An Active Ingredients Approach to Treating Posttraumatic Stress Disorder
J. Eric Gentry, Anna B. Baranowsky, and Robert Rhoton
Meta-analytic studies have extracted 4 common elements among effective posttraumatic stress disorder treatments: cognitive restructuring and psychoeducation, a deliberate and continually improving therapeutic relationship, relaxation and self-regulation, and exposure via narrative of traumatic experiences. The authors present a clinical treatment structure catalyzing these active ingredients into discrete therapeutic tasks that counselors can focus on to maximize treatment effectiveness. The 4 tasks represent an attempt to identify critical competencies and baseline standards for the field of trauma counseling.
Keywords: traumatic stress, PTSD, active ingredients, treatment, trauma competency
In the 37 years since posttraumatic stress disorder (PTSD) was conceptualized as a diagnosis (American Psychiatric Association, 1980), researchers and counselors have labored to develop and refine treatments for survivors of trauma. In 2010, a significant milestone was passed with the publication of the Department of Veterans Affairs (VA) and Department of Defense (DoD) treatment guideline for PTSD (Management of Post-Traumatic Stress Working Group, 2010), which presented clear evidence that trauma-focused treatment works best for clients with trauma-related symptoms. If a competent professional follows these guidelines, clients with PTSD can reasonably expect relief from their acute trauma symptoms and, with continued engagement, their more chronic symptoms as well (Baranowsky & Gentry, 2014; Briere & Scott, 2014; Cahill, Rothbaum, Resick, & Follette, 2009).
Since then, empirical meta-analytic research has produced additional sets of best practices and treatment guidelines to help counselors manage trajectories of treatment with trauma survivors and their families (Baranowsky & Gentry, 2014; Cahill et al., 2009; Cloitre et al., 2011, 2012; Forbes et al., 2007; Ursano et al., 2004). The discipline of trauma counseling has matured beyond determining whether treatment is effective and toward integrating the most effective methods of treatment. Now, the field is approaching another evolutionary leap in the understanding and prescription of treatment for posttraumatic conditions. Four active ingredients have been identified as common to all effective treatments for survivors of trauma and hypothesized to be primary mechanisms for the effects demonstrated by evidence-based treatments.
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