today i'm going to be talking about a
counter-intuitive
but highly effective form of treatment
for post-traumatic stress disorder
hi everyone today i'm going to be
talking about post-traumatic stress
disorder
and a cognitive behavioral therapy
for treating ptsd which is the form of
therapy that i use
when i'm treating a client with ptsd but
before i get into that
just a couple of disclaimers to go over
i'm a registered psychologist
in the province of british columbia
canada and this video is for
informational purposes
only it is not intended as a replacement
or substitute for
advice from your doctor or mental health
professional
if you're enjoying my videos and would
like to see more
please hit that subscribe button and
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a new video now with those things out of
the way
let's start talking about a treatment
for ptsd
now the treatment i do for ptsd is
something called cognitive behavioral
therapy and it's a form of treatment
that really focuses on
the interrelationships between behavior
thought and emotion and the treatment
for ptsd
uh is one that requires a person
to really understand it requires a
client to really understand
why ptsd happens and
how these therapeutic interventions are
actually going to
help because without a good
understanding
of what's going on with ptsd or a good
understanding for the rationale
for cognitive behavioral therapy for
ptsd
no one would actually want to do the
treatment that i'm going to be talking
about
so i did a previous video on kind of the
the cognitive behavioral explanation for
why ptsd happens so i'd highly encourage
you to watch that video
first because a lot of what i'm talking
about in today's video
won't make a lot of sense without that
understanding
now one of the keys to understanding
what happens in ptsd
is that people try really hard
to avoid reminders triggers
or thinking about the trauma
and that is perfectly natural it makes a
lot of sense
as to why a person wouldn't want to
think about a past traumatic event
because it can bring up a lot of
emotions and feelings that
a person had at the time and that can be
really distressing
but the problem is the more you try not
to think about something
the more you try to avoid thinking about
something
the more you end up thinking about it
so the metaphor i like to use is it's
almost like you're trying to hold a
beach ball underwater
and the more force and pressure you're
pushing to hold that beach ball
underwater
the beach ball keeps popping up and so
you have to then grab it and push it
back under water
a beach ball pops up you have to grab it
and keep pushing it back
under water so it's not a very effective
solution so a much better solution
is to take the air out of the beach ball
and that's kind of what
uh this treatment does is it
it's almost like you can think about the
emotion that a person experienced at the
time of the the traumatic event is
interlinked with the uh
the memories of the traumatic event and
so every time
the memories of the traumatic event come
up it brings up the same emotions
and so the treatment that i do
aims at separating the two of those so
a person can have the
thoughts without bringing up all of the
same emotions or bringing up the same
emotions to the same intensity
or the same amount of distress
so one of the main components for
treatment
is something that's called prolonged
imaginal exposure
and the idea of prolonged imaginal
exposure
is that i get my clients to write out
a detailed script of the traumatic event
in as much detail as
possible so what a person was
thinking what a person was feeling
as much sensory detail as possible
trying to
reimagine and recreate
what was happening during the traumatic
event
one of the things i often get my clients
to think about is to imagine
that there is a tape recorder in their
brain
that's recording everything that they're
thinking and experiencing
during this traumatic event and to get
that down
on a piece of paper as part of this
script
and the idea is once a person has this
script
is that they read over the script
over and over and over and over
and over again multiple times
on a daily basis and the idea is
by reviewing the script it's going to
bring up distress it's going to bring up
a lot of
anxiety and psychological distress a lot
of upset
the first time you read it the second
time you read it the third time you read
it
but the more you read it the more often
you read it
what ends up happening is that the
emotion
starts to drain away and starts to drain
out of the memory
uh the metaphor i use is that it's
almost like watching a horror film
over and over and over again right the
the first time you watched a horror film
it's really upsetting it's really
distressing
it's really bothersome the second time
you watch a horror film it's really
upsetting it's really distressing
really sort of grotesque could be even
worse than the first time you watched it
but if you watch this horror film over
and over and over again by the 100th
time you've watched the horror film
it's probably not going to be all that
distressing anymore because
you've experienced the horror film over
and over and over again and it's kind of
drained the emotion
out of it the horror film hasn't changed
one bit
it's the exact same horror film that was
the first time you watched it
but by the 100th time you've watched it
you no longer have that same emotional
reaction
well these trauma memories are kind of
like a personal horror film
and so what we're doing in this
prolonged imaginal exposure
is by reviewing the script over and over
and over again
it's draining the emotion out of it
and so over time what ends up happening
is
a person can have the memories of
the traumatic experience and it doesn't
bring up
the same amount of emotion or
psychological distress
and if the memory isn't bringing up the
same amount of
psychological distress or difficulties
then a person's not going to work so
hard
to try to not think about the traumatic
event
and what we know is that if you're not
working hard to try not to think about
something
those thoughts tend not to come up as
much
and so this prolonged imaginal exposure
works in multiple ways
it works to try and to help reduce the
distress
associated with the trauma memory but by
reducing the
distress associated with the trauma
memory
it means that the trauma memory doesn't
come up as much
because you're not trying to suppress
the trauma memory as much
now a second component to therapy that
that i do
is while we're doing this prolonged
imaginal exposure while my client is
reviewing the trauma script what we're
doing is we're looking for what i call
stuck points or parts of the
trauma script that a person develops
faulty uh assumptions or beliefs about
themselves other people or the world
right so one of the most common things
that i'll see is someone who was
sexually assaulted and one of the
beliefs that they have that's
maintaining their distress is
i should have worked harder i should
have fought off my
uh my attacker harder and so it was my
fault that i allowed that to happen to
me
well this is a really common
assumption faulty belief is that people
often think that whatever they did
was the wrong thing to do and that
anything else they could have done would
