Cognitive Behavioural Therapy (CBT) Provides The Best Result For PTSD

[willis williams]

Thanks you help by pointing and with friends like I got on here I make good on it.

 

[Wagon]

Also a Thanks from myself Anthony. I would have never started CBT if not for this site and your advice.

Many thanks

Wagon

 

[sisu]

Good job Wagon!!

 

[Learning Curve]

I'm not a mental health provider at all, but have the good fortune to be married to one which I guess helps counterbalance the bad fortune of having PTSD.

Personally, I've had very good results with EMDR -- obviously a single data point is an anecdote, not statistics.

However, I think it needs to be noted that the success rate of Exposure Therapy is not as clear cut a win as its adherents suggest. (And note -- my wife doesn't do EMDR or Exposure Therapy for PTSD sufferers, so I'm not advocating her preferred approach or anything like that). Exposure Therapy works, but part of the claimed success rates involved stem from the fact that participation rates from people with the worst, most complex sorts of combat trauma are very poor. They either don't come in the door at all or drop out of therapy because Exposure Therapy tends to hard and painful (and because the people with the worst trauma may not be overly prone to seeking help at all due to stigma associated with mental health treatment at all, etc.).

Again personally, I've not found EMDR to involve dredging up overwhelming emotions or recollections or the like. If done properly I don't think that can actually be an issue.

I've found CBT to be highly effective at addressing survivor guilt, which is a huge part of my personal situation as well, and which is, I think the negative stigma sort of issues you are talking about, but it has not helped with the physiological responses I go through when some stupid event pushes my "it's go time" buttons for no real, rational reason. EMDR has helped with that. I definitely need help with my survivor guilt, also -- and had I ever suck-started my pistol it would have been about survivor guilt, not PTSD -- but to me, at least, the two are separable and EMDR has proven to be the much better and more effective treatment for the PTSD part of the equation.

Not trying to pick a fight when saying the above -- I just disagree about EMDR being a bad idea, and have not personally experienced the downsides you describe. I am of the opinion that it should definitely be an arrow in the quiver for people needing treatment, though at the same time don't think it -- or anything else -- is a stand alone answer.

 

[Wagon]

Hmmmm,

Seems like a whole slew of answers out there. A logical methodology for anyone would seem to start with least severe and work your way up. Including meds. That is if you have the time. We all have to function for our families, jobs, etc.... But hell. How do you tell which one is the right one for you?

And there is no "cure" for this lovely condition, we are only treating symptoms. So some Vegemite eating person told me anyway.

Would be great to have a chart of therapies outlining risk factors, down sides, side effects etc.... some sort of road map of the ups and downs of treatments out there including meds and psycho-therapy.

Sorry Learning Curve, but the above does start to confuse the issue a bit, well for my small brain it does. And if one therapy addresses one thing, can you do another therapy at the same time.... psychotherapeuticly speaking speaking that is.

And if Russia attacked Turkey from behind would Greece help??? Huh?? OK thats enough from me for now. Goin a little wacky.

Wagon out.

 

[anthony]

EMDR is very good... it is one of the the four treatments approved for PTSD, though EMDR is actually a CBT therapy. As of 2010, the actual statistics for success of the treatment of PTSD stand as follows:

• Exposure Therapy
• Cognitive Therapy
• EMDR
• Stress Inoculation Training

These are the four Tier 1 approved CBT treatments for PTSD, all showing the most efficacy.

Most people when referring to CBT, refer to Cognitive, Exposure and Stress Inoculation, as those three have conclusively shown the most benefit for long term results. EMDR by itself is excellent, but fails for PTSD unless combined with other CBT components to provide the longevity.

LC, what you say about treatment rates for severe cases is absolutely true. Studies that show statistics are useless, as those studies use barely marginal cases, and exclude anyone with severe symptoms, which is PTSD. Studies are useless that have any type of control measure included for treatment outcome.

EMDR however, is only a traumatic memory processing therapy, it is outright proven, and admitted by Shapiro herself, as only traumatic memory processing. You must combine exposure therapy and other stress management components into the equation to provide longevity results, otherwise, everything you process through EMDR is all undone over the course of the following year or two, and suddenly the sufferer is back to square one. These are proven results on current 2010 data by the experts, ie. NIMH, US DOD VA, etc etc.

Even medication now, due thankfully to neuroscience, is starting to be wavered away slowly, as neuroimaging has proved there is no chemical imbalance, or chemical balance to begin with, backing pharmacological companies theoretical basis on the Pax Medica model claimed in the 70's when Prozac came about. It has been the only theory workable, until now after several years of neuroimaging data is showing the same results over and over, being medication should not be a preferred treatment option vs. psychotherapy.

