Evidence Based Treatments for Trauma-Related Psychological Disorders: A Practical Guide for Clinicians

Description

The second, completely updated edition of this book offers an evidence based guide for clinical psychologists, psychiatrists, psychotherapists and other clinicians working with trauma survivors in various settings. It provides easily digestible, up-to-date information on the basic principles of traumatic stress research and practice, including psychological and sociological theories as well as epidemiological, psychopathological, and neurobiological findings. However, as therapists are primarily interested in how to best treat their traumatized patients, the core focus of the book is on evidence based psychological treatments for trauma-related mental disorders. The full range of trauma and stress related disorders is covered, including Acute Stress Reaction, Complex PTSD and Prolonged Grief Disorder, reflecting important anticipated developments in diagnostic classification. Each of the treatment chapters begins with a short summary of the theoretical underpinnings of the approach, presents a case illustrating the treatment protocol, addresses special challenges typically encountered in implementing this treatment, and ends with an overview of related outcomes and other research findings. Additional chapters are devoted to the treatment of comorbidities, special populations and special treatment modalities and to pharmacological treatments for trauma-related disorders. A novel addition is the chapter on Innovative interventions to increase global mental health. The book concludes by addressing the fundamental question of how to treat whom, and when. Contents 1: Introduction 1.1 Why This Book? 1.2 The Content of the Book 1.3 Commonalities Across Psychological Treatments 1.4 The Cultural Dimension References Part I: Traumatic Stress: The Basic Principles 2: Trauma as a Public Health Issue: Epidemiology of Trauma and Trauma-Related Disorders 2.1 Global Burden of Trauma Exposure 2.2 Risk- and Protective-Factors for Trauma Exposure 2.2.1 Sociodemographic Factors 2.2.2 Within-Individual Factors 2.2.3 Social Contextual Factors 2.3 Consequences of Trauma Exposure 2.3.1 Posttraumatic Stress Disorder (PTSD) 2.3.2 ICD-11 CPTSD and PTSD 2.3.3 Acute Stress Disorder (ASD) 2.3.4 Prolonged Grief Disorder (PGD) 2.3.5 Other Psychological Disorders 2.3.6 Intergenerational Transmission of Trauma 2.4 Public Health Perspectives on Prevention 2.4.1 Primary Prevention 2.4.2 Secondary Prevention 2.4.3 Tertiary Prevention 2.5 Conclusion References 3: Psychological and Social Theories of PTSD 3.1 Introduction 3.2 Learning Theories 3.3 Dual Representation Theory 3.4 Cognitive Theory and ‘Hotspots’ in Trauma Narratives 3.4.1 Cognitive Theory of PTSD 3.4.2 ‘Hotspots’ in Trauma Narratives 3.5 Reconsolidation 3.6 Psychoanalytical Theory 3.6.1 Trauma as a Subjective Experience 3.6.2 Significance of the Personality in the Posttraumatic Process 3.6.3 Trauma as a Process with Social Dimensions 3.7 PTSD from a Societal Perspective 3.8 Conclusion References 4: An Integrative View on the Biopsychology of Stress and Posttraumatic Stress Disorder 4.1 Introduction 4.2 Role of Cumulative Trauma Exposure, Traumatic Stress, and Trauma