Treatment
Conventional therapy for
PTSD typically spans several years and involves both individual and group
therapy. Of the many varieties of therapy available for PTSD, almost
all emphasize exposure to the frightening stimulus. This is a common
treatment among many anxiety disorders.
The four most common
treatments for PTSD include psychodynamic theory (Foa, Rothbaum, &
Molnar, 1995), cognitive-behavior therapy (Foa, et al. 1995), pharmacotherapy
(Friedman & Southwick, 1995), and group therapy (Foa, et al., 1995).
There is alos the controversial eye-movement desensitization and reproccessing
therapy (EMDR) (Shapiro, 1989). Because of the unique involvement
of the trauma in the etiology of the disorder, therapists generally agree
that therapy can be divided into three phases (Friedman, 1996):
-
establishing trust, safety,
and "earning a right to gain access" to carefully guarded traumatic material
(Lindy, 1993).
-
trauma-focused therapy,
exploring traumatic material in depth, titrating intrusive recollections
with avoidant/numbing symptoms (Horowitz, 1986).
-
helping the patient disconnect
from the trauma and reconnect with family, friends , and society.
Psychodynamic Therapy
Psychodynamic psychotherapy
focuses on the traumatic event. The patient recounts the event to
a caring, empathetic listener (the therpaist). This helps the patient
develop more intense emotions (Marmar, Weiss, & Pynoos, 1995).
The therapist helps the patient identify current life situaions that exacerbate
PTSD symptoms.
Cognitive-Behavioral Therapy
The two cognitive-behavioral
approaches include exposure therapy and cognitive-behavior therapy.
Exposure therapy employs techniqies such as systematic desensitizaion and
imaginal flooding. It should be noted that, due to the nature of
the trauma in PTSD, in-vivo flooding is never used. Cognitive-behavioral
therapy includes techniques designed to manage anxiety. These include
relaxation training, stress inoculation training, cognitive restructuring,
breathing retraining, biofeedback, social skills training, and distraction
techniques (Fairbank, De Good, & Jenkins, 1981; Foa, et al., 1995;
Hyer, 1994; Muse, 1986).
Pharmacotherapy
Practically speaking, the
use of drugs in PTSD treatment can be very effective for symptomatic relief
of anxiety, depression, and insomnia (Friedman, 1991; Murburg, 1994; Southwick,
Krystal, Johnson, et al., 1992). Improvement has been achieved with
imipramine, amitriptyline, phenelzine, fluoxetine (Prozac), and propranolol
(Inderal). Southwick, et al. (1992) found that tricyclic antidepressants
and monoamine oxidase inhibitors are generally helpful in PTSD patients,
especially with regard to intrusion and avoidant symptoms. Fluoxetine
and amitriptyline have also shown efficacy against avoidant symptoms (Davidson,
Kudler, Smith, et al., 1990; Fesler, 1991; Van der Kolk, Dryfus, Michaels,
et al., 1994).
While no single drug
has emerged as a treatment for the actual post-traumatic disorder, drug
therapies are clearly useful for the relief of overwhelming symptoms.
The alleviation of these symptoms may make it possible for the client to
participate in individual and/or group therapy.
Group Therapy
Group therapy sessions
(often called "rap groups") developed following the Vietnam War in response
to pressure from the American Civil Liberties Union and Veterans-rights
organizations. They typically employ many of hte same techniques
as exposure therapy. These groups provide mutual support from others
who have experienced similar traumas and encourage the patient to begin
confronting their traumas (Davidson & Neale, 1998).
Eye-Movement Desensitization
and Reprocessing (EMDR)
Shapiro (1989) has developed
a controversial treatment for PTSD called eye-movement desensitization
and reprocessing (EMDR). In EMDR the patient is instructed to imagine
a painful traumatic memory while visually focusing on the rapid movements
of the therapist's finger. Shapiro believes that such saccadic eye
movements reprogram brain function so that the emotional impact of the
trauma can finally be integrated. Many have suggested that EMDR is
really exposure therapy and that the saccadic movements are irrelevant
(Pitman, Orr, Altman, et al., 1993). Currently, there is little well-controlled
empirical support for EMDR.
à
to "Prognosis"
to see the projected outcome of treatment
Next
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Questions?
E-mail the author: Gregory
Bayse
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