Cognitive Behavioral Therapy for Combat Term Paper

Pages: 15 (5327 words)  ·  Bibliography Sources: 15  ·  File: .docx  ·  Level: Doctorate  ·  Topic: Psychology

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Moreover, contrary to myth, patients are not generally unwilling or reluctant to undergo exposure therapy, but are able to recognize that exposure may be necessary to help them move past the traumatic event. The whole thought process behind trauma focused therapy is that by changing thoughts, the therapist can help achieve symptom reduction, and this hypothesis has been verified in a number of studies (Sobel et al., 2009).

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Despite the fact that some therapists have lingering, erroneous concerns about trauma-centered therapy, it has long been the preferred approach for treating PTSD. In fact, CPT, a form of trauma-centered therapy is considered the go-to treatment for PTSD. CPT is a counseling-based intervention that generally involves meeting with a therapist on a weekly basis in an effort to move the person suffering from PTSD, who is seen as stuck in the time of the event, past the event (National Center for PTSD, 2011). It is believed to work because the goal of CPT is to give the patient the skills he or she needs to handle the distressing thoughts that accompany PTSD. By changing how the person thinks about the traumatic event, the belief is that one can change how they feel about the event (National Center for PTSD, 2011). There are four main components to CPT: learning about the PTSD symptoms and how treatment can help; increasing awareness of thoughts and feelings; cognitive restructuring, which is learning skills to challenge thoughts and feelings; and understanding changes in beliefs that are common after a trauma (National Center for PTSD, 2011). Finally, patients undergoing CPT will be given practice assignments to use their new skills outside of a therapeutic setting (National Center for PTSD, 2011).

Term Paper on Cognitive Behavioral Therapy for Combat Assignment

PE therapy is another type of cognitive therapy, and it involves focusing on the traumatic event. The belief is that repeated exposure to the thoughts, feelings, and situations that the patient has been avoiding can demonstrate that those things do not have to be avoided. It begins with an identification of what scenarios the patients has been avoiding, and then involves confronting those situations until the patient feels a decrease in distress (National Center for PTSD, 2011). PE has four different components: education about symptoms and how treatment can help; breathing retraining to promote relaxation and stress management; real world practice in previously avoided scenarios; and imagination exposure (National Center for PTSD, 2011). The idea is that exposure to the traumatic event will eventually lead to desensitization, so that the patient can respond normally to the trauma or things that remind him or her of the trauma, instead of responding in a heightened or sensitized manner.

One of the more interesting and controversial research conclusions is that cognitive interventions may not be necessary given how effective behavioral interventions have been for anxiety and depression, and this outcome flies in the face of those who believe that behavioral changes are the result of cognitive changes achieved in CPT. If those studies are correct, then cognitive behavioral interventions may not be the appropriate way to treat PTSD; instead purely behavior interventions may be more appropriate than cognitive-behavioral approaches. Hassija and Gray investigated the relative efficacy of cognitive and exposure treatment to PTSD, focusing on whether the addition of cognitive restructuring to exposure therapy enhanced the cognitive changes one receives from the exposure therapy (2010). What they discovered was that cognitive restructuring could be beneficial for some symptoms of PTSD, specifically for guilt symptoms and detachment, and could enhance cognitive change (Hassija & Gray, 2010). Moreover, they discovered something somewhat unexpected, which is that restructuring, alone, can be as effective as restructuring with exposure-based behavior therapy (Hassija & Gray, 2010). They came to the conclusion that both cognitive therapy and exposure can be effective for patients with PTSD (Hassija & Gray, 2010).

This conclusion bolsters existing practices that suggest some cognitive component as part of EP. In fact, when one looks at the basic format of standard EP, one sees several cognitive components to the therapy. The patients are not simply exposed to the aversive stimuli or trauma and expected to acclimate non-trauma responses into their response repertoire. Instead, EP involves significant thoughts about the underlying trauma and how to deal with the symptoms they produce in the sufferer. This leads one to the conclusion that EP cannot be labeled a strictly behavioral therapy; it might not focus on cognition, but it certainly contains a number of cognitive elements.

