CBT for post-traumatic stress disorder
State-of-the-art CBT for post-traumatic stress disorder (PTSD) typically has three objectives:
• To help the person to stop reliving the trauma by addressing their incomplete and chaotic memory of the event.
• To change the negative views the person holds about the trauma and what it means for them.
• To help the person to no longer avoid reminders of the trauma, or to numb their feelings with alcohol or drugs.
Treatment normally involves ten to twelve weekly ninety-minute sessions, followed by three monthly ’booster’ sessions. This requires a very significant commitment of time (and emotion) on the part of the client. But a team of renowned CBT developers — Nick Grey, Freda McManus, Ann Hackmann, David Clark, and Anke Ehlers — has piloted an intensive course of treatment for PTSD, with sessions concentrated into one week. Let’s look at an example from them.
Mark, a 31-year-old professional, had been suffering from nightmares, flashbacks, anger, and depression following a motorbike accident nine months previously. He felt so distressed and low that he contemplated suicide every day.
During the first part of the week, Mark was encouraged to ’relive’ the accident in his imagination. His most upsetting memories were of sliding down the road after being hit by a car; the looming bus which he had believed would run him over; and lying in the road after the accident. Accompanying these memories were some very negative thoughts. He believed, for example, that his life was ’full of crap’, and that the image of him lying alone on the ground epitomized his general isolation.
As the sessions progressed, Mark was helped both to fill in the gaps in his memory of the trauma and to challenge his negative thoughts. He remembered, for example, that several passers-by had been helpful and attentive, and that he’d lain alone in the road for much less time than he’d previously believed. Through discussions with the therapist, Mark came to see that his life was far from as bleak as he sometimes felt it was, and that he wasn’t alone.
Mark was also encouraged to revisit the site of the accident — something he had always avoided. He began to ride his motorbike again. And for the first time, he was able to discuss his experience with his girlfriend.
A week after therapy, Mark’s symptoms were greatly improved. And the gains lasted: 18 months later, Mark was still well and enjoying life.