What We Do Hero

The STRONG STAR Training Initiative conducts Learning Communities with mental health providers through intensive 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 2 completed cases for review will be eligible to be recognized as STRONG STAR Network Partners.

University of Texas Health at San Antonio and the STRONG STAR Training Initiative is approved by the American Psychological Association to sponsor continuing education for psychologists. The CEs provided by 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 (eg. Galovski et al., 2012; Monson et al., 2006; Resick et al., 2002; Resick et al., 2015; Resick et al., 2017). CPT has also 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 empirical data over the past few decades. Its efficacy has been demonstrated with civilians and veterans and with various types of trauma including survivors of sexual and physical assault, combat trauma, natural disasters, motor vehicle accidents (Foa et al., 1999, 2005; 2018; Powers et al., 2010; Resick et al., 2002; Rothbaum el al., 2005; Schnurr et al., 2007). PE has been implemented in diverse treatment settings such as academic institutions, community clinics, and the Department of Veteran Affairs and Department of Defense clinics PE is a time-limited, cognitive-behavioral therapy for PTSD. Treatment typically ranges from 8-15, 90-minute sessions, and is conducted in individual sessions. Research studies suggest PE can also be conducted in 60-minute sessions (van Minnen & Foa, 2006; Nacasch et al., 2015).

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.

What We Do - Crisis Response Plan

Crisis Response Plan (CRP)

The CRP is a brief intervention used to reduce suicide risk for individuals experiencing crisis. CRPs have been shown to be effective as a stand-alone intervention and within treatment for suicide risk in clinical research (Byan et al., 2017; Rudd et al., 2015), and are used clinically within a variety of settings. In a recent study with active duty service members, comparing CRP to 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 (CBTi+n)

Research has shown that CBTi is highly effective for clients with insomnia alone and clients with insomnia and comorbid medical and psychological diagnoses, making it the first line treatment for chronic insomnia (Qaseem et al., 2016). Insomnia is a common residual symptom following treatments for depression and PTSD and may require targeted intervention. People with insomnia often develop sleep habits that may help with sleep loss in the short term but can actually keep sleep problems going over the long term. This can result in physiological activation close to bedtime and associating the bed/bedroom with frustration, dread, or anxiety.

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.