Load in PTSD Risk 4.2.1 Trauma Load and the Dose-Response Effect on PTSD 4.2.2 Fear/Trauma Network Model: Role of “Cold” and “Hot” Memories in PTSD 4.3 Brain and Cognitive Alterations in PTSD 4.3.1 Connection of Brain Alterations with PTSD Symptoms 4.3.2 Causes of PTSD-Related Cognitive and Brain Alterations 4.3.3 The p and g Factor Model and Its Relevance for PTSD Treatment 4.4 Genetics of PTSD 4.4.1 Heritability of PTSD Risk 4.4.2 Candidate Gene Studies 4.4.3 Genome-Wide Association Studies 4.4.4 Epigenetic Alterations in PTSD 4.5 Trauma-Related Alteration in Mitochondrial Functioning Leads to Energy Deficiency and Inflammation 4.5.1 Immune Cell Composition and PTSD 4.5.2 Low-Grade Inflammation and Cytokine Levels in PTSD 4.5.3 Cellular Energy Metabolism and Oxidative Stress in PTSD 4.6 Implication of Gut Microbiota in Stress and PTSD 4.7 Conclusion and Future Perspectives References 5: Understanding Pathways from Traumatic Exposure to Physical Health 5.1 Defining and Measuring Physical Health 5.2 A Conceptual Framework for Understanding How Traumatic Exposure Affects Physical Health 5.3 Review of the Literature 5.3.1 Explicit Tests of PTSD as a Mediator of the Relationship Between Traumatic Exposure and Physical Health 5.3.2 Evidence on Potential Mechanisms Through Which PTSD Affects Physical Health 5.3.3 Evidence on Whether Treating PTSD Improves Physical Health 5.4 Implications for Clinical Practice 5.5 Implications for Research 5.6 Implications for Society 5.7 Conclusions References Part II: Stress and Trauma Related Disorders 6: The Diagnostic Spectrum of Trauma-Related Disorders 6.1 Introduction 6.2 History of DSM 6.3 History of ICD 6.4 Classification in DSM-5 6.5 PTSD 6.5.1 DSM-5 6.5.2 ICD-11 6.6 Acute Stress Disorder 6.6.1 ICD-11 6.7 Complex PTSD 6.7.1 DSM-5 6.7.2 ICD-11 6.8 Prolonged Grief Disorder 6.8.1 ICD-11 6.8.2 DSM-5 6.9 The Structure of PTSD 6.10 Summary References Part III: Psychotherapy 7: Early Intervention After Trauma 7.1 Introduction 7.2 Providing Early Interventions to All Survivors 7.3 Who Should Receive Early Intervention? 7.4 Psychological Treatments for People with Acute Stress Reactions 7.5 Trauma-Focused Cognitive Behaviour Therapy 7.5.1 Case Study: Trauma-Focused Cognitive Behaviour Therapy 7.6 Alternatives to Trauma-Focused Early Intervention 7.7 Pharmacological Approaches 7.7.1 Selective Serotonin Reuptake Inhibitors 7.8 Stepped Care 7.9 Placing Early Intervention in Context 7.10 Lessons for Early Intervention 7.11 Concluding Comment References 8: Prolonged Exposure Therapy 8.1 Theoretical Basis for Prolonged Exposure 8.2 Implementing Prolonged Exposure Therapy 8.3 Special Challenges to Implementing Prolonged Exposure Therapy 8.3.1 Comorbid Depression 8.3.2 Comorbid Substance Use 8.3.3 Comorbid Traumatic Brain Injury 8.3.4 Comorbid Borderline Personality Disorder 8.3.5 Symptoms Associated with PTSD 8.3.6 Dropout 8.3.7 Contraindications to PE Implementation 8.4 Evidence Supporting Prolonged Exposure Therapy 8.5 Augmentation of Prolonged Exposure Therapy 8.6 New Models of Prolonged Exposure Therapy Delivery References 9: Cognitive Therapy for PTSD: Updating Memories and Meanings of Trauma 9.1 Understanding PTSD from a Cognitive Perspective 9.1.1 A Cognitive Model of PTSD 