Therapist's Guide to Posttraumatic Stress Disorder Intervention (eBook)

Front Cover 1
Therapist's Guide to Posttraumatic Stress Disorder Intervention 4
Copyright Page 5
Contents 6
Introduction 12
Part I: Biopsychosocial Aspects and Diagnosis of PTSD 16
Chapter 1 ASSESSING AND DIAGNOSING POSTTRAUMATIC STRESS DISORDER 18
Symptom Clusters and Additional Diagnostic Criteria 21
Category B: Persistent Re-experiencing of the Traumatic Event (At Least One Symptom) 21
Category C: Emotional Numbing and Avoidance 22
Category D: Hyperarousal 23
Categories E and F 24
Subthreshold PTSD 24
Common Reactions to Traumatic Experiences 26
PTSD and Quality of Life 27
The Effects of Traumatic Stress on the Body and the Mind 27
Additional Diagnostic Considerations 28
Differential Diagnosis 28
Multiaxial Diagnosis 29
Complex PTSD 30
Definition 30
Features of Complex PTSD 31
Somatic Memory 31
Dimensions of Pain 32
Defining Traumatic Memory 33
Stages of Dissociation 34
Prevalence/Frequency 34
Probability of Developing PTSD Risk 36
Specific Risk Factors 39
Psychiatric Risks Associated with PTSD 45
Personal Variables 46
Occupational Factors 47
Sociocultural Factors 48
Medical Factors 48
Comorbidity 48
Complications of Treatment Associated with Axis II Diagnoses 50
Substance Abuse/Dependence 52
A Special Case of Comorbidity 52
Functional Impairment of PTSD 56
Profile of Impaired Functioning 57
A Developmental Model of Functional Impairment 59
Functional Impairment as a Consequence of Chronic Domestic Trauma 59
Codependency and Safety 61
Functional Impairment as a "Lack of Balance" 62
Diagnostic Confusion Associated with Functional Impairment 62
The Case of Comorbid PTSD and BPD? 62
Diagnostic Ambiguity 63
Prognosis 63
Recovery 63
Treatment Resistance 64
Detection of Malingered PTSD 64
Assessment Instruments 66
The Clinical Interview 66
Screening Instruments 68
Brief Screening Scale for PTSD (Adapted from Kimerling et al., 2006) 68
The PTSD Symptom Checklist 69
Other Assessment Instruments 73
Chapter 2 THE NEUROBIOLOGY OF POSTTRAUMATIC STRESS 86
Defining the Stress System 86
Interactions between the Nervous and Immune Systems 88
The Hypothalamic–Pituitary–Adrenal Axis (HPA AXIS) 90
The Anatomy of the HPA Axis 90
Route of Action 91
HPA Function 91
Factors Regulating the HPA Axis 94
Pathology of Stress 95
Neuroactive Steroids 96
Genetic Variations 100
Neuroimaging 101
HPA Axis Dysregulation 103
Hippocampal Changes Associated with PTSD 104
Gender Considerations 105
Relationship between PTSD and Borderline Personality Disorder 105
PTSD and Major Depression 106
Neurobiological Pathways in Response to Stress 106
The Noradrenergic System 108
Locus Coeruleus and Norepinephrine 108
PTSD, Hormonal Levels and Brain Structures 110
Arousal 111
Numbing 111
Memory 111
Sleep 112
Psychosomatic 112
Serotonergic System 112
Immune Function 115
Psychoneuroimmunology 115
Functional Trauma Response 116
The Reptilian Brain and Psychopathology 117
Psychobiological Mechanisms of Vulnerability and Resilience 117
Vulnerability 120
Resilience 123
Building Psychological Resilience 125
Regulation of Reward and Motivation 126
Fear Conditioning 126
Social Behavior 127
Distinguishing Anxiety and Fear 127
Part II: Treatment 138
Chapter 3 TRANSTHEORETICAL AND MULTIMODAL INTERVENTIONS 140
Stages of Treatment for PTSD 141
Creating a Safe and Secure Environment 142
Difficulties and Challenges with this Population 143
Psychotherapeutic Interventions 144
Individual Therapies 145
Cognitive Behavioral Therapy 145
Cognitive Therapy 146
Dialectical Behavioral Therapy 146
Trauma Counseling 147
Exposure Therapy 148
Systematic Desensitization 149
Self-regulation Therapy 149
Anxiety Management 149
Stress Inoculation Therapy (SIT) 151
Psychodynamic Therapy 154
Problem-Focused Psychosocial Adjunctive Service 155
Dual Representation Therapy 156
Eye Movement Desensitization and Reprocessing 156
Somatic Treatment 159
Somatic Treatment Techniques 160
Pharmacological Treatments 165
Dual Diagnosis 166
Integrative Treatment 166
Group Therapy 167
Critical Incident Stress Debriefing/Psychological Debriefing 168
Additional Information about Group Therapy 169
Conjoint/Family Therapy (When Appropriate) 171
Pharmacological Treatments 172
Pharmacologic Recommendation 173
Integrative Interventions 175
Hypnosis 175
Spiritual/Religious Counseling 176
