What We Do Hero

The STRONG STAR Training Initiative conducts Learning Communities with mental health providers through competency-based training in evidence-based treatments for PTSD and related mental health problems.

Each Learning Community will consist of:

  • Pre-workshop reading and webinars
  • In-person workshop
  • Phone case consultation
  • Online provider portal with therapy resources, therapy note templates, assessment measures, video demonstrations and webinars on advanced practice topics
  • Organizational consultation
  • Continuing education credits

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.

The University of Texas Health Science Center at San Antonio is approved by the American Psychological Association to sponsor continuing education for psychologists. The University of Texas Health Science Center at San Antonio maintains responsibility for this program and its content. The CEs provided by the American Psychological Association are acceptable for most licensed professions when renewing their license. It is our experience that CE credits have been recognized by most professional state license boards. Please check with your board regarding the acceptability of the CE credit. Continuing education credits are available for in-person workshops and webinars.


What We Do - Cognitive Processing Therapy

Cognitive Processing Therapy (CPT)

Extensive research efforts have shown first-line treatments for PTSD, including Cognitive Processing Therapy (CPT), to be effective in reducing symptoms of PTSD with multiple types of trauma, including combat trauma, sexual trauma, and civilian trauma (e.g., Galovski et al., 2012; Monson et al., 2006; Resick et al., 2002; Resick et al., 2015; Resick et al., 2017). CPT also has been implemented in a variety of treatment settings including the Department of Veteran Affairs, Department of Defense, and community clinics.

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.

What We Do - Prolonged Exposure

Prolonged Exposure (PE)

Prolonged Exposure (PE) for PTSD is one of the most effective treatments for PTSD, with the largest amount of empirical data over the past few decades. Extensive research has shown PE to be effective in reducing PTSD with civilians and veterans and with various types of trauma, including sexual and physical assault, combat trauma, natural disasters, and motor vehicle accidents (Foa et al., 1999, 2005; 2018; Powers et al., 2010; Resick et al., 2002; Rothbaum et al., 2005; Schnurr et al., 2007). PE has been implemented in diverse treatment settings, such as academic institutions, community clinics, and military and VA clinics. PE is a time-limited, cognitive-behavioral therapy for PTSD. Treatment typically ranges from 8-15 individual sessions that last 90 minutes each. Research studies suggest that PE also can be conducted in 60-minute sessions (van Minnen & Foa, 2006; Nacasch et al., 2015).

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.

What We Do - Crisis Response Plan

Crisis Response Plan (CRP)

The Crisis Response Plan (CRP) is a brief intervention used to reduce suicide risk for individuals experiencing crisis. CRPs have been shown in clinical research to be effective as stand-alone interventions, and within treatment for suicide risk (Byran et al., 2017; Rudd et al., 2015), they are used clinically within a variety of settings. In a recent study with active duty service members comparing CRP to the widely used suicide risk management procedure Contracting for Safety, the CRP led to a 76% reduction in suicide attempts. Additionally, the CRP was associated with significantly faster decline in suicide ideation and fewer inpatient hospitalization days compared to Contracting for Safety in the 6-month follow-up (Bryan el al., 2017).

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.

What We Do - Cognitive Behavioral Therapy for Insomnia and Nightmares

Cognitive Behavioral Therapy for Insomnia and Nightmares (CBT-I&N)

Insomnia, or difficulty falling and staying asleep, is a common and often chronic condition associated with numerous physical and mental health conditions. It is a common residual symptom following successful treatments for comorbid mental health conditions, such as depression and PTSD, and may require targeted intervention. Cognitive behavioral therapy for insomnia (CBT-I) is the first-line recommended treatment for chronic insomnia and also may improve comorbid conditions such as depression, anxiety, and PTSD. CBT-I consists of multiple treatment components. One of the most effective components for treating insomnia is stimulus control therapy, which aims to associate the bed and bedroom with sleep rather than cognitive and physiological activation. Also highly effective is sleep restriction therapy, which aims to reduce time awake in bed by consolidating sleep into a schedule that more closely matches the person’s sleep ability. Relaxation training also is effective for reducing activation before sleep and during awakenings. CBT-I includes cognitive therapy for unhelpful cognitions related to sleep, problem solving to reduce stressors, and sleep hygiene to modify additional habits that could adversely impact sleep. CBT-I can be administered in four to eight sessions lasting 30-50 minutes each.

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).