Unfortunately, many people will experience a significant traumatic event during their lifetime. Traumatic events include, but are not limited to, experiences such as accidents, physical, sexual, or emotional abuse, diagnosis of a serious medical condition, the death or loss of a close friend or family member, or witnessing catastrophic events during combat or in first responding situations.
Most people experience distress immediately after these experiences, including nightmares, intrusive and upsetting images or memories of what happened, sleep difficulties, and negative thoughts about oneself, others, or the world. While some people recover over time without any formal intervention, others find that they continue to experience these symptoms for months or even years after the event. These symptoms may lead to development of Posttraumatic Stress Disorder (PTSD), depression, fear or anxiety, anger, impulsive behavior, relationship disturbances, and inability to function effectively and comfortably in one’s life.
Symptoms of PTSD include:
- Re-experiencing – such as nightmares, intrusive thoughts or memories, flashbacks;
- Avoidance of trauma-related reminders – not talking about what happened, not going to places that resemble the trauma situation;
- Negative changes in thought patterns and mood – detachment from others, self-blame, difficulties trusting others; and
- Changes in reactivity – being easily startled, impaired sleep, inability to concentrate.
The Trauma Treatment Program is designed to help clients overcome these symptoms of PTSD and re-engage in life without debilitating fear and anxiety. The appropriate course of treatment is designed based on the individual’s specific symptoms and needs to ensure the greatest likelihood of improvement.
Treatments offered are evidence-based, and cognitive-behavioral in nature. They have been shown to be effective treatments for PTSD as well as other comorbid conditions. The research has indicated that with such interventions, these symptoms diminish over time and one’s overall quality of life improves. Treatment is available for clients of all ages.
Treatments Offered at CCDBT:
- TF-CBT – for children and adolescents
- Prolonged Exposure (PE) – for adolescents and adults
- DBT-PE – for adolescents and adults who need both Dialectical Behavior Therapy and Prolonged Exposure
- Cognitive Processing Therapy (CPT) – for adults
TF-CBT consists of several core treatment components that are designed to be provided in a flexible and developmentally appropriate manner to address the unique needs of each child and family who have experienced traumatic events. It is a short-term, evidence-based treatment protocol that has been well-researched and shown to be effective in treating posttraumatic stress disorder (PTSD), depression, and behavioral problems (including sexual behavior problems) in children exposed to traumatic events. Research suggests the treatment may work in as few as 12 sessions. Of course, treatment may be provided for longer periods depending on the individual and family needs. Individual sessions for the child and for the parents, as well as joint parent-child sessions address the following topic areas:
- Providing psychoeducation to children and caregivers about the impact of trauma on children and common reactions to traumatic events
- Helping to identify and cope with a range of emotions
- Teaching and practicing coping skills
- Learning how to recognize the connections between one’s thoughts, feelings and behaviors, and how these may have been impacted by the trauma
- Encouraging children to share their traumatic experiences verbally, in writing, or in other developmentally appropriate ways
- Helping children and parents talk with each other about the traumatic event(s)
- Modifying inaccurate or unhealthy trauma-related thoughts or associations
- Helping caregivers develop skills for optimizing a child’s emotional and behavioral functioning
Prolonged exposure is an evidence-based treatment for Posttraumatic Stress Disorder (PTSD) that usually takes between 10 and 15 weeks to complete. It encompasses both exposure therapy and emotional processing to help clients overcome the re-experiencing and arousal symptoms of PTSD, such as nightmares, flashbacks, and hypervigilance. During exposure therapy, clients are helped to confront anxiety-evoking situations to overcome their fears and to confront situations that are safe but that feel dangerous to the client because of what happened to them. Emotional processing is used to help process and digest the traumatic memory. Through this repeated exposure, one can process the trauma in new ways, and reduce the power it has over one’s life. In this way, the treatment helps clients regain a sense of control over their emotions and fully participate in their lives again.
Components of PE Treatment
Prolonged exposure is an intense, time-limited treatment comprised of three main components: Psychoeducation, In-Vivo Exposures, and Imaginal Exposures.
- Psychoeducation involves teaching the client about the common responses to trauma and helping them understand how their avoidance is maintaining PTSD symptoms.
- In-Vivo Exposures are homework exercises that are completed between sessions to help clients confront situations that they have been avoiding, but that are actually safe. Much care and thought is involved in creating these assignments to ensure success and to build confidence in one’s ability to perform the tasks.
