What to Expect in CBT Treatment Series: Posttraumatic Stress Disorder
Written by: Dr. Hillary Gorin, PhD, LCP
This blog series will help you understand what to expect in Cognitive Behavioral Treatment (CBT) for a variety of different anxiety disorders, OCD, and PTSD. No matter what you are seeking help for, it can be very scary to start treatment. I assume most of my patients enter their first appointment with me with anxiety. I assume this for several reasons. 1. You are taking a big first step in your life to change something that may feel impossible to change; 2. Most of my patients experience an abundance of anxiety on a daily basis and new experiences make us all feel anxiety.
My hope is that this blog series helps you to have a better sense of what to expect in your treatment if you choose exposure-based CBT interventions. First and foremost, the first appointment will be a lot of data collection. In order to determine how I can be helpful, I must determine what your problem looks like. You can plan on me asking you a ton of questions. My goal is to determine what diagnoses you meet criteria for (to ensure I can treat those diagnoses) and to instill some hope in you that I can help you. Just like we would hope our doctors would evaluate what is broken before treating a broken bone and then tell us how they can be helpful, I want to use a scientific approach in my practice and give you some hope that the science works. Although a one size fits all approach does not work for everyone, I apply all evidence-based techniques or techniques that have been supported by ongoing research. In this series, you will find the general what’s and why’s of treatment with me. Also, if you are struggling with the motivation to get started, I include some information on why it may be worth it to take a chance on this treatment.
Posttraumatic Stress Disorder Treatment
What is Posttraumatic Stress Disorder (PTSD)?
Post-Traumatic Stress Disorder (PTSD) results from witnessing or being exposed to death, threatened death, or actual or threatened serious injury (American Psychiatric Association, 2013). Following such a terrifying event, our brains sometimes recover. Sometimes they do not. This is why PTSD is considered a recovery disorder (Resick et al., 2017). Symptoms include intrusive memories, efforts to avoid memories, increased negative emotions and thinking patterns, and hypervigilance or hyper-arousal (increased alertness and related physical symptoms). These are symptoms we all can experience after a traumatic event for a short period of time. However, PTSD occurs when these symptoms persist and start to impact your life, long term.
What will we work on?
If you seek PTSD treatment from me, you will have two treatment options:
The first is called Cognitive Processing Therapy or CPT. In CPT, we will focus on challenging unhelpful thoughts and beliefs that have resulted from your trauma (Resick et al., 2017). Additionally, I will help you process the traumatic memory and related emotions. By modifying beliefs related to your trauma and by effectively processing (as opposed to avoiding) the traumatic memory, you can start to recover from the trauma. I see PTSD as a disorder that causes my patients to relive the traumatic event, over and over again. I want you to be able to stop reliving the event. In order to do so, we need to process the event, so that you can put it in long term memory storage. Instead, PTSD asks you to continue opening the worst page of a scary book in your brain. We will take a look at the whole book so that you can close it and only look at it when you choose to, as opposed to when it intrudes into your mind (Resick et al., 2017).
The other treatment I offer is called Prolonged Exposure Therapy (PE). In PE, we will focus on gradually processing traumatic memories and challenging avoidance related to your trauma (Foa et al., 2007). What does this look like? You will talk about your trauma and be asked to do things you have been avoiding. One symptom of PTSD is avoidance of both the traumatic memory and situations, people, and places related to the traumatic event. In order to recover from PTSD, we must challenge this avoidance and re-enter life, despite the continued fear that something bad may happen. Prior to the trauma, you lived in the world and accepted the risks of doing so. I hope to help you learn to do this again. Of note, I will not ask my patients to do something that I myself would not do. I will not ask you to enter situations that are likely dangerous. We will modify all exercises according to CDC guidelines during the COVID-19 pandemic.
Why engage in this treatment?
For some, PTSD has completely debilitated their ability to live a comfortable and full life. For some, they are reliving their trauma every single day. So, it seems you have two choices. You continue living as if the trauma is still happening, or you decide to face the trauma directly so that you can get back a life without daily threats and fear. I am assuming that you are reading this page because you are tired of reliving your trauma. I am assuming that it is getting in the way of success, health, sleep, or enjoying the present moment. If so, you may want to give treatment a try.
Why this treatment works.
Every time you think of your trauma, your threat brain (the amygdala) is igniting (Resick et al., 2017). Every time you think of your trauma, your brain is telling your body to fight, flight, or freeze (the three threat response options we have). Both of these treatments aim to adjust this response by processing the trauma, facing the trauma, and returning to your life or to more rationale ways to view it.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007) Prolonged Exposure for PTSD: Emotional Processing of Traumatic Experiences: Therapist Guide. Oxford University Press.
Grayson, J. G. (2014). Freedom from Obsessive-Compulsive Disorder: A personalized recovery program for living with uncertainty. Berkley Books.
Resick, P. A., Monson, C. M., & Chard, K. M. (2017). Cognitive Processing Therapy for PTSD. The Guilford Press.
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