Clinician's Guide to PTSD: A Cognitive-Behavioral Approach, by Steven Taylor
Reading for one of my trauma classes. I’m not summarizing the whole thing, just bits I found especially interesting.
Chapter One: Clinical Features of PTSD. Nothing new here.
Chapter Two: Cognitive and Behavioral Features of PTSD.
Amnesia. People rarely have global amnesia for traumatic events (not even knowing it happened or having no memories of any of it), unless they also had a head injury or other physical damage (ETA: or are children, or there were a whole series of similar events, of which only some are remembered. What doesn't happen often: a sober adult has something horrible happen to them, and later does not even recall that it ever happened.) But partial amnesia is extremely common. A typical example is “weapon focus,” in which a person might recall every detail of the gun but nothing about the attacker’s face.
Taylor suggests that this is caused by “attentional narrowing,” which is a common result of extreme arousal. The apparent amnesia is caused by hyperfocus on certain details and total ignoring of others, so the ignored details were never encoded into memory at all. (As opposed to being forgotten or being present but inaccessible.)
My note: be upfront with people about this - they may never be able to recall everything, and that’s okay. Total recall is not necessary to healing.
Guilt. Trauma survivors tend to have a number of incorrect beliefs about the trauma which cause them a lot of pain and suffering. Helping them identify and argue with these beliefs can be very helpful. Great breakdown of common false beliefs on p. 34-35. I’ll just list a few.
- Hindsight bias. “I should have (magically) known the drink was roofied.”
- Justification distortion. “What I did/did not do during the trauma was unjustified.”
- Responsibility distortion. “It was entirely my fault.”
- Wrongdoing distortion. “What I did during the trauma went against my morals and ethics.”
These come about for the following reasons (I only excerpt a few); unraveling them and making them explicit may be very helpful.
- Judging your actions not based on the reality of the situation, but against an ideal or fantasy that didn’t actually exist. “I should have disarmed and kicked the asses of the men who were holding me at gunpoint.”
- Blaming yourself for not acting on ideas you didn’t get until after the fact. “I should have memorized the license plate.”
- Overlooking actual benefits of actual actions. (ie, you got out alive, possibly because of what you actually did.)
- Focusing only on imaginary good outcomes of actions you didn’t take. “If I’d tried to disarm him, I definitely would have succeeded.”
- Not taking into account that when all options are bad, selecting the least bad is a highly moral choice.
- Not taking time and emotional factors into consideration - what you’d do if you had an hour to contemplate it in the peace of your own living room is different from what you do when you have seconds and a gun to your head.
Beliefs about Symptoms
- People with PTSD often think their symptoms mean they’re “going crazy.”
- They tend to interpret emotions or physiological responses as objective truth. “My heart is pounding and I’m frightened, therefore the situation is dangerous.”
- Physical/emotional arousal has become so entwined with negative feelings that they may avoid all arousal, including that caused by exercise or positive feelings. (Anxiety sensitivity.) Interoceptive exposure (inducing arousal in a safe, controlled manner) is good for this.
Clinician's Guide to PTSD: A Cognitive-Behavioral Approach
Crossposted to http://rachelmanija.dreamwidth.org/1103843.html. Comment here or there.
Chapter One: Clinical Features of PTSD. Nothing new here.
Chapter Two: Cognitive and Behavioral Features of PTSD.
Amnesia. People rarely have global amnesia for traumatic events (not even knowing it happened or having no memories of any of it), unless they also had a head injury or other physical damage (ETA: or are children, or there were a whole series of similar events, of which only some are remembered. What doesn't happen often: a sober adult has something horrible happen to them, and later does not even recall that it ever happened.) But partial amnesia is extremely common. A typical example is “weapon focus,” in which a person might recall every detail of the gun but nothing about the attacker’s face.
Taylor suggests that this is caused by “attentional narrowing,” which is a common result of extreme arousal. The apparent amnesia is caused by hyperfocus on certain details and total ignoring of others, so the ignored details were never encoded into memory at all. (As opposed to being forgotten or being present but inaccessible.)
My note: be upfront with people about this - they may never be able to recall everything, and that’s okay. Total recall is not necessary to healing.
Guilt. Trauma survivors tend to have a number of incorrect beliefs about the trauma which cause them a lot of pain and suffering. Helping them identify and argue with these beliefs can be very helpful. Great breakdown of common false beliefs on p. 34-35. I’ll just list a few.
- Hindsight bias. “I should have (magically) known the drink was roofied.”
- Justification distortion. “What I did/did not do during the trauma was unjustified.”
- Responsibility distortion. “It was entirely my fault.”
- Wrongdoing distortion. “What I did during the trauma went against my morals and ethics.”
These come about for the following reasons (I only excerpt a few); unraveling them and making them explicit may be very helpful.
- Judging your actions not based on the reality of the situation, but against an ideal or fantasy that didn’t actually exist. “I should have disarmed and kicked the asses of the men who were holding me at gunpoint.”
- Blaming yourself for not acting on ideas you didn’t get until after the fact. “I should have memorized the license plate.”
- Overlooking actual benefits of actual actions. (ie, you got out alive, possibly because of what you actually did.)
- Focusing only on imaginary good outcomes of actions you didn’t take. “If I’d tried to disarm him, I definitely would have succeeded.”
- Not taking into account that when all options are bad, selecting the least bad is a highly moral choice.
- Not taking time and emotional factors into consideration - what you’d do if you had an hour to contemplate it in the peace of your own living room is different from what you do when you have seconds and a gun to your head.
Beliefs about Symptoms
- People with PTSD often think their symptoms mean they’re “going crazy.”
- They tend to interpret emotions or physiological responses as objective truth. “My heart is pounding and I’m frightened, therefore the situation is dangerous.”
- Physical/emotional arousal has become so entwined with negative feelings that they may avoid all arousal, including that caused by exercise or positive feelings. (Anxiety sensitivity.) Interoceptive exposure (inducing arousal in a safe, controlled manner) is good for this.
Clinician's Guide to PTSD: A Cognitive-Behavioral Approach
Crossposted to http://rachelmanija.dreamwidth.org/1103843.html. Comment here or there.