Watkins & Sprang & Rothbaum (2018). Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions. Flashcards
two types of treatments for PTSD
- trauma-focused treatment (directly addresses memories, thoughts and feelings about event)
- non-trauma focused treatments (bv. relaxation, stress inoculaton training, interpersonal therapy)
medications for ptsd
Sertraline, Paroxetine, Fluoxetine, Venlafaxine. but The combination of psychotherapy and medication is not recommended by either of these guidelines
what therapies were strongly recommended by both guidelines
Prolonged exposure, cognitive processing therapy and cognitive behavioural therapy.
prolonged exposure includes:
- psychoeducation about PTSD and common reactions to trauma
- breathing retraining
- in vivo exposure
- imaginal exposure
PE is based on which theory
emotional processing theory, which suggests that traumatic events are not processed emotionally at the time of the event, leading to dysfunctional fear structures.
According to this theory 2 conditions are necessary to alter fear structures and for exposure to work:
* Fear structure must be activated
* New information that is incompatible with the false information in the fear structure must be incorporated into the structure.
cognitive processing theory rationale
CPT assumes that following a traumatic event, survivors attempt to make sense of what happened, often time leading to distorted cognitions regarding themselves, the world, and others. In an attempt to integrate the traumatic event with prior schemas, people often assimilate, accommodate, or over-accommodate. CPT allows for cognitive activation of the memory, while identifying maladaptive cognitions (assimilated and over-accomodated beliefs) that have derived from the traumatic event. The main aim of CPT is to shift beliefs towards accommodation.
assimilation=
when incoming information is altered in order to confirm prior beliefs/frameworks, which may result in self-blame for a traumatic event
accommodation=
a result of altering beliefs enough in order to accommodate new learning (positive in this context)
over-accomodation
changing ones beliefs to prevent trauma from occurring in the future, which may result in beliefs about the world being dangerous or people being untrustworthy.
on what theories is CPT based
social cognitive theory and informed emotional processing theory.
Cognitive thinking skills are introduced through establishing the connection between thoughts, feelings, and emotions related to the individual’s maladaptive cognitions about the event and learning ways to challenge them
oke
3 elements of CBT
- modifying negative appraisals
- correcting autobiographical memory
- eliminating problematic behavioral and cognitive strategies
voorbeeld behavioural techniques in CBT
- imaginal exposure
- writing or reading (aloud) the traumatic memory,
- in vivo exposure to trauma-related stimuli
voorbeeld cognitive techniques in CBT
- identifying dysfunctional thoughts and thinking errors
- Elicit rational alternative thoughts
- Reappraise beliefs about themselves, the trauma and the world
Rates of dropout appear to be similar across PE, CPT and trauma-focused CBT
oke
dus welke zou je moeten kiezen
Research and meta-analyses comparing PE, CPT, and trauma-focused CBT do not show one treatment outperforming the others for PTSD.
Guidelines and strong research evidence recommend PE, CPT, and trauma-focused CBT as the first-line treatment, also considering:
* patient preferences (even compared to medication)
* clinician expertise
The guidelines put forth by the VA/DoD and the APA are recommendations for providers who treat individuals with PTSD and both strongly recommend PE, CPT and trauma- focused CBT. Each of these treatments has a large evidence base showing their effectiveness. These treatments are all trauma- focused, which means they directly address memories of the traumatic event or thoughts and feelings related to the traumatic event. Treatments with the strongest evidence should be the first line of treatment for PTSD whenever possible, with consideration of patient preferences and values and clinician expertise.
oke
