PTSD Professional Perspective: Cognitive & Behvioural Therapies, Part 1
Friday, May 21st, 2010 • PTSD Guest Post: Professional Perspective •
Ever wonder what CBT (Cognitive Behvioral Therapy) is all about, and how it can help with PTSD recovery? You’re in luck! Today Adrian Soden lays it all out for us — what CBT is, plus how and why it works.
Treatment From the Perspective of Cognitive Behavioral Therapy
Post-Traumatic Stress Disorder (PTSD) is a common reaction to trauma, in which the victim displays a variety of cognitive and behavioural symptoms which encompass both the anxiety and emotional responses, including the unwanted and repeated re-experiencing of the event, disassociation, hyper-arousal, “feeling numb” and avoidance of stimuli which may trigger reminders of the trauma. Studies have also indicated that changes in memory functioning occurs, which are comparable with those found with depressed patients (a tendency towards recall of trauma related material and difficulty recalling autobiographical memories of specific incidents: Buckley et al 2000).
Current understanding of PTSD, in the context of CBT, has shifted from the social-cognitive, information processing, anxious-apprehension and conditioning theories to the more recent Emotional processing theory (Foa & Riggs 1993; Foa & Rothbaum, 1998) and Cognitive theory (Clarke & Ehlers 2000) and, whilst this may not involve significantly differing treatment techniques (exposure, habituation, challenging automatic thoughts & modification of dysfunctional beliefs, etc.), these techniques can be applied more intelligently so as to have a far greater impact on the problem.
‘Cognitive Behavioural Therapy’ (CBT) is not a therapy per-se, but a collection of therapies including behaviour therapy, cognitive therapy, and other therapies based on the pragmatic combination of the behavioural and cognitive theories and represent a unique category in psychological interventions as it originates from both the behavioural and cognitive psychological models of human function, these include theories of emotion, developmental (both normal and abnormal) and psychopathology.
CBT does involve making a lot of lists, keeping diaries, etc. Initially this is mainly for assessment/continuing assessment purposes but later can become a tool for treatment (eg. a list of all feared or avoided situations can be adapted into a hierarchy for graded exposure), later still and these lists, diaries, etc. may again be adapted to use as tools for relapse prevention planning.
Following assessment the therapist and patient will work together to construct an idiosyncratic formulation of all of the maintaining factors of the problem — this takes into account the physical, emotional, behavioural, cognitive and motivational symptoms, situational triggers — both overt & covert and “modifiers” (both positive and negative). These are then examined and prioritised and the basic structure for therapy is negotiated.
PTSD is very much a “mixed bag” when it comes to treatment; there are obvious behavioural problems (avoidance of stimuli, etc.) which will be treated with graded exposure and cognitive problems (negative automatic thinking, perception of threat etc) which may demand more of a cognitive approach.
Buckley, T. C., Blanchard, E. B., & Neill, W. T. (2000). “Information processing and PTSD: a review of the empirical literature”. Clinical Psychology Review, 20, 1041-1065.
Clarke D, M & Ehlers A (2000). “A cognitive model of posttraumatic stress disorder”. Behaviour Research and Therapy 38
Foa, E. B., & Riggs, D. S. (1993). “Post-traumatic stress disorder in rape victims”. In J. Oldham, M. B. Riba, & A.
Tasman, Annual review of psychiatry, Vol. 12 (pp. 273±303). Washington, DC: American Psychiatric Association.
Foa, E. B., & Rothbaum, B. O. (1998). “Treating the trauma of rape”. Cognitive-behavior therapy for PTSD. New York: Guilford.
Adrian Soden originally qualified as a Registered Nurse (Mental Health) in August 1995 and has worked in a variety of mental health settings, including Acute Admissions, Forensic and continuing care. He commenced Specialist Psychotherapy training (incorporating ENB650) in September 2000 at the Sheffield Hallam University and graduated with honours as an Adult Behavioural Psychotherapist. For more info visit: http://www.astconsultancy.co.uk/index.html
Tune in next week when Adrian Soden explains Graded Exposure.
The opinions in this post are solely those of the author. To contribute to ‘Professional Perspective’ contact Michele.