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10 - CBT for PTSD

from Part Two - Cognitive Behavioral Therapy for Posttraumatic Stress Disorder

Published online by Cambridge University Press:  06 January 2022

By
Lily A. Brown  and
Edna B. Foa
Edited by
Gillian Todd  and
Rhena Branch
Gillian Todd
Affiliation:
University of East Anglia
Rhena Branch
Affiliation:
University of East Anglia
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Summary

Posttraumatic stress disorder (PTSD) can be effectively treating using a variety of cognitive behavioral therapies. This chapter reviews the evidence base for cognitive behavioral therapies for PTSD, including prolonged exposure (PE), cognitive processing therapy (CPT), and others. Strategies for gold-standard diagnosis and ongoing progress monitoring of PTSD are described, as are considerations for determining readiness for CBT for PTSD. A case formulation of a fictitious patient is presented using emotional processing theory to illustrate one approach to treatment using PE, including therapist scripts for additional guidance. This case formulation includes a focus on socializing patients to PE, which is intended to assist therapists who are new to the model. An overview of the progress of this fictitious but realistic case is presented for demonstrative purposes.

Keywords

cognitive behavior therapy ,posttraumatic stress disorderprolonged exposure therapyemotional processing theorycognitive processing therapy
Type
Chapter
Information
Evidence-Based Treatment for Anxiety Disorders and Depression
A Cognitive Behavioral Therapy Compendium
 , pp. 177 - 194
Publisher: Cambridge University Press
Print publication year: 2022

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References

Key Reading

Cusack, K., Jonas, D. E., Forneris, C. A., Wines, C., Sonis, J., Middleton, J. C., … & Gaynes, B. N. (2016). Psychological treatments for adults with posttraumatic stress disorder: A systematic review and meta-analysis. Clinical Psychology Review, 43, 128–141.Google Scholar
Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., Smits, J. A. J., & Hofmann, S. G. (2018). Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. Depression and Anxiety. doi:10.1002/da.22728Google Scholar
Powers, M. B., Halpern, J. M., Ferenschak, M. P., Gillihan, S. J., & Foa, E. B. (2010). A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Clinical Psychology Review, 30(6), 635–641. doi:10.1016/j.cpr.2010.04.007Google Scholar

For Additional Reading

Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences therapist guide (Treatments that work). Oxford University Press.CrossRefGoogle Scholar

