Treatment
editA number of psychotherapy approaches have been designed with the treatment of trauma in mind—EMDR, progressive counting (PC), somatic experiencing, biofeedback, Internal Family Systems Therapy, and sensorimotor psychotherapy.
There is a large body of empirical support for the use of cognitive behavioral therapy[1][2] for the treatment of trauma-related symptoms,[3] including post-traumatic stress disorder. Institute of Medicine guidelines identify cognitive behavioral therapies as the most effective treatments for PTSD.[4] Two of these cognitive behavioral therapies, prolonged exposure[5] and cognitive processing therapy,[6] are being disseminated nationally by the Department of Veterans Affairs for the treatment of PTSD.[7][8] Seeking Safety is another type of cognitive behavioral therapy that focuses on learning safe coping skills for co-occurring PTSD and substance use problems.[9] While some sources highlight Seeking Safety as effective[10] with strong research support,[11] others have suggested that it did not lead to improvements beyond usual treatment.[9]
Recent studies show that a combination of treatments involving dialectical behavior therapy (DBT), often used for borderline personality disorder, and exposure therapy is highly effective in treating psychological trauma.[12] If, however, psychological trauma has caused dissociative disorders or complex PTSD, the trauma model approach (also known as phase-oriented treatment of structural dissociation) has been proven to work better than simple cognitive approach. Studies funded by pharmaceuticals have also shown that medications such as the new anti-depressants are effective when used in combination with other psychological approaches.[13]
Trauma therapy allows processing trauma-related memories and allows growth towards more adaptive psychological functioning. It helps to develop positive coping instead of negative coping and allows the individual to integrate upsetting-distressing material (thoughts, feelings and memories) and to resolve these internally. It also aids in growth of personal skills like resilience, ego regulation, empathy, etc.[14]
Processes involved in trauma therapy are:
- Psychoeducation: Information dissemination and educating in vulnerabilities and adoptable coping mechanisms.
- Emotional regulation: Identifying, countering discriminating, grounding thoughts and emotions from internal construction to an external representation.
- Cognitive processing: Transforming negative perceptions and beliefs about self, others and environment to positive ones through cognitive reconsideration or re-framing.
- Trauma processing: Systematic desensitization, response activation and counter-conditioning, titrated extinction of emotional response, deconstructing disparity (emotional vs. reality state), resolution of traumatic material (in theory, to a state in which triggers no longer produce harmful distress and the individual is able to express relief.)
- Emotional processing: Reconstructing perceptions, beliefs and erroneous expectations, habituating new life contexts for auto-activated trauma-related fears, and providing crisis cards with coded emotions and appropriate cognitions. (This stage is only initiated in pre-termination phase from clinical assessment and judgement of the mental health professional.)
- Experiential processing: Visualization of achieved relief state and relaxation methods.
A number of complementary approaches to trauma treatment have been implicated as well, including yoga and meditation.[15] As an integrative treatment, yoga increases coping skills that focus on being in the present moment [16]. Yoga can reduce worry, anxiety, and avoidance through present focused breathing and concentration techniques we well as advancing acceptance and nonjudgmental thoughts and behaviors [17]. Similarly, meditation promotes mental focus through various meditative approaches, including mindfulness meditation, mantra meditation, and compassion meditation [18].
- ^ "What is Cognitive Behavior Therapy (CBT)?". Association for Behavioral and Cognitive Therapies.
- ^ Schnurr, PP.; Friedman, MJ.; Engel, CC.; Foa, EB.; Shea, MT.; Chow, BK.; Resick, PA.; Thurston, V.; et al. (Feb 2007). "Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial". JAMA. 297 (8): 820–30. doi:10.1001/jama.297.8.820. PMID 17327524.
- ^ "ABCT Fact Sheets: Trauma". Association for Behavioral and Cognitive Therapies.
- ^ Institute of Medicine (2008). Treatment of posttraumatic stress disorder: An assessment of the evidence. Washington, DC: The National Academies Press.
- ^ McLean, CP.; Foa, EB. (Aug 2011). "Prolonged exposure therapy for post-traumatic stress disorder: a review of evidence and dissemination". Expert Rev Neurother. 11 (8): 1151–63. doi:10.1586/ern.11.94. PMID 21797656.
