Summary
Contents
Subject index
Trauma: Contemporary Directions in Theory, Practice, and Research is a comprehensive text on trauma, including such phenomena as sexual abuse, childhood trauma, PTSD, terrorism, natural disasters, cultural trauma, school shootings, and combat trauma. Addressing multiple theoretical systems and how each system conceptualizes trauma, the book offers valuable information about therapeutic process dimensions and the use of specialized methods and clinical techniques in trauma work, with an emphasis on how trauma treatment may affect the clinician. Intended for courses in clinical practice and psychopathology, the book may also be useful as a graduate-level text in the allied mental health professions.
Cognitive-Behavioral Theory
Cognitive-Behavioral Theory
Cognitive-behavioral therapy (CBT) approaches are rooted in the fundamental principle that an individual's cognitions play a significant and primary role in the development and maintenance of emotional and behavioral responses to life situations. In CBT models, cognitive processes, in the form of meanings, judgments, appraisals, and assumptions associated with specific life events, are the primary determinants of one's feelings and actions in response to life events and thus either facilitate or hinder the process of adaptation. CBT includes a range of approaches that have been shown to be efficacious in treating posttraumatic stress disorder (PTSD). In this chapter, we present an overview of leading cognitive-behavioral approaches used in the treatment of PTSD. The treatment approaches discussed here include cognitive therapy/reframing, exposure therapies (prolonged exposure [PE] and virtual reality exposure [VRE]), stress inoculation training (SIT), eye movement desensitization and reprocessing (EMDR), and Briere's self-trauma model (1992, 1996, 2002). In our discussion of each of these approaches, we include a description of the key assumptions that frame the particular approach and the main strategies associated with the treatment. In the final section of this chapter, we review the growing body of research that has evaluated the effectiveness of cognitive-behavioral treatments for PTSD.
CBT
Three fundamental assumptions underscore cognitive-behavioral models of treatment (D. Dobson & Dobson, 2009; K. Dobson & Dozois, 2001). The first assumption is that cognitive processes and content are accessible and can be known. Although in many instances specific thoughts or beliefs may not be in one's immediate awareness, with proper training and practice individuals can become aware of them. The second key assumption is that our thinking mediates the way that we respond to environmental cues. From this perspective, people do not just react emotionally or behaviorally to life events. Instead, CBT holds that the way we think about our reality is central to how we react to that reality. The third fundamental assumption of CBT is that such cognitions can be intentionally targeted, modified, and changed. Consequently, when such cognitions are changed in the direction of more rational, realistic, and balanced thinking, the individual's symptoms will be relieved, and the person will have increased adaptability and functionality. This change can occur as a result of the individual's working alone, perhaps with the use of self-help material, or through engagement with a trained practitioner in one of the various CBT approaches.
CBT and PTSD
Traditionally, CBT approaches to treatment of PTSD have been driven by two broad theoretical orientations that aim to explain the way fear is developed and processed. These orientations are learning theory (Mowrer, 1960; Wolpe, 1990) and emotional-processing theory (Clark & Ehlers, 2004; Ehlers & Clark, 2000; Foa & Kozak, 1986; Foa, Steketee, & Rothbaum, 1989; Hembree & Foa, 2004; Rachman, 1980).
Learning Theories
Learning theories are most often associated with behavioral approaches that focus on modifying behavior by manipulating environmental cues (i.e., antecedents or reinforcers). Learning theories have focused on explaining how the mechanisms of fear and avoidance of the traumatic memory associated with PTSD are conditioned, activated, and reinforced. From this perspective, unhealthy fears may develop from a single traumatic episode or from exposure to a series of unpleasant events (Wolpe, 1990). Fears can be acquired on the basis of association through classical conditioning, or they can be learned vicariously through the process of observation (Bandura, 1977, 1986). That is, a person may learn to react with fear by observing others’ fearful reactions to specific objects or events.
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