Each Learning Community will consist of:
Providers who complete the PTSD Learning Community and submit two completed cases for review will be eligible to be recognized as STRONG STAR Network Partners.
CPT can be implemented in multiple formats, including individual treatment, group treatment or individual + group treatment. CPT is a 12-session cognitive-behavioral treatment for PTSD that can be personalized to include fewer or additional sessions. CPT teaches patients to recognize and challenge dysfunctional cognitions about their traumatic experiences and current beliefs about themselves and others (Resick, Monson & Chard, 2016). Through CPT, patients learn about symptoms of PTSD and the connection between trauma-based thoughts and feelings. CPT clinicians engage patients to recognize and challenge unrealistic thoughts, referred to as “stuck points,” throughout the course of treatment. Common trauma-related stuck points include: “It’s my fault the trauma happened”; “If I would have done something different, I could have prevented the trauma.” During later sessions, themes of safety, trust, power and control, esteem, and intimacy are explored as areas possibly affected by the trauma. Throughout, the therapist utilizes Socratic dialogue to facilitate cognitive change. Derived from the Socratic method of learning, Socratic dialogue values patients coming to know something for themselves rather than the therapist teaching or telling them.
The key treatment components in PE include: psychoeducation about the rationale for treatment procedures and the impact of trauma, repeated in vivo exposure to situations the client is avoiding because of trauma-related fear, prolonged (repeated) revisiting of the trauma memories, and processing, where the therapist and client discuss new learning and changed beliefs about the trauma and symptoms.
Avoidance of trauma-related thoughts and situations is the hallmark of PTSD. Patients with PTSD avoid things that remind them of the trauma; as a result, they isolate themselves, spend limited time with family and friends, and don’t engage in the necessary activities of daily life (e.g., grocery shopping). They end up living very limited lives. Through the processes in PE and exposure to trauma-related content, clients learn that thinking about trauma memories is not dangerous, that low-risk situations that remind them of the trauma or make them feel unsafe as a result of the trauma are not dangerous, and that they can handle these situations and thoughts. As a result of the therapist helping clients to confront instead of avoid, PTSD symptoms remit and clients are able to expand their lives.
CRP for suicide prevention is a client-centered intervention tailored to the individual in suicidal crisis. It is developed collaboratively, handwritten in the client’s own words on a note card that can fit easily in a pocket or wallet to be kept with the client and accessed in times of high emotional distress. The CRP is a checklist of strategies to follow when in crisis to help clients manage emotional distress instead of acting on urges for suicidal behaviors. The CRP contains five key components: personal warning signs, self-management strategies, reasons for living, social support, and professional crisis support.
Frequent nightmares cause disrupted sleep and also are associated with comorbid difficulties such as substance use, health problems, and suicide risk over and above the effects of depression and PTSD. Nightmares also may require targeted intervention. Cognitive behavioral therapy for nightmares (CBT-N) can alleviate nightmare frequency and severity and also improve sleep, PTSD, and depression in civilians and veterans. CBT-N may include variations such as Imagery Rehearsal Therapy and Exposure, Relaxation, and Rescripting Therapy and consists of multiple treatment components. These components include psychoeducation about trauma, nightmares, and sleep; modification of unhelpful sleep habits; relaxation training; and interventions that directly target nightmare content. Clients are guided in exercises to confront and rescript their dream with the therapist and to practice at home. CBT-N can be administered in three to six sessions lasting 50-90 minutes each.
Insomnia and nightmare treatment often are combined and described as cognitive behavioral therapy for insomnia and nightmares (CBT-I&N).