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Trauma is real, and its negative effects on health can be widespread, targeting various aspects of life. With varied responses, some people recover quickly from a traumatic experience on their own, while others progress to acquire post-traumatic stress disorder (PTSD), requiring professional help. While various therapies are available to manage this disorder, CBT interventions for PTSD have been emerging as the most effective ones. Also known as trauma-informed cognitive behavioral therapy, CBT can help people with traumatic pasts find healthy ways to manage their hurtful emotions and behaviors with the ultimate goal of creating a life worth living. Understanding more about what this therapy entails and what to expect from it can make CBT for trauma more effective.
CBT Therapy For Trauma: How Does it Work?
Cognitive behavioral therapy or CBT directed at trauma management does not always go back to explore the initial trigger of PTSD. On the other hand, it can help people adjust and realign their negative feelings, behaviors, and thoughts that have been stopping them from enjoying a good quality of life. This is achieved by breaking down bigger issues affecting the day-to-day activities followed by creating small, easily achievable changes, such as coping strategies, or newer thinking patterns.
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CBT focused on trauma relies on several main components, often represented through the acronym PRACTICE. This acronym breaks down into the following:
Psychoeducation & Parenting
In this component, a therapist educates a patient with PTSD and makes them realize what trauma is and its effects, including the emotional and behavioral responses that it triggers. This step also includes helping patients learn behavior management techniques.
Relaxation Techniques
In this component, a therapist teaches patients various healthy and effective relaxation methods to manage or reduce stress. These relaxation methods may include guided imagery, progressive muscle relaxation, and breathing exercises.
Affective Expression & Regulation Skills
Trauma can frequently trigger intense emotions in a person, such as fear, sadness, and anger. A therapist uses CBT for trauma to address these issues by helping patients identify and express their overwhelming responses and emotions in addition to developing healthier ways to calm down.
Cognitive Coping Skills
Many people with PTSD find trauma to be confusing and can face difficulties facing it. Hence, therapists create a treatment plan for PTSD using CBT techniques to help such people understand the connection between their thoughts, feelings, and behaviors along with identifying and rectifying accurate thoughts about it.
Trauma Narrative & Processing
Sharing traumatic events and their impacts may involve verbal, artistic, symbolic, and written narratives. CBT teaches people with PTSD to use these narratives to express and process their trauma along with all connected experiences through exposure exercises under a therapist’s supervision.
In Vivo Exposure
Exposure instead of avoidance is one of the best and most effective ways to overcome anxiety and fear associated with trauma. Hence, CBT therapy for trauma involves in vivo exposure which allows gradually exposing a patient to things that remind them of their trauma. This approach decreases the level of sensitization and the negative emotional responses associated with all trauma reminders. Moreover, this component also helps patients manage their emotional reactions to unexpected reminders in the future.
Conjoint Therapy Sessions
This component of CBT for trauma management involves creating and maintaining healthy relationships with family members. With this component, both parties get a chance to practice their communication skills and discuss trauma in a controlled therapeutic environment.
Enhancing Future Growth and Personal Safety
People with past traumas must acquire personal safety skills and learn how to establish healthy relationships. Hence, CBT techniques for trauma often involve a discussion on different ways to avoid future trauma and prioritize personal safety while learning the means to keep growing and healing.
In many instances, experts treating PTSD with CBT may also use specialist talking therapy sessions emphasizing other forms of healing, like counseling, where patients can discuss their emotions and thoughts in a safe place. Others may promote interpersonal talking therapy focusing on a patient’s relationship with their loved ones.
Diving into a Typical CBT Session for Trauma Management
The exact layout of a CBT session can vary for different patients depending on the nature of their challenges. However, in most cases, it focuses on:
- A problem they face, such as a difficult situation happening at present or an event in the future likely to cause them concern
- What their thoughts and emotions and how they affect them physically (such as by causing pain, sleep problems, or digestive issues)
- How they behave in response to the issues mentioned above
The core feature of CBT therapy for trauma is that the leading therapist does not tell patients how to dismantle the relationship between things. Instead, they help them understand and practice self-management and self-resolution by highlighting unhelpful connections and supporting them in identifying the helpful ones that they can apply every day. In simpler words, patients attending CBT interventions for trauma can find solutions to dismantle the negative cycle through steps that are achievable and practical in real life. Some examples of this include the following:
Socratic Questioning
This technique aims at challenging illogical or irrational thoughts. Patients are directed to take a piece of paper and pen and write down all thoughts that they think are destructive or irrational. Next, they write down facts that support and contradict these thoughts as a reality. Once a person has identified the evidence, they can make a judgment on their thoughts, either based on evidence or their opinion. The purpose of Socratic questioning is to encourage people with PTSD to deep dive into the thoughts that plague their minds while offering opportunities to evaluate and analyze them. The technique can serve as an excellent tool for identifying and defusing thoughts not coming from a place of truth.
