EBT: Prolonged Exposure
Consultant: Dr. William Brim
Attendees (number): 5
Case summary: We did not have any particular cases for staffing today but as is often the case (pun intended), a case example did come up tied to the theme and article (see below). One participant from a VA setting noted that she has a veteran with a history of childhood abuse who has presented with multiple problem areas that look like PTSD, but he is unwilling to discuss the childhood traumas and while he has intrusive thoughts and dreams about his experience in the military they are not of trauma but of stress associated with being in the military.
He describes relationship problems, problems sleeping, hyperarousal, and the intrusive thoughts and dreams. He reported dissociating during arguments with his significant other and “waking up” saying things he would not normally say. He refuses to talk about childhood trauma. We discussed whether or not an EBP PTSD treatment is appropriate at this time and the fact that affect regulation to manage dissociation might be a good intervention at this time whether as prep for PE or CPT or not.
An attendee from an MTF noted that reports similar to those described in this case are often seen at a military clinic following return from deployment even when not exposed to a specific trauma. It was noted that often education about stress and teaching of stress management skills with the expectation that they would be able to relearn to manage stress was helpful for this sub-population.
Themes noted: In the absence of cases I brought up two recent articles (see below) related to the concept of a dissociative subtype of PTSD and the push to add this subtype to the DSM-V. This generated some discussion about cases where there was some degree of dissociation and while the articles noted that high dissociators may not respond as well to traditional delivery of EBPs for PTSD, our discussion noted that there may be ways to prepare clients who are recognized as highly dissociative for the traditional EBPs by teaching some affect regulation, grounding techniques and stress management (relaxation skills) prior to engagement in therapy. Thoughts???
Articles discussed and references if available: The two articles discussed both appeared in a recent edition of Depression and Anxiety. Lanius, R.A., Brand, B., Vermetten, E., Frewen, P.A. and Speigel, D. The dissociative subtype of posttraumatic stress disorder: Rationale, clinical and neurobiological evidence, and implications. Depress Anx 2012; 00:1-8. and Resick, P.A., Suvak, M.K., Johnides, B.D., Mitchell, K.S. and Iverson, K.M. The impact of dissociation on PTSD treatment with Cognitive Processing Therapy. Depress Anx 2012: 00: 1-12.