Using Evidence-Based Practices to Treat
Veterans With PTSD continued from page 20
that about half of the events that we target together are combator service-related , while the others pertain to traumatic events from childhood and young adulthood .
Regardless of the associated event , PTSD is associated with a host of functional problems and negative outcomes among military personnel and veterans , including occupational and marital dissatisfaction , violence , alcohol and substance use , and suicide . PTSD is a condition of avoidance , in which those with PTSD may avoid situations , places , things , memories , thoughts , and emotions related to the traumatic event . Through the lens of CPT , we view avoidance as perpetuating non-recovery , because though it has likely served them in many ways , avoidance may ultimately maintain their PTSD symptoms . Many times , the participants who come to our program believe that they will never recover , or that they will never not have PTSD . If you share this belief , you may be encouraged by the hopeful evidence that suggests that PTSD does not need to be a life-long condition .
WHAT TREATMENTS ARE THERE FOR PTSD ?
There are several Evidence-Based Practices ( EBPs ) for treating trauma and PTSD , including Prolonged Exposure ( PE ) Therapy , Eye Movement Desensitization and Reprocessing ( EMDR ), Trauma-Focused Cognitive Behavioral Therapy ( TF-CBT ), and Written Exposure Therapy ( WET ). Cognitive behavioral treatments tend to be the most highly efficacious treatments for PTSD ( see the box on EBPs on page 22 ). However , as with any evidence-based practice , an intervention that works for one person may not be the best fit for another .
The informed consent process offers an opportunity to describe the unique features of CPT as a treatment option . CPT
What Are Stuck Points ?
has been found to be one of the most effective treatments for PTSD . Recent research also suggested that that PTSD outcomes are moderated by session frequency : CPT sessions spaced closer together yield better effects than CPT sessions that are spaced further apart . We work with our participants over the course of two weeks for what I call “ marathon therapy .” As part of our trials , we administer 10 sessions of CPT over the course of two weeks , with five sessions held each week .
THE SIX PHASES OF COGNITIVE PROCESSING THERAPY ( CPT )
CPT is one of several first-line , evidence-based treatments for PTSD . A manualized , time-bound treatment to address PTSD symptoms , CPT has six phases ( described below ) and is typically delivered over the course of approximately 12 weekly sessions . Individuals may move more quickly or take more time to navigate through sessions , with sessions being completed in as few as eight sessions or as many as 16 . Our STRIVE program is currently evaluating the effectiveness of a two-week protocol with 10 sessions to explore if CPT can be effective in an intensive , set-session format . ( See more about STRIVE in the box on page 22 .)
It was originally created in the 1990s to address symptoms of PTSD in survivors of sexual assault and has since been adopted for use among the general population .
“ Stuck points ” is the colloquial term for cognitive distortions and limiting beliefs . Psychoeducation is a fundamental component of CPT , and typically within the first session , mental health counselors help clients reflect on their own stuck points . They are often distorted , extreme , “ black or white ,” and ultimately self-defeating .
Stuck points may look and sound like :
Phase I — Pretreatment assessment and pretreatment issues : Many counselors will
• “ If I hadn ’ t gone out that night , I wouldn ’ t have been assaulted .”
• “ No one can be trusted .”
• “ I will never recover .”
• “ Because of what I ’ ve done , I will never be happy .”
• “ I must be on guard at all times .”
• “ I will always be unlovable .”
• “ If I feel my emotions , I will lose control .”
• “ All men are dangerous .”
Clients may have repeated these stuck points to themselves so many times that they seem inherently true ; however , we mental health professionals consider , with our clients , how these stuck points can be challenged , just as we do with other distorted beliefs that clients have . consider pre-treatment sessions to address co-occurring symptoms and concerns , to review the course of treatment , and to provide psychoeducation about the effects of trauma and PTSD .
Phase II — Psychoeducation on PTSD , thoughts , and emotions : CPT begins with psychoeducation about the features of PTSD , specifically hyperarousal , intrusions , and autobiographic memory . I tell participants that in our work together , we will
continued on page 22 The Advocate Magazine 2022 , Issue # 3 American Mental Health Counselors Association ( AMHCA ) www . amhca . org
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