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Post-Traumatic Stress Disorder

Treatments

Cognitive Behavioral Therapy - Virtual Reality Exposure Therapy

Treatment Summary: After determining base-line levels of PTSD on the CAPS (clinician administered PTSD scale), the client is provided a psycho-educational session that explains PTSD and the course of treatment. In this situation, three sessions were dedicated to exploring the traumatic event or narrative. Once the trauma has been explored the client was administered six virtual reality exposure sessions. These sessions involved placing the client into a simulated HUMVEE with a head-mounted display to simulate the environment (in this case, Iraq) and the sights and sounds associated with the trauma. Coping skills are incorporated into the exposure therapy and augmented through homework assignments and video reviews of previous sessions.

  • Reference: Miyahira, S., Folen, R., Hoffman, H., Garcia-Palacios, A, and Schaper, K., (2010). Effectiveness of brief VR treatment for PTSD in war-fighters: a case study. Annual Review Of Cybertherapy and Telemedicine,8, 169-172.
  • Submitter: Michæl McDonald

Cognitive Behavior Therapy and Pharmacotherapy

Treatment Summary: Cognitive Behavior Therapy (CBT) and pharmacotherapy are the primary treatment approaches used to treat combat-related PTSD. Empirically supported CBT approaches such as Prolonged Exposure Therapy and Cognitive Processing Therapy are considered to be the most efficacious (Sharpless & Barber, 2011). Prolonged Exposure Therapy (PE) is about facing one's fears. PE seeks to put the client back in touch with his or her terrifying thoughts, feelings, and experiences in a safe way through repeated exposure (imaginal exposure) (Sharpless & Barber, 2011). Cognitive Processing Therapy (CPT) focuses on cognitive restructuring and challenging the meaning we ascribe to events (McCarthy & Petrakis, 2011). Eye Movement Desensitization and Reprocessing (EMDR) is based on the premise that traumatic events have not been processed completely. This process is completed by visually tracking the therapist's hand movements (National Center for PSD, 2011). Stress Inoculation Therapy (SIT) is a stress management technique that teaches clients how to cope with increasing levels of anxiety by building on successes with smaller amounts of anxiety (National Center for PTSD, 2011).Virtual Reality Therapy (VR) is a form of exposure therapy where exposure takes place in a virtual reality. Clients are exposed to traumatic situations via a computer-generated virtual environment using sensory stimuli through vision, hearing, smell, and touch (Reger & Gahm, 2008). SSRIs: Pharmacotherapy includes the use of selective serotonin reuptake inhibitors (SSRIs) (antidepressants) such as sertraline (Zoloft) and Paroxetine (Paxil). Antipsychotics provide another alternative (National Center for PTSD, 2011).

  • Reference: McCarthy, E. & Petrakis, I. (2011). Case report on the use of cognitive processing therapy-cognitive, enhanced to address heavy alcohol use. Journal of Traumatic Stress, 24(4), 474-478. doi:10.1002/jts.20660 Reger, G. M. & Gahm, G. A. (2008). Virtual reality exposure therapy for active duty soldiers. Journal of Clinical Psychology, 64(8), 940-946. doi:10.1002/jclp.20512 Sharpless, B. A., & Barber, J. P. (2011). A clinician's guide to PTSD treatments for returning veterans. Professional Psychology: Research and Practice, 42(1), 8-15. doi:10.1037/a0022351 U.S. Department of Veterans Affairs, National Center for PTSD. (2011). Understanding PTSD treatment. Retrieved from http://www.ptsd.va.gov/public/pages/gen-treatment.asp
  • Submitter: Fran Hoffman

Group Based Exposure Therapy

Treatment Summary: In this particular case study, group based exposure therapy was used to ease the PTSD symptoms of Vietnam Veterans. The study at three phases all of which centered around a group. The first phase included group therapy sessions twice a week with an emphasis on a united group. In the next phase is where the psychotherapists introduced group presentations in which the participants reviewed traumatic scenes from their time in the war. The participants were asked to "expose" themselves in a controlled setting to the horrors that had left mental scars. Also group therapy sessions were scaled back to once a week. In the final phase of the case study, participants went back to a group therapy focus with a focus on healing. The participants were asked to envision funerals for their fallen commrads and other healing scenarios. The results were positive in that the participants PTSD symptoms were reduced and self-accounts of depression were also improved.

