Academic journal article Journal of Cognitive Psychotherapy

Treatment of PTSD Using Cognitive and Cognitive Behavioral Therapies

Academic journal article Journal of Cognitive Psychotherapy

Treatment of PTSD Using Cognitive and Cognitive Behavioral Therapies

Article excerpt

This article reviews the assessment and cognitive behavioral treatment of patients with civilian trauma related posttraumatic stress disorder (PTSD), and presents a case example to illustrate the use of cognitive behavioral therapy for PTSD. Areas of importance for assessment include thorough trauma history, PTSD symptomatology, comorbid disorders, coping skills, distorted cognitions, and level of behavioral avoidance. There are now several cognitive behavioral therapies available for the treatment of PTSD that have been empirically validated. These treatments will be briefly described and the extant treatment outcome literature will be reviewed. A case example, highlighting cognitive strategies within cognitive behavioral therapy, is presented.

There are now several therapies available for the treatment of posttraumatic stress disorder (PTSD) that are primarily cognitive, include cognitive components, are based on cognitively oriented theory, or propose to change faulty cognitions or fear networks. These treatments have undergone or are currently undergoing trials for efficacy and/or comparison to each other. Before discussing treatment, however, we will review the diagnostic criteria for PTSD, provide a review of cognitive behavioral theories as they apply to the development and treatment of PTSD, and discuss relevant assessment issues.


The diagnosis of PTSD is unique in that it requires the presence of a traumatic event. Specifically, DSM-IV requires that the person be exposed to a traumatic event in which both of the following were present:

1. the person experienced, witnessed or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others, and

2. the person's response involved intense fear, helplessness, or horror. Examples of such events are rape, physical assault, a serious car accident, the murder of a family member or close friend, a natural disaster, or military combat.

There are three main sets of symptom criteria pertaining to the diagnosis of PTSD: reexperiencing, numbing and avoidance, and arousal symptoms. Reexperiencing symptoms include having thoughts about the event, even when the individual is not trying to think about it; distressing dreams about the event; acting or feeling as though the traumatic event is occurring again; feeling very distressed when confronted with reminders of the traumatic event, and experiencing physical symptoms that were experienced at the time of the traumatic event (i.e., heart racing, sweating) when reminded of the event.

Avoidance and numbing symptoms include trying to avoid thoughts, feelings or conversations that are reminders of the traumatic event, avoidance of activities, places, or people that are reminders of the traumatic event, not being able to remember important parts of the traumatic event, and not feeling very interested in participating in activities that used to be of interest. Another avoidance and numbing symptom that may be experienced includes a sense of foreshortened future, such as thinking he/she will never get married or have children or a career, or not expecting to have a normal life span. Finally, numbing of emotions may occur. An example of this symptom would be difficulty experiencing loving feelings.

The final set of PTSD symptoms are arousal symptoms. These include difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, feeling on guard even when there is no reason to be, and being more easily startled by unexpected or sudden noises. In order to diagnose this disorder the following criteria must be met: one reexperiencing symptom, three of avoidance and numbing symptoms, and two arousal symptoms for at least one month after the trauma. There are really two components to diagnosing PTSD: determining the traumatic event history, and assessing the symptoms of PTSD. …

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