It works on some, but they actually don't know how... and as there is no chemical balance to imbalance like thought, this tends to back why results are so hit and miss with medication types and dosages.

Neuroimaging is now beginning to put a lot of holes in existing theories, which have been accurate as we have known nothing else, but now technology is allowing us to see the brain and its associated areas as provoked under controlled situations.

 

[Wagon]

I think I finally understand all the acronyms and what they mean. Using slightly different terminology here. My treatment is called MetaCognitive Therapy. Perhaps for shortening. But methods remain same.

Thanks

wagon

 

[anthony]

There are many names under the CBT umbrella... for example, Dialectic Behavioural Therapy (DBT) is CBT + specific focus on emotional distress control for those with PTSD + personality disorder.

Basically, it works heavily on getting emotional stability first, so the person can then deal better with reactions when they begin looking into their trauma. The personality disorder is normally due to complex childhood trauma / significant long-term emotional and physical abuse. DBT is CBT... just very specialised for a specific branch. Prolonged Exposure (PE) therapy is the most successful for all under the CBT umbrella for the treatment of PTSD, IF, done correctly. It has the best results for military, as military are trained to be very hands on, face the problem type people, do military often pickup and relate the best to PE vs. talking about their emotions.

 

[adeline]

Anthony, this treatment is almost exactly what is being done with my husband here at his PTSD program.There are some variations and what not but it seems to help him right now with processing his trauma and learning new ways to deal with it all. I have seem some positive results and of course regression. But he is starting to open up and come out of his shell.

 

[anthony]

Good to hear. The basic 12 week model is only an introduction. It actually takes much longer than that to be perfectly honest. The normal period for trauma therapy is 3 - 6 months, then another year or two to really wrap your head around it and practice, practice, practice... progressively swapping out a negative with a positive and improving your life the way you want it.

 

[reddevil1111]

Ok -So I have read this and am still a bit confused about treatemnt. I have a large list of issues. PTSD from my childhood abuse. (really bad stuff) I also have PTSD from Combat and in addition I am also Bi-polar.
So Anti depressants are out. I take pain meds for injuries but only as needed and I try to keep that down as much as I can.
I am on Lamotrigine for the bi-polar (200 mgs)
Also, I am taking Prazosin (2mg and soon to go to 3mg)to reduce my nightmares and allow me some sleep. I can go 2-3 days without sleep without it.
my Therapist is pushing EMDR on me. I have had only a little bit on grounding taught to me. I have tried it and it has no affect on me when I come out of my flashbacks. I dont have the options like some for the VA as the nearest va hospital is over 100 miles from me. (And I dont trust the VA ..not one bit) So I get some low income help from my local county. I live in a mountain community and my options are very limited.
Do I try the EMDR? or just stop working with the therapist? Those are my options. Thoughts? thanks,Dan

 

[willis williams]

I live 90 miles away from the spokane wa. VA. It is not that bad of a comute for me because I recieve travel pay and actually make money when I go. The VA is not all bad the groups for PTSD and similar one are free and if you are service conected you will be paid to go and they usually have late evening classes so it doesn't affect your life to bad. I was hospitalized from a drug named seroquil for five week. I have PTSD and am also bi-polar. After I got out of the hospital they were very accomidating and looked after me on a regular basis. Then it faded no more 1 month appointments the care was gone. But the groups I cotinued for three months and attend a theripist every two weeks he is paid by the VA but is independant. As for CBT or EMDR if a therapist is a good one the will be straight up honest and tell you that they can't handle it. Lets face it you start digging around in all that hidden shit your going to get a reaction good our bad. I would never recommend anyone stoping therapy enless they have an awsome support group to watch over you. I have been wating on my new son so i can get some time to focus on me and I am going to try and attend a intensive CBT coarse probably in oregon. I upped my therapy to every week because I am not bonding the way I should with Taylan my son. I take lamotrigine, lithium, trazidone, stomach meds, And valuem as needed. I don't have any good answers I just wanted you not to feel like your the only one fighting this. Therapy has helped me more than all the other shit hell I ain't even figured out how to ground yet and I been seeing docs since 1998. I even took off walk about last night no din't even tell my sweety where I went it was just in the woods by a mountain lake but I was gone. The programs at the VA are good if you pick and choose your battles. My therapist recomends the CBT and speaks very highly of it and he should know since he spent plenty of time in nam as a marine and is still pretty f*ckup physically but got his head back on straight through simelar treatments. Sorry for the long post but I will cut them back after this one. TEX