Question

Pick one of the major psychological disorders we learn about this week (Mood Disorders, Anxiety Disorders, Posttraumatic Stress Disorder, Dissociative Disorders, Personality Disorders). Given what we know about the different types of therapy, how would you go about treating the disorder? Please be sure to explain your reasoning. Do you feel this type of therapy is generally the best? Why?

Answer 1

Treatment of Posttraumatic Stress Disorder (PTSD):

This can be done through a combination of pharmacological and psychological interventions, since PTSD is rooted in both biological and psychological underpinnings. Interventions for PTSD may be classified into the following:

Psychosocial interventions: This may include exposure-based interventions (EBIs). In exposure-based behavioural therapies for PTSD, the therapist’s goal is to help the patient to systematically approach, instead of avoiding, safe but feared stimuli (e.g., the memory of the trauma) in the absence of the feared consequences (anxiety), until the feared consequences are disconfirmed and the automatic fear response to trauma-related stimuli diminishes. One such protocol is Prolonged Exposure (PE) therapy. Patients are taught a brief relaxation breathing exercise in the beginning and they receive psychoeducation about PTSD symptoms and maintenance factors. The patient then revisits and describes the trauma memory aloud for a prolonged time in order to extinguish the fear response associated with the memory, which is called imaginal exposure. As ‘homework’ between sessions, patients listen to recordings of the therapy sessions and practice the in vivo exposures.

Cognitive-based interventions: Cognitive Processing Therapy (CPT) is one such intervention, the goal of which is to rely on directly targeting maladaptive thinking patterns rather than the resulting behaviours, that maintain PTSD symptoms. The initial sessions of CPT include psychoeducation about PTSD symptomatology and the role of avoidance in maintaining PTSD. The patient writes a statement of impact that the traumatic event had on their life, specifically about how the trauma affected the patient’s beliefs about self, others and the world. This is read aloud and discussed with the therapist. The therapist begins to gently question any potential maladaptive thinking patterns, thereby helping the patient discover over-generalized or unhelpful automatic thoughts. Over time, the therapist works with the patient to develop strategies for generating more useful or accurate thinking patterns. The last sessions focus on specific areas of one’s life that are likely affected by maladaptive trauma-related thought patterns, including the areas of safety, trust, esteem and intimacy. At the end of treatment, the patient re-writes the impact statement, which is used to evaluate treatment gains.

Eye Movement Desensitization and Reprocessing (EMDR): In this, PTSD is viewed as a result of insufficient processing of the traumatic memory. EMDR hypothesizes that the trauma memory, if not fully processed, is stored in its initial state, preserving any misperceptions or distorted thinking patterns that occurred at the time of the trauma. Patients are trained in strategies for managing negative emotions. To prepare for ‘reprocessing,’ patients generate a list of traumatic experiences, along with distorted beliefs related to the experience and desired beliefs. During the reprocessing phase, the therapist asks the patient to bring to mind a vivid visual representation of the traumatic memory, along with the distorted belief, and to focus on the physical sensations related to the traumatic memory. The patient is then instructed to engage in bilateral eye movements, following the therapist’s finger from left to right for several repetitions. The patient visualizes the memory while continuing to engage in the bilateral stimulation. The patient is asked what experiences emerge next, and the cycle is repeated. The patient later practices thinking the desired thought with the visual image of the trauma brought to mind. The bilateral eye movements are hypothesized to reduce distress attached to the trauma memory, thereby reducing avoidance, and allowing for increased attention to more adaptive thinking patterns that are then attached to the traumatic memory.

Relaxation-based psychotherapeutic interventions: One such intervention includes Stress Inoculation Training (SIT). It is based on the conceptualization that PTSD symptoms are maintained as a result of ongoing perceptions of situational demands outweighing the available coping resources. The primary goal in SIT, therefore, is to increase the patient’s sense of mastery over their anxiety, and to ‘inoculate’ patients against future episodes of pervasive anxiety and stress. Treatment focuses on skill training in a vast array of anxiety-management strategies such as breathing retraining, muscle relaxation, negative-thought stopping, and restructuring/challenging maladaptive cognitions. Relaxation skills are trained and practiced in sessions using techniques such as behavioural rehearsal and imagery, modelling and role-play. Mastering the use of anxiety management skills in increasingly challenging, anxiety-provoking and stressful situations is viewed as producing ‘inoculation’ against future problems.

Pharmacological interventions: Its foundation is supported by a growing literature for the association between PTSD and dysregulations in neurotransmitter and neuroendocrine systems.

In my opinion, an eclectic approach towards the treatment of PTSD is the most ideal. The ultimate goal must be to select one/a combination of intervention(s) that suit(s) the patient, rather than fitting the patient into a particular model or intervention.