CBT for Post-traumatic Stress Disorder (PTSD)
PTSD is a reaction to a real or perceived threat to loss of life or serious injury. The causes of trauma are varied, but can include accidents, assaults, natural disasters, crashes, rape, sexual or physical abuse, childhood neglect, bereavement and military combat. PTSD can significantly affect individuals who personally experience the trauma, those who witness it, those involved in recovery or rescue, as well as friends or family members.
PTSD has now been recategorised from an anxiety disorder to a Trauma and Stress Related Disorder in DSM-5. This also introduced a preschool subtype of PTSD for children aged six years or younger. Like many other psychological conditions, PTSD can occur on a full or sub-clinical basis.
Trauma professionals also tend to differenciate between “Small T” and “Big T” traumas. Small T traumas can include issues such as divorce, complicated grief, non-professional media exposure and childhood emotional abuse. Big T trauma is normally diagnosed using the criteria outlined below.
Diagnostic Criteria
The following eight criteria are for individuals aged seven or older. These criteria are used by a trained psychological health professional to help determine whether an individual is experiencing symptoms and reactions consistent with PTSD:
Criterion A: Stressors
The trauma survivor must have been exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence. The traumatic exposure must have occured in a minimum of one of the following four ways:
- Through direct personal exposure to the situation.
- Through personally whitnessing the situation or event.
- Indirectly, by learning that a close relative or friend has been exposed to trauma. (If the event involved actual or threatened death, it must have been violent or accidental).
- Through persistent or extreme indirect exposure to aversive details of the situation or event.
Criterion B: Intrusions / Re-experiencing
The traumatic event must be persistently re-experienced in a minimum of one of the following ways:
- Repetitive intrusive thoughts or memories.
- Traumatic nightmares.
- Dissociative reactions including flashbacks.
- Intense or prolonged distress after exposure to traumatic reminders such as incident anniversaries.
- Marked physiologic reactivity after exposure to trauma-related reminders, such as a place or related situation.
Criterion C: Avoidance
- The trauma survivor attempts to avoid a minimum of one of the following:
- Trauma-related thoughts or feelings.
- Trauma-related external triggers , such as situations, people, places, objects or activities.
Criterion D: Negative Alterations in Cognitions and Mood
The trauma survivor must have experienced a deterioration in a minimum of two of the following areas:
- Ability to recall key features of the traumatic event (This can involve dissociative amnesia and should not be due to head injury or alcohol / drugs use).
- Negatively distorted beliefs and expectations about oneself or the world.
- Distorted blaming of self or others for causing the traumatic event or consequences.
- Persistent negative traumatic emotions, such as horror, fear, anger, shame or guilt.
- Markedly reduced interest in pre-traumatic activities.
- Feeling alienated, detached or estranged from others.
- Inability to experience positive emotions.
Criterion E: Increased Arousal and Reactivity
The trauma survivor experiences increased reactivity in at least two of the following areas:
- Irritable or aggressive behaviour.
- Difficulty concentrating.
- Self-destructive or reckless behaviour.
- Hypervigilant behaviour.
- Being easily startled.
- Disturbed Sleep.
Criterion F: Duration of Symptoms
The trauma survivor should have experienced persistent symptoms in Criteria B, C, D and E for more than one month.
Criterion G: Functional Significance
The trauma survivor experiences Significant symptom-related distress or functional impairment in social or occupational settings.
Criterion H: Exclusion
The Traumatic distress or Disturbance is not due to medication, substance use or any other diagnosed illness.
Dissociation Sub-types
Dissociation has been separated out from the symptom clusters and it’s presents can now be specified as a sub-type within PTSD. Although there are several types of dissociation, the following two have been identified for diagnostic purposes:
- Depersonalisation, which involves feeling detached or disconnected from one’s self.
- Derealisation, which involves feeling that one’s surroundings are unreal.
The marked symptoms of anxiety and hyper-arousal associated with PTSD, can also lead to unexplained muscle pain, palpitations, fatigue, headaches, broken sleep, irritability, loss of impulse control and periods of emotional numbness.
PTSD reactions usually occur within 4 weeks of the traumatic event, however it is not unusual for PTSD to be triggered months or even years after the initial event. In general, the earlier the event, the more severe the traumatic reaction.
PTSD can affect people in a profound way, frequently leading to further worry about losing control or going crazy. It is often linked to secondary emotional and physiological anxiety symptoms, panic attacks and depression if left untreated. In a small number of cases, Complex PTSD can be triggered by traumatic events that are thought to reactivate memories of early abuse. This can sometimes be confused with a Borderline Personality Disorder.
How PTSD Is Treated
Most people recover from traumatic events without prolonged traumatic reactions or PTSD. The lifetime prevalence of PTSD is between five and ten percent. The first therapy stage therefore involves something known as "watchful waiting"to see how the symptoms develop usually within the first four weeks following the traumatic event. Where normal traumatic reactions persist into PTSD, Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitisation Reprocessing (EMDR) are used to treat the problem. You can use the downloadable Thought Record available here to monitor and alter the reactions to situations in which you feel the emotional and physical effects of trauma.
CBT works by identifying and altering the cognitive patterns that maintain the traumatic reaction. This also involves graded behavioural exposure and rescripting work to build a sense of emotional control and personal resilience. EMDR involves the use of special eye movements, physical taps or audio tones to convert unprocessed traumatic experiences into normal memory. At Think CBT, both approaches are used on an integrated basis to maximise recovery and to best meet the individual needs and preferences of the client.
CBT and EMDR are the NICE recommended treatments of choice for PTSD. The research evidence clearly demonstrates that these forms of treatment are more effective than other forms of therapy and medications.
If you want to talk to a Psychotherapist trained in Cognitive Behavioural Therapy and EMDR, you can complete the simple contact form and we will organise a free initial telephone consultation. You can also take the PTSD test by clicking on the following link:
Cognitive Behavioural Therapy enhanced by EMDR for post-traumatic stress, brings the same rigor, structure and focus to the problem that it provides for many other psychological, emotional and behavioural problems.
Follow the evidence and take a positive step towards changing your situation.
Call us now on 01732 808 626, click here to send a message or email us at info@thinkcbt.com. You can also find out more about our services by clicking this link.
Think CBT is committed to providing access to affordable independent Cognitive Behavioural Therapy. Our aim is to support tangible improvements in the psychological health and well being of our clients, contributing to better lives worth changing for.
There are many psychotherapists and counsellors offering cognitive behavioural therapy. Always ensure that your therapist is professionally accredited with the British Association of Behavioural and Cognitive Psychotherapy (BABCP).