The above information is particularly relevant when one considers that the Veterans Administration actively promotes two particular and distinct treatments for PTSD: CPT and PE. The vast majority of VA facilities currently offer either CPT or PE, with many of them (72%) offering both types of therapy (Karlin et al., 2010). The results from the different types of therapies are comparable and both therapies have been proven to be effective in treating veterans with PTSD. Recent studies have shown that CPT was effective in reducing PTSD severity by 30% or more in 28% of cases, while PE was effective in reducing PTSD severity by 30% or more in 30% of cases (Karlin et al., 2010). However, there is a lingering treatment problem that is not necessarily related to the type of treatment offered, but does impact treatment offered and possibility long-term prognosis. That is the belief among both patients and practitioners that PTSD is a chronic life-long disorder that is treatment resistant (Karlin et al., 2010). As a result, future research may want to focus on patient and therapist beliefs about the disorder and how those beliefs impact treatment outcomes. Furthermore, this study did not examine the overlap between the two treatment protocols; it seems unlikely that any form of PE would not have a cognitive element.

With the realm of CBT, PE, which some refer to as desensitization, has been the primary way to treat veterans with PTSD. While PE can be effective, recent studies suggest that there may be advantages to alternative therapies, particularly CPT, which includes cognitive and exposure components (Monson et al., 2006). "Although originally developed for women suffering sexual assault-related PTSD, CPT seems well suited to the veteran population and VA treatment setting. CPT focuses on the range of emotions, in addition to anxiety, that may result from traumatization (e.g., shame, sadness, anger), can be generalized to comorbid mental health conditions and day-to-day problems, is in a manualized format amenable to widespread dissemination, and can be delivered in a group format" (Monson et al., 2006). Moreover, when looking at specific subcomponents of PTSD such as trauma-related guilt, CPT is frequently more effective than PE (Monson et al., 2006). This evidence suggests that CPT might be the more effective of the two approaches.

Because treatments are relatively successful, one of the problems that might occur is when a patient is treatment resistant. Prior thinking about the condition may lead both patient and therapist to give up on treatment options under the erroneous belief that nonresponsive PTSD cannot be cured. In fact, for many years, PTSD was considered a chronic condition and the prognosis for individual patients was not very good. New research not only suggests that is false, but also that treatment for PTSD can be successful after a relatively short duration. Examining combat veterans returning from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) who exhibited PTSD, researchers found that patients responded rapidly to PE treatments. In fact, after as few as six sessions, patients showed significant improvements in both depression and PTSD symptoms (Tuerk et al., "Prolonged" 2010). The most significant declines in symptoms were noted in the first five sessions, which may suggest that the impact of PE levels off after an initial success period. The results suggest that PE should be used as part of the standard treatment for combat veterans with PTSD. However, the research also suggests that a therapist should be able to determine the efficacy of PE alone in a patient within a relatively short period of time. If PE has not demonstrated a significant impact within the first six sessions, it might be appropriate for a therapist to introduce other interventions. This is an important development, because the standard PE intervention is far greater than six weeks. For those veterans who are responding to treatment, this extended treatment period may be beneficial and is almost certainly non-harmful. However, if a patient is not responding to traditional PE, one has to consider the possibility that extended PE is simply reinforcing the existing anxiety that is linked to the trauma. Therefore, future researchers should certainly consider moving non-responsive patients from PE only groups to CPT groups after six weeks of treatment and then comparing their response rates to a control groups left in PE for the standard duration of treatment. One would assume better results in the CPT group of treatment resistant soldiers than the PE alone group.

Moreover, it is important to keep in mind that therapy can exist in a variety of different contexts and modalities. For… [END OF PREVIEW] . . . READ MORE

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