The inability to express emotions effectively in the social context, particularly negative feelings, is also frequently associated with drug abuse. Emotional disturbance is often encompassed within psychopathology. From the psychometric perspective, clinically significant psychopathology is present when severity exceeds two standard deviations from the population mean. In effect, the severity score ranks in excess of the 95th percentile in the population on a trait (e.g., anxiety)....

Subjective Factors

Cognitive biases, individual preconceptions (and misconceptions), life experiences, cultural context, the subject's general outlook (e.g. pessimism, locus of control), as well as social biases, such as family history and related beliefs of being vulnerable, may also influence the interpretation of risk information (Bottorff et al. 1998).

Trial and Error

The convergence of behavioral ecology and cognitive psychology has generated considerable interest in how the cognitive capacities of animals influence their behavior (Yoerg, 1991 Belisle and Cresswell, 1997 Dukas, 1998 Kamil, 1998). When examining this relationship, one key consideration must be the extent to which an animal's cognitive abilities are merely single-purpose adaptations tailored for specific functions rather than broader cognitive capacities (Stephens, 1991 McFarland and Boser, 1993). We are only beginning to understand how often and under what circumstances the evolution of cognitive skills has pushed animals across a threshold, so to speak, enabling them to respond flexibly and adaptively to problems outside of the context in which these skills originally evolved (see Dennett, 1996).

Cvd Project Findings

A primary hypothesis of the cognitive theories of depression is that certain negative cognitive styles confer vulnerability to symptoms and diagnoses of depression. Although cognitive styles are not immutable (Just et al., 2001) and are open to modification (e.g., through cognitive therapy see DeRubeis & Hollon, 1995), these styles are typically viewed as relatively stable risk factors. Findings from the CVD project have supported the relative stability of cognitive styles. Specifically, the cognitive styles of our participants remained stable from before to during and after intervening episodes of major depression (Berrebbi, Alloy, & Abramson, 2004). In addition, participants' attributions and inferences for particular negative life events they experienced remained stable over the 5-year follow-up (Raniere, 2000). Thus, cognitive styles appear to be a relatively traitlike vulnerability factor. One method of testing the cognitive theories' vulnerability hypothesis is to examine...

Suppression

A possible result of suppression, a form of avoidance wherein individuals try to block out or inhibit thoughts or feelings, is the recurrence of intrusive traumatic cognitions (Clark, Ball, & Pape, 1991 Wegner, Shortt, Blake, & Page, 1990), which, as noted earlier in the chapter, may result in a paradoxical effect of amplification. Current research suggests that attempting to avoid or suppress unwanted negative thoughts, emotions, and memories as a means to create psychological health may actually contribute to a magnification of the negative emotional responses and thoughts, and to a longer period of experiencing those events (Wegner & Schneider, 2003 Wenzlaff & Wegner, 2000 Wegner, 1994 Cioffi & Holloway, 1993 Wegner & Zanakos, 1994). This means that suppression presents risks of amplification Avoidance of thoughts increases their importance (a cognitive fusion process), which then increases their negative impact and induces further efforts to avoid them. Personally relevant...

Anger

Anger is a very common response following a traumatic experience (Hyer et al., 1986 Riggs, Dancu, Gershuny, Greenberg, & Foa, 1992). It has been proposed that anger may serve to inhibit anxiety following a trauma, especially when effortful avoidance is unsuccessful (Riggs et al., 1995). Indeed, patients who display anger during the initial narrative tend not to respond positively to exposure therapy (Foa et al., 1995 Jaycox, Perry, Freshman, Stafford, & Foa, 1995). People who present with anger as the primary emotional response may benefit more from anger management strategies, including anxiety management and cognitive therapy techniques (Chemtob, Novaco, Hamada, & Gross, 1997).

Ongoing Stressors

It is important to note that there are important limitations to the current evidence for the effective use of CBT shortly after trauma exposure. First, although CBT does lead to significant reductions in recently traumatized people who complete treatment, a significant proportion of participants do drop out of treatment. For example, 20 of participants dropped out of both the Bryant et al. (1999) and Bryant et al. (2005) studies. That is, intent-to-treat analyses in these studies indicate modest benefits of CBT (Bryant et al., 1999, in press). This pattern clearly points to the need for interventions that are efficacious and manageable for more recently traumatized people. For example, providing nonexposure-based therapies (such as cognitive therapy) may be better tolerated by some patients. Alternately, teaching coping skills prior to exposure may help some patients cope with the exposure more effectively (Cloitre, Koenen, Cohen, Han, 2002). Second, most early intervention treatment...

