Therapist's Guide to Posttraumatic Stress Disorder Intervention

✍ Scribed by Sharon L. Johnson

• Publisher: Academic Press
• Year: 2009
• Tongue: English
• Leaves: 353
• Series: Practical Resources for the Mental Health Professional
• Edition: 1
• Category: Library

✦ Synopsis

Sharon Johnson is the author of the best selling Therapist's Guide to Clinical Intervention now in its second edition. In this new book on PTSD, she lends her practical outline format to understanding PTSD assessment, treatment planning, and intervention. The book begins with a summary information on PTSD definition, and prevalence, assessment, and the evidence basis behind different treatment options. The book offers adjunctive skill building resources to supplement traditional therapy choices as well as forms for use in clinical practice. This clinician's guide to diagnosing and treating PTSD is written in a concise format with much of the material in outline or bullet point format, allowing easy understanding of complex material for the busy therapist. The book includes a definition of the disorder, diagnostic criteria, the neurobiology of the disorder, tools and information for diagnosing clients, information on functional impairment, interventions, treatment planning, skill building, and additional clinician resources. * Outlines treatment goals and objectives for DSM-IV PTSD diagnosis * Discusses interventions and the evidence basis for each * Offers skill building resources to supplement treatment * Provides business and clinical forms for use with PTSD patients

