Posttraumatic Stress Disorder
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Abstract This chapter provides an overview of cognitive behavioral therapy for posttraumatic stress disorder. The current diagnostic criteria for posttraumatic stress disorder are presented along with a brief discussion of expected changes to be implemented in the upcoming DSM ‐5 . The primary goal of the chapter is to outline the cognitive behavioral conceptualization of posttraumatic stress disorder and to illustrate how this has informed current treatments. Emotional processing and social cognitive theories are discussed, and treatments with significant empirical support are reviewed, including prolonged exposure therapy, virtual reality exposure therapy, cognitive processing therapy, stress inoculation treatment, and eye movement desensitization and reprocessing therapy. In addition, some emerging treatments for posttraumatic stress disorder are presented, including mindfulness, couples and family interventions, and interpersonal therapy. The inclusion of pharmacological interventions is briefly discussed, including the augmentation of exposure therapy with D‐cycloserine.Keywords:
Exposure therapy
Cognitive processing therapy
Acute Stress Disorder
Methods Post-traumatic Stress Disorder (PTSD) is a disabling anxiety disorder that is highly prevalent among members of the Armed Services who have served in combat operations.1 Evidence-based cognitive behavioral therapies for PTSD include Cognitive Processing Therapy (CPT), Prolonged Exposure (PE) therapy, and Eye Movement Desensitization and Reprocessing (EMDR) which lead to clinically improved outcomes in ~50% of all treated cases2-4 and typically require between 8-15 treatment sessions. Pharmacological approaches to treating PTSD do not resolve the cause of PTSD and patients frequently experience side effects and withdrawal. Accelerated Resolution Therapy (ART) is a new exposure-based therapy that uses eye movements and is designed to be brief (i.e. 1-5 treatment sessions).
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Cognitive behavior therapy(CBT) has proven to be an effective treatment for posttraumatic stress disorder(PTSD),which typically comprises psychoeducation,exposure,cognitive restructuring,anxiety management training.CBT has been applied for PTSD caused by assault,terrorism,road traffic accidents,combat,earthquake,etc.Eye movement desensitization and reprocessing has been proposed as an effective treatment for PTSD.However,a debate has been triggered by efficacy.Randomized controlled trial of CBT for PTSD must be conducted to enhance the validity of studies results.
Psychoeducation
Cognitive processing therapy
Exposure therapy
Acute Stress Disorder
Traumatic stress
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To examine potential differential responses in men and women to cognitive behavior therapy for posttraumatic stress disorder (PTSD).Fifty-two men and 56 women diagnosed with PTSD participated in randomized controlled trials of cognitive behavior therapy for PTSD. Participants were randomly allocated to either (a) exposure-only therapy (Ex) or (b) exposure-based treatment combined with cognitive restructuring (ExCR).There were no significant differences between men and women in treatment response immediately after treatment in either Ex or ExCR. At 6-month follow-up, men displayed significantly more severe PTSD symptoms in the Ex group compared with women in the Ex group, and compared with men and women in the ExCR conditions.These findings suggest that men with PTSD have a reduced maintenance of treatment gains following exposure therapy compared with women, but display less relapse if exposure therapy is combined with cognitive therapy. These findings are consistent with evidence that women recall emotional memories and retain extinction memories more strongly than men, which may facilitate emotional processing and long-term treatment gains.
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Back to table of contents Previous article Next article Clinical & Research NewsFull AccessProlonged Exposure Therapy Helps Ward off PTSDAaron LevinAaron LevinSearch for more papers by this authorPublished Online:4 Jul 2008https://doi.org/10.1176/pn.43.13.0013aPatients with acute stress disorder had fewer posttraumatic stress disorder (PTSD) symptoms at follow-up after a clinical trial of exposure-based therapy than did patients getting cognitive restructuring therapy or placed on a treatment waiting list, according to Australian psychologist Richard Bryant, Ph.D.More attention in recent years to early intervention following traumatic events has increased interest in what the primary therapeutic approach should be, wrote Bryant and colleagues in the June Archives of General Psychiatry.The researchers studied 90 patients who had experienced nonsexual assault or a motor vehicle crash and were diagnosed with acute stress disorder (ASD) from 2002 to 2006. They were randomized to receive five 90-minute sessions of either prolonged exposure therapy or cognitive restructuring therapy. A third group was placed on a wait list and told they would be reassessed after six weeks and then offered active treatment.Prolonged exposure patients were told to “verbalize reliving the trauma experience in a vivid manner that involved all perceptual and emotional details.” They were given homework exercises. Later sessions and homework included visualizing images of trauma exposure and real-life exposure to associations with their trauma. The last session included relapse-prevention strategies to help patients damp down PTSD symptoms if they recurred.Cognitive restructuring (CR) treatment involved identifying and monitoring maladaptive thoughts by “Socratic questioning, probabilistic reasoning, and evidence-based thinking.” Some homework and relapse prevention were included in this treatment too.Prolonged exposure showed large effect sizes, and cognitive restructuring showed moderate effect sizes, compared with the wait-list group. After six weeks, 33 percent of the exposure group met PTSD criteria compared with 63 percent of the cognitive restructuring patients, and 77 percent of those on the wait list.At the six-month follow-up, 37 percent of the exposure group met PTSD criteria while 63 percent of the cognitive restructuring group did. The researchers did not compare a combination of the two therapies with the single treatments.The effect was seen early in the course of exposure treatment, even as cognitive restructuring patients continued experiencing distress.Many therapists hesitate to use exposure therapy because it can cause distress and possibly drive patients away from therapy, according to the researchers. However, only five subjects reported adverse effects, all due to high distress, and dropped out of the study. Two subjects were in the exposure arm, and two were in the CR arm. Overall, patients getting exposure therapy reported less distress at the end of the last three sessions than did patients getting CR therapy.