Academic journal article The International Journal of Behavioral Consultation and Therapy

Functional Analytic Psychotherapy as an Adjunct to Cognitive-Behavioral Treatments for Posttraumatic Stress Disorder: Theory and Application in a Single Case Design

Academic journal article The International Journal of Behavioral Consultation and Therapy

Functional Analytic Psychotherapy as an Adjunct to Cognitive-Behavioral Treatments for Posttraumatic Stress Disorder: Theory and Application in a Single Case Design

Article excerpt

Posttraumatic Stress Disorder (PTSD) is an anxiety disorder resulting from the experience of a traumatic event (e.g., sexual assault, military combat, natural disaster) with resulting emotions of fear, helplessness, or horror (Diagnostic and Statistical Manual of Mental Disorders 4th edition, Text-Revision; DSM-IV-TR, American Psychiatric Association, 2000). PTSD is characterized by re-experiencing symptoms (e.g., flashbacks, nightmares), avoidance (e.g., avoiding thinking or talking about the trauma, avoiding situations that remind one of the trauma), and hyperarousal (e.g., hypervigilance, irritability). Nearly 70% of Americans have experienced a traumatic event and approximately 6.8% of the population meets criteria for PTSD (Kessler et al., 2005), with higher prevalence rates among women and combat veterans (Kulka et al., 1990; Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993; Tanielian, & Jaycox, 2008).

Cognitive-behavioral interventions have been developed to help individuals who are struggling with PTSD. The most widespread and empirically supported are Prolonged Exposure (PE; Foa, Hembree, Rothbaum, 2007) and Cognitive Processing Therapy (CPT; Resick & Schnicke, 1993). PE is an empirically supported behavioral treatment for PTSD that has been demonstrated to help alleviate symptoms of PTSD through in-vivo and imaginal exposure exercises. In-vivo exposure involves the client approaching avoided situations gradually to learn skills to cope with anxiety. Increased exposure to feared situations makes it more possible to engage those over time (i.e., habituation to evocative stimulus conditons). Imaginal exposure involves the repeated processing of the traumatic memory during therapy sessions in order to experience the trauma related feelings and thoughts that have been avoided. By repeated exposure to the feared memory and other private events, clients gain new skills in tolerating anxiety and learn ways to experience these private behaviors without avoiding. CPT is a cognitively-focused intervention that also can contain an emotional processing component where clients write about the traumatic event in detail. This allows clients to experience the natural emotions that rise from the process without engaging in avoidance coping. In addition, CPT focuses on restructuring trauma-related maladaptive thoughts about the meaning of the traumatic event, the self, others, and the world that maintain symptoms (e.g., "No one can be trusted," "Because I walked down the street with him and he raped me, I cannot keep myself safe"). While these treatments have been shown to greatly benefit those who suffer from PTSD in reducing targeted symptomatology (Chard, 2005; Foa et al., 2005; Resick, Nishith, Weaver, Astin, & Feuer, 2002), retention of clients in treatment has been a concern; approximately one-fifth of clients drop out of cognitive-behavioral treatments for PTSD (Hembree et al., 2003). In a review of dropout in studies of PTSD treatments, Schottenbauer and colleagues (2008) reported dropout as high as 50% for PE, CPT and other cognitive-behavioral interventions. Although researchers suggest symptom exacerbation after beginning imaginal exposure in PE does not lead to attrition (Foa, Zoellner, Feeny, Hembree, & Alvarez-Conrad, 2002), it is unclear why so many clients dropout of these intensive treatments. Nevertheless it is important for clinicians and researchers to examine how to reduce dropout rates through enhanced cognitive-behavioral approaches. Strategies to accomplish this may focus on building trust between the therapist and client.

THERAPEUTIC ALLIANCE

In cognitive-behavioral interventions for PTSD, clinicians ask clients to discuss feelings and thoughts they are trying to avoid. In essence, clients are asked to approach the situations they fear the most. It seems reasonable to assume that a strong therapeutic alliance must be at the core of this type of cognitive-behavioral intervention, especially since compared to those without PTSD, individuals with PTSD report more effort strategically attempting to avoid emotional expression around others (Roemer, Litz, Orsillo, & Wagner, 2001). …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.