9.1.2 Empirical Studies Testing the Proposed Factors 9.1.2.1 Negative Appraisals 9.1.2.2 Memory Processes 9.1.2.3 Behaviors and Cognitive Responses That Maintain PTSD 9.2 How to Do Cognitive Therapy for PTSD 9.2.1 Theory-Informed Individual Case Formulation 9.2.2 Therapeutic Style 9.2.3 Individual Case Formulation and Treatment Rationale 9.2.4 Modifying Excessively Negative Appraisals of the Trauma and Its Sequelae 9.2.4.1 Reclaiming or Rebuilding Your Life Assignments 9.2.4.2 Changing Meanings of Trauma by Updating Trauma Memories 9.2.4.3 Changing Appraisals of Trauma Sequelae 9.2.5 Memory Work to Reduce Reexperiencing 9.2.5.1 Imaginal Reliving and Narrative Writing 9.2.5.2 Identification and Discrimination of Triggers of Reexperiencing Symptoms 9.2.5.3 Site Visit 9.2.5.4 Imagery Work 9.2.6 Dropping Unhelpful Behaviors and Cognitive Strategies 9.2.7 Ending Therapy: Blueprint 9.2.8 Flexible Order of Interventions 9.2.9 Considerations for Remote Delivery of CT-PTSD 9.2.10 Duration of Treatment 9.3 Special Challenges 9.3.1 Comorbidity 9.3.2 Dissociation 9.3.3 Multiple Trauma 9.3.4 Physical Problems 9.4 Evaluations of Cognitive Therapy for PTSD References 10: Cognitive Processing Therapy 10.1 Theoretical Underpinnings 10.2 Clinical Description of CPT 10.3 Special Challenges 10.4 Empirical Support References 11: EMDR Therapy for Trauma-Related Disorders 11.1 The Adaptive Information Processing (AIP) Model 11.1.1 Mechanisms of Action from an AIP Perspective 11.2 Treatment Overview 11.3 Single Trauma 11.4 Developmental Trauma 11.5 Clinical Challenges 11.5.1 Children and Adolescents 11.5.2 Complex PTSD 11.5.3 Addictions 11.5.4 Military Personnel 11.6 Research 11.6.1 Research on EMDR’s Efficacy for PTSD in Adults 11.6.2 Research on EMDR’s Efficacy for PTSD in Children and Adolescents 11.6.3 Research on EMDR’s Efficacy for Treatment of Recent Trauma 11.6.4 Research on EMDR’s Efficacy for Depression 11.6.5 Research on EMDR’s Efficacy in the Treatment of Pain 11.7 Research on the Effects of Eye Movements References 12: Narrative Exposure Therapy (NET): Reorganizing Memories of Traumatic Stress, Fear, and Violence 12.1 The Theoretical Basis of NET: Trauma-Related Disorders Are Disorders of Associative Memory 12.1.1 The Structure of Traumatic Memories 12.1.2 The Building Block Effect of Traumatic Load for Trauma-Related Mental Illness 12.2 The Rationale and Logic of NET 12.3 NET Step by Step 12.3.1 Session 1: Diagnosis and Psychoeducation 12.3.2 Session 2: The Lifeline Exercise 12.3.3 Session 3: The Narration 12.3.4 Session 4 and Subsequent Sessions: Completing the Narration 12.3.5 Cognitive Restructuring and the Days After 12.3.6 Final Session of the NET Module 12.3.7 Follow-Up Period 12.3.8 Overview of the Therapeutic Elements of NET 12.4 NET as an Evidence-Based Treatment 12.5 Challenges 12.6 Conclusion References 13: Brief Eclectic Psychotherapy for PTSD 13.1 Introduction 13.2 Theoretical Underpinnings of BEPP 13.2.1 Acceptance of Emotions 13.2.2 Understanding the Meaning of Emotions 13.2.3 Facing the Often Horrific Reality of the Trauma 13.3 BEPP Protocol 13.3.1 First Session: Psychoeducation 13.3.2 Sessions 2–6: Imaginal Exposure 13.3.3 Mementos and Letter Writing 13.3.4 Sessions 7–15: Finding Meaning and