CURRENT DIRECTIONS AND
CHALLENGES IN THE
TREATMENT OF POSTTRAUMATIC
Posttraumatic stress disorder (PTSD) arises when a person experiences a traumatic event and then develops particular symptoms that persist for at least a month [American Psychiatric Association (APA), 2000]. Factor analyses reveal four distinct types of PTSD symptoms, each varying on a continuum of severity: reexperiencing symptoms (e.g., nightmares, flashbacks), effortful avoidance (e.g., efforts to avoid thinking about the trauma), numbing of general responsiveness (e.g., restricted range of affect), and hyperarousal symptoms (e.g., exaggerated startle response) (Asmundson et al., 2000; King, Leskin, King, & Weathers, 1998).
In North America, PTSD has a lifetime prevalence of about 8%. It persists for over a year in at least 50% of cases, and is likely to be chronic if it persists for at least 3 months (APA, 2000; Davidson et al., 1996). The disorder is associated with increased risk of other anxiety disorders, mood disorders, and substance-use disorders (APA, 2000). PTSD is associated with elevated health care costs, even after controlling for depression; chronic medical illness; and demographic variables (Walker et al., 2003). Thus, PTSD is associated with considerable personal and economic burden.
Over the past two decades there have been many important advances in understanding and treating PTSD. Contemporary cognitive-behavioral theories of this disorder emphasize expectations and appraisals about the meaning of aversive experiences (e.g., Chemtob, Roitblat, Hamada, Carlson,