Two exposure therapists take a hike in the woods in Alaska... It sounds like the beginning of a bad joke, right? Bad joke as it might be, my intention is to use this hiking event to demonstrate how situational factors, purposely manipulated or accidentally occurring, can greatly impact the distress experienced during an in vivo exposure exercise.
A creative program at the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin called My Life, My Story caught my attention recently. This unique initiative invites Veterans to share their life stories with an interviewer who takes notes. Subsequently, the interviewer writes up the Veteran’s story in a one-page first-person account and reviews it with the patient, who can add more details or correct mistakes. The thousand-word biographies are then attached to the patients’ medical records for clinicians to read.
During my recent research on Post-Traumatic Stress Disorder (PTSD) treatments, I have been spending more time reading about moral injury and reflecting on therapeutic practices that incorporate tools such as forgiveness and spirituality into the healing process. I have worked with clients of different faith backgrounds and different spiritual practices. I am careful to ask questions in order to assess what this means to the individual, as I know my own faith expression and experience may be very different from their own. I have worked with clients who are Buddhist, Islamic, Jewish, Wiccan and all have taught me a great deal and we have worked well together. If a client tells me their faith is important to them and wishes we integrate it into treatment, we work on this.
Let’s take a look at a specific model of CBT to treat anger. The premise of this treatment model is that anger develops from unmet expectations. Norman Cotterell, Ph.D., Clinical Coordinator, Beck Institute, puts it this way: “We expect people to treat us fairly and they don’t. We expect children to respect the wishes of their elders and they don’t. We expect the government to have our needs at heart and it doesn’t. Each time there is a gap between expectation and reality, anger is more than willing to fill in that gap. We may decline. We may accept. But it’s important to know that it’s a choice we are making” *. Perceived loss of control for getting important values met causes anger.
What is one of the most common symptoms that comes to mind when you think of Post-Traumatic Stress Disorder (PTSD)? If you thought of nightmares, you’re not wrong. In fact, up to 61% of people who have PTSD experience nightmares on a regular basis (Pigeon, Campbell, Possemato, & Ouimette, 2013).