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

2. 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

3. PTSD Education

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

5. 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

6. 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

7. 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

8. 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”

9. 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

10. 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”

11. 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

12. 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