Cognitive-Behavioral Therapy for PTSD

Abstract

Description Several forms of cognitive-behavioral therapy (CBT) have been studied as treatments for chronic adult posttraumatic stress disorder (PTSD) resulting from a range of traumatic events. However, the amount and quality of sup-porting evidence varies substantially for different CBT programs. Exposure therapy refers to a series of procedures designed to help individuals confront thoughts and safe or low-risk stimuli that are feared or avoided. Applied to the treatment of PTSD, most exposure therapy programs include imaginal expo-sure to the trauma memory and in vivo exposure to reminders of the trauma or triggers for trauma-related fear and avoidance, although some CBT pro-grams have been limited to one type of exposure. Systematic desensitization is procedurally distinct from other forms of exposure therapy in that it involves the explicit pairing of the trauma-related memories and reminders with mus-cle relaxation to inhibit the fear, whereas other exposure therapy programs do not routinely seek actively to inhibit fear during exposure exercises. Stress inoculation training (SIT) is a multicomponent anxiety management treatment program that includes education, muscle relaxation training, breathing retraining, role playing, covert modeling, guided self-dialogue, and thought stopping. SIT programs may also include assertion training and exposure therapy components, although studies of SIT for chronic PTSD have typically left out one or both of these components because they were included in the comparison condition under investigation. Training in pro-gressive muscle relaxation is both a part of SIT and a stand-alone comparison treatment. Biofeedback training, another approach to promote relaxation, uses