Survivor Education

Education is a primary component of all efforts to provide early mental health response, including cognitive-behavioral interventions. It is provided via verbal interactions between helper and survivor, individually and in groups, and via written or media communications. It is intended to change beliefs by normalizing the experience of the survivor and making stress reactions seem more predictable and less frightening. it is intended to change behavior by instigating and reinforcing adaptive...

Special Issues in Assessment of PTSD

Several clinicians highlight the importance of considering the different populations on which an assessment instrument for PTSD was validated when selecting a measure. The need to develop instruments that are culturally sensitive has been of great interest for many years as a result of documentation of ethnocu1tural-specific responses to traumatic events. For example, several researchers have provided evidence of differences between people from ethnic minorities and European Americans in the...

Case Example Illustrating Common Obstacles

Sam was a 34-year-old unemployed European American male with a college education. He had a long history of alcohol and drug abuse, starting with his first drink at the age of 8. In addition, Sam had an extensive history of being physically and sexually assaulted. At the time he sought treatment, he had already been abstinent from alcohol and drugs for 6 months, due to a previous traumatic incident. Thus, at his initial assessment, Sam met criteria for PTSD, major depressive disorder, and...

Focus on Ideals

It is difficult to imagine two mental disorders that each individually, and especially in combination, lead to such demoralization and loss of ideals. This loss of ideals in PTSD has been written about, for example, in work on shattered assumptions (Janoff-Bulman, 1992) and the search for meaning (Frankl, 1963). Some research has found that trauma survivors who are able to create positive meanings from their suffering fare better than those who do not (Janoff-Bulman, 1997). There is also a loss...

Ipt The Matrix For

Our initial treatment approach was standard IPT, a proven efficacious treatment for depression that includes abnormal grief as a possible problem area. Complicated grief resembles major depression in symptoms of dysphoric affect, guilty ruminations, suicidality, and social withdrawal so it seemed reasonable that IPT would be an efficacious treatment. Surprisingly, though, we found that standard IPT did not appear to sufficiently reduce CG symptoms in many patients. Consistent with this...

What Is Complicated Grief

Bereavement and grief are universal experiences. Many features of acute grief resemble symptoms of major depression. Consequently, there is a long history of linking grief and depression in psychiatric thinking. Bereavement triggers an episode of major depression in about 20 of individuals who lose a loved one. However, not all grief-related problems meet criteria for major depressive disorder. There is a rich clinical literature describing pathological grief reactions, under various...

Sexual Concerns

Individuals who have experienced sexual assault or CSA frequently report problems with sexual functioning and sexual satisfaction (e.g., see Browne & Finkelhor, 1986 Leonard & Follette, 2002 Resick, 1993, for reviews). Many individuals experience a relationship between childhood sexual abuse and later sexual problems, which has been supported by numerous empirical studies and case reports. CSA survivors are reported to have significantly more sexual problems (Becker, Skinner, Abel,...

Thinking Outside The Black

We mentioned earlier that behavior had to be considered in context to be properly understood. At that point context meant considering the behavior in terms of the patient's history and the antecedents and consequences of his or her behavior. Context actually entails even more. At a psychological level, a patient is changed by every new experience that contributes to his or her history. Treatment itself can be thought of as adding to the person's history to change the impact of the traumatic...

Tools For Traumarelated Problems

Cognitive-behavioral treatments are built around a set of fundamental helping procedures that target different sets of problems encountered by trauma survivors. These are (1) coping skills training, that focuses on teaching clients to respond effectively to the many situation-specific challenges associated with PTSD and other trauma-related difficulties, and to replace existing maladaptive responses with more effective ones (2) prolonged exposure, that works to reduce conditioned fear responses...

Assessment

Most forms of help for trauma survivors involve some kind of assessment, and the assessment process itself may sometimes influence behavior. Assessment involves validation of concerns and may provide education about stress reactions, direct attention to reactions, reduce emotional avoidance, and so on. Some research with trauma survivors has suggested that assessment and self-monitoring may engender sustained reduction in PTSD symptoms in some trauma survivors (Tarrier, Sommerfield, Reynolds,...

Shame and Its Relationship with Guilt

Many trauma survivors experience both guilt and shame (e.g., Dutton, 1992 Hogland & Nicholas, 1995 Lisak, 1994). Guilt and shame tend to be yoked in trauma, because when survivors implicate themselves as playing a significant role in a tragic, irreparable outcome, they are also prone to conclude that the outcome reflects on their entire self, personality, or character (Kubany & Watson, 2003b). For example, one woman concluded that she was evil and a monster because she believed there were...

Depression and Suicide Risk

Individuals who are considered a suicide risk in the acute phase require support, containment, and possibly antidepressant medication or hospitaliza-tion. The risk of providing suicidal individuals with exposure is that it may enhance their attention toward the negative aspects of their experience. There is considerable evidence that depressed people have poor retrieval of specific positive memories (Williams, 1996), so depressed individuals may have difficulty reinterpreting their traumatic...

Integrated Treatment of PTSD and Substance Abuse

Seeking Safety is designed to continually integrate attention to both disorders that is, both are treated at the same time by the same clinician. This integrated model contrasts with a sequential model, in which the client is treated for one disorder, then the other a parallel model, in which the client receives treatment for both disorders but by different treaters or a single model, in which the client receives only one type of treatment (Weiss & Najavits, 1997). An integrated model is...

Assessment Of Cognitions

An extensive review of potential measurements to use to assess cognitions is beyond the scope of this chapter. However, a few measures deserve mention for those readers who are seeking appropriate assessment instruments that are sensitive to changes in cognition anticipated over the course of treatment. Among the commonly used measures of cognition are the Trauma and Attachment Belief Scale (TABS Pearlman, 2003), the Personal Beliefs and Reactions Scale (PBRS Mechanic & Resick, 1993), the...

Description Of Empirical Research

Over a decade of research has now accumulated that generally supports the efficacy of stage I DBT for the problems it aims to treat. DBT has been evalu ated in seven well-controlled studies across four research groups, and in six additional nonrandomized controlled studies (for excellent, in-depth reviews, see Koerner & Dimeff, 2000 Koerner & Linehan 2000 Lieb, Zanarini, Schmahl, Linehan, & Bohus, 2004). Across studies, DBT has been found to significantly reduce the frequency of...

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...

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...

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...

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...