- Imaginal Exposures are completed in the therapy sessions and involve telling the trauma narrative to allow for confrontation and processing of the images and emotions related to the event. These sessions are recorded and the client listens to them between sessions.
Who Is Appropriate for PE?
Individuals who have experienced a traumatic event and are experiencing symptoms of PTSD such as nightmares or sleep disturbances, flashbacks, intrusive thoughts of the event, avoidance of situations and reminders of what happened, hyperarousal when reminded of the situation, and impairment in functioning due to the traumatic event that last for more than one month following the trauma. The individual must remember aspects of the traumatic situation and cannot be engaging in life-threatening behaviors at the present time. If you struggle with interpersonal or emotion regulation difficulties in addition to the trauma symptoms, the combined Dialectical Behavior Therapy and Prolonged Exposure (DBT-PE) approach may be a good fit.
What Will the Treatment Be Like?
PE usually consists of 10-15 weekly individual psychotherapy sessions. These sessions are 90 minutes in length. Besides the weekly individual PE sessions, clients will have homework exercises to listen to the recorded exposures from the session and to complete their in-vivo exposure exercises. Symptoms will be assessed and monitored throughout the treatment to ensure that clients are getting better and progressing as expected.
Benefits of Doing PE Treatment
Prolonged exposure has shown to be a very effective treatment for PTSD. In addition to reducing these symptoms, PE treatment helps to decrease depression, anxiety, anger and irritability, and to increase satisfaction and engagement in one’s life.
DBT-PE is an evidence-based protocol that is effective with both male and female adults and adolescents. It was developed to treat PTSD in clients with complex emotional issues and high-risk behaviors (e.g., suicidal ideation, self-harm, substance use, severe dissociation, personality disorders). DBT-PE is a one-year program that integrates Prolonged Exposure (PE) with adherent, standard DBT. It includes adaptations to the standard PE approach to more effectively address complex needs of these clients and to help build a “life worth living” while also promoting trauma recovery.
Stages of Treatment
Treatment occurs in three stages. Stage 1 is akin to standard DBT, and includes weekly individual therapy, group skills training, and phone coaching. The goal of Stage 1 is to achieve stabilization and enhance one’s ability to identify and tolerate intense emotions. Individuals must be free from self-harm or life-threatening behaviors for at least 2 months prior to beginning the Prolonged Exposure (PE) stage of treatment. Stage 2 involves directly targeting trauma symptoms. During this stage of treatment, the client continues to engage in individual and group DBT while also incorporating an additional individual session per week of PE. In Stage 3, DBT is used to address any residual problems, such as enhancing relationships and further building one’s “life worth living.”
Benefit of DBT-PE
Research indicates that the treatment is both safe and effective in reducing PTSD symptoms, as well as suicidal and self-injurious behavior, dissociation, shame, guilt, depression, and relationship problems. It has been demonstrated to be more effective than DBT or PE alone in individuals with trauma and emotion regulation issues.
CPT is an evidence-based therapy for PTSD. Studies have demonstrated that CPT significantly reduces symptoms of PTSD as well as other comorbid symptoms, such as depression, anxiety, and anger. Traumatic experiences, as well as the way we have thought about or made sense of the experiences and how others have reacted to our experiences, can lead us to develop negative thoughts that interfere with our lives and damage our relationships.
These damaging and likely inaccurate thoughts might sound like:
- “I could’ve prevented it – it’s all my fault”
- “The world is a dangerous place”
- “I cannot trust other people”
- “My gut is all wrong about people or situations”
Even though these thoughts make sense given the experience, they may be interfering with your ability to function in your life. CPT helps to identify and shift these thoughts that cause distress or keep you “stuck.” This process can help change how you feel and act, make sense of the trauma, and decrease avoidance of trauma-related thoughts, feelings, or reminders that may be negatively impacting you.
What Will Treatment Look Like?
Treatment involves exploring your trauma-related symptoms and how they impact your life; building awareness of your thoughts and feelings; learning skills to help you challenge, question, or balance your thoughts; and identifying how trauma has affected your beliefs about safety, trust, control, self-esteem, and relationships. There are two versions of CPT; one involves writing a narrative of the trauma, and the other does not. Research has shown that both versions are effective. CPT generally consists of twelve 50-minute sessions, though can be extended as needed. Partners or loved ones may be integrated into treatment depending on the situation.