Body Work 176
Martial Arts Training 177
Art Therapy, Dance Therapy, or Creative Writing 177
Journaling 177
Acupuncture 177
Massage Therapy 177
Qi Gong 177
Reiki 177
Shiatsu 177
Somatic Experiencing (Peter Levine) 178
Yoga 178
Chapter 4 TREATMENT PLANNING 186
First-line Interventions 187
Cognitive Behavioral Therapy 188
Pharmacologic Treatment 188
Individual Internal and External Resources 188
Basic Treatment Planning 189
Second Injury 191
Sanctuary Trauma 191
Initial Assessment 192
Treatment Setting 192
Psychosocial Rehabilitation 193
Therapeutic Groups 196
Case Management 196
Treatment Plan: Symptom Review 197
Treatment: Safety Factors 199
Safety and Stabilization 199
Assessing Risk (Johnson, 2004) 201
Suicide 201
Dangerousness 204
Psychological Debriefing as an Individual Intervention 205
Treatment Planning: Goals, Objectives, and Interventions 205
Intrusions 206
Avoidance 211
Hyperarousal (Physiological Reactivity) 215
Dissociation 220
Depression (Johnson, 2004) 222
Anxiety (Johnson, 2004) 228
Grief 233
Stress Management/Stress Inoculation (Johnson, 2004) 236
Anger (Dahlen and Deffenbacher, 2001) 238
Impulse Control 242
Assertiveness in Communication 244
PTSD and Substance Use 246
Personality Disorder 250
Eating Disorders 250
Reconnection 250
Pharmacological Interventions 252
Specific Treatment Strategies Decision Tree 253
Additional Treatment Issues Associated with Complex PTSD 254
Stage 1: Stabilization and Safety 254
Special Considerations 255
Military Personnel 255
Combat-Related PTSD Factsheet 256
First Responders (Law Enforcement, Firefighters, etc.) 257
Severe Motor Vehicle Accident 258
Part III: Skill Building 266
Chapter 5 RESOURCES FOR IMPROVED COPING 268
Feeling Safe and Secure 268
Safety and Emotional Numbing 269
Understanding Where You Are At 270
Creating Your Own Safe Place 271
Journaling 272
Defining What Does and Doesn't Work 273
Exposure Therapy 274
Writing About Your Experience 275
Getting Started 276
Planning Goals 278
Do You Have PTSD? 279
Writing an Outline of the Trauma 281
Developing a Trauma Time Line 282
Common PTSD Thoughts 283
Learning from Trauma 284
Chronic Pain as Part of Recurring Trauma 284
Strategies for Dealing with Re-experiencing Trauma 285
The Next Level: Moving from Self-awareness to Self-management 287
Managing Self-talk 287
Dealing with Fear when the Danger is Past 292
Talking Yourself through Fear 293
Finding Meaning: Beginning to Understand 294
Triggers and Flashbacks 295
Stress Management 296
Developing and Utilizing Social Supports 301
Dealing with One Trigger at a Time: Safely Exposing Yourself to the Past 302
Self-monitoring 304
Challenging Avoidance: Facing the Problem 305
Overcoming Dissociation 307
Problem-solving the Physical Symptoms of PTSD 311
Identifying and Managing Emotion 312
Depression 312
Panic Anxiety 313
Being Mindful in Managing Anxiety 314
Mindfulness 315
Identifying Your State of Mind 316
Defense Mechanisms 317
Guilt 318
Bad Memories and Fear 319
Mapping Autonomic Activity 320
Beliefs about Power and Control 322
Coping with a Difficult Situation 323
Forgiveness and Self-blame 323
Impact of the Traumatic Event on Relationships 324
Trust 325
Intimacy Safety and Security 327
Boundaries 328
Affirming Healthy Boundaries 329
Fun Goals 330
Communication 331
The Steps of Positive Assertiveness 332
Listening and Giving Feedback 333
Saying "No" 333
Dealing with Uncomfortable Emotions 334
Improving Communication Skills 335
Finding Meaning 336
Habits for Success 337
Commitment to Healing 338
Coming to Terms with Assuming the Patient Role 339
Guidelines for Completing Your First Step toward Emotional Health 339
Psychological Health 340
Review of the Impact of the Trauma on Your Life 341
Strengthening Resilience 342
Managing a Crisis Situation 343
The Habit Log 346
Daily Recovery Schedule 347
Maintaining Progress 348
Reinforcing the Progress of Treatment Goals 348
Helping Ways of Thinking and Doing 348
PTSD Relapse Prevention 350
Practicing Change 353
Anticipating How to Cope with an Emergency 354
Getting Unstuck 354
Relaxing without Substances 355
Self-control 357
Coping with Disappointment 357
Self-confidence 358
Self-care Behaviors (Johnson, 2004) 359
Index 362
A 362
B 362
C 363
D 363
E 364
F 364
G 364
H 364
I 365
J 365
L 365
M 365
N 365
O 365
P 365
Q 366
R 366
S 366
T 368
U 369
V 369
Y 369