Concerns About Exposure Therapy

Therapists often raise concerns that the emotional arousal experienced by trauma survivors undergoing exposure therapy may be extremely distressing and even damaging. Indeed, several clinical researchers have expressed reservations about the safety of exposure therapy in the treatment of at least some populations with PTSD (e.g., Cloitre et al., 2002 Kilpatrick & Best, 1984 Pitman et al., 1991). Two potential safety issues, in particular, have gained attention in the literature (1) exposure...

References

P., & Teasdale, J. (1978). Learned helplessness in humans Critique and reformulation. Journal of Abnormal Psychology, 87, 49-74. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC Author. Anderson, G., Yasenik, L., & Ross, C. A. (1993). Dissociative experiences and disor ders among women who identify themselves as sexual abuse survivors. Child Abuse and Neglect, 17, 677-686. Bach, P.,...

Studies of PE

The efficacy of PE has been investigated in six separate studies. In the first of these, Foa et al. (1991) compared rape survivors treated with PE to a waiting-list control group, a group receiving supportive counseling, and another treated with SIT (Meichenbaum, 1977 Veronen & Kilpatrick, 1983). SIT is a CBT package that teaches clients several anxiety management strategies and encourages them to apply these strategies in their daily life. At the end of nine treatment sessions, women in the...

S

Safe Coping Sheet, 239 Safety, 239-240 Safety Contract, 239 Safety parameters, 244 Safety Plan, 239 School-age children, therapy, 411, 412 Schreckneurosis, 3 Seeking Safety Group, 249 Seeking Safety model difficulties encountered, 250-251 efficacy of, 247-248 implementation considerations, 248251 key principles, 239-243 overview of, 231-239 PTSD SUD treatment, 231 treatment omissions, 244-245 Self as context, 158-161, 164-165 Self-analysis, ACT, 149 Self-appraisal case study, 347-348 shame, 331...

Assessment and Case Formulation

A pretreatment assessment was conducted over the course of two sessions. The therapist gathered information regarding Danielle's current emotional and behavioral functioning as well as details regarding her experience of sex ual abuse in order to formulate a treatment plan. This information was gathered through the administration of semistructured diagnostic and background interviews as well as standardized measures tapping symptoms of PTSD, depression, anxiety, and behavior problems. Ms....

Types of Assessment Measures

Clinician-administered structured diagnostic interviews are considered extremely valuable tools for assessing PTSD symptomatology (Keane et al., 1995). Although it is standard practice in clinical research settings to employ structured diagnostic interviews, the use of these types of interviews in the clinical setting is less common, with perhaps the single exception of clinical forensic practice (Keane, 1995 Keane, Buckley, & Miller, 2003). In general, the infrequency of use may be due to...

Functional Problems In Ptsd

The point of describing what is entailed in a conceptual understanding of a functional analytic case conceptualization is to notice the idiographic nature of the assessment process for the purpose of identifying additional sources of information of variance in problem behaviors to improve clinical outcome. There are many sources about how to conduct and even quantify a functional analysis (e. g., Follette, Naugle, & Linnerooth, 2000 Hawkins, 1986 Hayes, Nelson, & Jarret, 1987 Haynes,...

Ptsd As A Risk Factor For Retraumatization

Several epidemiological studies have found that after an individual has experienced one high-magnitude stressor, he or she is at risk for experiencing additional traumatic events over the lifespan (Breslau, Davis, Andreski, & Peterson, 1991 Kilpatrick, Saunders, Veronen, Best, & Von, 1987). Of even greater significance is the report that, at least among rape victims, the presence of PTSD, in and of itself, contributes to risk for repeated traumatization (National Victim Center and Crime...

What Is Cg Treatment

CGT treatment (CGT) is a 16-session psychotherapy model that is delivered in three phases consisting of a beginning, middle, and termination see Figure 12.1). In the beginning phase the therapist provides an introduction to the treatment model, in which grief is understood to be a natural inborn, biopsychosocial pathway to adjustment to a painful loss. Characteristic features of grief are reflections of separation distress and traumatic distress, manifested in various ways that can be...

