Center for Cognitive Therapy
Mark E. Oakley, Ph. D.
POSTTRAUMATIC STRESS DISORDER
The most recent scientific evidence suggests that many of the symptoms a person experiences for the first month after a trauma are normal. These symptoms can include sleep disturbance, decreased concentration, anxiety, sadness, anger, irritability, hypervigilence, re-experiencing of traumatic events, and disruptions in social and work related functioning.
In the first four weeks following a trauma, psychological interventions should be limited to "first aid" type treatments. These efforts may include encouraging the traumatized individual to contact those people who might provide a normal source of support and comfort in their life and to facilitate contact with loved ones, nearby and far away. Any discussion of the trauma in the initial four weeks should include only what the individual wants to talk about.
Symptoms that persist beyond four weeks following a trauma and that may be indicative of a posttraumatic stress disorder are as follows:
- Recurrent and intrusive recollections of trauma.
- Recurrent distressing dreams of the trauma.
- Acting or feeling as if the trauma is recurring.
- Intense psychological distress and/or physiological reactivity upon exposure to cues that resemble the traumatic event.
- Efforts to avoid anything associated with the trauma.
- Markedly diminished interest or participation in significant activities.
- Feelings of detachment or estrangement from others.
- Difficulty falling or staying asleep.
- Irritability or anger
- Exaggerated startle responses
Exposure therapy and cognitive therapy are two recommended therapies considered effective for PTSD. Exposure therapy for PTSD involves a gradual and graded confrontation of images and situations associated with the trauma that are avoided because of the anxiety they elicit. Recent research establishing the importance of cognitive factors in the development and persistence of PTSD support Cognitive Therapy approaches for PTSD that test beliefs about the long term effects of the trauma and that help the person to organize and complete their memory of the trauma. (Ehlers & Clark, 2000.) These procedures appear to help individuals with PTSD to process and appraise the traumatic experience in a more integrated and less distressing manner.
For individuals who have experienced a single traumatic event, the typical course of treatment involves 15 to 20 weekly sessions. Most of these sessions are 45 to 50 minutes in length, although some may be 90 minutes in length.