Each Learning Community will consist of:
Providers who complete the PTSD Learning Community and submit 2 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.
There are four main treatment components in PE: 1) Repeated in vivo exposure to situations the client is avoiding because of trauma-related fear; 2) Prolonged (repeated) revisiting of the trauma memories followed by processing where the therapist and client discuss the traumatic experience and consider and related unhelpful, erroneous thoughts; 3) Education about common reactions to trauma; and 4) Breathing retraining, i.e., teaching the client how to breath in a calm way. Avoidance of trauma related thoughts and situations is the hallmark of PTSD. Patients with PTSD cannot do things that remind them of the trauma, as a result they isolate, spend limited time with family and friends, and don’t do the necessities in 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 are not dangerous, that low risk situations that remind them of the trauma or 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 expands 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.
CBTi consists of multiple treatment components. The most effective strategies for treating insomnia are stimulus control therapy, which aims to associate the bed/bedroom with sleep rather than cognitive and physiological activation, and 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 is also effective for reducing activation before sleep and during awakenings. CBTi includes cognitive therapy for unhelpful cognitions related to sleep and problem solving to reduce stressors and sleep hygiene to modify additional habits that could adversely impact sleep. CBTi can be administered in 4-8 sessions lasting 30-50 minutes each. CBTi can improve insomnia and may also improve daytime symptoms of depression, anxiety, and PTSD.
Frequent nightmares not only cause disrupted sleep, but are also associated with substance use, health problems, and suicide risk even after controlling for the effects of depression and PTSD. Exposure Relaxation and Rescripting Therapy for Nightmares (ERRT) was developed to help reduce the frequency and intensity of trauma related nightmares. ERRT can be administered as a standalone treatment in group or individual format in 3-5 sessions of 60-90 minutes each or in conjunction with CBTi. Nightmare treatment components include psychoeducation about trauma, nightmares, and sleep, modification of unhelpful sleep habits, relaxation training, and interventions targeting nightmare content directly. Clients are guided in exercises to confront and rescript their dream with the therapist and practice at home. This exercise is thought to reduce anxiety associated with nightmares and to empower the patient to have different emotions before bed resulting in a reduction in nightmare frequency and severity which, in turn, can restore sleep and daytime functioning.