Prolonged Exposure Therapy Prolonged exposure therapy (PE; Foa et al., 2007, 2019) is a form of CBT that encourages clients to gradually confront “trauma-related memories, feelings, or situations” to slowly reduce avoidance symptoms and behaviors (McSweeney, 2020). PE often starts with psychoeducation around PTSD avoidance symptoms and various relaxation strategies. Sessions gradually incorporate “in-vivo exposures to safe situations” that have been avoided (McSweeney, 2020). For instance, a child who had a scary, traumatic medical procedure may be exposed to medical tools or pictures of hospitals. In the next phase of treatment, clients begin to talk through their traumatic memories, in a process called imaginal exposure, to slowly reduce avoidance and intrusive memories (McSweeney, 2020). Essentially, rather than the traumatic memories intruding on the client, the client slowly gains control over the memories and their reactions to them (McSweeney, 2020). PE is one of the most highly studied treatments for PTSD and is in the APA Clinical Practice Guideline as a “strongly recommended” treatment for PTSD (APA, 2017a). Cognitive Processing Therapy Cognitive Processing Therapy (CPT; Resick et al., 2017) is based in cognitive theory and the belief that traumatic events may disrupt schemas, particularly in the areas of safety, trust, power/ control, esteem, and intimacy (Galovski et al., 2022). If these disrupted schemas persist and lead to inaccurate beliefs about oneself, others, and the world, PTSD may result. CPT focuses on providing education about the cognitive model; identifying disrupted schemas, termed “stuck points”; and engaging in cognitive restructuring to identify more accurate and balanced viewpoints. Cognitive restructuring occurs through the use of Socratic questioning in session and completion of out of session worksheets. CPT additionally includes an optional assignment of completing a written trauma account. CPT was originally designed as a 12-session protocol but is now provided across a variable number of sessions based upon client progress (Galovski et al., 2022). CPT has been shown to be effective in both individual and group formats (Galovski et al., 2022) and is listed as a “strongly recommended” treatment for PTSD in the APA Clinical Practice Guideline (APA, 2017a). Acceptance and Commitment Therapy Acceptance and commitment therapy (ACT) is based on the theory that individuals often suffer because they are overfocused on trying to understand and explain psychological events in relation “to their long-term desired qualities of life” (Hayes et al., 2006, p. 2). ACT targets “experiential avoidance,” which is the avoidance of unwanted internal thoughts, emotions, and physiological experiences (Settles et al., 2017). “Experiential avoidance is problematic for several reasons: (1) It does not actually get rid of the unwanted thought, emotion, or experience; (2) failed attempts to avoid painful internal experiences can result in an increased sense of failure and perceived “brokenness”; and (3) efforts to remove pain take tremendous amounts of energy that interfere with pursuing valued activities and relationships (Settles et al., 2017 p. 3). Given that avoidance is a hallmark symptom of PTSD, ACT can be useful in shifting the client’s framework from changing their internal experience to building “psychological flexibility” in which they are able to acknowledge and make room for their internal experiences (i.e., trauma reminders) and pursue a meaningful life in spite of them (Settles et al., 2017). Clients are taught to increase psychological flexibility through six core processes: Mindfulness, willingness, connection to personal values, committed action, defusion, and observing self. Research has shown ACT to be an effective individual and group treatment in reducing PTSD symptoms (Wharton et al., 2019). Integrated Therapeutic Approaches In order to address the complexities of working with trauma survivors, some therapies have been developed that incorporate aspects of various therapeutic approaches. In the sections below, examples of such treatments are presented, including dialectical
In addition to meridian-based therapies, such as the emotional freedom technique, Tapas acupressure technique (Fleming, 1999), and Healing from the Body Level Up (Swack, 2002), there are also a number of systems of energy work based on chakras, breathing techniques, and yogic practices (van der Kolk, 2014). The technique that has received the most investigation is tapping on acupressure points (acupoints) (Feinstein, 2021). This technique has been combined with elements of cognitive and exposure therapies in the Emotional Freedom Technique (EFT; Church, 2013) and has been supported through many empirical studies and clinical trials (Church et al., 2018). The clinician can become trained in some of these methods or refer clients to adjunctive energy workers for part of the overall treatment protocol. Cognitive-Behavioral Therapy Cognitive-behavioral therapy (CBT) identifies and modifies faulty or distorted negative thinking styles (cognitions) and associated maladaptive behaviors. Originally developed by Aaron Beck (1972), it has been elaborated and expanded upon by Beck and others in the last several decades for the treatment of many psychological and somatic disorders and has been employed extensively to aid in healing the posttrauma sequelae of anxiety and depression. Cognitive behavioral therapy is based on the premise that a person’s thoughts and belief systems are connected to moods and emotions that can affect their perception of an event. The meaning individuals make out of traumatic experiences in their lives will have a direct effect on their physical, emotional, and behavioral responses to those events. CBT rests on the premise that individuals can change their understanding of and the meaning they make out of an event and that they can then change the influence the event has on their lives. This therapy teaches individuals to examine previously unexamined thoughts, beliefs, behaviors, and emotions, and allows them to re-examine their presuppositions. Doing so can change thinking patterns that can lead to unhealthy behaviors and debilitating emotional responses, such as anxiety and depression. By identifying automatic thoughts and consciously and systematically challenging them, clients can develop alternate explanations for events or responses, rather than trauma-based responses, such as “It’s all my fault,” “No man can be trusted,” “I’m a bad person,” “I’m still not safe,” or “It’s still happening.” This method of working can help clients reframe their personal narratives from trauma-based life stories to ones that allow for random chance and personal efficacy. Trauma-Focused Cognitive-Behavioral Therapy Trauma-focused cognitive-behavioral therapy (TF-CBT; Mannarino et al., 2014) is a short-term trauma intervention designed for children. Developmentally appropriate language is used to provide psychoeducation about child trauma and trauma reminders (e.g., kids are taught about their biological alarm systems). Children are then taught creative relaxation skills (e.g., pizza breathing) and they learn about affect (e.g., the possibility of having two feelings at once—complex feelings). Using games, professionals then teach children how thoughts, feelings, and behaviors are interconnected. Once these foundational skills are established, children engage in trauma narrative processing, which can be done through play, in drawings, through journaling, or through other child-specific modalities. Throughout treatment, parents participate in occasional conjoint sessions in which the child client shares what they have been learning and the parent learns how to facilitate continued therapeutic growth at home. TF-CBT is considered a “level one” intervention for school-age children and adolescents and a “level two” intervention for preschool-age children (McGuire et al., 2021), and one meta- analysis concluded that TF-CBT was marginally more effective than EMDR in treating trauma in children and adolescents (Lewey et al., 2021).
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Book Code: PYFL4024
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