References

Acierno, R., Knapp, R., Tuerk, P., Gilmore, A. K., Lejuez, C., Ruggiero, K., … & Foa, E. B. (2017). A non-inferiority trial of prolonged exposure for posttraumatic stress disorder: In person versus home-based telehealth. Behaviour Research and Therapy, 89, 57–65. doi:10.1016/j.brat.2016.11.009CrossRefGoogle ScholarPubMed
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.Google Scholar
Asukai, N., Saito, A., Tsuruta, N., Kishimoto, J., & Nishikawa, T. (2010). Efficacy of exposure therapy for Japanese patients with posttraumatic stress disorder due to mixed traumatic events: A randomized controlled study. Journal of Traumatic Stress, 23(6), 744–750. doi:10.1002/jts.20589Google Scholar
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. Psychological Corporation.Google Scholar
Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Journal of Traumatic Stress, 28(6), 489–498. doi:10.1002/jts.22059Google Scholar
Brown, L. A. Armey, M. A., Sejourne, C., Miller, I. W., & Weinstock, L. (2016). Suicide risk in psychiatric inpatients with PTSD. Psychiatry Research, 243, 191–197.CrossRefGoogle Scholar
Brown, L. A., Fernandez, C., Kohn, R., Saldivia, S., & Vincente, B. (2018). Pre-disaster PTSD as a moderator of the relationship between natural disaster and suicidal ideation over time. Journal of Affective Disorders, 230, 7–14.Google Scholar
Bryan, C. J., Clemans, T. A., Hernandez, A. M., Mintz, J., Peterson, A. L., Yarvis, J. S., & Resick, P. A. (2016). Evaluating potential iatrogenic suicide risk in trauma-focused group cognitive behavioral therapy for the treatment of PTSD in active duty military personnel. Depression and Anxiety, 33(6), 549–557. doi:10.1002/da.22456CrossRefGoogle ScholarPubMed
Bryan, C. J., Mintz, J., Clemans, T. A., Leeson, B., Burch, T. S., Williams, S. R., Maney, E., & Rudd, M. D. (2017). Effect of crisis response planning vs. contracts for safety on suicide risk in U.S. Army Soldiers: A randomized clinical trial. Journal of Affective Disorders, 212, 64–72.CrossRefGoogle ScholarPubMed
Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., Smits, J. A. J., & Hofmann, S. G. (2018). Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. Depression and Anxiety. doi:10.1002/da.22728CrossRefGoogle Scholar
Cox, K. S., Mouilso, E. R., Venners, M. R., Defever, M. E., Duvivier, L., Rauch, S. A., … & Tuerk, P. W. (2016). Reducing suicidal ideation through evidence-based treatment for posttraumatic stress disorder. Journal of Psychiatric Research, 80, 59–63.Google Scholar
Cusack, K., Jonas, D. E., Forneris, C. A., Wines, C., Sonis, J., Middleton, J. C., … & Gaynes, B. N. (2016). Psychological treatments for adults with posttraumatic stress disorder: A systematic review and meta-analysis. Clinical Psychology Review, 43, 128–141.Google Scholar
Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319–345. doi:10.1016/S0005-7967(99)00123-0Google Scholar
Foa, E. B., Asnaani, A., Rosenfield, D., Zandberg, L. J., Gariti, P., & Imms, P. (2017). Concurrent varenicline and prolonged exposure for patients with nicotine dependence and PTSD: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 85, 862–872. doi:10.1037/ccp0000213Google Scholar
Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences – Therapist guide. Oxford University Press.Google Scholar
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99(1), 20–35.CrossRefGoogle ScholarPubMed
Foa, E. B., McLean, C. P., Capaldi, S., & Rosenfield, D. (2013b). Prolonged exposure vs supportive counseling for sexual abuse–related PTSD in adolescent girls: A randomized clinical trial. JAMA, 310(24), 2650–2657. doi:10.1001/jama.2013.282829Google Scholar
Foa, E. B., McLean, C. P., Zang, Y., Rosenfield, D., Yadin, E., Yarvis, J. S., … & Peterson, A. L. (2018). Effect of prolonged exposure therapy delivered over 2 weeks vs 8 weeks vs present-centered therapy on PTSD symptom severity in military personnel: A randomized clinical trial. JAMA, 319(4), 354–364. doi:10.1001/jama.2017.21242Google Scholar
Foa, E. B., McLean, C. P., Zang, Y., Zhong, J., Rauch, S., Porter, K., … & Kauffman, B. Y. (2016a). Psychometric properties of the Posttraumatic Stress Disorder Symptom Scale Interview for DSM-5 (PSSI-5). Psychological Assessment, 28(10), 1159–1165. doi:10.1037/pas0000259CrossRefGoogle ScholarPubMed
Foa, E. B., McLean, C. P., Zang, Y., Zhong, J., Powers, M. B., Kauffman, B. Y., … & Knowles, K. (2016b). Psychometric properties of the Posttraumatic Diagnostic Scale for DSM-5 (PDS-5). Psychological Assessment, 28(10), 1166–1171. doi:10.1037/pas0000258CrossRefGoogle ScholarPubMed
Foa, E. B., Rothbaum, B. O., Riggs, D. S., & Murdock, T. B. (1991). Treatment of posttraumatic stress disorder in rape victims: A comparison between cognitive-behavioral procedures and counseling. Journal of Consulting and Clinical Psychology, 59(5), 715–723.Google Scholar
Foa, E. B., Tolin, D. F., Ehlers, A., Clark, D. M., & Orsillo, S. M. (1999). The posttraumatic cognitions inventory (PTCI): Development and validation. Psychological Assessment, 11, 303–314.CrossRefGoogle Scholar
Foa, E. B., Yusko, D. A., McLean, C. P., et al. (2013a). Concurrent naltrexone and prolonged exposure therapy for patients with comorbid alcohol dependence and PTSD: A randomized clinical trial. JAMA, 310(5), 488–495. doi:10.1001/jama.2013.8268Google Scholar
