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...

Emotional Processing Theory of Natural Recovery

Although a necessary condition for the development of PTSD, exposure to trauma per se does not inevitably lead to chronic PTSD. Prospective studies of traumatized individuals indicate that PTSD symptoms, general anxiety, depression, and disruption in social functioning are common immediately after the traumatic event. Over the subsequent weeks and months, the majority of individuals recover naturally, with symptoms declining most rapidly during the 1- to 3-month period immediately following the...

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...

Amy W Wagner Marsha M Linehan

Dialectical behavior therapy (DBT) was initially developed for the treatment of chronically suicidal individuals who meet criteria for borderline personality disorder (BPD). Because the majority of people with BPD have histories of trauma and meet criteria for posttraumatic stress disorder (PTSD), it seems appropriate to describe DBT in a book on the treatment of trauma. There are two potential applications of DBT to individuals with histories of trauma. One main application is to achieve...

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...

Does Asd Predict Ptsd

There are now 12 prospective studies of adults that have assessed the relationship between ASD in the initial month posttrauma and development of subsequent PTSD (Brewin, Andrews, Rose, & Kirk, 1999 Bryant & Harvey, 1998 Creamer, O'Donnell, & Pattison, 2004 Difede et al., 2002 Harvey & Bryant, 1998a, 1999b, 2000a Holeva, Tarrier, & Wells, 2001 Kangas, Henry, & Bryant, 2005 Murray, Ehlers, & Mayou, 2002 Schnyder, Moergeli, Klaghofer, & Buddeberg, 2001 Staab, Grieger,...

Complications And Obstacles For Fap Therapists In Treating Complex Ptsd

Trauma-focused treatments can be emotionally difficult for therapists of any theoretical orientation, leading to the potential for vicarious traumatization (Brady, Guy, Poelstra, & Fletcher-Brokaw, 1999) and secondary traumatic stress disorder and compassion fatigue (Figley, 1995). Histories of trauma are also found among mental health professionals, with studies suggesting that about 30 report a history of trauma during childhood (Follette, Polusny, & Milbeck, 1994 Pope &...

Recent Advances in Psychological Assessment of Adults with Posttraumatic Stress Disorder

Brief Terence M. Keane Originally conceptualized in the DSM-III American Psychiatric Association, 1980 as relatively rare, traumatic events and posttraumatic stress disorder PTSD are now viewed as common across the world. As interest in PTSD grows internationally, so does the need for sensitive and specific diagnostic interviews, questionnaires, and psychological tests. As progress is made in understanding the impact of trauma on psychological functioning, the...

Overview of Treatment Approach Acceptance Theory and Intervention

Psychological Inflexibility Hexaflex Act

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...

Persistent Avoidance of Stimuli Associated with the Trauma

A child who is physically and sexually abused over an extended period of time is, of course, motivated to escape and avoid the pain and humiliation. In contrast to a circumscribed trauma, the direct avoidance of the aversive stimuli would be impossible because the child cannot physically escape or prevent the exposure. When a beloved parent or caretaker is also the perpetrator of the abuse, the trauma is particularly heart-wrenching. Incest creates an association between love, dependence, and...

Edward S Kubany Tyler C Ralston

There is considerable evidence that cognitions play an important role in the maintenance or chronicity of posttraumatic stress e.g., Brewin, Dalgleish, amp Joseph, 1996 Ehlers amp Clark, 2000 Foa, Ehlers, Clark, Tolin, amp Orsillo, 1999 Kubany et al., 1996 Kubany amp Watson, 2002, 2003a . This research has emphasized survivors' phenomenology, much of which involves guilt and shame see Kubany, 1998, for a brief review . Research reviewed elsewhere shows that trauma-related guilt is a common...

Guilt Assessment

Assessment is an integral part of the CT-TRG model. We use a structured interview and specially designed questionnaires 1 to identify idiosyncratic sources of trauma-related guilt, 2 to assess clients' faulty thinking patterns, and 3 to evaluate treatment efficacy. Structured Guilt Assessment Interview We use a structured interview to identify important issues across five domains of guilt Kubany amp Manke, 1995 . This interview which also includes follow-up probes consists of five core...

Analysis of the Behavior in Context

One of the fundamental issues in functional understanding of clinical interventions is to appreciate the proper unit and level of analysis of a behavioral problem. In the case of PTSD it can be tempting to see the problem as residing in the relationship between the patient and the traumatic stressor. In fact, because there is considerable variability in how patients respond to stressors, we must infer that there are other factors that affect course and outcome. From a behavior analytic...