Proposed Treatment Model Skills Training In Affect And Interpersonal Regulation Modified Prolonged Exposure

The treatment model recommended for retraumatized women is a two-phase model in which the first phase of treatment focuses on skills training in affect and interpersonal regulation (STAIR). Training includes skills development in (1) identifying and labeling feeling states (especially feelings of threat), (2) tolerating distress and modulating negative affect, and (3) identifying abuse-related interpersonal schemas that initiate and shape negative interpersonal situations and developing...

What Is Cg Treatment

CGT treatment (CGT) is a 16-session psychotherapy model that is delivered in three phases consisting of a beginning, middle, and termination see Figure 12.1). In the beginning phase the therapist provides an introduction to the treatment model, in which grief is understood to be a natural inborn, biopsychosocial pathway to adjustment to a painful loss. Characteristic features of grief are reflections of separation distress and traumatic distress, manifested in various ways that can be...

Edward S Kubany Tyler C Ralston

There is considerable evidence that cognitions play an important role in the maintenance or chronicity of posttraumatic stress (e.g., Brewin, Dalgleish, & Joseph, 1996 Ehlers & Clark, 2000 Foa, Ehlers, Clark, Tolin, & Orsillo, 1999 Kubany et al., 1996 Kubany & Watson, 2002, 2003a). This research has emphasized survivors' phenomenology, much of which involves guilt and shame (see Kubany, 1998, for a brief review). Research reviewed elsewhere shows that trauma-related guilt is a...

References

P., & Teasdale, J. (1978). Learned helplessness in humans Critique and reformulation. Journal of Abnormal Psychology, 87, 49-74. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC Author. Anderson, G., Yasenik, L., & Ross, C. A. (1993). Dissociative experiences and disor ders among women who identify themselves as sexual abuse survivors. Child Abuse and Neglect, 17, 677-686. Bach, P.,...

Historical Conceptualizations

When the scientific approach to psychopathology emerged in the 19th century, the zeitgeist was to determine organic pathogeneses, such as lesions of the nervous system, as the major cause of nervous disorders. Posttraumatic reactions were no exception to this theoretical organic orientation. Some of the most detailed writings and elaborated conceptualizations of traumatic reactions are found in the literature on combatants. Starting with the Civil War, American conceptualizations of...

Symptoms Of Complex Ptsd

The DSM-IV descriptions of PTSD symptoms (American Psychiatric Association, 1994) were developed for problems resulting from circumscribed, physical trauma. The aversive stimuli and the resultant symptoms for such trauma are relatively easy to specify. Furthermore, in order to be diagnosed with PTSD, the trauma has to be remembered. This implies that the clients are able to tolerate anxiety to the extent that they are aware of the traumatic conditioning, attribute their PTSD symptoms to the...

Overview

The title of the treatment, Seeking Safety, expresses a central idea When a person has both active substance abuse and PTSD, the most urgent clinical need is to establish safety. Safety is an umbrella term that signifies various elements safety from substances, safety from dangerous relationships (including domestic violence and drug-using friends), and safety from extreme symptoms, such as dissociation and self-harm. Many of these self-destructive behaviors reenact trauma having been harmed...

Assessment

Assessment methods focus on the goals of change in ACT facilitating acceptance, defusion, values, and committed action. We review both clinically useful and research-capable assessment types in this section. We do not address assessment of PTSD per se for that see Pratt, Brief, and Keane, Chapter 3, this volume. The Acceptance and Action Questionnaire (AAQ Hayes, Strosahl, et al., 2004d Bond & Bunce, 2003) is a self-report measure that attempts to assess several of the key features of ACT...

Ptsd As A Risk Factor For Retraumatization

Several epidemiological studies have found that after an individual has experienced one high-magnitude stressor, he or she is at risk for experiencing additional traumatic events over the lifespan (Breslau, Davis, Andreski, & Peterson, 1991 Kilpatrick, Saunders, Veronen, Best, & Von, 1987). Of even greater significance is the report that, at least among rape victims, the presence of PTSD, in and of itself, contributes to risk for repeated traumatization (National Victim Center and Crime...

