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New Directions in PTSD and Substance Use Treatment
Published in Anka A. Vujanovic, Sudie E. Back, Posttraumatic Stress and Substance Use Disorders, 2019
Emily R. Dworkin, Keren Lehavot, Tracy L. Simpson, Debra Kaysen
In this chapter, we focus on three ways of incorporating technology into the treatment of PTSD/SUD: (1) remote delivery of treatments by clinicians, (2) technological supplementation of face-to-face treatments, and (3) delivery of self-help treatments via technology. Treatments for PTSD, SUD, and PTSD/SUD that have not been adapted to involve technology or treatments involving technology that target either PTSD or SUD but have an unknown impact on the other comorbid disorder are outside of the scope of this review, though we provide brief summaries of the extant relevant literature where available (see also Possemato, Marsch, & Bishop, 2014). We review treatments for PTSD/SUD that involve technology, present evidence for their feasibility and efficacy, and describe considerations for the use of these approaches.
Trauma and Post-Traumatic Stress Disorder
Published in David B. Cooper, Jo Cooper, Palliative Care Within Mental Health, 2018
An exact prevalence of PTSD and trauma-related symptoms in palliative and hospice care settings is unknown and likely due to psychological treatment not being a priority in facilities providing palliative and end-of-life care. In a sample taken from a Veterans Affairs (VA) facility in 2010, roughly 17 percent of patients demonstrated PTSD symptomology in the last month of life (Alici et al. 2010). Most of this sample did not enter care with a PTSD or related diagnosis, which suggests that their symptoms had been undetected or not reported during their lifetime or that they developed PTSD-related symptoms after admission into end-of-life care. Other research implies that being critically ill can be traumatic, further spiking prevalence rates up to 60 percent (Schelling et al. 2001; Jackson et al. 2007). There are a growing number of evidence-based treatments that target trauma-related diagnoses. Some of the most commonly used treatments for PTSD include Prolonged Exposure Therapy, Cognitive Processing Therapy, Eye Movement Desensitization and Reprocessing, and Present-Centered Therapy (Bradley et al. 2005; American Psychological Assessment (APA) Division 12 2016). Yet, without a clear-cut history or a formal diagnosis, how should non-mental health professionals assess for trauma when they suspect it might be contributing to current problems?
Post-traumatic stress disorder
Published in MS Thambirajah, Case Studies in Child and Adolescent Mental Health, 2018
Despite the high prevalence of childhood trauma, studies regarding psychotherapy for children suffering from PTSD are scarce, especially regarding the treatment for paediatric PTSD following single-incident trauma. Treatment practices for this population rely mainly on the paradigms of therapy for adult PTSD and paediatric PTSD following sexual abuse. No evidence exists that a particular treatment approach (e.g. individual, group or family) of delivery of the therapeutic treatment is superior. The best available evidence supports outpatient trauma-focused psychotherapy containing cognitive-behavioural components, including exposure strategies, stress management, cognitive/narrative re-structuring and parental treatment components. While psychotropic medication has been found to be helpful in reducing symptoms of PTSD in adults, in children and adolescents, their use has little to add to psychological management. The National Institute for Health and Clinical Excellence (NICE) has recently reviewed the evidence base for the treatment of PTSD in adults and children and recommends trauma-focused cognitive behavioural therapy (TFCBT) and eye movement desensitisation and reprocessing (EMDR) as the two first-line treatments for PTSD (NICE, 2005).
Eye movement desensitization and reprocessing for post-stroke post-traumatic stress disorder: Case report using the three-phase approach
Published in Brain Injury, 2022
There are a number of evidence-based treatments for PTSD. Several of these are cognitive and/or behaviorally based, such as cognitive processing therapy [CPT; Resick, Monson, & Chard, 13], prolonged exposure [PE; 14], and trauma-focused cognitive-behavioral therapy [TF-CBT; 15]. However, these approaches may not work for all patient populations, including those with co-occurring neurological disorders. For example, PE and CPT have been found to have substantial drop-out rates (16), which may be due to the aversive nature of the exposure. Managing dysregulation that can arise from exposure to traumatic material may be further challenged in persons with neurological disorders who are experiencing neurological dysregulation, such as pseudobulbar affect (17). Additionally, CBT-oriented approaches such as CPT and TF-CBT may be limited by their reliance on verbal expression of trauma narratives, which could be compromised in certain patients such as those with post-stroke aphasia or other cognitive impairments (18). Finally, the recent APA guidelines for the treatment of PTSD (19) have been criticized as being too cognitive/behaviorally focused (20) and may lack ecological validity for many persons with trauma (21), including those with more complex trauma presentations such as child abuse histories.
Acceptance and forgiveness therapy for veterans with moral injury: spiritual and psychological collaboration in group treatment
Published in Journal of Health Care Chaplaincy, 2022
Patricia U. Pernicano, Jennifer Wortmann, Kerry Haynes
MI is a serious condition, with increased risk of suicide, which is difficult to resolve without addressing both the psychological aspects of the condition (negative self-appraisals/attributions, faulty assumptions, and stuck points) and the spiritual components (meaning-making; spiritual distress due to unresolved guilt, blame, and judgment). Veterans with MI do not respond as positively to traditional forms of CBT for PTSD treatment, as these do not address spiritual distress or guilt-worthy actions that leave veterans demoralized, alienated, and depressed (Litz et al., 2009). Some MI treatment models are re-formatted cognitive behavioral treatments for PTSD (Currier et al., 2021), spiritually driven programs ( Harris et al. 2011), or one-on-one treatments for active-duty military such as Adaptive Disclosure (Litz et al., 2009). None of the available models for treating MI included the full array of components we sought.
Posttraumatic stress disorder and eating disorders: maintaining mechanisms and treatment targets
Published in Eating Disorders, 2021
Karen S. Mitchell, Erica R. Scioli, Tara Galovski, Perry L. Belfer, Zafra Cooper
The two leading treatments for PTSD, Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT), are both grounded in cognitive behavioral theory, including the impact of trauma on information processing and memory function (Lang, 1977). Foa et al.’s (1989) emotional processing theory specifically informed the development of PE. According to this theory, a fear network is formed after exposure to a traumatic event. As this fear network develops, objectively safe stimuli (e.g., nighttime, loud noises, people who remind survivors of their perpetrator) become associated with danger. Avoidance of trauma reminders prevents the processing of trauma-related emotions that are necessary for recovery. In PE, emotional processing is achieved using in vivo exposure to trauma-related situations and imaginal exposure to the traumatic event (Foa et al., 2007).