Psychotherapies for Post Traumatic Stress Disorder Part I: TFCT, CPT John D. McKellar, PhD Clinical Psychologist Department of Veteran Affairs, Clinical Educator Stanford University

Reactions to Trauma These responses adaptive and understandable in that they are aimed at helping the individual to avoid the situation Remember this situation so it NEVER happens again Keep the body alert prepared to avoid this happening again Avoid any situation like this in the future

PTSD Education

Trauma Focused Cognitive Behavioral Therapy Components Education about Impact of Trauma Relaxation Training Cognitive Coping Techniques Trauma Narrative In vivo exposure

Relaxation Training Deep Breathing Imagery Progressive Muscle Relaxation The goal of these exercises is to “ground” the individual in the current moment or to generally “turn down the volume” for individuals who are chronically aroused

Cognitive Coping- Thought Record Situation Emotion/ Feeling Negative Thought(s) Evidence that Supports the Worst Thought Evidence Against the Worst Thought Balanced way of Seeing Negative Thought Re-rate Emotion/ Feelings (Who, what, where, when) (How do you feel? Rate on scale of 0-10) (What are the exact thoughts? Which one is most distressing?) Heard car backfire and started looking for targets Anxious- 10 Fearful- 10 -My heart won’t stop thumping Something is about to happen I need to find cover - I am not safe (most distressing) -My heart is thumping - My adrenaline is running - I know that noise means something bad is going to happen - I am not in a war zone - I am not in Iraq - I feel horrible but that doesn’t necessarily mean anything is happpen- ing, but I do hate this feeling Anxious- 8 Fearful- 8

Trauma Narrative A verbal or written account of most distressing aspects of the trauma Often may be listened to repeatedly or written repeatedly This is “exposure” to the traumatic re-experiencing

In vivo exposure Create of a fear hierarchy- list of avoided or feared places, situations, ranked from least to most distressing Exposure begins with least distressing and works to most distressing Exposures take place in the “real world”

Cognitive Processing Therapy Components Education about Impact of Trauma Trauma Narrative Identifying “Stuck Points”- negative thoughts related to the trauma (e.g.,I should have fought harder) Challenging Negative Thoughts Discussing Common Trauma Topics: Safety/Trust, Power/Control/Anger, Esteem/Intimacy

Stuck Points Stuck points are strong negative beliefs that create unpleasant emotions and unhealthy behaviors. They may be conflicts with prior beliefs and beliefs after the trauma. “I am able to protect myself” changes to “I cannot keep myself safe” Also stuck points can be due to prior beliefs that are now confirmed by the trauma. “I cannot trust authority” matches “My commanding officer put our platoon in danger”

Trauma Narrative A verbal or written account of most distressing aspects of the trauma Often may be listened to repeatedly or written repeatedly This is “exposure” to the traumatic re-experiencing

Common Trauma Topics Safety/Trust Power/Control/Anger Self esteem/Intimacy The commonality across these topics is that most thoughts or beliefs related to these topics become very polarized or extreme