- ^ Resick, PA.; Galovski, TE.; O'Brien Uhlmansiek, M.; Scher, CD.; Clum, GA.; Young-Xu, Y. (Apr 2008). "A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence". J Consult Clin Psychol. 76 (2): 243–58. doi:10.1037/0022-006X.76.2.243. PMC 2967760. PMID 18377121.
- ^ Hamblen, Schnurr; Rosenberg, MA; Eftekhari. "Overview of Psychotherapy for PTSD". U.S. Department of Veterans Affairs.
{{cite web}}
: Unknown parameter|lastauthoramp=
ignored (|name-list-style=
suggested) (help) - ^ Karlin, BE.; Ruzek, JI.; Chard, KM.; Eftekhari, A.; Monson, CM.; Hembree, EA.; Resick, PA.; Foa, EB. (Dec 2010). "Dissemination of evidence-based psychological treatments for posttraumatic stress disorder in the Veterans Health Administration". J Trauma Stress. 23 (6): 663–73. doi:10.1002/jts.20588. PMID 21171126.
- ^ a b Roberts, Neil P.; Roberts, Pamela A.; Jones, Neil; Bisson, Jonathan I. (2015). "Psychological interventions for post-traumatic stress disorder and comorbid substance use disorder: A systematic review and meta-analysis". Clinical Psychology Review. 38: 25–38. doi:10.1016/j.cpr.2015.02.007. ISSN 0272-7358.
- ^ Lenz, A. Stephen; Henesy, Rachel; Callender, Karisse (2016). "Effectiveness of Seeking Safety for Co-Occurring Posttraumatic Stress Disorder and Substance Use". Journal of Counseling & Development. 94 (1): 51–61. doi:10.1002/jcad.12061. ISSN 0748-9633.
- ^ "Seeking Safety for PTSD with Substance Use Disorder | Society of Clinical Psychology". www.div12.org. Retrieved 2018-09-26.
- ^ Frommberger, Ulrich (2014). "Post-Traumatic Stress Disorder – a Diagnostic and Therapeutic Challenge". Deutsches Arzteblatt International.
- ^ Steele K, van der Hart O, Nijenhuis ER (2005). "Phase-oriented treatment of structural dissociation in complex traumatization: overcoming trauma-related phobias". Journal of Trauma & Dissociation. 6 (3): 11–53. CiteSeerX 10.1.1.130.8227. doi:10.1300/J229v06n03_02. PMID 16172081.
- ^ Briere, John N.; Scott, Catherine (25 March 2014). Principles of Trauma Therapy: A Guide to Symptoms, Evaluation, and Treatment (DSM-5 Update). SAGE Publications. ISBN 9781483351254 – via Google Books.
- ^ Pradhan, Basant; Kluewer D’Amico, Jessica; Makani, Ramkrishna; Parikh, Tapan (2015-07-10). "Nonconventional interventions for chronic post-traumatic stress disorder: Ketamine, repetitive trans-cranial magnetic stimulation (rTMS), and alternative approaches". Journal of Trauma & Dissociation. 17 (1): 35–54. doi:10.1080/15299732.2015.1046101. ISSN 1529-9732.
- ^ "International Journal of Yoga Therapy/Yoga Therapy Today -". doi:10.17761/ijyt.22.1.v71h07m12412k218.
{{cite journal}}
: Cite journal requires|journal=
(help); line feed character in|title=
at position 57 (help) - ^ "International Journal of Yoga Therapy/Yoga Therapy Today -". doi:10.17761/ijyt.22.1.v71h07m12412k218.
{{cite journal}}
: Cite journal requires|journal=
(help); line feed character in|title=
at position 57 (help) - ^ Lang, Ariel J.; Strauss, Jennifer L.; Bomyea, Jessica; Bormann, Jill E.; Hickman, Steven D.; Good, Raquel C.; Essex, Michael (2012-06-05). "The Theoretical and Empirical Basis for Meditation as an Intervention for PTSD". Behavior Modification. 36 (6): 759–786. doi:10.1177/0145445512441200. ISSN 0145-4455.