Mar. 14th 2019 Advice / information

Treating post-traumatic stress disorder: Are there any options other than CBT?

Cognitive behavioural therapy (CBT) has been proven to be the psychotherapy of choice to help people with post-traumatic stress disorder. Nonetheless, there are other types of psychotherapy that have been shown to be effective in the treatment of post-traumatic stress disorder.

Exposure-based therapy

Unlike CBT, which combines both exposure and cognitive modification strategies, exposure-based therapy only applies exposure strategies in its therapeutic plan. It includes imaginative exposure strategies to the memory of the traumatic event, as well as in vivo exposure to the reminders of the traumatic event. These interventions are based on the principle of habituation, whereby a person exposed repeatedly, gradually and over a long period of time to stressful elements (memory of the trauma or external reminders of the trauma) eventually becomes accustomed to these elements, resulting in a decrease in the associated fear.

Cognitive therapy

Cognitive therapy focuses only on identifying and modifying problematic thoughts related to trauma. People who have experienced a traumatic event are often confronted with thoughts and beliefs that generate strong unpleasant emotions. For example, how victims interpret what they have experienced influences the emotions they feel, such as shame, guilt, and fear. Cognitive therapy aims to identify these thoughts and apply strategies to modify them, thereby reducing the associated emotions.

Eye Movement Desensitization and Reprocessing (EMDR)

This integrative psychotherapy approach has been studied and proven to be effective in the treatment of trauma. EMDR was developed following a fortuitous discovery by American psychologist Dr. Francine Shapiro that eye movements could reduce emotional distress associated with traumatic memories. The theory underlying this intervention is that during a traumatic event, the brain is unable to fully integrate the experience, including associated emotions, into memory. Thus, EMDR aims to directly affect neurological functioning by promoting the brain’s ability to adequately process trauma information. During therapy, the therapist asks specific questions about the traumatic event in order to activate the memory network by guiding the client through a series of eye movements or other alternative movements (tapping or sounds). At the end of therapy, desensitized victims still remember the event, but this memory would no longer cause intense distress.

Narrative exposure therapy

Narrative exposure therapy is called a brief intervention that is similar to the rationale of CBT, but is more appropriate for individuals suffering from post-traumatic stress disorder symptoms as a result of multiple traumatic events throughout their lives. This therapy was first developed to help war refugees with whom it was difficult to identify only one traumatic event. The psychotherapist helps the victim to formulate a detailed account from birth to today, paying particular attention to the traumatic events experienced and the emotions aroused. It is assumed that a complete and coherent narrative, rather than incomplete and fragmented, promotes the rehabilitation process. The focus on traumatic events allows the victim to expose themselves to these memories and the emotions generated, promoting a process of habituation and thereby reducing post-traumatic stress disorder symptoms.

The choice of the type of therapy to undertake is up to the patient. Whenever possible and in case of doubt, it is advisable to meet with several therapists before making a choice.

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