Integration 13.3.5 Session 16: Farewell 13.4 Special Challenges 13.4.1 Choice of Trauma for Imaginal Exposure 13.4.2 Understanding the Rationale Is Vital 13.4.3 Avoidance of Writing 13.4.4 Therapist Skills 13.5 BEPP in Different Populations 13.5.1 Brief Eclectic Psychotherapy for Traumatic Grief (BEP-TG) 13.5.2 Brief Eclectic Psychotherapy for Moral Trauma (BEP-MT) 13.6 BEPP Research 13.6.1 BEPP in the Police Force 13.6.2 BEPP in General Outpatient Populations 13.6.3 Neurobiological Research 13.7 Conclusion References 14: STAIR Narrative Therapy 14.1 Introduction 14.2 Theoretical Underpinnings: A Resource Loss Model of Trauma Recovery 14.3 Description of the Protocol 14.4 Case Description 14.4.1 History and Symptoms/Commitment to the Treatment (Session 1) 14.4.2 History of Emotional Expression (Session 2) 14.4.3 Emotional Regulation and Tailoring of Coping Skills (Sessions 3–4) 14.4.3.1 Flexibility in Ordering of Emotion Regulation Interventions 14.4.3.2 Emotion Regulation Through the Cognitive Channel 14.4.3.3 Emotion Regulation Through the Body Channel Focus on Naming Feelings Focus on Experiencing Feelings 14.4.3.4 Emotion Regulation Through the Behavior Channel 14.4.4 Interpersonal Models (Sessions 5–8) 14.4.5 Role-Playing (Sessions 5–8) 14.4.6 Change in Core Relationship Models 14.4.7 Narrative Therapy (Sessions 9–16) 14.5 Challenges to Implementing STAIR Narrative Therapy 14.6 Research 14.6.1 STAIR Narrative Therapy Randomized Controlled Trials 14.6.2 STAIR Narrative Therapy Open Trial for 9/11 Survivors 14.6.3 STAIR Alone: RCT, Comparison, and Open Trials 14.6.4 Summary Remarks References 15: Prolonged Grief Disorder Therapy (PGDT) 15.1 Theoretical Underpinnings 15.2 How to Conduct PGDT 15.2.1 Pretreatment Assessment 15.2.2 Sessions 1–3: Getting Started 15.2.3 Core Revisiting Sequence 15.2.4 Midcourse Review and Closing Sequence 15.3 Challenges in Implementing PGDT 15.4 Our Treatment Research References 16: Innovative Interventions to Improve Global Mental Health 16.1 Introduction 16.2 Mental Health Problems Around the World 16.3 Mental Health in Children 16.4 The Nature of Posttraumatic Mental Health in Humanitarian Crises 16.5 Risk Factors 16.6 Mechanisms of Global Mental Health 16.6.1 Role of Appraisals 16.6.2 Moral Injury 16.6.3 Information Processing 16.7 Treating Mental Health Conditions in Low- and Middle-Income Countries 16.8 The Development of Task-Shifting Paradigms 16.9 Transdiagnostic Treatments 16.10 Challenges for Global Mental Health 16.10.1 Recognizing the Importance of Culture 16.10.2 Treatment Non-response 16.10.3 The Need for Economic Benefits 16.11 Concluding Comment References Part IV: Treating Comorbidities 17: Trauma and Addiction: A Clinician’s Guide to Treatment 17.1 Introduction 17.2 Various Models 17.3 Major Findings 17.4 Recommendations for Practice 17.5 Future Developments 17.6 Case Example 17.7 Closing References 18: Treating PTSD and Borderline Personality Disorder 18.1 Treatment Approaches for Co-occurring PTSD and Borderline Personality Disorder 18.1.1 Single-Diagnosis Treatments 18.1.1.1 Cognitive Processing Therapy (CPT) 18.1.1.2 Prolonged Exposure (PE) 18.1.2 Parallel Treatments 18.1.2.1 Cognitive Behavioral Therapy for PTSD and Severe Mental Illness (CBT for PTSD) 