News The Four Tiers Of Ptsd Treatment

[anthony]

I've been thinking about this lately, and reviewing some documents citing each specific techniques success and failure, and I've come to the conclusion that CBT as a total package is actually more accurately in excess of 95% successful in PTSD treatment.

Ok, what are the four Tier 1 therapies for PTSD? Easy:

1. Trauma Focused Cognitive Behavioural Therapy (TF-CBT)
2. Prolonged Exposure Therapy (PE)
3. Stress Inoculation Training (SIT)
4. Eye Movement Desensitization & Reprocessing

The first three comprise a complete CBT bundle treatment program. EMDR requires a little of the first three combined to make a complete CBT bundle.

The more data I review, and thinking backwards over past years, uniquely the above therapies average around the 60% - 70% success range based on specific session quantities for the purpose of a study. What these studies don't usually factor in, some have, is the individual severity of some sufferers.

Studies that have factored this in, limited in quantity, have shown results at 90% - 100% success. Most only perform 12 sessions for the purpose of a study, to obtain majority results.

Thinking about my own work with people in private, anyone I've worked with who has stuck out the entire process is for the most part, no longer upon this website, as they're now back in life. The same seems to go for those who are treated by the worlds experts, and who also stick it out for the full duration, they seem to be completely healed.

This leaves me only two possibilities for why the proven and approved tier 1 therapies for PTSD fail, being the client or the person delivering the therapeutic technique.

I'm no expert by any means, though I can see that a technique is a guide that must be used and adapted to each person uniquely. You don't change the technique, you adapt to the issues being presented. I think if the therapist isn't providing feedback and alternatives from all different views, that is the first issue on their behalf. These aren't their beliefs, but realms of possibilities to be thought about, applied and tried. Then you have the sufferer. WOW... so many give-up because its just all too hard and takes too long. People want it quick and want the fix now. They don't want to discover the answer themselves, they think someone telling them what is wrong and how to fix it will fix them. Wrong! The brain just doesn't work that way.

So on review of data from the above four tiers, it seems when you have a therapist who uses a lot of common sense combined with knowledge about all the therapies above, and who can adapt them to suit each person, with a sufferer who is truly dedicated to putting in a lot of hard self-work, beyond just an hour of therapy per week, the success rate is nearly guaranteed for 95% improvement. The only unknown factor is the time to recover due to the severity.

Debatable?

 

[piratelady]

I have to say when I first read this I was taken aback. Now that I look back on my therapy experiences I can see the point.

First therapist - offered no feedback other than "You really need to talk about this in detail.." Other than that, it was me recounting horrible situations over and over.

New therapist - He points out alternatives and then puts the ball in my court to let me decide how to proceed. What I do is my decision. If I fall on my ass helps me up, we re-assess and move on. Rather than just re-hashing details we focus on how I feel and what we need to do to make the changes I need to make.

I feel like I've learned more in 3 sessions with new therapist than I did in nearly a year with first therapist. I can see now, how if someone takes the time to work on stuff outside of therapy and receives good feedback inside of therapy healing can be dramatically improved.

 

[The Albatross]

While my psychologist's technique worked well with ADD/ADHD (taught me to slow down my thoughts enough most of the time to process and not freeze or sputter), he used the same technique several times for multiple sessions with me and it didn't work at all. I've learned more management stuff with REBT, CBT, ACT and DBT with self help or this forum than I have with him.

Very encouraging to read that the people you worked with are doing so well Anthony.

 

[anthony]

What makes me often think of failure for PTSD, and this is based on this sites majority are females who've been sexually abused, is that many in that trauma category want an empathetic female for them to listen. There is no common sense, no outside of the box concepts or ideas, not pushing the person to get back outside their comfort zone.

Don't take that the wrong way, that is not an all or nothing statement, it is a majority statement found in female therapists who deal in sexual trauma. When first abused, they are absolutely the people you need to be with, no question about it. But when it comes to healing trauma and dealing with PTSD, they are not the people to be with. You will endup healing for 10, 15 or 20 years, and still not be close to getting your life straight. You'll just be a whole lot lighter in the pocket and experience years of duress that just aren't necessary to suffer IMO.

That is my biggest pet hate with PTSD, in that the industry designed to help recover PTSD actually exacerbates PTSD's longevity, when the techniques are already there and proven effective to near 100%. You just need a common sense therapist and a sufferer really wanting to knuckle down and work hard for a short period of time to get through the worst.

Once you get a person through their worst, they actually use that to get themselves through the rest... with little need for assistance. They might only need vent or bounce some ideas around once in a blue moon, otherwise they quickly learn how to function effectively and self correct as they go. The more experience they obtain from the techniques learnt, the better they become. Nobody heals PTSD staying in bed, moping around, wanting pity for the trauma and injustice they've endured or going to the pub / sticking your head in the sand the moment it gets a bit tough to do hard work.

This is what often makes me want to scream with all these initiatives to try and market some new nonsense, more assessment and studying required to find something, etc etc etc. It comes out as blah, blah, blah. All the hard work has already been done for us all... TF-CBT, PE, SIT and EMDR, proven beyond any doubt empirically as the most effective treatments for PTSD. That only leaves those two variables, being the teacher and the student.

he used the same technique several times for multiple sessions with me and it didn't work at all

That is the exact issue... a technique has a time and a place, and these people must use the right one from within a therapy model through judgement and common sense. Like you found, four CBT models used correctly for each specific aspect as you raised it, is what works. All those four use TF-CBT, PE and SIT, it is how they use them that differs, based on the specific application of the problem presented.

