Monday, April 13, 2009

PTSD Treatment: Cognitive Behavioral Therapy

Continuing our educational exploration of PTSD treatment options, next up on the list: Cognitive Behavioral Therapy (CBT). One of the most prevalent therapies for healing trauma, CBT is based on the premise that changing the way we think changes the way we behave. It’s all about thought monitoring, baby; learning to hear your own internal dialogue, recognize when it’s skewed, and become adept at implementing tools that intercept the bad thoughts and replace them with good. Sounds easy, no?

Actually, it is pretty easy. A quick example: my trauma was medical, which meant ever afterward any medical situation had me shaking like a leaf, tongue-tied, unable to communicate and an emotional bowl of jelly. Henry taught me to pre-empt my total emotional disintegration by cultivating awareness. When I felt myself getting uptight and anxious, I had to recognize and act on it, not accept and flow with it. A really useful technique he taught me was this: When I began feeling anxious in a situation, Henry told me to sit down in a chair, back straight, feet planted firmly parallel on the floor about a foot apart. I was told to place my hands on my thighs, palm down and take a deep breath. This posture – straight spine, flat feet, hands open – sends a subconscious message to the body of being grounded, which translates to the mind as a state of strength, peace and control. I began using this tool in every medical appointment and was surprised to see how effectively it worked.

So, as CBT teaches us to consciously engage in the moment of our own thoughts it can be a useful tool in our coping & healing bag of tricks. Most importantly, it engages us in the moment, which we often tend not to do on our own. Dissociation was a huge issue for me; CBT helped me begin finding a way to stay present, and to positively manage that present, too, which was a whole new world for me.

Digging a little deeper: As defined by in a really great article that even explains the historical evolution of CBT, this thought provoking modality “is an action-oriented form of psychosocial therapy that assumes that maladaptive, or faulty, thinking patterns cause maladaptive behavior and "negative" emotions. (Maladaptive behavior is behavior that is counter-productive or interferes with everyday living.) The treatment focuses on changing an individual's thoughts (cognitive patterns) in order to change his or her behavior and emotional state.”

According to the American Institute for Cognitive Therapy (AICT), "In a recent national study of the general population, researchers found that 48 % of the population has had a psychiatric disorder during their lifetime. The most common class of disorders was anxiety disorders, accounting for 25 % of the population.” Always nice to know we’re part of a bigger pool, not the odd duck paddling around a puddle of no consequence. And also, nice to know we’re included in a group that can be helped by a specific psychological approach.

An interesting intro to PTSD/CBT from the AICT:

How does cognitive-behavioral therapy for PTSD help?

There are three steps to recovering from PTSD. First, your therapist will teach you ways to cope with the feelings and tension that come with the memories. These include ways to relax your body and to take your mind off the pain.

Second, your therapist will help you face the memories. He or she will guide you in retelling the story of what happened. The more you do this, the less upsetting the memories will become and the more you will be able to find a sense of peace.

Finally, your therapist will teach you ways to change negative thinking and handle problems in your life.

A number of studies have found that cognitive-behavioral therapy helps people with PTSD feel better. These studies have included combat veterans as well as victims of rape, assault, and other traumas.

How long is therapy for PTSD?

How long treatment lasts depends on how many traumas you suffered and how severe they were, how bad your symptoms are now, and how many other problems you are having in your life. For people who have been through a single traumatic event, 12 to 20 sessions are usually enough. Most of these sessions will be 45 to 50 minutes long, but a few may be as long as 90 minutes.

In addition to learning thought monitoring techniques, according to Psychiatric News the benefits of CBT include,

In terms of psychotherapies for PTSD, the various cognitive-behavioral therapies, particularly exposure therapy and cognitive restructuring, seem to be the most solidly evidence-supported treatments… Exposure therapy helps a person confront the memory of a psychological trauma in a therapeutic manner and come to terms with it. Cognitive restructuring enables a person to identify negative, irrational beliefs having to do with a psychological trauma and to replace them with truthful, rational beliefs…. In the opinion of Barbara Rothbaum, Ph.D., a leading PTSD-treatment researcher at Emory University in Atlanta, exposure therapy is supported by the strongest scientific evidence. Twelve studies back it.

So, there you go: a quick overview of CBT and its worth in the PTSD healing mix. For further reading and info check out:

CBT Definition & History

Have you used CBT during your healing journey? Share your experience by leaving a comment.

(Photo: catscape)


Acorn said...

I've had a lot of success with CBT. I've learned to ground myself when I start feeling a panic attack coming on. I visualize a place that I love, where I'm always peaceful and happy.

Also, EMDR has helped by confronting the past and turning the negative and haunting images into positive ones.

I have learned from reading this blog to simply "Find Joy" in everyday life.

Marj aka Thriver said...

I'm glad that, in your example, you recognized your feelings. They are good signal indicators, if we pay attention to them. Another good post for The Blog Carnival Against Child Abuse, if you care to submit.

Michele Rosenthal said...

@Marj - I think the toughest thing as a survivor is to learn to trust your instincts again. For me, I felt so lost in my new 'survivor' identity; there wasn't any way to trust anything. CBT helped me regain that connection with myself. Hmmm, I feel another post coming on!

Kristen said...

It is so nice to know that PTSD can be treated without abrasive drugs and needles. The only thing you have to worry about is finding a therapist who prescribes Cognitive Behavioral Therapy. There are other things you can do at home on your own as well. I just found a book called No Open Wounds-Heal Traumatic Stress Now. It is a new kind of self-help book for the rest of us who don’t have a degree in psychology! It’s easy to read with real-world stories, and diagrams you can follow.

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