✦ Table of Contents

Cover Page
......Page 1
Copyright Page......Page 2
Introduction......Page 3
Biopsychosocial Aspects and Diagnosis of PTSD......Page 6
Assessing and Diagnosing Posttraumatic Stress Disorder......Page 7
Category B: Persistent Re-Experiencing of the Traumatic Event (at Least One Symptom)......Page 10
Category C: Emotional Numbing and Avoidance......Page 11
Category D: Hyperarousal......Page 12
Subthreshold PTSD......Page 13
Common Reactions to Traumatic Experiences......Page 15
The Effects of Traumatic Stress on the Body and the Mind......Page 16
Depression......Page 17
Multiaxial Diagnosis......Page 18
Definition......Page 19
Somatic Memory......Page 20
Dimensions of Pain......Page 21
Defining Traumatic Memory......Page 22
Prevalence/Frequency......Page 23
Probability of Developing PTSD Risk......Page 25
Age......Page 28
Gender......Page 29
Gender Differences in PTSD for Military Service Personnel......Page 31
Ethnic and Cross-Cultural Factors......Page 32
Aggressive Behavior......Page 33
Psychiatric Risks Associated with PTSD......Page 34
Personal Variables......Page 35
Occupational Factors......Page 36
Comorbidity......Page 37
Complications of Treatment Associated with Axis II Diagnoses......Page 39
A Special Case of Comorbidity......Page 41
Functional Impairment of PTSD......Page 45
Profile of Impaired Functioning......Page 46
Functional Impairment as a Consequence of Chronic Domestic Trauma......Page 48
Codependency and Safety......Page 50
The Case of Comorbid PTSD and BPD?......Page 51
Recovery......Page 52
Detection of Malingered PTSD......Page 53
The Clinical Interview......Page 55
Brief Screening Scale for PTSD (Adapted from Kimerling et al., 2006)......Page 57
Part A......Page 58
Part B......Page 60
Part C Substance Abuse Assessment......Page 61
Other Assessment Instruments......Page 62
Posttraumatic Stress Diagnostic Scale (PDS)......Page 63
References and Further Reading......Page 64
Defining the Stress System......Page 74
Interactions Between the Nervous and Immune Systems......Page 76
The Anatomy of the HPA Axis......Page 78
HPA Function......Page 79
Factors Regulating the HPA Axis......Page 82
Pathology of Stress......Page 83
Neuroactive Steroids......Page 84
Genetic Variations......Page 88
Neuroimaging......Page 89
HPA Axis Dysregulation......Page 91
Hippocampal Changes Associated with PTSD......Page 92
Relationship between PTSD and Borderline Personality Disorder......Page 93
Neurobiological Pathways in Response to Stress......Page 94
Locus Coeruleus and Norepinephrine......Page 96
PTSD, Hormonal Levels and Brain Structures......Page 98
Memory......Page 99
Serotonergic System......Page 100
Humoral Immunity......Page 103
Functional Trauma Response......Page 104
Psychobiological Mechanisms of Vulnerability and Resilience......Page 105
Vulnerability......Page 108
Resilience......Page 111
Hardiness......Page 112
Building Psychological Resilience......Page 113
Fear Conditioning......Page 114
Distinguishing Anxiety and Fear......Page 115
References and Further Reading......Page 116
Treatment......Page 126
Transtheoretical and Multimodal Interventions......Page 127
Stages of Treatment for PTSD......Page 128
Creating a Safe and Secure Environment......Page 129
Difficulties and Challenges with this Population......Page 130
Psychotherapeutic Interventions......Page 131
Cognitive Behavioral Therapy......Page 132
Dialectical Behavioral Therapy......Page 133
Trauma Counseling......Page 134
Exposure Therapy......Page 135
Anxiety Management......Page 136
Dual Awareness......Page 137
Stress Inoculation Therapy (SIT)......Page 138
Phase 2: Skills Acquisition, Consolidation, and Rehearsal......Page 139
Phase 3: Application Training......Page 140
Psychodynamic Therapy......Page 141
Problem-Focused Psychosocial Adjunctive Service......Page 142
Eye Movement Desensitization and Reprocessing......Page 143
Somatic Treatment......Page 146
Somatic Treatment Techniques......Page 147
Body Awareness and Boundary Exercises......Page 148
Grounding Techniques......Page 150
Pharmacological Treatments......Page 152
Integrative Treatment......Page 153
Group Therapy......Page 154
Critical Incident Stress Debriefing/Psychological Debriefing......Page 155
Additional Information about Group Therapy......Page 156
Conjoint/Family Therapy (When Appropriate)......Page 158
Pharmacological Treatments......Page 159
Pharmacologic Recommendation......Page 160
Hypnosis......Page 162
Body Work......Page 163
Shiatsu......Page 164
References and Further Reading......Page 165
Treatment Planning......Page 172
First-Line Interventions......Page 173
Individual Internal and External Resources......Page 174
Basic Treatment Planning......Page 175
Sanctuary Trauma......Page 177
Hospitalization Contraindicated......Page 178
Psychosocial Rehabilitation......Page 179
Psychosocial Functioning......Page 180
Independent Living Environment......Page 181
Case Management......Page 182
Treatment Plan: Symptom Review......Page 183
Safety and Stabilization......Page 185
Risk Factors to Consider During Assessment......Page 187
Treatment Focus and Objectives......Page 188
Risk Factors to Consider During Assessment......Page 190
Treatment Planning: Goals, Objectives, and Interventions......Page 191
Safety......Page 192
Challenging Guilt......Page 193
Flashbacks......Page 194
Resolving Unfinished Business......Page 195
Family Education (When Appropriate)......Page 196
Decrease Avoidance......Page 197
Improve Coping......Page 198
Managing Anxiety......Page 199
Emotionally Reconnecting......Page 200
Hyperarousal (Physiological Reactivity)......Page 201