18.1.3 Phase-Based Treatments 18.1.3.1 Dialectical Behavior Therapy for PTSD (DBT-PTSD) 18.1.4 Integrated Treatments 18.1.4.1 Dialectical Behavior Therapy (DBT) 18.1.4.2 DBT with the DBT Prolonged Exposure Protocol (DBT+DBT PE) 18.1.5 Summary 18.2 Special Challenges 18.2.1 Suicide and Self-Injury 18.2.2 Emotion Dysregulation 18.2.3 Dissociation 18.3 Case Example 18.3.1 Identifying Information and Relevant History 18.3.2 Treatment Process 18.3.2.1 DBT 18.3.2.2 The DBT PE Protocol 18.3.2.3 DBT After the DBT PE Protocol 18.4 Future Directions References 19: The Complexity of Chronic Pain in Traumatized People: Diagnostic and Therapeutic Challenges 19.1 Chronic Pain and Trauma 19.2 Relationship of Chronic Pain and PTSD 19.3 Neurobiology of Chronic Pain in Traumatized People 19.3.1 Neuronal Pain Sensitization Mechanisms 19.3.2 Imprinting as a Factor of Pain Chronification 19.3.3 Synergisms Between Pain System and the Anxiety System 19.3.4 Pain-Numbing Mechanisms 19.4 Diagnosis and Differential Diagnosis of Pain in PTSD 19.5 Treatment for Comorbid PTSD and Chronic Pain 19.6 Case Report 19.7 Conclusion References Part V: Treating Special Populations 20: Evidence-Based Treatments for Children and Adolescents 20.1 Introduction/Background 20.1.1 Epidemiology of Trauma and Trauma-Related Disorders in Children and Adolescents 20.1.2 Assessment of Child Trauma and Validity of Diagnostic Criteria for Children 20.1.2.1 Diagnostic Issues 20.2 Early Intervention: Treatment of Acute Stress and Prevention of PTSD 20.2.1 Rationale 20.2.2 Intervention Programmes and Components 20.2.3 State of Evidence 20.2.4 Current Recommendations 20.3 Treatment of PTSD and Other Trauma-Related Disorders 20.3.1 Fundamentals of Therapy 20.3.2 Cognitive-Behavioural Therapy 20.3.2.1 Background 20.3.2.2 Procedure/Components 20.3.2.3 Evidence 20.3.3 Eye Movement Desensitisation and Reprocessing (EMDR) 20.3.3.1 Background 20.3.3.2 Procedure/Components 20.3.3.3 Evidence 20.3.4 Psychodynamic Therapy 20.3.4.1 Background 20.3.4.2 Procedure/Components 20.3.4.3 Evidence 20.3.5 School-Based Interventions 20.3.5.1 Background 20.3.5.2 Procedure and Components 20.3.5.3 Evidence 20.3.6 Pharmacological Treatment 20.3.6.1 Background 20.3.6.2 Procedure 20.3.6.3 Evidence 20.3.7 Young Children 20.4 Summary and Conclusion References 21: Treating PTSD Symptoms in Older Adults 21.1 PTSD in Older Populations 21.2 Physical, Mental, and Social Aspects of Aging: Describing the Target Group 21.3 Psychotherapy with the Aging Client 21.4 Guidelines for Psychotherapy with Older Adults 21.5 Treating PTSD Symptoms in Older People 21.5.1 Mindfulness-Based Cognitive Therapy 21.6 Advice to Clinicians Working with Older People with PTSD Symptoms References 22: Treatment of Traumatized Refugees and Immigrants 22.1 Introduction 22.2 Clinical Challenges 22.2.1 Severity of Trauma, Shattered Assumptions, Loss of Self-Sameness 22.2.2 Physical Disabilities and Complaints 22.2.3 Insecure Residency Permit Status 22.2.4 Cultural and Social Uprooting 22.2.5 Survivor’s Guilt, Perpetrator’s Guilt, Moral Injury 22.2.6 Peer-Based Approaches 22.2.7 Summary and Recommendations References 23: Considerations in the Treatment of Veterans with Posttraumatic Stress Disorder 23.1 Introduction 23.2 