Exposure Therapy
This intervention helps people face and control their fears through slow exposure to their traumatic experiences or memories. The technique may use mental imagery, visits to triggering places or writing about a traumatic experience. Virtual reality can also be used to expose a person to an environment that includes their feared situations. Regardless of the method a therapist chooses, exposure therapy slowly desensitizes a person to the triggers of their trauma.
Cognitive Processing Therapy
Also known as CPT, this therapy is an adaptation of cognitive therapy that involves recognizing and reevaluating trauma-related thinking. The technique focuses on the way a person views themselves and the world following a traumatic experience. In most cases, PTSD can lead to inaccurate thinking that keeps a person stuck and prevents recovery. With CPT, such people look at the way trauma has occurred and impacted their thinking. CPT can be particularly beneficial for people who blame themselves for their traumas.
Stress Inoculation Training
Also known as SIT, stress inoculation training is another type of CBT that aims to decrease anxiety by helping people learn healthy coping skills to deal with stress due to PTSD. Many therapists use it as a standalone treatment while some combine it with other forms of CBT for better outcomes. The main goal of SIT is to teach patients how to react differently to their underlying symptoms by helping them learn different coping skills. These coping skills may include muscle relaxation, breathing retraining, assertiveness skills, and cognitive restructuring.
Are CBT Techniques for PTSD Effective?
While the research around trauma-focused CBT continues to grow, most studies have found it to be an effective intervention for long- and short-term success in different age groups. Following is the evidence that confirms its efficacy for PTSD management:
- Research observing CBT has deemed it a culturally validated approach across various populations.
- Compared to placebo, the therapy has been reported as moderately helpful in managing anxiety-related disorders. The researchers; however, found that the dropout rates were higher in people with PTSD, especially in people with exposure therapy. This highlights that experts need more specialized forms of CBT for PTSD. [1]
- Research has noted a significant improvement and a simultaneous reduction in PTSD symptoms, including anxiety and depression, in people receiving CBT sessions. [2]
- CBT has also been found to be appropriate, helpful, and safe in people with acute and chronic PTSD belonging to any age group [3]
- A review of clinical trials performed between 1980 to 2005 found CBT to be equal to cognitive therapy and exposure therapy in the reduction of PTSD symptoms and maintenance of alternative healthy behaviors. [4]
FAQs
How effective is CBT for posttraumatic stress disorder?
CBT has been used to treat various behavioral and mental health issues in addition to PTSD. These issues include criminality, schizophrenia, anxiety, depression, substance misuse, insomnia, anger and aggression, and eating disorders, each with a high rate of success. Its success rate with PTSD can vary based on factors like the type of trauma, individual trauma response, other comorbidities, etc. However, most studies have indicated its success rate as 61 to 82.4 percent.
Is CBT for trauma equally effective for everyone?
The reason why CBT is so frequently offered to people with PTSD is because it can help them break down their difficulties and symptoms into smaller, more easily achievable goals. However, CBT may not be equally effective in everyone and the rate of non-responsiveness may be as high as 50%, depending on factors, like comorbidities.
How can I find a CBT therapist for PTSD?
Choosing a therapist for CBT can be difficult and most experts recommend using a local online directory to start researching. You can also consider asking your primary care provider for a referral. Fortunately, many therapists now provide teletherapy where clients can attend therapy online without physically being present, which broadens their choice of a provider.
References
1 Mendes DD, Mello MF, Ventura P, de Medeiros Passarela C, de Jesus Mari J. A systematic review on the effectiveness of cognitive behavioral therapy for posttraumatic stress disorder. The International Journal of Psychiatry in Medicine. 2008 Sep;38(3):241-59.
2 Ehlers A, Grey N, Wild J, Stott R, Liness S, Deale A, Handley R, Albert I, Cullen D, Hackmann A, Manley J. Implementation of cognitive therapy for PTSD in routine clinical care: effectiveness and moderators of outcome in a consecutive sample. Behavior research and therapy. 2013 Nov 1;51(11):742-52.
3 Kar N. Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: a review. Neuropsychiatric disease and treatment. 2011 Apr 4:167-81.
4 Mendes DD, Mello MF, Ventura P, de Medeiros Passarela C, de Jesus Mari J. A systematic review on the effectiveness of cognitive behavioral therapy for posttraumatic stress disorder. The International Journal of Psychiatry in Medicine. 2008 Sep;38(3):241-59.