“Dropout rates in the present study were comparable to dropout rates across chronic PTSD studies,” wrote Bryant and colleagues.In a rigorous review of treatments for PTSD, the U.S. Institute of Medicine last fall said that the only treatment for PTSD supported by a strong evidence base was exposure therapy.“The current findings suggest that direct activation of trauma memories is particularly useful for prevention of PTSD symptoms in patients with ASD,” they wrote. “[A]daptation occurs when the individual repeatedly engages with trauma reminders and learns that there is no aversive outcome.”The study showed that not only was using prolonged exposure treatment beneficial, but also it did not result in more therapy dropouts or aversive responses than other approaches.For Bryant and colleagues, the conclusions are clear. “[T]here is a need to better educate mental health care providers about the use of [prolonged exposure] as a frontline intervention for ASD,” they said.“Treatment of Acute Stress Disorder: A Randomized Controlled Trial” is posted at.▪ ISSUES NewArchived
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This literature review examines the efficacy of Eye Movement Desensitization and Reprocessing (EMDR) relative to other evidence-based treatments for Posttraumatic Stress Disorder (PTSD), such as Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT). The paper explores the problem of PTSD; outlines the history, theory, and initial trials of EMDR; and examines five randomized controlled trials which compare EMDR to PE or CPT. Results suggest that neither treatment model produces significantly greater reductions in PTSD symptoms, though there is some evidence that EMDR may be better tolerated and produce desired results faster than other treatments.
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Exposure therapy
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Previous studies have reported that adding cognitive restructuring (CR) to exposure therapy does not enhance treatment gains in posttraumatic stress disorder (PTSD). This study investigated the extent to which CR would augment treatment response when provided with exposure therapy. The authors randomly allocated 118 civilian trauma survivors with PTSD to receive 8 individually administered sessions of either (a) imaginal exposure (IE), (b) in vivo exposure (IVE), (c) IE combined with IVE (IE/IVE), or (d) IE/IVE combined with CR (IE/IVE/CR). There were fewer patients with PTSD in the IE/IVE/CR (31%) condition than the IE (75%), IVE (69%), and IE/IVE (63%) conditions at a 6-month follow-up assessment. The IE/IVE/CR condition resulted in larger effect sizes than each of the other conditions in terms of PTSD and depressive symptoms. These findings suggest that optimal treatment outcome may be achieved by combining CR with exposure therapy in treating PTSD patients.
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Methods Posttraumatic Stress Disorder (PTSD) is a prevalent, disabling anxiety disorder.1 Psychotherapies used to treat PTSD, including cognitive behavioral therapies (CBT) and Eye Movement Desensitization and Reprocessing (EMDR), may require long-term treatment2 and provide only partial resolution of symptoms. Similarly, pharmacological approaches to treating PTSD do not resolve the cause of PTSD and clients frequently experience side effects and withdrawal. Accelerated Resolution Therapy (ART), a new eye movement, exposure-based therapy, is brief (i.e. 1-5 sessions) and does not require an established client/therapist relationship.
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Introduction: Post-traumatic stress disorder (PTSD) is a condition that affects 10-20% of people who will experience a serious mental injury in their lives. Soldiers are one of the most vulnerable social groups to develop PTSD as they reach several factors which may induce the PTSD. The aim of the study: The purpose of this work was to find literature on PTSD among people in the military service. Material and method: Literature has been found and selected among articles found in the websides such as PubMed and Google Scholar. Description of the state of knowledge: Literature describes both - factors predisposing to PTSD, and describtions of numerous methods of therapy for soldiers such as cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), cognitive processing therapy (CPT) and Exposure Therapy. In addition, the literature provides many innovative methods to help combat the PTSD. It is important not only to inform the soldier about the therapy, but also to enable him to undergo it regularly. It is worth mentioning, for example, video to home - VTH, which is an extension of Exposure Therapy. Thanks to it, even if someone for some reason cannot participate in therapy in the place where it takes place, it can be done at home without fear of getting to the therapy. Summary: There are many methods of PTSD therapy. In addition to pharmacological, psychotherapy is very important. Soldiers should undergo these therapies and should be encouraged to complete cycles so that they can feel the effects of the therapy.
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Combat stress reaction
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