Treatment of Posttraumatic Disorders

Cognitive Behaviour Therapy for Post-Traumatic Stress Disorder

Smith, P., Perrin, S., & Yule, W. (1999). Cognitive behaviour therapy for post-traumatic stress disorder. Child Psychology & Psychiatry Review, 4(4), 177-182.

The authors discuss Post-traumatic Stress Disorder (PTSD) in children and Cognitive-behavioral therapy (CBT) used for its treatment. The articles purpose is to study treatment outcomes in patients. Cognitive-behavioral therapy is the widely common complex form of psychotherapy that combines cognitive therapy and behavioral therapy. The cognitive approach suggests that psychological disorders are caused by inappropriate or illogical thoughts, human beliefs, and dysfunctional stereotypes of ones thinking, and changing them will solve the problem.

The behavioral approach based on behaviorist theory involves changing human behavior through the promotion and reinforcement of desired behaviors and lack of reinforcements of undesirable forms of behavior. There are three clusters of symptoms after the traumatic event: re-experiencing symptoms, avoidant symptoms and arousal symptoms that arise after violence, natural disaster, extreme stress and other factors. The article mentions the physiological basis for PTSD that is an unconditioned stimulus provoking involuntary responses when the stimuli that were neutral earlier become conditioned ones. The problem is that a child with trauma can easily find stimuli for fear or anxiety in the environment.

CBT involves old memories and imaginary and in vivo exposure to trauma related cues and memories in tolerable doses. The example given in the article is the child remembering details of the stress while the clinicians goal is to make it not stressful so that the child handles, tolerates and understands the fear. For this reason, children are asked to breathe deeply, relax muscles, trying to increase positive vision of things. The authors mention the notion of SUDs (Subjective Units of Distress) that helps children to estimate their level of anxiety. Other functions of CBT treatment include eliminating all possible negative outcomes of stress as common reactions, such as sleep disturbance, separation anxiety, anger and behavioral problems, prolonged grief reactions, and generalized anxiety, guilt, self-blame, helplessness, and vulnerability.

CBT is important not only for children but also for their parents while those who tend to frequently talk about the traumatic events are subjected to more serious and longer treatment. Parents should be willing to listen to their children. The conclusions of the article are that CBT for PTSD treatment is behavior-oriented and clinical practice that does not always comply with the theory of treatment. There is a gap in understanding how PTSD influences information processing, what other effective interventions may be used for children treatment and how the trials can be described as currently there is no relevant information on these issues.

How to Help After National Catastrophes: Findings Following 9/11

Honos-Webb, L., Sunwolf, Hart, S., & Scalise, J. T. (2006). How to help after national catastrophes: Findings following 9/11. The Humanistic Psychologist, 34(1), 75-97.

The article is more practice-oriented and describes the example of traumatic outcomes of the terrorist attacks of 9/11 in students at the university in Northern California. There were seventy participants and two interventions studied and discussed that were journal writing and story listening. During the first intervention, students wrote an essay about their emotions concerning the traumatic event and in the other intervention they listened to event-related stories and clinicians studied their emotional responses to them. In the first case, students had to write for 20 minutes every day during the period of four days. This model follows the Pennebaker paradigm. The goal of listening to stories was to give the feeling of hope by illustrating how others overcome obstacles. These interventions were exposure-based and both groups indicated long-term improvement in their mental state concerning the terrorist attacks of 9/11. However, the authors mentioned that some studies demonstrated worsening of condition after writing the essay. One more traumatic event discussed was the outcomes of Hurricane Katrina. The complexity of two tragedies lied in the fact that 9/11 influenced more people than those directly involved in it, giving others the realization of realness" while Hurricane Katrina involved a man-made natural disaster (flooding).

The article mentions previous studies on lingering posttraumatic stress disorder after the bombing in Oklahoma City. The authors studied short-term and long-term outcomes that were both measured by trauma consequences. Moreover, the article focused on aptitudetreatment interactions and container model. The study was based on several hypotheses. First, people had clinically elevated levels of trauma symptoms. Furthermore, the participants had a better condition of post-intervention trauma symptoms after writing an essay and listening to the stories. Lastly, for people who had experienced loss before story listening is associated with greater improvements in trauma symptoms than the writing assignment. The experiment included PTSD checklist with 17 points of measurement, the Impact of Event Scale, the Inventory of Complicated Grief.