  • Reference: Ready, D. (2012). Combining Group-Based Exposure Therapy With Prolonged Exposure to Treat U.S. Vietnam Veterans With PTSD: A Case Study. Journal Of Traumatic Stress, 25(5), 574-577.
  • Submitter: Brittany Campbell

Eye movement desensitization and reprocessing (EMDR)

Treatment Summary: EMDR employs paired attention tasks to assist the client with processing the traumatic event. A client is informed to concentrate on a distressing image or memory, the emotions, and cognitive factors associated with the traumatic event. Immediately after the client establishes a connection with the traumatic event the therapist introduces bilateral stimulation. The simplest type of bilateral stimulation entails the therapist moving their fingers back and forth in front of the client's face. The therapist then instructs the client to follow their fingers with their eyes. Auditory and/or tactile stimuli such as musical tones or hand tapping can also be utilized through bilateral stimulation. The bilateral stimulation is utilized until the clients anguish is decreased and confidence in more positive trauma associated thoughts has increased

  • Reference: N/A
  • Submitter: N/A

Trauma-focused cognitive behavioral therapy

Treatment Summary: Trauma focused cognitive behavioral therapy is also a treatment of choice for clients suffering with PTSD. This method uses techniques such as cognitive restructuring and stimulus confrontation to help alleviate the symptoms of posttraumatic stress disorder. The therapist can induce stimulus confrontation by utilizing systematic desensitization or in vivo exposures. The in vivo exposures place the clients in situations that they have previously avoided and/or that cause them anxiety. When therapists utilize trauma-focused cognitive behavioral therapy they typically request the client to describe the traumatic event so that the client has to face the disturbing incident. This therapy also requires the client complete homework assignments comprised of listening to an audio tape of the trauma narrative from one of their first sessions and frequently practicing in vivo exposures.

  • Reference: Ponniah, K., & Hollon, S. (2009). Empirically supported psychological treatments for adult acute stress disorder and posttraumatic stress disorder: A review. Depression and Anxiety, 26, 1086-1109. doi:10.1002/da.20635 Seidler, G., & Wagner, F. (2006). Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD: A meta-analytic study. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 36, 1515-1522. doi:10.1017/S0033291706007963
  • Submitter: N/A

Cog Beh.

Treatment Summary: A relatively new concept has been introduced in the treatment of PTSD. Cognitive behavioral therapy is conducted by teleconferencing. Teleconferencing is a technological procedure which helps individuals see or hear through a computer or video screen. This helps individuals in different locations to interact and serves as an advantage to the therapist because they can see the client's body language which provides a better understanding of their reactions. It provides state of the art psychological services to people living outside urban areas and suffers with severe or chronic psychological or physical problems. Teleconferencing provides quicker access to health care services, reduced wait list, travel time and cost. A teleconferencing study, conducted by Germain, Marchand, Bouchard, Drouin and Guay, was used to compare the effectiveness of Cognitive Behavioral Therapy for PTSD. Its purpose was to determine the effectiveness of treatment regardless of face to face or videoconferencing. Treatment included face to face groups and videoconference setting. Participants in both groups received CBT therapy for a period of sixteen to twenty-five weeks depending on the type of trauma experienced. Videoconferencing participants received twenty-one sessions and face to face participants an average of nineteen sessions. Therapy was flexible and patterned to fit the needs of each individual participant. Results indicated that 81% of videoconference participants and 75% of face to face participants no longer met the criteria for PTSD after the completion of treatment. The results indicate that the overall effect of treatment was a decrease in anxious and depressive reactions and an improvement in the physical and mental conditions of the participants. The use of videoconferencing did not seem to affect the effectiveness of CBT therapy. It appears to be comparable to that of face to face treatment. More research is needed to verify the results of this study. The results of this individual study seem to support the effectiveness of videoconferencing psychotherapy and increase the availability of service for people who do not have access for many different reasons.

  • Reference: Germain, V., Marchand, A., Bouchard, S., Drouin, M., Guary, S. (2009). Effective of Cognitive Behavioral Therapy Administered by Videoconference and Posttraumatic Stress Disorder, Cognitive Behavior Therapy, 38:1, 42-53. Retrieved from http://ebscohost.com.zeus.tarleton.edu:81/ehost/detail?vid=5&hid=5&sid=deaæ4a7-7e54-4096-61e3-79cfe70158a%40sessionmgr11
  • Submitter: N/A
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