Flexible Applications of Cognitive Processing Therapy

Evidence-Based Treatment Methods

Tara E. Galovski, Reginald D.V. Nixon, Debra Kaysen

• Publisher: Academic Press
• Year: 2020
• ISBN:
  9780128168851
• Topic: Psicología
• Subtopic: Psicología clínica

Flexible Applications of Cognitive Processing Therapy: Evidence-Based Treatment Methods provides a detailed roadmap on how to apply therapy to a wide-range of complex patients. Starting with an exploration of the development of CPT, the book then segues into a practical discussion on flexible adaptations of therapy. Dissemination and implementation of CPT is covered next, and the book concludes with directions for future research. It provides clinical guidance on treating PTSD with patients who express high levels of anger, shame, guilt, and other forms of emotionality, while also providing insight on research on the effectiveness of CPT on other comorbid disorders.

The book also reviews the outcomes of clinical trials of CPT inside and outside the United States, including examining modifications and outcomes in a diverse array of patient populations.

• Traces the history and development of cognitive processing therapy (CPT)
• Outlines empirically-supported modifications to CPT
• Looks at international applications of CPT in diverse patient populations
• Discusses common challenges to therapy outcome and how to overcome them

Part I

Cognitive Processing Therapy: Supporting Evidence

• Chapter 1: The face of PTSD
• Chapter 2: Ancestral roots: the origins of CPT
• Chapter 3: Treatment development: The early years
• Chapter 4: Emerging as an effective therapy: CPT is put to the test

Chapter 1

The face of PTSD

Abstract

Treating posttraumatic stress disorder (PTSD) is complicated and complex. The disorder itself includes 20 symptoms categorized into four different clusters. Impairment in functioning across major life domains is also readily apparent in PTSD clinical presentations and, indeed, is a requirement for meeting criteria for the disorder. To add to the complexity of PTSD, the disorder rarely occurs in isolation with other types of mental illness, such as depression, panic disorder, and substance use disorders that are quite often diagnosed along with PTSD. Further, patients presenting with PTSD can look very different from one another in terms of the types of exposures to traumatic events, family histories, social support systems, and physical health complications. This chapter seeks to describe PTSD and provides three case vignettes to illustrate the unique nature of each patient presenting with PTSD.

Keywords

PTSD

treating PTSD

clinical case vignettes

cognitive processing therapy

DSM-5 PTSD criteria

clinical complexities

Chapter outline

• What is PTSD?
• Clinical complexities
• The toll of PTSD
• Cognitive processing therapy
• Overview of the book
• Case studies
  • Case 1: Anna’s story
  • Case 2: Steve’s story
  • Case 3: Julie’s story
• Setting the stage
• References

What is PTSD?

You may have heard the adage, “If you’ve seen one, you’ve seen ‘em all!” This saying could not be further from the truth when considering clinical presentations of posttraumatic stress disorder (PTSD). The unique nature of each individual trauma and the nuances of the context in which that trauma occurred, coupled with prior trauma history and comorbid disorders and conditions, all contribute to the unique and variable clinical presentations that clinicians will grapple with when treating trauma survivors suffering from PTSD. The diagnostic criteria for PTSD was recently expanded in the Diagnostic and Statistical Manual, 5th Edition (DSM-5: American Psychiatric Association, 2013) to include 20 symptoms distributed over four clusters. The sheer number of symptoms and the number of possible combinations of symptoms that can result in the diagnosis of PTSD attests to the variability in clinical presentations that a therapist may observe across patients presenting with the exact same diagnosis. For example, one patient suffering from PTSD may appear withdrawn and emotionally numb or shutdown while another may present as quite emotional and have difficulty containing that emotion throughout the therapy sessions. A third patient may exhibit a significant fearful and anxious demeanor and may dissociate frequently when presented with reminders of the trauma while a fourth patient may become angry and even volatile during and outside the session. Given the heterogeneity in the diagnostic criteria and the variability that therapists observe across clinical presentations, it may be difficult to imagine how one single therapy can possibly be effective across all of these different manifestations of one disorder.

Clinical complexities

Adding to the clinical challenges inherent in treating this disorder, PTSD rarely occurs in isolation, meaning that it is quite common for multiple additional disorders to co-occur with PTSD, including substance use disorders, insomnia, major depression, and/or personality disorders. Indeed PTSD is less likely to present as a sole diagnosis than it is to present with one or more comorbid conditions (Bradley, Greene, Russ, Dutra, & Westen, 2005). It can be quite challenging for the treating therapist to first differentially diagnose various disorders, which ...