Cognitive Behavioral Therapy for Post-Traumatic Stress Disorder

Cognitive behavioral therapy (CBT) is a broad term that refers to a number of interventions designed to change the way people think about and understand situations and behaviors. This reduces the frequency of distressing negative reactions and emotions. Two erroneous beliefs found in those with post-traumatic stress disorder (PTSD) are that the world is dangerous and the individual with PTSD is incompetent. CBT is used to change these beliefs, and successful CBT will result in the patient no longer believing that the world is dangerous or that they are incompetent.

CBT normally lasts from 9-12 individual sessions, lasting about 60-90 minutes, administered once or twice weekly. Patients are normally also assigned homework to practice specific interventions on their own between sessions. The most often used interventions include exposure therapy, stress inoculation training (SIT), and cognitive restructuring. These therapies may be used on their own or they may be combined. Another type of CBT is eye movement desensitization and reprocessing (EMDR).

Exposure Therapy
Exposure therapy is a treatment designed to help you confront safe but feared thoughts, situations, objects, people, places, or activities. These things elicit anxiety in the PTSD sufferer and are avoided, which takes a negative toll on everyday life. Gradual exposure will reduce the debilitating anxiety and avoidance centered on the feared situations and objects, and let the PTSD sufferer lead a more normal life.

Exposure therapy designed for PTSD involves imaginative exposure to the trauma memory. The patient is instructed to close her eyes and remember the traumatic event by imagining that it's currently happening. They will provide detailed descriptions of all thoughts, physical sensations, and emotional reactions to the memory. This is repeated several times over the course of therapy and it is taped to be listened to later as homework.

PTSD patients are also exposed to real life situations and objects that trigger anxiety and avoidance. Each person, place, situation and activity that triggers anxiety and avoidance is identified and evaluated for safety and relevance to the patient's normal functioning. Then these things are repeatedly confronted until anxiety and avoidance centered on them goes away. Therapy starts small and works its way to more feared and challenging situations.

The goal of exposure therapy is to help the individual confront and process traumatic memories and correct erroneous thoughts about the world and the self that derive from them.

Stress Inoculation Training
Stress inoculation training (SIT) consists of teaching the PTSD sufferer how to manage their anxiety reactions to situations, memories, etc. they normally fear and avoid. For the physical manifestations of anxiety (heightened breathing and heart rate, hyperventilation, muscle tension), SIT teaches controlled breathing and progressive muscle relaxation. For intrusive thoughts and worrying, SIT teaches patients how to interrupt their thought patterns and think of positive imagery. This way, the PTSD sufferer can control and lessen their PTSD symptoms.

Cognitive Restructuring
Cognitive restructuring helps patients identify and challenge their erroneous beliefs and interpretations. It is based on the idea that it is not actual events that cause negative emotional reaction but the interpretation of those events. Therefore, cognitive restructuring seeks to replace worry and anxiety with more positive and productive emotions through the way a patient thinks. People undergoing this therapy are taught to look at their negative beliefs and evaluate the pros and cons of maintaining them. They carefully consider the likelihood of their fears and the cost of those outcomes and look for possible alternative explanations and ways of thinking.

Eye Movement Desensitization And Reprocessing
In eye movement desensitization and reprocessing (EMDR), the therapist has the PTSD sufferer remember their trauma briefly and then engage in cognitive restructuring. In addition to this, the therapist has the patient engage in rapid left to right eye movements.

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