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Management: Psychotherapeutic interventions Many forms of psychotherapy have been advocated for trauma-related problems such as PTSD. Basic counseling practices common to many treatment responses for PTSD include education about the condition and provision of safety and support. The psychotherapy programs with the strongest demonstrated efficacy include cognitive behavioral programs, variants of exposure therapy, stress inoculation training (SIT), variants of cognitive therapy (CT), eye movement desensitization and reprocessing (EMDR), and many combinations of these procedures. Treatment for PTSD relieves symptoms by helping to deal with the experienced trauma . Rather than avoiding the trauma and any reminder of it, treatment will encourage patient to recall and process the emotions and sensations they felt during the original event. In addition to offering an outlet for emotions that have been bottling up, treatment for PTSD will also help to restore the sense of control and reduce the powerful hold the memory of the trauma has on their life. In treatment for PTSD, patients will: 1. 2. 3. 4. Explore their thoughts and feelings about the trauma Work through feelings of guilt, self-blame, and mistrust Learn how to cope with and control intrusive memories Address problems PTSD has caused in life and relationships
Types of treatment for post-traumatic stress disorder (PTSD) 1. Trauma-focused cognitive-behavioral therapy. Cognitive-behavioral therapy for PTSD and trauma involves carefully and gradually exposing yourself to thoughts, feelings, and situations that remind you of the trauma. Therapy also involves identifying upsetting thoughts about the traumatic event particularly thoughts that are distorted and irrationaland replacing them with more balanced picture. Family therapy. Since PTSD affects both you and those close to you, family therapy can be especially productive. Family therapy can help your loved ones understand what youre going through. It can also help everyone in the family communicate better and work through relationship problems caused by PTSD symptoms. EMDR (Eye Movement Desensitization and Reprocessing) incorporates elements of cognitivebehavioral therapy with eye movements or other forms of rhythmic, left-right stimulation, such as hand taps or sounds. Eye movements and other bilateral forms of stimulation are thought to work by unfreezing the brains information processing system, which is interrupted in times of extreme stress.
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1. Trauma-focused cognitive-behavioral therapy. Cognitive behavioral therapy (CBT) seeks to change the way a trauma victim feels and acts by changing the patterns of thinking or behavior, or both, responsible for negative emotions. CBT has been proven to be an effective treatment for PTSD and is currently considered the standard of care for PTSD.
Exposure therapy A type of cognitive behavioral therapy that involves assisting trauma survivors to re-experience distressing trauma-related memories and reminders in order to facilitate habituation and successful emotional processing of the trauma memory. Most exposure therapy programs include both imaginal confrontation with the traumatic memories and real-life exposure to trauma reminders; this therapy modality is well supported by clinical evidence.
2. Family Therapy Family therapy, also referred to as couple and family therapy, family systems therapy, and family counseling, is a branch of psychotherapythat works with families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of interaction between family members. It emphasizes family relationships as an important factor in psychological health Techniques. Family therapy uses a range of counseling and other techniques including: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. communication theory media and communications psychology psychoeducation psychotherapy relationship education systemic coaching systems theory reality therapy attachment-focused family therapy the genogram
The number of sessions depends on the situation, but the average is 5-20 sessions. A family therapist usually meets several members of the family at the same time. This has the advantage of making differences between the ways family members perceive mutual relations as well as interaction patterns in the session apparent both for the therapist and the family. These patterns frequently mirror habitual interaction patterns at home, even though the therapist is now incorporated into the family system. Therapy interventions usually focus on relationship patterns rather than on analyzing impulses of the unconscious mind or early childhood trauma of individuals.
3. EMDR (Eye Movement Desensitization and Reprocessing) Eye Movement Desensitization and Reprocessing (EMDR) is a comprehensive, integrative psychotherapy approach. It contains elements of many effective psychotherapies in structured
8 PHASES OF TREATMENT The amount of time the complete treatment will take depends upon the history of the client. Complete treatment of the targets involves a three pronged protocol (1-past memories, 2-present disturbance, 3-future actions), and are needed to alleviate the symptoms and address the complete clinical picture. The goal of EMDR therapy is to process completely the experiences that are causing problems, and to include new ones that are needed for full health. "Processing" does not mean talking about it. "Processing" means setting up a learning state that will allow experiences that are causing problems to be "digested" and stored appropriately in your brain. That means that what is useful to you from an experience will be learned, and stored with appropriate emotions in your brain, and be able to guide you in positive ways in the future. The inappropriate emotions, beliefs, and body sensations will be discarded. Negative emotions, feelings and behaviors are generally caused by unresolved earlier experiences that are pushing you in the wrong directions. The goal of EMDR therapy is to leave you with the emotions, understanding, and perspectives that will lead to healthy and useful behaviors and interactions. Phase 1: History and Treatment Planning Generally takes 1-2 sessions at the beginning of therapy, and can continue throughout the therapy, especially if new problems are revealed. In the first phase of EMDR treatment, the therapist takes a thorough history of the client and develops a treatment plan. This phase will include a discussion of the specific problem that has brought him into therapy, his behaviors stemming from that problem, and his symptoms. With this information, the therapist will develop a treatment plan that defines the specific targets on which to use EMDR. These targets include the event(s) from the past that created the problem, the present situations that cause distress, and the key skills or behaviors the client needs to learn for his future well-being. One of the unusual features of EMDR is that the person seeking treatment does not have to discuss any of his disturbing memories in detail. So while some individuals are comfortable, and even prefer, giving specifics, other people may present more of a general picture or outline. When the therapist asks, for example, "What event do you remember that made you feel worthless and useless?" the person may say, "It was something my brother did to me." That is all the information the therapist needs to identify and target the event with EMDR. Phase 2: Preparation For most clients this will take only 1-4 sessions. For others, with a very traumatized background, or with certain diagnoses, a longer time may be necessary. Basically, your clinician will teach you some specific techniques so you can rapidly deal with any emotional disturbance that may arise. If you can do that, you are generally able to proceed to the next phase. One of the primary goals of the preparation phase is to establish a relationship of trust between the client and the therapist. While the person does not have to go into great detail about his disturbing memories, if the EMDR client does not trust his clinician, he may not accurately report what he feels and what changes he is (or isn't) experiencing during the eye movements. If he just wants to please the clinician and says he feels better when he doesn't, no therapy in the world will resolve his trauma. In any form of therapy it is best to look at the clinician as a facilitator, or guide, who needs to hear of any hurt, need, or disappointments in order to help achieve the common goal. EMDR is a great deal more than just eye movements, and the clinician needs to know when to employ any of the needed procedures to keep