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Overview of Cognitive Behavioral Treatments for PTSD

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Updated April 09, 2014

Cognitive behavioral treatments for PTSD have been found to be very successful in reducing peoples' symptoms and improving their quality of life.

Several different therapies would be considered "cognitive-behavioral" that are regularly used to treat PTSD:

  • Exposure Therapy

  • Stress-Inoculation Training

  • Cognitive Processing Therapy

Each of these therapies will briefly be discussed below.

Exposure Therapy

Over time, people with PTSD may develop fears of reminders of their traumatic event. These reminders may be in the environment. For example, certain pictures, smells, or sounds may bring about thoughts and feelings connected with the traumatic event. These reminders may also be in the form of memories, nightmares, or intrusive thoughts. Because these reminders often bring about considerable distress, a person may fear and avoid them.

The goal of exposure therapy is to help reduce the level of fear and anxiety connected with these reminders, thereby also reducing avoidance. This is usually done by having the client confront (or be exposed to) the reminders that he fears without avoiding them. This may be done by actively exposing someone to reminders (for example, showing someone a picture that reminds him of his traumatic event) or through the use of imagination.

By dealing with the fear and anxiety, the patient can learn that anxiety and fear will lessen on its own, eventually reducing the extent with which these reminders are viewed as threatening and fearful. Exposure therapy is usually paired with teaching the patient different relaxation skills. That way the patient can better manage his anxiety and fear when it occurs (instead of avoiding).

Stress-Inoculation Training

The basic goal of Stress-Inoculation Training (SIT) is to help a patient gain confidence in his ability to cope with anxiety and fear stemming from trauma reminders.

In SIT, the therapist helps the client become more aware of what things are reminders (also referred to as "cues") for fear and anxiety. In addition, clients learn a variety of coping skills that are useful in managing anxiety, such as muscle relaxation and deep breathing.

The therapist helps the patient learn how to detect and identify cues as soon as they appear so that the patient can put the newly learned coping skills into immediate action. In doing so, the patient can tackle the anxiety and stress early on before it gets out of control.

Cognitive-Processing Therapy

Cognitive-Processing Therapy (CPT) was developed by Resick and Schnicke to specifically treat PTSD among people who have experienced a sexual assault. CPT lasts 12 sessions. CPT can be viewed as a combination of cognitive therapy and exposure therapy.

CPT is like cognitive therapy in that it is based in the idea that PTSD symptoms stem from a conflict between pre-trauma beliefs about the self and world (for example, the belief that nothing bad will happen to me) and post-trauma information (for example, the trauma as evidence that the world is not a safe place). These conflicts are called "stuck points" and are addressed through the next component in CPT -- writing about the trauma.

Like exposure therapy, in CPT, the patient is asked to write about his traumatic event in detail. The patient is then instructed to read the story aloud repeatedly in and outside of session. The therapist helps the client identify and address stuck points and errors in thinking, sometimes called "cognitive restructuring." Errors in thinking may include, for example, "I am bad person" or "I did something to deserve this." The therapist may help the patient address these errors or stuck points by having the client gather evidence for and against those thoughts.

Evidence for the Success of These Treatments

All of the treatments discussed here have been found to be successful in the treatment of PTSD. Which one is right for you depends upon what you feel most comfortable with. For example, some people do not feel comfortable with actively confronting reminders of a trauma or writing about a past traumatic experience. Therefore, SIT may be a better choice. The most important thing is that you find a therapist that you feel comfortable with and trust.

You can learn more about cognitive behavioral treatments for PTSD that have support in reducing the symptoms of PTSD (such as Prolonged Exposure, Cognitive Processing Therapy, and Seeking Safety) at the American Psychological Association.

Sources:

Keane, T.M., & Barlow, D.H. (2002). Posttraumatic stress disorder. In D.H. Barlow (Ed.), Anxiety and its disorders, 2nd edition (pp. 418-453). New York, NY: The Guilford Press.

Litz, B.T., & Roemer, L. (1996). Post-traumatic stress disorder: An overview. Clinical Psychology and Psychotherapy, 3, 153-168.

Resick, P.A., & Calhoun, K.S. (2001). Posttraumatic stress disorder. In D.H. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual, 3rd edition (pp. 60-113). New York, NY: Guilford Press.

Resick, P.A., & Schnicke, M.K. (1992). Cognitive processing therapy for sexual assault survivors. Journal of Consulting and Clinical Psychology, 60, 748-756.

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