Decrease or Eliminate Sleep Disturbance (Difficulty Falling or Staying Asleep)......Page 202
Decreased Distractibility......Page 203
Improved Anxiety Management......Page 204
Improve Family Functioning......Page 205
Decrease Or Eliminate Sensory/Perceptual Distortions......Page 206
Improved Stress Management......Page 207
Depression......Page 208
Referral Assessment for Medication Evaluation......Page 209
Development or Utilization of Resources and Social Supports......Page 210
Cognitive Restructuring......Page 211
Educate Patient (and Family if Appropriate) on Medication Issues......Page 212
Increased Awareness of Feelings of Anxiety and Fear......Page 214
Improve Coping......Page 215
Cognitive Restructuring......Page 216
Improve Self-Esteem......Page 217
General Side-Effects of Medication......Page 218
Emotional Reactions......Page 219
Physical Reactions......Page 220
Coping With Triggers......Page 221
Stress Management/Stress Inoculation......Page 222
Goals Used in the Development of Stress Management Skills......Page 223
Anger......Page 224
Managing Anger......Page 225
Goals Used in the Development of Anger Management Skills......Page 226
Additional Considerations......Page 227
Eliminate Danger to Others......Page 228
Improve Coping Skills......Page 229
Identify Communication Style......Page 230
Communication of Difficult Feelings......Page 231
Thorough Assessment for Referral and Treatment......Page 232
Improved Self-Control......Page 233
Improved Communication......Page 234
Improved Family Interaction......Page 235
Reconnection......Page 236
Relationships......Page 237
Pharmacological Interventions......Page 238
Compliance......Page 239
Stage 1: Stabilization and Safety......Page 240
Dohrenwend et al. (2008)......Page 241
Consequences......Page 242
First Responders (Law Enforcement, Firefighters, etc.)......Page 243
Severe Motor Vehicle Accident......Page 244
References and Further Reading......Page 246
Skill Building......Page 251
Feeling Safe and Secure......Page 252
Safety and Emotional Numbing......Page 253
Understanding Where You are at......Page 254
Creating Your Own Safe Place......Page 255
Journaling......Page 256
Defining What Does and Doesn’t Work......Page 257
How Does Exposure Therapy Work?......Page 258
Writing About Your Experience......Page 259
Getting Started......Page 260
Planning Goals......Page 262
Do You Have PTSD?......Page 263
Writing an Outline of the Trauma......Page 265
Developing a Trauma Time Line......Page 266
Common PTSD Thoughts......Page 267
Chronic Pain as Part of Recurring Trauma......Page 268
Understanding and Managing Flashbacks......Page 269
Questions Exploring the Experience of Flashbacks......Page 270
Managing Self-Talk......Page 271
Realistic Self-Talk......Page 272
Positive Self-Talk = Cognitive Restructuring......Page 273
Rational Self-Talk and Difficult Anniversaries......Page 274
Avoidance......Page 276
Talking Yourself Through Fear......Page 277
Finding Meaning: Beginning to Understand......Page 278
Managing Flashbacks and Triggers......Page 279
Warning Signs of Stress......Page 280
Relaxation Techniques......Page 281
Characteristics of a Supportive Relationship......Page 285
Dealing with One Trigger at a Time: Safely Exposing Yourself to the Past......Page 286
Trusting Yourself to Confront Triggers......Page 287
Self-Monitoring......Page 288
Challenging Avoidance: Facing the Problem......Page 289
Overcoming Dissociation......Page 291
Understanding Feeling in Control......Page 293
Dissociation and Three Modes of Memory......Page 294
Problem-Solving the Physical Symptoms of PTSD......Page 295
Management Choices; the way out of Depression......Page 296
Treatment for Panic Anxiety......Page 297
Be A.W.A.R.E.......Page 298
Getting to the Right State of Mind: the Wise Mind......Page 299
Identifying Your State of Mind......Page 300
Defense Mechanisms......Page 301
Guilt......Page 302
Bad Memories and Fear......Page 303
Mapping Autonomic Activity......Page 304
Beliefs About Power and Control......Page 306
Forgiveness and Self-Blame......Page 307
Impact of the Traumatic Event on Relationships......Page 308
Trust......Page 309
Intimacy Safety and Security......Page 311
Check Out Your Emotional Boundaries......Page 312
Affirming Healthy Boundaries......Page 313
Fun Goals......Page 314
Control Talk......Page 315
The Steps of Positive Assertiveness......Page 316
Saying “No”......Page 317
Dealing with Uncomfortable Emotions......Page 318
How You Present Yourself: Body Language......Page 319
Finding Meaning......Page 320
Habits for Success......Page 321
Commitment to Healing......Page 322
Guidelines for Completing Your First Step Toward Emotional Health......Page 323
Psychological Health......Page 324
Review of the Impact of the Trauma on Your Life......Page 325
Strengthening Resilience......Page 326
Normal Feelings/Emotions to Experience with a Crisis......Page 327
Physical and Mental Sensations......Page 328
What Helps......Page 329
The Habit Log......Page 330
Daily Recovery Schedule......Page 331
Helping Ways of Thinking and Doing......Page 332
Effective Coping......Page 334
Psychological First Aid for Coping with a Lapse......Page 335
Interrupting a Potential Relapse......Page 336
Practice......Page 337
Getting Unstuck......Page 338
Rest and Relaxation......Page 339
Sleep......Page 340
Coping with Disappointment......Page 341
Self-Confidence......Page 342
Self-Care Behaviors (Johnson, 2004)......Page 343
Resources and Further Reading......Page 344
B......Page 346
D......Page 347
H......Page 348
P......Page 349
S......Page 350
T......Page 352
Y......Page 353