Trauma Management Therapy

Description of Strategy

A trauma is defined as an event consisting of actual or threatened death or serious injury, or a threat to the physical integrity of self or others. In addition, the response to the event involves intense fear, helplessness, or horror. Following traumatic life events, individuals exhibit a range of reactions. Many people recover naturally and do not need psychological or psychiatric intervention. For a variety of reasons, other individuals may experience trauma-related responses, marked by psychological distress or some impairment in functioning. Posttraumatic stress disorder (PTSD) and acute stress disorder (ASD) are two diagnoses that describe symptom patterns shown by some individuals following traumatic life events. Studies reveal variable findings for the percentage of individuals who develop PTSD after experiencing a trauma, with the highest rates found for events such as rape, combat, and child abuse. The prevalence of ASD has also been found to vary and depends on the severity and duration of the trauma as well as the degree of exposure to the trauma.

For a diagnosis of PTSD to be appropriate, individuals must first experience, witness, or be confronted with a trauma. Individuals with PTSD experience at least one type of reexperiencing symptom (e.g., intrusive, distressing recollections of the trauma, distressing dreams about the trauma, feeling as if the traumatic event were recurring); at least three types of avoidance symptoms (e.g., avoiding thoughts or feelings associated with the trauma, inability to recall important aspects of the trauma, feelings of detachment from others); and at least two kinds of arousal symptoms (e.g., sleep problems, irritability/anger, difficulty concentrating). These symptoms must be experienced repeatedly, cause distress, and last for at least 1 month for an individual to be diagnosed with PTSD.

Like PTSD, a diagnosis of ASD also includes reexperiencing, avoidance, and arousal symptoms following a traumatic life event. A main difference between ASD and PTSD is that ASD lasts a minimum of 2 days and a maximum of 4 weeks and must occur within 4 weeks of the traumatic event. In addition, individuals with ASD experience three or more kinds of dissociative symptoms during or after the trauma. These include a sense of numbing or detachment, a reduction in the awareness of one's surroundings, an inability to recall important aspects of the trauma, and feelings of unreality regarding one's self or the traumatic situation. Trauma survivors with ASD are at increased risk of developing PTSD.

Of the trauma-focused therapies, many of the cognitive-behavioral therapies have been outlined in detail and have been most thoroughly researched to date. These therapies all utilize some form of exposure-based and cognitive-based interventions. Exposure-based interventions may consist of vividly imagining and describing the traumatic event (imaginal exposure), writing about the event in detail, or actually going to places or performing activities that have been [Page 597]avoided due to anxiety (in vivo exposure). The general rationale for the exposure components of the interventions is to break (or reduce) the connection between stimuli that do not represent realistic threats (e.g., memories of the trauma, nondangerous reminders of the trauma) and the emotional responses they provoke. When clients no longer associate certain thoughts or situations with fear, their avoidance of these cues is typically reduced. Exposure also serves to facilitate the process of recalling and accepting traumatic events.

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