Prolonged Exposure

In general, exposure for ASD utilizes the same exposure protocols as those described for chronic PTSD (see Riggs, Cahill, & Foa, Chapter 4, this volume Foa & Rothbaum, 1997). The first stage in considering exposure is determining the patient's suitability for this procedure. As mentioned above in the context of assessment, caution should be exercised in providing exposure to any recently traumatized individual who displays signs of being at risk for an adverse reaction to the distress that will be elicited by exposure. When commencing exposure, some patients will skip over the most distressing aspects of the experience because they cannot tolerate the affective response. This self-editing can be permitted initially, but it is important that as therapy proceeds, these hot spots receive close attention. Once a patient demonstrates in therapy that he or she can tolerate the exposure, daily homework exercises should be initiated. It is also especially useful to integrate cognitive therapy...

Session Structure

A powerful strategy, grounding, is offered to help clients detach from emotional pain. Three types of grounding are presented (mental, physical, and soothing), with an experiential exercise to demonstrate the techniques. The goal is to shift attention toward the external world, away from negative feelings.

Of Communication

Communication serves for both the primary control of the situation (problem-focused coping) and the secondary control of the situation (emotion-focused coping). Information exchange about the disease and treatment promotes primary control. It enables those involved to define the problem and make attempts to solve it. Communication about the disease directed at secondary control of the situation promotes understanding and acceptance of the disease and aims to reduce negative emotions and strengthen positive emotions. This is illustrated by the parent who maintains telling the child it will get better. With this he or she invites the child to view the situation in a certain (optimistic) way, and thus attempts to reinforce the child's hope and reduce fear.

Double Protection

In the communication between the child and the parents, it is very striking that protecting oneself is often achieved through protecting the other. Attempts to influence the other person's appraisal in order to reduce the other person's negative emotions not only involve compassion and to their children than parents of children with asthma and parents of healthy children. The findings obtained were equivalent for the mothers and the fathers. We believe that, in order to be able to count their child among the lucky ones who will survive the disease, parents create an image of vitality and zest for life. This positive attribution by parents of children with cancer may be a beneficial coping strategy as long as the emotional feelings of children are not underestimated. Caregivers should be aware of this coping strategy, especially if this coping strategy is out of balance or pathological. It can also be possible that children give their parents the impression they are doing fine to...

Attention

This chapter addresses the ways cognitive science disciplines have inquired into the attention process. Resting on the seminal work of William James (1890), the discipline of cognitive psychology has developed most of the current concepts of attention in conjunction with the invention of new behavioral tasks that evoke particular aspects of the attention process. The discipline of neuroscience, in turn, has adopted many of these behavioral tasks to produce attentional states in monkeys and humans that can be measured by various physiological techniques such as single-cell recordings, evoked response potentials (ERPs), positron emission topography (PET), and functional magnetic resonance imaging (fMRI).

Empirical Research

Over the past 15 years studies have been conducted that examined the efficacy of trauma-focused CBT models in individual and group contexts with children who have suffered sexual abuse. Deblinger, McLeer, and Henry (1990) first reported the findings of a pilot investigation examining the effectiveness of individual CBT designed for children who had suffered sexual abuse and who met DSM-III-R criteria for PTSD. The results revealed no significant improvement during a 2- to 3-week pretreatment baseline period, but significant improvements on standardized measures of PTSD, anxiety, depression, and behavior problems at posttreatment. However, it was noted that at posttreatment, a significant proportion of the treated children continued to exhibit mild depressive symptoms. This finding led the investigators to combine exposure-based interventions with cognitive therapy techniques that might more effectively target depressive symptoms.

Treatment Model

Gradual exposure and trauma processing are the foundation of this treatment model. The skills discussed above help prepare children for this phase of therapy, in which they are gradually exposed to their own thoughts, feelings, memories, and reminders of their abuse until they can tolerate all of these without significant distress. This component of treatment may be anxiety-provoking for children, caregivers, and therapists alike, perhaps making it difficult for therapists to implement. However, it may be a critical skill for children to learn to tolerate and cope with trauma-related distress, as opposed to avoiding or suppressing negative emotions, in general. A rationale for why gradual exposure is important should be given to both child and caregiver. A useful analogy is to compare gradually talking about sexual abuse to easing oneself into a cold swimming pool (Deblinger & Heflin, 1996)

Clinical features

Cataplexy has been considered pathognomonic of narcolepsy despite the fact that it can be seen, exceptionally, as an independent problem. Its isolated presence may lead to question whether daytime sleepiness also occurs. Its presence does not distinguish between primary and secondary narcolepsy. As already mentioned by Daniels 42 , it consists of a sudden drop of muscle tone triggered by emotional factors, most often by positive emotions, more particularly laughter, and less commonly by negative emotions such as anger. In a review of 200 narcoleptics with cataplexy, all reported that laughter related to something that the person found hilarious, triggered an event surprise with an emotional component was the second most common trigger. Cataplexy occurs more frequently when trying to avoid taking a nap and feeling sleepy, when emotionally drained or with chronic stress. Elderly subjects with very rare incidence of cataplexy may see a great increase in frequency during a period of grief...