have resulted in a better outcome
but the problem is we don't know that to
be true
so by a person just being in my office
the only way they're in my office is if
they're alive
so whatever the person did
in that traumatic traumatic situation
the traumatic event
during that assault whatever they did
helped keep them alive and so
uh just because i assumed that if i had
fought the person off
then that would have led to a better
outcome well how do i know
that if i tried to fight the person off
it wouldn't have gotten worse
maybe they would have killed me
if i'd fought so the thing is
we we often come at these memories or
these trauma memories
having a whole bunch of information that
we didn't have at the moment that it was
happening
and so it's almost like we're using this
retrospective information to
look back on it and say yeah but i
should have done this instead
well how would i have known to have done
that instead i didn't have the
information at the time
so as we're going through the trauma
script what we're looking for is these
assumptions and beliefs that a person
has that are maintaining their distress
and really challenging the validity of
these beliefs
because that's one of the things that
can really contribute to and maintain
the distress
of ptsd is that these traumatic events
kind of
change the way we view the world and we
view ourselves
and we view other people and so
before a person experiences a traumatic
event this is case for all of us we all
have
assumptions and beliefs about the world
we have assumptions and beliefs about
ourselves and other people
and so for example
i know logically that every time i get
in my car and i drive somewhere
there's a chance i could get into a
serious motor vehicle accident
but deep down i kind of have this
assumption that
that's not going to happen to me that
when i'm driving from point a to point b
i'm going to get there just fine and i'm
not going to have an accident
so that's where my assumptions are
but what can happen if i have a serious
motor vehicle accident and a really
traumatic motor vehicle accident
is it shifts my beliefs and assumptions
about
the world about motor vehicle travel to
now
be maybe a different extreme where now i
believe that
every time i get in my car i'm at
high risk of being killed in a motor
vehicle accident
well that may not be true
and so uh by having that belief that i'm
at extremely high risk
it just maintains my anxiety it
maintains my distress
and so it's important to really
challenge some of those assumptions
and beliefs that stem from these
traumatic events
another thing about these assumptions
and beliefs that's important to
recognize is that
sometimes these assumptions and beliefs
are really adaptive
in one environment
but aren't so adaptive when you're no
longer in that environment
so i often see this with soldiers or
people who've been in combat
being hyper aware uh being suspicious
of other people being constantly on the
lookout
for danger or threat is really adaptive
and actually makes a lot of sense
if you're in a war zone
but those same types of assumptions and
beliefs and behaviors
are no longer adaptive when you're out
of that war zone
when you're in a place where there isn't
danger and threat everywhere
but if you approach this new environment
with the same rules
that you had in the dangerous or
threatening environment
it's going to continue to make you feel
like you're in danger
or threat now even though there is no
danger
and threat so
really understanding identifying and
challenging these beliefs and
assumptions is a critical
component of ptsd treatment and it's
something that i do while we're doing
the prolonged
imaginal exposure and the third
component
of treatment is behavioral exposure
what can happen with ptsd is that
uh people will avoid triggers they'll
avoid
situations they'll avoid activities
they'll avoid
people that will br that tend to bring
up memories
of the traumatic event and what that can
end up doing
is to make a person's world smaller
and smaller and smaller they avoid
people
they avoid activities they avoid doing
things
and what they end up doing becomes less
and less and less and this can be
extremely
interfering and disabling for a person
so after we've done the prolonged
imaginal exposure after we've challenged
these beliefs
and gotten a person to think about
the world themselves and others in a bit
of a different way
we then test that out by doing
behavioral exposures getting a person to
do exposures to situations that they
have avoided because it brought up
memories of the trauma
and made them feel really distressed so
for people who've been in a serious
motor vehicle
accident i'll get them to do exposures
of
driving and driving in different
situations driving near
the scene where the accident happened
for people who say were
you know a bank teller who was held up
at gunpoint
the idea is to get them to gradually do
exposure to
being near banks or going inside
bank branches at first maybe different
than the one
where the where the robbery took place
and then eventually getting to being
back in the
bank branch where the robbery took place
so the idea is
uh really facing these triggers and
draining the emotion out of the triggers
because again the triggers bring up
memories
uh which are distressing and so
by repeated exposure to the triggers
it may bring up the memories but because
the prolonged imaginal exposure
drains some of the emotion out of the
memories it's not so distressing
and so this behavioral exposure is
really aimed at
trying to reduce the amount of
impairment
or negative impact that the ptsd has had
on a person's life
and allows their world to start getting
a little bit bigger
and bigger and bigger
so this cognitive behavioral treatment
of ptsd
i know it sounds quite logical in theory
and it is and it the thing i like about
it
is that it works and there's lots of
evidence to demonstrate
that cognitive behavioral therapy for
ptsd
is one of the most effective treatments
for ptsd
this exposure to the memories exposure
to
uh triggers challenging these stuck
points
it's uh it's kind of the gold standard
for treatment
but one of the problems is this can be
really difficult
so um it's one of the things when i'm
working with my clients i
often highlight it's it's kind of like
that buckley's cough syrup
commercials you know that it tastes
awful but it works
this type of treatment really does taste
awful
it really is a challenging form
of treatment and i always tell my
clients this
it's not going to be easy but
neither is living with ptsd and so
by doing this treatment even though it's
going to be difficult and even though
it may make things worse in the short
term
in the long term it can be really
effective
and can really help a person put these
traumatic events
in into their past file them away
and so that they're not as distressing
or interfering
or causing a person as much trouble or
difficulty
so i hope you find that helpful a
better explanation or understanding of
how it is we actually go about
treating ptsd i'd love to hear your
thoughts and ideas about this
so please leave me some comments down
below
i read all of them and like to respond
to any questions
that come up thank you for making it all
the way to the end of this video
and i will see you in the next one