Session Structure

The session structure includes a check-in, a quotation (to emotionally engage clients), handouts, and a check-out (see Table 10.2). The structure is designed to model good use of time, appropriate containment, and achievement of goals. For clients with SUD and PTSD, who are often impulsive and Specialized Populations and Delivery TABLE 10.1. Seeking Safety Topics 1. Introduction to treatment Case Management This topic covers (a) introduction to the treatment, (b) getting to know the client, and...

Session Design and Clinical Sequence

The format we describe here, termed trauma focus group therapy (TFGT), is based upon our work with male veterans receiving outpatient treatment for combat-related trauma (Foy et al., 2002 Schnurr et al., 2003). Group rules are explained to each prospective member in a preliminary individual session. Rules cover expectations in three critical areas (1) the need for consistent attendance, with prior notice for planned absence (2) use of positive tone in giving feedback during group participation...

Risk Factors Related to Affect Dysregulation

Evidence is accumulating that certain problems associated with affect regulation, such as alexithymia and dissociation, are risk factors for sexual assault (Cloitre, Scarvalone, & Difede, 1997). In addition, there is anecdotal evidence that affect dysregulation, defined as a state of alternating experiences of emotional flooding and numbing, may also be a contributing risk factor. Lastly, use of alcohol and drugs, often reported as coping mechanisms intended to blunt painful or overwhelming...

Functional Analytic Clinical Assessment in Trauma Treatment

Assessment serves a variety of functions. In Chapter 3 of this volume, Pratt, Brief, and Keane provide a review of assessment procedures for the diagnosis of posttraumatic stress disorder (PTSD) as well as scales for assessing treatment outcome. One purpose of assigning a diagnostic label is its implication that a particular treatment will lead to a useful outcome, when properly applied to the appropriate person. If that useful outcome were always the case, then assessment for the purpose of...

Guidelines for Client Selection

The most important and obvious consideration in determining whether a client is a good match for DBT is if the client's problems are the types of problems that DBT aims to treat. As mentioned above, one of the primary reasons we advocate for diagnostic interviewing is that it provides a means of reliably assessing constellations of presenting problems and effectively utilizing the relevant treatment outcome literature. DBT would be recommended to the extent that the client falls into a...

Lisa M Najavits

I just felt so ugly, hateful and evil. I hated myself. There was nothing good in me. I didn't know I was someone. I would always look down. But when I drank, it made me feel confident, secure and happy. It made me feel all the things I was not. quoted in Stamm, 2002 This client put into words what many live day to day the use of substances to escape the emotional pain of trauma. Having suffered childhood physical and sexual abuse by multiple family members, the client began using substances at...

Measurement Tools for ASD

There are currently three structured measures specifically designed to assess for ASD. The first measure to be developed was the Stanford Acute Stress Reaction Questionnaire SASRQ . The original version of the SASRQ Cardena, Classen, amp Spiegel, 1991 was a self-report inventory that indexed dissociative 33 items , intrusive 11 items , somatic anxiety 17 items , hyperarousal 2 items , attention disturbance 3 items , and sleep disturbance 1 item symptoms, and different versions of this measure...

Complications And Obstacles For Fap Therapists In Treating Complex Ptsd

Trauma-focused treatments can be emotionally difficult for therapists of any theoretical orientation, leading to the potential for vicarious traumatization Brady, Guy, Poelstra, amp Fletcher-Brokaw, 1999 and secondary traumatic stress disorder and compassion fatigue Figley, 1995 . Histories of trauma are also found among mental health professionals, with studies suggesting that about 30 report a history of trauma during childhood Follette, Polusny, amp Milbeck, 1994 Pope amp Feldman-Summers,...

Fap An Ideal Behavioral Therapy For Complex Ptsd

In theory, the treatment for complex PTSD involves the same exposure-based procedures described for circumscribed PTSD. That is, the evocative stimuli need to be identified and described, the client must be willing to expose him- or herself to these stimuli and not avoid or escape from them, and the stimuli should be presented in vivo. Because complex PTSD involves difficult-to-describe evocative stimuli, however, it is difficult to devise an in vivo exposure treatment that presents the...