Presentation on theme: "ACTIVE INGREDIENTS of Trauma Therapy"— Presentation transcript:
1ACTIVE INGREDIENTS of Trauma Therapy CAPSULE 2ACTIVE INGREDIENTS of Trauma TherapyJ. Eric Gentry, PhD
2Capsule 2: Active Ingredients & Therapeutic Relationship Viktor Frankl & Positive ExpectancyEffective Treatment – VA/DoD GuidelinesChanging the Paradigm – Benish, Imel & Wampold (2008)Active Ingredients of Trauma TherapyTherapeutic Relationship & FIT
3A very important and often overlooked component of treatment. Positive ExpectancyA very important and often overlooked component of treatment.
4“That which is to give light Resiliency“That which is to give lightMust endure burning”- Viktor Frankl
5Between stimulus and response there is a space Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.- Viktor Frankl
6Effective TreatmentTrauma-focused treatment is up to 86% more effective than no treatmentTrauma focused treatment is more effective than supportive therapyMaturation - No longer need to prove trauma-focused treatment is effectiveRift in Field: Evidence-Based Manualized Tx vs. Non-specific ComponentsNo difference among treatments that workAll effective treatments share common components
72010 VA/DoD Guidelines http://www. healthquality. va VA/DoD CLINICAL PRACTICE GUIDELINEFOR MANAGEMENT OF POST-TRAUMATIC STRESSDepartment of Veterans AffairsDepartment of DefensePrepared by:The Management of Post-Traumatic Stress Working GroupWith support from:The Office of Quality and Performance, VA, Washington, DC & Quality Management Division, United States Army MEDCOM
8RECOMMENDATIONS1. A supportive and collaborative treatment relationship or therapeutic alliance should be developed and maintained with patients with PTSD.Evidence-based psychotherapy and/or evidence-based pharmacotherapy are recommended as first-line treatment options.Specialized PTSD psychotherapies may be augmented by additional problem- specific methods/services and pharmacotherapy.Consider referral for alternative carem odalities (Complementary Alternative Medicine) for patient symptoms, consistent with available resources and resonant with patient belief systems. [See Module I-2]Patients with PTSD who are experiencing clinically significant symptoms, including chronic pain, insomnia, anxiety, should receive symptom-specific management interventions. [See Module I-3]Management of PTSD or related symptoms may be initiated based on a presumptive diagnosis of PTSD. Long-term pharmacotherapy will be coordinated with other intervention.
9A B C D I Level Treatments CBT (PE, DTE, CPT, SIT) EMDR None Patient Education, Imagery Rehearsal Therapy, Psychodynamic Therapy, Hypnosis, Relaxation Techniques, Group Therapy, and Family Therapy [Trauma-focused Supportive Therapy]DIWeb-based Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Acceptance and Commitment Therapy, along with Complimentary and Alternative Medicine approaches such as yoga, acupuncture, mindfulness, massageA = Strong evidence + First-line Recommendation / B = Good evidence + recommendation (second line) / C = Fair evidence + no recommendation / D = Contraindicated / I = Inconclusive
11ACTIVE INGREDIENTSFigley & Carbonell (1995 & 1996). Clinical Demonstration ProjectEMDR, CBT, TIR, TFT, NLP, TAT & OthersDemonstrate effectivenessDiscussion of “active ingredients”Led to my qualitative research on the same
1254 Trauma ExpertsFirst-line interventions matched to specific symptoms included emotion regulation strategies, narration of trauma memory, cognitive restructuring, anxiety and stress management, and interpersonal skills. Meditation and mindfulness interventions were frequently identified as an effective second-line approach for emotional, attentional, and behavioral (e.g., aggression) disturbancesCloitre, Courtois, Charuvastra, Carapezza, Stolbach & Green, 2011
14Healing Trauma: Active Ingredients (Gentry, 1999) Therapeutic Relationship – develop and maintain. Emotional bond + Completion of Tasks + Mutual Goals + Positive expectancy.Relaxation – Reciprocal Inhibition (exposure + relaxation). Parasympathetic dominanceExposure/Narrative – sharing with safe other chronology of “micro-events” of traumatic experience (making non-verbal explicit)Cognitive Restructuring – Normalizing symptoms, psychoeducation, correcting perceptionsSeems Non-sequiter1999 research that looked at effective treatment of traumatic stress[I will be doing a training for PESI on Trauma and greif all over the country over the next year. Please come to this if you’d like tot learn more about this]
16Therapeutic Relationship A supportive and collaborative treatment relationship or therapeutic alliance should be developed and maintained with patients with PTSD [2010; VA/DoD Guidelines]the therapeutic relationship is most often cited as one, if not the most, potent transtheoretical ingredient of psy- chotherapy (2013; Miller, Hubble, Chow & Siedel).A “supportive & Collaborative” relationship is assumed for all evidence-based treatments, however, not many therapists practice evidence-based demonstration achieving and maintaining therapeutic relationship.
17Relaxation/Self-Regulation Indigenous to ALL effective treatmentsANS Dysregulation central to the symptoms and distress of trauma survivors.“You cannot have PTSD inside of a relaxed body” – EgTX must go beyond teaching relaxation into coaching toward mastery our clients to monitor and regulate their ANS.Soften muscles while confronting perceived threats IS trauma treatmentMUST be able to keep body relaxed while confronting traumata or treatment can be retraumatizing
18EXPOSURE/NARRATIVE Indigenous to ALL effective treatments Integrating traumata that is repressed, suppressed or dissociatedReciprocal Inhibition (Wolpe, 1964)Conditioned Stimulus = CR of Anxiety (> ANS)Conditioned Stimulus + Relaxation = Extinction of CRExposure + RelaxationNarrative most potent form of exposureSequencing & languaging of traumata (i.e., sensory memories) with relaxed body completes both integration & desensitizaton
19Cognitive Reprocessing Psycho-educationValidationNormalizingCorrecting distortions (causation/world-view)MindfulnessMonitoring and evolving “self-talk”
20Examples “Normal” response - Over-adapted (Hard part done) Understanding of relationship of painful learning, perceived threat & ANS reactionPTSD = System attempting to heal itselfMemory fragments attempting to integrate but paired with terror. Requires relaxation + intentional exposureStress = perceived threat = dysregulated ANSShame = absence of narrative“That which doesn't’t kill you makes you stronger” … only if it is integrated. Disintegrated it weakens you.
21Additional CAM Family Therapy Group Therapy Substance Use Tx MassageMovement/YogaExerciseAcupunctureBody-oriented Treatment (TRE – Berceli)Family TherapyGroup TherapySubstance Use TxCommunity Resources
22In 2013, Feedback Informed Treatment (FIT)–that is, formally using measures of progress and the therapeutic alliance to guide care–was deemed an evidence-based practice by SAMHSA, and listed on the official NREPP website. It’s one of those good ideas. Research to date shows that FIT as much as doubles the effectiveness of behavioral health services, while decreasing costs, deterioration and dropout rates. (www.scottdmiller.com)
23Positive Outcomes & Excellence in Treatment www.scottdmiller.com Collect empirical data evaluating the quality of the therapeutic relationshipGenerate honest feedback from client on methods to improve therapy (i.e. relational)Be willing to change toward what works best for client—demonstrate that change