As I work with clinicians who are trained in evidence-based treatments for PTSD, one query is raised repeatedly…Should I use Cognitive Processing Therapy (CPT) or Prolonged Exposure (PE) to treat patient X?
PTSD is one of the signature disorders of the OIF/OEF conflict. PTSD is characterized by symptoms of re-experiencing, avoidance/numbing and hyperarousal. As many as 20% of the US service members returning from Iraq or Afghanistan since 2001 may have PTSD (www.iom.edu/militaryptsd). We may safely assume that a significant number of veterans from the current conflict and other eras will need effective treatment to alleviate PTSD symptoms. Let’s review…
Dissociation is not unusual during psychological traumatization, and dissociative symptoms commonly occur with PTSD. Its manifestation both peri-trauma and during trauma recall is disturbing to both patients and therapists. Some trauma experts believe dissociation plays a unique role in management of trauma-related distress. A dissociative subtype of PTSD is being considered for DSM-V.
Smart phones, they’re everywhere. In fact, currently there are approximately 91.4 million smartphones in the United States alone. Whether or not you have one and no matter your views on how good, bad or ugly smartphones are for society, statistically speaking the probability that your clients wear one like an extra appendage is very high. In fact, approximately 3 out of 5 clients aged 25 – 34 own a smartphone, which is more than any other age group.
The last blog entry on in vivo exposure discussed some strategies to help your client be better prepared to benefit from in vivo exposure. This week I want to talk about “post-in vivo processing”. We don’t usually emphasize processing when we discuss in vivo exposure but it is just as important for in vivo exercises as it is for imaginal exposure. Post-in vivo processing is not merely a check the box activity to make sure the homework was done but instead is an opportunity for a client to reflect on the homework assignment, and extract some understanding or insight from the experience of facing fear and living to tell about it. For some, this may simply mean concluding, “It was easier than I expected it to be!” But for others, it may mean evaluating and dismantling some strongly held beliefs that have kept them “safe” from harm for a long time. Give example?
A common concern we hear from new PE therapists is that they’re not sure how to record sessions or are uncomfortable setting this expectation about the treatment.
If recording sessions has not been explained to your patient before they arrive to Session #1 of the treatment, or even if it has been mentioned to them before, it’s important at the very beginning of the first session to explain this standard procedure (again) and why it is used in PE. Candor is critical.