PTSD pt 2 2 21 24 Brief Review Classical Conditioning Develops Fear Conditioned Stimuli Unconditioned Stimuli Unconditioned Response Operant Conditioning Maintains Fear Avoidance Conditioned Avoidance response This model represents negative reinforcement Common Factors in Treatment Factors that are important regardless of the treatment approach 1 Positive therapist client relationship a Established through therapist empathy 2 Treatment credibility a Clients accept and understand the treatment rationale b Regardless of the unique therapist approach the client should understand why and how it can help work 3 Confronting approaching painful emotions a Goal is to learn how to accept and experience emotions rather than avoid suppress b Ex discussing the traumatic experience to address the PTSD directly Cognitive Behavioral Model of PTSD Goal To end this cycle by trying to change behavioral responses to emotions Reducing avoidance behaviors Challenging maladaptive conditions thoughts Reducing stress Two Cognitive behavioral approaches for PTSD Prolonged exposure PE Cognitive Processing Therapy CPT Prolonged Exposure PE 8 15 sessions Well researched across a wide range of cultures countries and types of trauma Based on the theory that avoidance maintains symptoms Core Components in vivo exposure and imaginal exposure In Vivo Exposure Gradually confronting feared situations in real life Create an exposure hierarchy to expose them to the trauma slowly Rationale Tests out beliefs and expectations and learn something new Re engages client with what is important to them Reduce excessive fear the more you practice Imaginal Exposure Recount the narrative of trauma memory by telling it out loud and repeatedly Rationale Helps client distinguish memory from present reality Reduces excessive fear the more you run through the event and learn to view it as just a memory Helps client develop a more balanced view of trauma teaches them how the event was out of their control Video of a veteran who experiences PTSD She experienced anger and fear after returning from deployment Afraid to walk through crowds drive or expect a bomb to explode around the corner She was pretending to be strong and acting like she could face the world She was able to talk about her experiences fears and worries without judgment Through exposure therapy Ex reduce the frequent locking and checking of the door by putting a sticky note on the door to remind her she checked it already Created conflict in her relationship with her husband who also had PTSD from combat She went to relationship counseling and it helped tremendously Cognitive Processing Therapy CPT 12 weekly sessions Well researched across a wide range of traumas sexual assault combat etc Based on the idea that there are shifts in beliefs following trauma Core component examining and challenging maladaptive beliefs Ex Physical Assault thoughts It s my fault I was assaulted Shift in belief about oneself I can never trust anyone again Shift in beliefs about others The world is dangerous Shift in beliefs about the world Identify examine and challenge all these beliefs to change perception of oneself others and the world Practice Problems symptoms PTSD 1 Having an exaggerated startle response is an example of which category of PTSD Arousal 2 Which of the following is NOT considered a risk factor for the development of Longer duration of trauma Lack of dissociation during trauma Lack of social support Avoidant coping 3 The overarching goal of CBT for PTSD is to break the cycle of maladaptive Thoughts feelings and behaviors Avoidance stress and thoughts Stress thoughts and defense mechanisms