SUCCESSFUL TREATMENT WITH PROLONGED EXPOSURE THERAPY

Post-Traumatic Stress Disorder (PTSD) is a trauma-related disorder caused by exposure to an event involving actual or threatened death, serious injury or sexual violence. These events may include—but are not limited to—acts of violence, combat situations, witnessing domestic violence, natural disasters, car accidents, or stress related to acts of racism. PTSD may develop in individuals who have these experiences or witness others having them. The disorder may also arise in individuals who learn of a traumatic event occurring to a family member or other loved one. Individuals who experience repeated or extreme details of traumatic events in the course of their jobs—such as first responders—are also at increased risk of developing PTSD.

In the aftermath of a traumatic event, people often suffer symptoms such as intrusive memories of the experience, negative emotional states, and anxious arousal. For most people, these symptoms naturally run their course and resolve on their own. Others, however, do not recover naturally and struggle to come to terms with the event. What sets PTSD apart from normal post-traumatic stress is the prolonged duration of symptoms. If a trauma is sufficiently intense, or if a person experiences trauma repeatedly, the symptoms of PTSD are considered to be normal responses.

The symptoms of PTSD fall within four categories:

RELIVING THE TRAUMA:

• Bad dreams
• Frightening thoughts
• Intrusive memories of the trauma
• Flashbacks — reliving the trauma as if it is happening again
• Intense distress when reminded of the event

AVOIDANCE SYMPTOMS:

• Staying away from places, events, or objects that are reminders of the experience
• Efforts to avoid memories, thoughts, or feelings associated with the event
• Avoidance of external reminders that arouse distressing emotions associated with the trauma

NEGATIVE MOOD AND COGNITIONS:

• Feeling emotionally numb
• Feeling strong guilt, depression, or worry
• Distorted sense of blame about the event
• Losing interest in activities that were enjoyable in the past
• Having trouble remembering the dangerous event
• Exaggerated negative beliefs about self, others, or the world
• Social detachment or estrangement from others
• Inability to feel positive emotions
• Persistent negative emotions

HYPERAROUSAL SYMPTOMS:

• Being easily startled
• Feeling tense or “on edge”
• Having difficulty sleeping
• Angry outbursts
• Physical symptoms of anxiety, like a racing heart or sweating
• Reckless or self-destructive behavior
• Poor concentration

Research has validated two primary methods of treatment that lead to major improvements in patients suffering from PTSD: Prolonged Exposure and Cognitive Processing Therapy.

WHAT IS PROLONGED EXPOSURE?

Prolonged Exposure (PE) is a treatment developed by Dr. Edna Foa and colleagues at the University of Pennsylvania that helps the individual overcome their anxiety and avoidance head on. PE has four elements:

1. Education on the therapy: The patient is educated on common trauma reactions and PTSD. This process helps them understand their symptoms and the overall goals of their treatment.
2. Breathing techniques: Often when trauma occurs or someone with PTSD is reliving the trauma, their breathing pattern and speed changes. Learning to control the way their breathing can help people mitigate the immediate stress, lessening its impact.
3. Real-world application: In many cases, PTSD sufferers will avoid doing things that may be linked to their trauma, for example someone who served overseas and had their convoy bombed may not want to drive, or someone who has experienced sexual assault may avoid any situation that could provide intimacy with another person. Real world therapy helps them to confront the anxiety in a safe way that has no risk of further trauma. Over time this helps reduce the stress and helps them regain control.
4. Talking through the trauma: This part of the process is talking about the trauma over and over with a therapist, which helps the person with PTSD gain control over the thoughts and feelings associated with the event. This has been the show to reduce stress and eliminate the fear of the memories of the traumatic event.

WHAT IS COGNITIVE PROCESSING THERAPY?

Cognitive Processing Therapy (CPT) is a treatment developed by Dr. Patricia Resick and colleagues at the University of Missouri–St. Louis that addresses how traumatic experiences disrupt and distort people’s beliefs about themselves, other people, the world. CPT focuses on beliefs formed or confirmed by the trauma more than on the details of the trauma itself; a recounting of the event may be included as part of the treatment but is not required for it be effective. CPT emphasizes the person’s thoughts about the causes and consequences of the trauma, and how these in turn shape emotions and behaviors. CPT has the following features:

1. Education on the therapy: The patient is educated on PTSD and how traumatic experiences often affect people. This process helps them understand both their symptoms and the treatment itself.
2. Identifying and challenging distorted beliefs: People with PTSD often attempt to make sense of the events by altering their beliefs about what happened; other times, they change their beliefs about themselves and the world. Many do both. These “stuck points” often generalize to other situations not related to the original trauma and may be rooted in pre-trauma experiences. Patients learn to separate thoughts from emotions and to see how beliefs shape and determine feelings and behavior. Distorted beliefs, by nature, lead to distorted emotions and unhelpful behaviors.
3. Cognitive restructuring: CPT involves daily practice identifying stuck points relating to both the original trauma and current stressful experiences, then developing more helpful, balanced beliefs about these events. Patients learn to observe and challenge their own distorted thoughts, as well as identify and resist the unhelpful mental shortcuts that sustain PTSD symptoms. Developing a balanced view of self, others, and the original trauma fosters more positive emotions and effective behaviors.
4. Five core themes: The final stage of CPT focuses on a series of themes of negative beliefs that were either formed following the trauma or were seemingly confirmed by the event: Safety, Trust, Power/Control, Esteem, and Intimacy. One by one, patients work through these five modules, apply the skills they have acquired to develop more effective ways of relating to themselves and others.

WHO IS AFFECTED BY PTSD?

Anyone that experiences a traumatic event in their life can suffer from PTSD, men, women, Black, Hispanic, White are all affected by PTSD. Women however are more likely to get PTSD with studies showing that 20 percent of women may suffer PTSD in their lifetime. Compared to men at eight percent, there is a large difference. 60 percent of American adults will suffer some form of trauma over the course of their life. One reason that women are considered higher risk for PTSD is they at higher risk of suffering some form of sexual assault over their lifetime then men, one of the traumatic events that can trigger PTSD.