Coping Support

A prime example of a skills set relevant to survivors of recent trauma is that of anxiety management. Stress inoculation training has been found effective in treating people with chronic PTSD (Foa et al., 1999), and anxiety management skills (e.g., breathing retraining, relaxation) are part of the intervention package used by Bryant and colleagues to successfully treat acute stress disorder. Although the addition of anxiety management training to exposure and cognitive therapy as an early treatment for acute stress disorder did not result in improved outcomes over and above the effects of cognitive therapy and exposure (Bryant et al., 1999), anxiety management was not tested as an intervention in its own right in this study. Echeburua, de Corral, Sarasua, & Zubizarreta (1996) randomly assigned 20 treatment-seeking female survivors of recent ( 90 days) sexual assault to either a cognitive-behavioral package intervention or to progressive muscular...

Dissemination

Most mental health providers have not been trained in evidence-based treatments for PTSD and other trauma-related problems. Consequently, as cognitive-behavioral early interventions are developed, it will be a challenge to disseminate them to those who serve the various populations of trauma survivors, many of whom are volunteers, paraprofessionals, or professionals who are unfamiliar with cognitive-behavioral interventions. Recent evidence and experience does suggest, however, that mental health professionals can be rapidly trained in the delivery of these treatments. As noted previously, rape crisis counselors trained to deliver an evidence-based treatment for chronic PTSD (exposure therapy) demonstrated a clinical impact similar to that shown in efficacy trials (Foa et al., 2001). In their successful open trial of cognitive therapy with survivors of the 1998 Omagh terrorist bombing, Gillespie et al. (2002) provided an important initial demonstration of the feasibility of training...

Recommended Reading

L., & Hodge, G. K. (1992). Cognitive therapy Possible strategies for optimizing outcome. Psychiatric Annals, 22(9), 459-463. Maddux, J. E. (1993). Social cognitive models of health and exercise behavior An introduction and review of conceptual issues. Journal of Applied Sport Psychology, 5(2), 116-140. Norman, P., & Conner, M. (1993). The role of social cognitive models in predicting attendance at health checks. Psychology and Health, 8(6), 447-462. Organista, K. C., Munoz, R. F., & Gonzalez, G. (1994). Cognitive-behavioral therapy for depression in low-income and minority medical outpatients Description of a program and exploratory analyses. Cognitive Therapy and Research, 18(3), 241-259.

What Is Cg Treatment

CGT is conceptualized as an intervention that seeks to remove impediments to the progression of primary grief and facilitate integration of loss-related thoughts and feelings into the mental and emotional life of the bereaved. Impediments include dysphoric emotions and problematic attitudes or beliefs about the death. CGT targets blocked positive as well as negative emotions and seeks to relieve guilt about positive as well as negative emotions. For the person with CG, the event of the death was a psychological trauma that has led to a PTSD-like reaction. Thus techniques to relieve traumatic distress are a key augmentation component of CGT. Difficulty feeling a positive connection to the deceased and yearning and longing for the lost relationship are forms of separation distress. Several components of CGT target this problem. In addition, given that positive emotions of optimism, compassion, acceptance, and forgiveness contribute to a favorable outcome in natural grief, we seek to...

Normalization

Acute stress reactions in negative ways will be at risk for posttrauma problems or whether intervention can change those interpretations and thereby improve outcomes. In most posttrauma care, helpers try to normalize acute stress reactions by simply telling survivors that these are common, normal, and not dangerous. But among those at risk for development of PTSD, such simple instruction may be insufficient. Again, cognitive-behavioral methods might be used profitably to accomplish normalization cognitive therapy methods might be used to address negative interpretations of reactions, breathing training methods might help reduce the intensity of hyperarousal symptoms or increase their controllability, and interoceptive exposure might be used to reduce fear of anxiety sensations.

Studies of PE

Resick et al. (2002) compared PE with cognitive processing therapy (CPT), a form of cognitive therapy specifically developed for rape survivors (Resick & Schnicke, 1992), and a waiting-list condition. In addition to the cognitive therapy techniques that form the core of CPT, this program includes an exposure component of repeatedly writing and reading the trau

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