What Is Complicated Grief

Bereavement and grief are universal experiences. Many features of acute grief resemble symptoms of major depression. Consequently, there is a long history of linking grief and depression in psychiatric thinking. Bereavement triggers an episode of major depression in about 20 of individuals who lose a loved one. However, not all grief-related problems meet criteria for major depressive disorder. There is a rich clinical literature describing pathological grief reactions, under various...

Fap An Ideal Behavioral Therapy For Complex Ptsd

In theory, the treatment for complex PTSD involves the same exposure-based procedures described for circumscribed PTSD. That is, the evocative stimuli need to be identified and described, the client must be willing to expose him- or herself to these stimuli and not avoid or escape from them, and the stimuli should be presented in vivo. Because complex PTSD involves difficult-to-describe evocative stimuli, however, it is difficult to devise an in vivo exposure treatment that presents the...

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). There are three phases in CT-TRG (1) assessment, (2) guilt...

The Fear Structure of PTSD

Foa, Steketee, and Rothbaum (1989) proposed that a traumatic event is represented in memory as a fear structure that is characterized by a large number of harmless stimulus elements erroneously associated with the meaning of danger. These erroneous associations are reflected in the perception of the world as entirely dangerous. In a further development of emotional theory for PTSD, Foa and Jaycox (1999) suggested that the physiological and behavioral responses that occurred during and after the...

Integrative Behavioral Couple Therapy

An important development in behavioral couple treatment has been the development of integrative behavioral couple therapy (IBCT Christensen, Jacobson, & Babcock, 1995). This approach to the treatment of couple distress is consistent in many ways with the principle-based intervention that we present in this chapter. IBCT is an empirically validated intervention that combines the change-oriented strategies of traditional behavioral couple therapy (TBCT Jacobson, & Margolin, 1979), including...

Cognitive Models Of Ptsd

Information-processing theory has been widely used to understand the development and maintenance of anxiety disorders, including PTSD (Lang, 1979, 1985). This theory suggests that emotions, such as fear, are encoded in memory in the form of networks, where representations of anxiety-provoking events are stored. Fear networks are hypothesized to contain three important types of information (1) information about the feared stimuli or situation (2) information about the person's response to the...

Overview of Treatment Approach Acceptance Theory and Intervention

Act Hexaflex With Questions

The following section provides detailed information about how to use ACT in a clinical setting. There are several main goals that are generally presented in order when using ACT. This is not to say, however, that the ACT goals cannot be presented in a different order, or that the ACT therapist cannot choose to emphasize one goal over another, depending on the client's specific issues. ACT is diverse and flexible and allows for a range of concepts to be presented depending on client needs. Here...

Case Example Illustrating Common Obstacles

Sam was a 34-year-old unemployed European American male with a college education. He had a long history of alcohol and drug abuse, starting with his first drink at the age of 8. In addition, Sam had an extensive history of being physically and sexually assaulted. At the time he sought treatment, he had already been abstinent from alcohol and drugs for 6 months, due to a previous traumatic incident. Thus, at his initial assessment, Sam met criteria for PTSD, major depressive disorder, and...

Integrating Cbt And Ipt In

Because IPT already has a grief focus with goals that are consistent with treating CG, and our group has extensive experience using IPT effectively, we decided to base our targeted CGT in an IPT framework. Goals for treating CG were similar to IPT grief-focus goals, and we included the core three-phase IPT method as an organizing framework. We integrated CBT strategies for treatment of PTSD as well as cognitive strategies for dealing with separation distress into this framework. We found that...

Overview of Treatment Approach

As mentioned, DBT is structured into stages of treatment, and these correspond to stages of disorder. Stage I DBT targets severe behavioral dyscontrol, with the goal of achieving overall behavioral control. Once behavioral control is achieved, it becomes possible to work on other important goals Stage II targets problems with emotional experiencing including PTSD-related problems , with the goal of increasing the capacity for normative emotional experiencing without escalating or blunting stage...