Military Culture and Context 23.3 Combat Service 23.3.1 Grief and Loss 23.3.2 Moral Injury 23.3.3 Considerations for Treatment 23.4 Military Sexual Harassment and Assault 23.4.1 Prevalence 23.4.2 Mental Health Consequences 23.4.3 Considerations for Treatment 23.5 LGBTQ+ Identity and Minority Stress 23.6 Summary and General Treatment Considerations 23.6.1 Barriers to Seeking Mental Health Care 23.6.2 Assessment and Treatment 23.6.3 Online Resources References Part VI: Special Treatment Modalities 24: Group Treatment for Trauma-Related Psychological Disorders 24.1 History of Studying Group Treatment for Trauma Survivors 24.2 Efficacy of Group Treatment for Trauma-Based Psychological Symptoms 24.2.1 Trauma-Focused Group Treatment 24.2.2 Non-trauma-Focused Group Treatment Approaches 24.3 Considerations for Different Trauma Populations and Different Settings 24.4 Methodological Considerations for Group Therapy Studies 24.5 Comorbid Conditions and Individual Characteristics 24.6 Benefits of Group Treatment 24.7 Considerations for Group Treatment 24.8 Summary References 25: Couple Treatment for Posttraumatic Stress Disorder 25.1 Conceptualizing Partner Involvement in Treatment 25.2 Evidence Supporting Couple Treatments for PTSD 25.2.1 Disorder-Specific Couple Therapy 25.2.1.1 Cognitive-Behavioral Conjoint Therapy for PTSD 25.2.1.2 Structured Approach Therapy 25.2.1.3 Emotionally Focused Couple Therapy for Trauma 25.2.1.4 Couple Treatment for Addiction and PTSD 25.2.2 Partner-Assisted Interventions 25.2.2.1 Lifestyle Management Course 25.2.3 Generic Couple Therapy 25.2.3.1 Behavioral Couple/Family Therapy 25.2.3.2 K’oach Program 25.2.4 Education and Family-Facilitated Engagement 25.2.4.1 Support and Family Education Program 25.2.4.2 Reaching Out to Educate and Assist Caring, Healthy Families Program 25.2.4.3 Coaching into Care Program 25.2.4.4 PTSD Family Education 25.3 Discussion References 26: Telemental Health Approaches for Trauma Survivors 26.1 Introduction 26.2 Telemental Health (TMH) 26.3 TMH and Trauma 26.4 Examples of TMH Approaches Applied to Trauma Populations 26.4.1 Clinical Video-Teleconferencing (CVT) 26.4.2 Web-Based Interventions 26.4.3 mHealth 26.5 Conclusion and Future Directions References Part VII: Pharmacotherapy 27: Pharmacological Treatment for Trauma-Related Psychological Disorders 27.1 Introduction 27.2 The Evidence 27.2.1 Results of Meta-Analyses 27.2.2 Key Points for Interpretation 27.3 Treatment Guidelines for PTSD 27.4 Pharmacological Prescribing for PTSD in Clinical Practice 27.4.1 Using the Algorithm 27.4.1.1 Algorithm Notes 27.4.1.2 Common Adverse Effects 27.5 Summary References Part VIII: Conclusions 28: Next Steps: Building a Science for Improving Outcomes 28.1 Overview 28.2 Progress in Treatment Development 28.3 History of Inconsistent Findings Regarding Predictors of Response 28.3.1 Patient Profiles as Predictors of Response across Treatments 28.3.2 Patient Profiles as Predictors of Differential Treatment Outcomes 28.4 Common Factors: Therapeutic Alliance 28.4.1 Patient-Therapist Matching 28.5 Flexible Delivery and Sequencing of Treatment Components 28.6 Expanding Attention to a Range of Outcomes: Functional Impairment 28.7 The Potential of Machine Learning 28.8 Summary References