Cognitive Behavioral Treatment of TraumaI. CBT - Cognitive Behavioral TherapyCognitive Cognition Thought Behavioral Behavior Therapy Treatment Of – Improving/Changing = Changing Thoughts And Behaviors II. Trauma effects - Why is it important to deal with thoughts: Guilt, Shame and Fear - Guilt/Shame “It was my fault” “I should have done something to stop it” “This only happens to bad people” Fear: “its going to happen again” “No one is trustworthy” “Life is scary” “I’m not safe” III. Cognitive Behavioral InterventionsA. Relaxation and Stress Management Techniques B. Psychoeducation C. Exposure – Direct Discussion of Traumatic Events D. Cognitive Restructuring – Reframing Attributions and Meaning A. Relaxation and Stress Management Techniques: 1. Feeling Identificationa) Feelings charts/faces b) Feelings cards c) Situation cards d) other e) other2. Breathing Exercises a) Shallow vs. abdominal, b) Slow vs. fast, c) Focus on entry/leaving points d) other e) other 3. Progressive Muscle Relaxation a) Muscle groups, tensing and relaxing, counting to 5 or 10 up and down b) Addition of imagery of happy place, music c) Audio tapes d) Young children – how you make body go to sleep at night, feel comfortable e) other f) other 4. Thought Stopping a) Rubber band on wrist b) ‘Rip picture up’ in mind c) Plan on certain time of day for minutes to think about it d) other e) other 5. Positive Thinking Strategies. a) Lists of people in their lives they can trust b) Lists of happy memories c) When felt strong, secure d) Safety plans e) Empowering future dreams, goals f) other g) other B. Psychoeducation 1. Goals: a) Normalize responses to traumatic events b) Reinforce accurate cognitions about the event 2. Steps: a) General information about the trauma b) Common emotional and behavioral responses to the trauma c) Client’s own responses, and positive coping d) Treatment plan and expectations of positive outcome C. Exposure – Direct discussion of traumatic events. 1. Goals: a) Desensitization b) Resolve avoidance symptoms c) Correction of distorted cognitions d) Model adaptive coping 2. Gradual Exposure – Steps: a) Start with least traumatic or most general aspect of the event b) Gentle invitations to tell what happened, and praise c) Later reviews of descriptions, allow more details d) Explore and correct cognitive distortions (next topic) D. Cognitive Restructuring – Reframing Attributions and Meaning; Cognitive Schemas 1. Re structuring or Re framing a Cognitive Schema a) Example – reinforcing the walls of a house so it stops cracking and holds up better. Still same house. b) Cognitive Schema – how I see the world - my House of Thoughts – changing my thoughts so I can still be me, but can have less anxiety when I confront a stressor i. Ex. My schema for tasks – I can think when I’m given a new task, “I don’t have time for this, I don’t know how I’ll get it done, I’m going to have to work late…” ii. My re-structured schema – “I have time to stop and look at all my tasks and reprioritize.” “I will get done what needs to get done”. iii. other examples: 2. Attributions and Meaning a) Attributions (ex. DV) i. Because I’m bad ii. Because I’m so worthless I have to be hit iii. Because this is the way that women are treated iv. Because life is for suffering v. other vi. othervii. Because sometimes bad things happen, and because the perpetrator chose to do it, and I didn’t know how to stop him b) Meanings i. This is the way that dad’s and mom’s act to each other ii. I am going to be like this if I get married when I grow up iii. Anger is scary and dangerous, and I should hold it in iv. other v. other vi. My parents did something wrong and I can get help if I need it 3. Correcting Distorted Cognitions a) Identify: Beliefs about why the trauma occurred, and Assumptions about meanings i. Self-concept ii. Beliefs about the world iii. Beliefs about other people iv. Beliefs about the future v. other b) RESPECT and EMPATHIZE c) Provide corrective information i. Suggest alternative explanations and interpretations d) Encourage re-framed/positive interpretations IV. Research (ref: Anthony Mannarino, PhD, Judith Cohen, MD, and Lucy Berliner, PhD. Center for Traumatic Stress in Children and Adolescents, MCP Hahnemann University School of Medicine, Allegheny General Hospital, Four Allegheny Center, Pittsburgh, PA 15212)
a. not requested by victims/witnesses, and one or two sessions only Why? This can often overstimulate victims, and circumvent their normal coping skills. |