cbt summary

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A summary of Cognitive behavioral Therapy for treating complex traumatic stress disorders

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Cognitive-Behavioral Therapy : 

Cognitive-Behavioral Therapy A.J. McConnell Psy 765: Family Violence & Trauma Union Institute & University Fall 2010

Cognitive Behavioral Therapy : 

Cognitive Behavioral Therapy CBT’s primary objective is to improve functioning and emotional well-being by identifying the beliefs, feelings, and behavior associated with an individual’s complex traumatic history. These beliefs, feelings, and behaviors are revised during the course of therapy to meet the client’s desired outcome and positive life goals. Emphasis is on identifying and reducing symptoms, developing a strong therapist-client relationship, strengthening interpersonal relationship skills, and process each traumatic memory.

Research on CBT : 

Research on CBT CBT is the most efficient psychotherapy model to reduce symptoms of PTSD. CBT techniques used for CTSD have been adapted from models that are successful in treating traditional symptoms associated with PTSD. CBT reduces symptoms of CTSD: Dissociation Interpersonal Problems / Negative interpersonal beliefs Negative mood Regulation Impaired Self-References

Goals of Therapy : 

Goals of Therapy Build a strong therapist-client relationship Assist client in identify ways in which thoughts and behaviors limit healthy functioning Develop alternative strategies to address harmful thoughts and/or behaviors Enhance self-regulation and secure attachment Client needs to develop a positive self-identify where symptoms associated with past events are not perceived as character flaws

Phases of CBT Treatment : 

Phases of CBT Treatment Phase 1: Safety / Stabilization Emotion Regulation Interpersonal Relationship Skills Phase 2 Emotional Processing of Traumatic Memories

Safety / Stabilization : 

Safety / Stabilization Early sessions consist of Psychoeducation on maladaptive coping behaviors Goal is to replace maladaptive coping behaviors with strategies that promote health without negative consequences Work with the Client in Developing a Safety Plan A safety plan is needed to proceed with processing traumatic memories Build the Therapeutic Alliance Strength of early therapeutic alliance in CBT is associated with decreasing symptoms associated with the complex trauma history

Purpose of Emotion Regulation : 

Purpose of Emotion Regulation Emotion Regulation Strategies are developed and reviewed after stabilization Help clients identify triggers related to self-harm and other maladaptive behaviors This part of phase 1 is intended to give clients security in their emotional experience, as well as develop the confidence to confront traumatic experiences with the therapist Acceptance and exploration of feelings is a core task of CBT Viewed as a prerequisite to self-coherence and self-identity

Emotion Regulation : 

Emotion Regulation Client works with therapist in identifying their feelings, what they think about the feelings, and how they manage their feelings. Emotion regulation strategies are understood in the context of the client’s family history A client develops an understanding of their emotional reactions to stressors, and emotion-driven behaviors

Emotion Regulation Strategies : 

Emotion Regulation Strategies Focused breathing Naming and Verbalization of feelings Awareness of feelings and the situation when emotions are elicited.

Dissociation & Emotion Regulation : 

Dissociation & Emotion Regulation Dissociation is a result of the client feeling overwhelmed by their emotions Feelings that are viewed as unacceptable or overwhelming may result in dissociation/splitting. CBT focuses on helping the client resolve their fear of their emotions by accepting their feelings associated with their traumatic history instead of dissociating Self-Monitoring forms

Interpersonal Skills : 

Interpersonal Skills Interpersonal skills are used to develop assertiveness, focus on personal needs, and coping with imbalances of power, authority, and distrust Review Interpersonal schemas Discuss how feelings from the past interfere with current interpersonal skills Assist the client in developing alternative interpersonal schemas Goal is to have the client develop alternative schemas that produce positive and stable relationships with friends and family that are in their life currently. Role playing

Insecure-Disorganized Attachment & Related Relationship Problems : 

Insecure-Disorganized Attachment & Related Relationship Problems Most CBT approaches for CTSD recognize the potential role of insecure or disorganized attachment in the early life of many clients Examination of the client’s early caretaker relationships. Current interpersonal relationship skills are based on early life experiences

Phase 2: Emotional Processing of Traumatic Memories : 

Phase 2: Emotional Processing of Traumatic Memories Phase 2 Goals: reduce client’s PTSD symptoms Assist client in placing their trauma memories into perspective as part of their life story

Emotional Processing of Traumatic Memories : 

Emotional Processing of Traumatic Memories Emotional Processing of traumatic memories occurs through storytelling Processing traumatic memories creates awareness of a self that comprises a past, present, and potential future Therapist serves as a facilitator as the client tells the story for each traumatic memory

Storytelling : 

Storytelling Assist the client in creating a hierarchy of memories Select the memory the client believes they can tolerate the most A review of the safety plan and emotion regulation skills is recommended before starting the narrative Identify and Review preferred emotion regulation strategies as needed The client is instructed to verbalize the memory The story is tape-recorded for future review

Developing a Sense of Self through Storytelling : 

Developing a Sense of Self through Storytelling After the client completes the narrative, the client is instructed to name the various feelings experienced as they told the story Client and Therapist identify the interpersonal schemas that are present in the narrative This provides client with an explanation of ongoing behaviors A client may feel liberated from the schemas Identifies the link between past experiences and current behavior

Outcomes of Emotional Processing : 

Outcomes of Emotional Processing Narrative storytelling assists clients in identifying sensory perceptions, bodily sensations, beliefs, and behaviors Clients may often express surprise, relief, pleasure, and pride in accomplishing the narrative Storytelling is a creative act and should enhance a sense of autonomy, independence, and self-determination Also develops a sense of self in time. The presence of a therapist symbolizes a secure attachment for the client

Benefits of CBT : 

Benefits of CBT Short-term Therapy (12-20 sessions) CBT is an evidence-based model Symptoms are known to decrease during the course of therapy A five year follow-up study found that clients who received CBT did not experience a relapse in symptoms (see Chard & Buckley, 2010) Effective in treating comorbid conditions on Axis 1 & 2 while simultaneously focusing on the trauma history.

Limitations of CBT : 

Limitations of CBT Majority of research focuses on adults with a significant history of childhood trauma Minimal research on individuals whose first traumatic experience occurred after age 18 Limited Research on Non-western cultures

Limitations of CBT : 

Limitations of CBT Predictors of poor treatment outcomes (Chard & Buckley, 2010) Hostile or critical family / friends Substance Abuse Greater pain severity Lower global functioning Phase 2 (emotional processing) may not be necessary Drop out rate Type of CBT model differs based on age group (Ford, 2010) Example: Prolonged Exposure for adults; TF-CBT for children

References : 

References Chard, K.M., & Buckley, A.F. (2010). Cognitive-behavioral treatments for post-traumatic stress disorder. In R.A. Lantus, E. Vermetten, and C. Pain (Eds.), The impact of early life trauma on health and disease: The hidden epidemic (pp. 268-279). New York, NY: Cambridge University Press Ford, J.D. (2010). Just thing about it: How can cognitive therapy contribute to the treatment of PTSD? Clinical Psychology: Science and Practice, 17(2), 128-133. DOI: 10.1111/j.1468-2850.2010.01202.x Jackson, C., Nissenson, K., &Cloitre, M. (2009). Cognitive-behavioral therapy. In C.A. Courtois and J.D. Ford (Eds.), Treating complex traumatic stress disorders: An evidence-based guide (pp. 243-263). New York, NY: The Guilford Press.

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