If people stopped reading one book on a therapy and instead educated themselves on a vast cross-section, they would quickly see the full scope and potential of specific therapies. I think a lot of people confuse the C&BT counselling therapy that focuses on cognitive distortions and reality with the CBT model, which comprises far more expansive areas of common sense and distortions, and how to apply them to a specific issue.

 

[The Albatross]

Weird though, now that you raised it, that even though I had sexual traumas... my shrinks were all men except the initial Rape Crisis Therapist. Though I always was aware of who was in the office, if the secretary was there. My main occasional glitch, is men who are not my husband and my car.

 

[The Albatross]

P.S. If you're ever willing to take me on... I'd love to hear your ideas about neurology since between my former therapist and my Internal Medicine Doctor I've been tagged with PTSD with DID type behaviors, ADD/ADHD, and a very ambiguous ICD-9 code this year "COSA" Co-occuring Stimulating Activity. Off topic, and as you develop your site, I'm game and I welcome your comments.

 

[Rumors]

Just wondering, or perhaps reading your post and thinking that I may go through some of this during my therapy, how detailed is exposure therapy? I haven't been in a place where I was capable of talking about anything without having an anxiety attack. Maybe I can now I am not sure. I am worried about it though bc I don't want to have a meltdown. The anxiety of melting down is almost as bad as talking about stuff. Anyway, just wondering how "exposed" exposure therapy leaves a person.
Thanks for the insight.

 

[intothelight]

Just want to share my own personal experience here too. I was in therapy for over a year with a therapist who was primarily teaching me positive coping techniques, but would do little more that just "talk" therapy. When I pushed her to work with me using CBT, all I got was excused. I wasted a lot of time and money.

I learned to manage my symptoms and heal more on my own using your (Anthony's) one page therapy outline than I did during that entire year. Now I am seeing a trauma therapist, to help me finish the things I could not do on my own. Basically making the emotional connections by using CBT and some DBT techniques. Also find myself needing more therapy due to stressful life situations.

Funny thing is I am finding myself handling some of the greatest stress in my life far better that I ever felt would be possible. No it isn't perfect and there is still work to do, but if I am doing this well with what is going on in my life, I feel the possibilities are endless and the future looks very bright.

But again, it is entirely up to the individual to take responsibility for their own healing. A therapist gives us tools and it is up to us to use them, and to keep at it until we get it.

Just my .02

 

[piratelady]

What makes me often think of failure for PTSD, and this is based on this sites majority are females who've been sexually abused, is that many in that trauma category want an empathetic female for them to listen. There is no common sense, no outside of the box concepts or ideas, not pushing the person to get back outside their comfort zone.

I was the definitely not in the majority. I have always been so worried about having a woman therapist. I always fear they would judge me and I wonder what they would have done in the same situation. Male therapists are the only therapist for me!

Speaking more to their personality, yes in the beginning I did need someone to be empathetic and listen. Once I got past that part, and was ready to dive in, the therapist was unable or unwilling to accommodate so I had to find someone new. I then found the other extreme - which was someone who was all about change and progress and wouldn't know "empathy" if it smacked him in the face. I think in a therapist, no matter where you are at in therapy, they must be able to push you for change but listen and be empathetic when necessary...balance... is my word of the week :)

That is my biggest pet hate with PTSD, in that the industry designed to help recover PTSD actually exacerbates PTSD's longevity, when the techniques are already there and proven effective to near 100%. You just need a common sense therapist and a sufferer really wanting to knuckle down and work hard for a short period of time to get through the worst.

I wonder if perhaps many therapists are concerned that they will push too hard cause more harm than good. Perhaps, more often than not, they underestimate the sufferer...of course I guess that goes back to the therapist being part of the road block to healing.

If people stopped reading one book on a therapy and instead educated themselves on a vast cross-section, they would quickly see the full scope and potential of specific therapies. I think a lot of people confuse the C&BT counselling therapy that focuses on cognitive distortions and reality with the CBT model, which comprises far more expansive areas of common sense and distortions, and how to apply them to a specific issue.

I have to say, I've never heard of C&BT

 

[anthony]

Most therapists are worried about being sued or such... to busy covering their arse nowadays due to political correctness gone stupid. The best therapist are independent, as they don't answer to an organisation that is covering their arse, which is often worse. An independent, it is your word against theirs, so you would want to have all your ducks in a row to complain legally, and especially if they keep thorough documentation.

Independents are where you're less likely to have issues... though never say never, as there are plenty of idiots spanned across the globe in all sorts of industries.

 

[AS1975]

So what do you suggest? I have so much shit coming out of so many different compartments in the 'put it in and forget about it' box that I have to pick individual incidents, I'm also using journaling/diaries to get things in order because it is all mixed up. I wanted to use either CBT/EMDR and the psychiatrist chose EMDR for the major incidents and it seems to be effective, I can now think about certain events and see the good that came of them. I suspect other forms of counseling would be needed for the bulk issue(s), but getting the biggies recategorised in my head has to help surely?

 

[Hashi]

The best therapist are independent, as they don't answer to an organisation that is covering their arse, which is often worse. An independent, it is your word against theirs, so you would want to have all your ducks in a row to complain legally, and especially if they keep thorough documentation.

No idea how the therapy system works in your country compared to mine. Just to clarify - by independent, do you mean that they're still accredited by a recognised body?

I'm not interested in arse covering, really, or how many ducks and how they're aligned for a legal case. Just that who I'm seeing has done more than a couple of weekend courses. But maybe you mean this.

Where I am, there isn't anything inherently wrong with organisations - in fact, I found it helpful to think that someone was a specialist with specialist support from their organisation. It was "independents" who gave me the bother.

Also curious, regarding your first post, about what is defined as successful PTSD treatment.