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How does Cognitive Behavioral Therapy Help Treat Post Traumatic Stress Disorder?

written by: Mercedes Hamshar • edited by: Daniel P. McGoldrick • updated: 9/24/2010

Cognitive-behavioral therapy (CBT) is arguably the most effective treatment for post traumatic stress disorder. There are a number of reasons for its effectiveness, including the correction of distorted cognition and correcting conditioned responses to a traumatic event.

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    CBT for post traumatic stress disorder is a common treatment approach. Post traumatic stress disorder is an extreme response to a traumatic event or series of events. This event must have involved actual or threatened death, or another serious threat such as a severe physical injury. The development of the post traumatic stress disorder diagnosis was actually spurred on by the aftermath of the Vietnam war to explain the collection of symptoms that war veterans frequently present with, previously referred to as combat stress. In women, rape is the most common cause of post traumatic stress disorder.

    The symptoms of post traumatic stress disorder are grouped into three clusters. The first cluster is re-experiencing, which involves constantly recalling the event (intrusive thoughts) even when trying not to think about it (sometimes referred to as flashbacks) and having nightmares about the event. The second cluster is avoidance, which involves avoiding stimuli (such as places or objects) and emotions associated with the event. This emotional avoidance can cause a person with post traumatic stress disorder to become incredibly isolated. The third cluster is increased arousal symptoms, such as hypervigilence, difficulty sleeping and concentrating and an exaggerated startle response (Kring et al, 2007).

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    How Cognitive-behavioral Therapy Treats Post Traumatic Stress Disorder

    Cognitive-behavioural therapy (CBT) is arguably regarded the most effective way to treat post traumatic stress disorder. There are several forms of CBT that may be used, either alone or in conjunction. They are all based on the same cognitive-behavioral principles with their effectiveness due to their shared exposure component. Exposure is an effective treatment for post traumatic stress disorder for a number of reasons.

    Firstly, repeated exposure (either in vivo or in vitro) is thought to promote the extinction of conditioned fear reactions that have developed as a response to the event and associated stimuli. This reduces the anxiety that occurs when facing the event and corrects the belief that anxiety will always be caused by it unless associated stimuli can be avoided or escaped.

    Secondly, the process of deliberately confronting the feared memory blocks negative reinforcement of cognitive and behavioral avoidance. That is, prior to treatment, sufferers of post traumatic stress disorder will avoid stimuli, feelings, or people associated with the event which reduces anxiety, but does not aid them in the long run. Thirdly, by re-experiencing the event in a therapeutic setting safety is incorporated into the traumatic memory, helping the patient to realize that merely remembering the event is not dangerous and need not provoke anxiety.

    Fourth, focus on the trauma memory helps the patient to differentiate the trauma event from other events and see it as a specific occurence. This combats the tendency to view the world as inherently dangerous that occurs in post traumatic stress disorder.

    Lastly, re-experiencing the traumatic event in therapy allows the therapist to help the patient identify and address distorted cognitions both within the memory of the event and the anxiety symptoms that follow. This is referred to as cognitive restructuring. According to cognitive-behavioural therapists, this is essential in treating any mental health disorder (Foa et al, 2009).

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    References

    Kring, A.M., Davison, G.C., Neale, J.M. & Johnson, S.L. (2007) Abnormal Psychology. USA: John Wiley & Sons.

    Foa, E.B., Keane, T.M. & Friedman, M.J. (2009) Effective treatments for PTSD: practice guidelines from the international society for traumatic stress studies. New York: The Guilford Press.