The article gives recommendations and provides parallels with people affected by Hurricane Katrina. The recommendations are divided into those intended for people who were not directly affected by the hurricane and those directly related to it. The main objective was to treat the standard approach to disaster interventions with much caution and use an indirect approach. The story telling focusing on positive events is much better than deep investigation of disaster-related feelings that are too hurtful.

Assessment and Conclusions

The articles How to Help After National Catastrophes: Findings Following 9/11 and Cognitive Behaviour Therapy for Post-Traumatic Stress Disorder both focus on the issues of treatment after a traumatic event and its consequences. Post-traumatic stress disorder (PTSD) can occur in people who survived the catastrophe, had witnessed the disaster, as well as those who were engaged in disaster relief, including emergency workers and law enforcement officials. Additionally, PTSD development can be aggravated by friends or family members of those who have gone through traumatic experiences. The theoretical base for both studies is similar. All authors studied the mechanisms and outcomes of PTSD that include anxiety, fears, anger, grief, vulnerability and many other factors. However, children may have slightly different consequences such as fear of being separated from their parents, loss of previously acquired skills and abilities, and nightmares. They may have pessimistic and repetitive games in which the subject or aspects of traumatic events are repeated, while new fears, phobias or concerns that are not related to traumatic events might appear along with the pain for no apparent reason or aggression.

The article Cognitive Behaviour Therapy for Post-Traumatic Stress Disorder is more theoretical; however both studies describe the experiments. The difference is in people studied: Smith, Perrin, and Yule (1999) investigated PTSD in children while another article studied seventy university students affected. Cognitive Behaviour Therapy for Post-Traumatic Stress Disorder focused on cognitive behavior treatments methods, parents-children relationship, and CBT used specifically for parents. CBT is based on the idea according to which the feelings and behavior of a child are not determined by the situation in which he/she has found him/herself but by perception of the situation. For children it is important to identify negative thoughts that cause anxiety and depression, evaluating the negative thoughts in terms of their realism and change them to more constructive ones, more fully reflecting the reality and not provoking anxiety or depression as well as bringing life back to normal and eliminating typical triggers connected with trauma. Smith et al. (1999) identify the problem of using CBT for PTSD treatment which is the fact that it focuses only on behavior and does not include a cognitive aspect. Therefore, most of their theories are not supported by clinical results.

The article How to Help After National Catastrophes: Findings Following 9/11 studies more practical aspect of post-traumatic disorder treatment. The study is based on a wide-scale experiment involving students of different nationalities, with bereavement and without it, while the previous article focused on children exclusively. The previous study by Smith et al. (1999) proposed CBT as a treatment measure making it flexible and adjustable to the level of trauma, but Honos-Webb, Sunwolf, Hart, and Scalise (2006) examined how two methods of story listening and journal writing affect the post-traumatic conditions. Story listening positively affected people with prior bereavement. Additionally, How to Help After National Catastrophes: Findings Following 9/11 gives a deep insight on terrorist attack 9/11 and Hurricane Katrina. The authors showed how mass tragedies of different origin were similar in terms of psychological and traumatic outcomes. While another article focuses on CBT, the article by Honos-Webb et al. (2006) emphasizes the aptitude treatment interactions and individual theories.

Two studies examined the specialties of PTSD. The reason for them was always a traumatic event, which resulted in the development of PTSD. The event is usually so overwhelming and frightening that it affects everyone involved. Because of traumatic events, almost every person might experience at least several symptoms of PTSD. When people do not feel safe, it is quite normal to feel detached from the other people or separated from the world (derealization). People with PTSD often have nightmares, suffer from fear, and practically cannot stop thinking about the event that occurred. These symptoms are a normal reaction to traumatic and stressful situations.

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However, in most people, these symptoms pass quickly. Symptoms can last for days or weeks, but eventually they go away. But if you have Post-Traumatic Stress Disorder (PTSD), these symptoms remain for longer periods of time. You do not feel that these symptoms have subsided. Instead, you may feel that they are compounded.

Both articles are important because they study how to treat PTSD without medical intervention. The paper, How to Help after National Catastrophes: Findings Following 9/11 is more justified as it is supported by empirical proofs. The best results are obtained by a technique in which at the beginning of the attack, the patient is taught to focus on the bright distracting memory that eventually forms a habit and mind automatically moves to neutral or positive emotions, bypassing the traumatic experience as a trigger. The talks, listening and writing are suitable methods that comply with the abovementioned principle of rethinking trauma and tolerating triggers. The proper treatment, psychotherapy, support (especially in cases where children are affected) will help to cope with PTSD (Post Traumatic Stress Disorder) and return to normal life.

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