I offer two treatments of Posttraumatic Stress Disorder (PTSD) – Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE). Both are extensively researched protocols, with over 43 randomized controlled trials (the gold standard in psychological research) showing consistent improvements in quality of life in the long-term.
Veterans Affairs in both Canada and the USA endorse both CPT and PE as effective treatments for PTSD, as does the Canadian First Responders Mental Health Alliance.
CPT is a structured protocol of 12-15 sessions conducted weekly or twice weekly where clients with symptoms of post traumatic stress disorder (PTSD) learn skills to confront their self-limiting beliefs and help themselves going forward. CPT is a cognitive approach.
PE is also a structured protocol and is usually completed within 8 – 15 sessions conducted weekly. In the PE process clients learn to face the memories, situations and emotions they have avoided. PE is a behavioural approach.
These two treatments align really well with my personal values because:
- They are designed around the assumption that you are strong enough to have endured PTSD and are therefore strong enough to process the impacts of the trauma
- Avoidance is a central feature of PTSD. You may be avoiding the memories, thoughts and feelings about the trauma, but also people, places and things that might remind you of the trauma. This is a natural and understandable response. However, avoidance can severely limit your life. You may be avoiding all feelings, even joy, contentment, connection and fulfillment. You may be using substances or food or overwork to avoid. The therapist gently encourages clients to approach rather than avoid their traumatic memories, feelings and beliefs in the safety of the sessions so that the client can break their patterns of avoidance in their daily lives.
- CPT and PE involve educating clients about trauma and PTSD and their impacts, so they understand what is happening to them
- CPT and PE promote skill-building, so clients leave in a more empowered position. Clients are required to practice skills learned between sessions. The practice work is not time-consuming but needs to be done consistently. This consistency solidifies the skills, and builds habits for the client to take with them after the sessions have ended.
- CPT and PE involve ongoing monitoring of PTSD and depressive symptoms using self-reporting tools that are clear and straightforward.
- CPT and PE involve a lot of choice for clients. In CPT you are not required to talk about the traumatic event in great depth if you chose not to. There is, however, a model that involves writing about the event in depth, but this is your choice. In PE you will choose activities to face that will help you learn to face your memories. Traumatic events were either enacted upon us and we had no choice or we made terrible choices that haunt us. Reclaiming choice is a healthy step to addressing the symptoms of PTSD.
- The focus in CPT is on healing the ways that a traumatic event has changed your beliefs about yourself, about others and about the world. The emphasis is on the meanings we create to understand what has happened, and the feelings that get buried or entangled in the meaning.
- The focus in PE is to slowly and carefully learn to tolerate distress so that you can choose to revisit memories, emotions and situations if you want or need to without being overwhelmed.
- The goal for both is for you to understand and accept reality rather than seeing the world through the lens of fear and avoidance or shame.
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