Grubaugh, A. L., Veronee, K., Ellis, C., Brown, W., & Knapp, R. G. (2017). Feasibility and efficacy of prolonged exposure for PTSD among individuals with a psychotic spectrum disorder. Frontiers in Psychology, 8, 977. doi:10.3389/fpsyg.2017.00977Google Scholar
Linehan, M. (1993). Cognitive behavior treatment for borderline personality disorder. Guilford Press.Google Scholar
McLean, C. P., Su, Y. J., & Foa, E. B. (2015b). Mechanisms of symptom reduction in a combined treatment for comorbid posttraumatic stress disorder and alcohol dependence. Journal of Consulting and Clinical Psychology, 83(3), 655–661. doi:10.1037/ccp0000024CrossRefGoogle Scholar
McLean, C. P., Yeh, R., Rosenfield, D., & Foa, E. B. (2015a). Changes in negative cognitions mediate PTSD symptom reductions during client-centered therapy and prolonged exposure for adolescents. Behaviour Research and Therapy, 68, 64–69. doi:10.1016/j.brat.2015.03.008CrossRefGoogle ScholarPubMed
Powers, M. B., Halpern, J. M., Ferenschak, M. P., Gillihan, S. J., & Foa, E. B. (2010). A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Clinical Psychology Review, 30(6), 635–641. doi:10.1016/j.cpr.2010.04.007Google Scholar
Ragsdale, K. A., & Voss Horrell, S. C. (2016). Effectiveness of prolonged exposure and cognitive processing therapy for U.S. veterans with a history of traumatic brain injury. Journal of Traumatic Stress, 29(5), 474–477. doi:10.1002/jts.22130Google Scholar
Resick, P. A. (1992). Cognitive treatment of crime-related post-traumatic stress disorder. In Peters, R. D., McMahon, R. J., & Quinsey, V. L. (Eds.), Aggression and violence throughout the life span (pp. 171–191). Sage Publications.Google Scholar
Resick, P. A., Nishith, P., Weaver, T. L., Astin, M. C., & Feuer, C. A. (2002). A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of Consulting and Clinical Psychology, 70(4), 867–879.Google Scholar
Resick, P. A., & Schnicke, M. K. (1992). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60(5), 748–756.Google Scholar
Resick, P. A., Wachen, J. S., Dondanville, K. A., Pruiksma, K. E., Yarvis, J. S., Peterson, A. L., … & Young-McCaughan, S. (2017). Effect of group vs individual cognitive processing therapy in active-duty military seeking treatment for posttraumatic stress disorder: A randomized clinical trial. JAMA Psychiatry, 74(1), 28–36. doi:10.1001/jamapsychiatry.2016.2729Google Scholar
Ruglass, L. M., Lopez-Castro, T., Papini, S., Killeen, T., Back, S. E., & Hien, D. A. (2017). Concurrent treatment with prolonged exposure for co-occurring full or subthreshold posttraumatic stress disorder and substance use disorders: A randomized clinical trial. Psychotherapy and Psychosomatics, 86(3), 150–161. doi:10.1159/000462977Google Scholar
Schiff, M., Nacasch, N., Levit, S., Katz, N., & Foa, E. B. (2015). Prolonged exposure for treating PTSD among female methadone patients who were survivors of sexual abuse in Israel. Social Work Health Care, 54(8), 687–707. doi:10.1080/00981389.2015.1058311Google Scholar
Schnurr, P. P., Shea, M. T., Friedman, M. J., & Engel, C. C. (2007). Posttraumatic stress disorder and cognitive behavioral therapy – In reply. JAMA, 297(24), 2965.Google Scholar
Shapiro, F. (2001). Eye movement desensitization and reprocessing (EMDR): Basic principles, protocols, and procedures (2nd ed.). Guilford Press.Google Scholar
Sijbrandij, M., Kunovski, I., & Cuijpers, P. (2016). Effectiveness of internet-delivered cognitive behavioral therapy for posttraumatic stress disorder: A systematic review and meta-analysis. Depression and Anxiety, 33(9), 783–791. doi:10.1002/da.22533Google Scholar
Sloan, D. M., Marx, B. P., Lee, D. J., & Resick, P. A. (2018). A Brief exposure-based treatment vs cognitive processing therapy for posttraumatic stress disorder: A randomized noninferiority clinical trial. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.4249Google Scholar
Valentine, S. E., Borba, C. P., Dixon, L., Vaewsorn, A. S., Guajardo, J. G., Resick, P. A., … & Marques, L. (2017). Cognitive processing therapy for Spanish-speaking Latinos: A formative study of a model-driven cultural adaptation of the manual to enhance implementation in a usual care setting. Journal of Clinical Psychology, 73(3), 239–256. doi:10.1002/jclp.22337Google Scholar
Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P., & Keane, T. M. (2013a). The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Available from the National Center for PTSD at www.ptsd.va.gov.Google Scholar
Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P., & Keane, T. M. (2013b). The Life Events Checklist for DSM-5 (LEC-5). Available from the National Center for PTSD at www.ptsd.va.gov.Google Scholar
Wolf, G. K., Kretzmer, T., Crawford, E., Thors, C., Wagner, H. R., Strom, T. Q., … & Vanderploeg, R. D. (2015). Prolonged exposure therapy with veterans and active duty personnel diagnosed with PTSD and traumatic brain injury. Journal of Traumatic Stress, 28(4), 339–347. doi:10.1002/jts.22029Google Scholar
Yalch, M. M., Hebenstreit, C. L., & Maguen, S. (2018). Influence of military sexual assault and other military stressors on substance use disorder and PTS symptomology in female military veterans. Addictive Behaviors, 80, 28–33. doi:10.1016/j.addbeh.2017.12.026Google Scholar

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