Post-traumatic stress disorder: A congnitive-contextural approach

Most people are psychologically effected by an extreme trauma and for a significant minority the debility is long term, often expressed as post-traumatic stress disorder (PTSD). A cognitive-contextual approach is described in which the prime focus is upon teaching the client how to interact adaptively with the memory of the trauma by: a) facilitating a switch from a primarily perceptual to a more conceptual level of processing the trauma itself; and b) placing the trauma in the context of past life experiences and determining its relevance for the future. The approach is illustrated by the treatment of a PTSD diagnosed motor vehicle accident victim.     

The nature of irrational and rational beliefs: Progress in rational emotive behavior theory

This paper discusses some limitations of Ellis's Rational Emotive Behavior Therapy. It is suggested that the present definition of irrational and rational beliefs is inadequate. The present theory is unclear whether irrational beliefs are exaggerated negative evaluations or empirical distortions of reality. It is proposed that irrational beliefs are core schemes, and that the concept of schema replace the present definition of beliefs. Ellis's position that demandingness is at the center of irrational thinking and emotional disturbance is examined. Research has failed to support this theory. It is proposed that demandingness and self-downing may be separate types of core irrational schemes. Research strategies are suggested that could test Ellis's position on the centrality of demandingness and on the nature of irrational beliefs in general.It is also suggested that irrational beliefs differ on their level of abstraction. The present REBT theory fails to identify which level of abstraction is necessary to cause disturbance, at which level of abstraction therapists should seek change, and whether a therapist should intervene first at higher or lower levels of abstract beliefs. It is suggested that a therapist only seek change to the level of abstraction that matches the client's concerns and that therapists begin to intervene at lower levels of abstraction and move up to more abstract cognitions as therapy progresses.The Institute for Rational Emotive Therapy     

Post-traumatic stress disorder in families

When one or more members of a family are traumatized, the entire family can suffer from post-traumatic symptoms. Unfortunately, this may go unrecognized by the family, friends, and professionals. A cycle of post-traumatic victimization and fragmentation of family integrity can lead to disastrous consequences. The post-traumatic phases leading to such a destructive outcome are discussed in detail. Treatment of the traumatized family should include psychoeducational, psychodynamic, systemic, behavioral and spiritual interventions.     

Memory and attention in combat-related post-traumatic stress disorder (PTSD)

Vietnam combat veterans assigned diagnoses of PTSD were compared on measures of attention/concentration, new learning, and memory with Army National Guard enlistees who reported no unusual traumatic events or stress-related symptoms. Results showed that PTSD veterans performed more poorly than the comparison sample on a measure of verbal learning, exhibiting less proficient cumulative acquisition across repeated exposures, greater sensitivity to proactive interference, and more perseverative errors. Veterans with PTSD diagnoses also evidenced impairments in word fluency and visual attention/tracking abilities. These preliminary findings suggest that diagnoses of chronic PTSD in combat veterans are associated with cognitive performance deficits, when comparisons are made with military troops judged to be free of stress-related psychopathology. Results are consistent with self-reported complaints of concentration and memory impairments among PTSD-diagnosed clinical samples, thus highlighting the need for continued investigation of the neuropsychologlcal sequelae of prolonged stress exposure.     

Emotional working memory capacity in posttraumatic stress disorder (PTSD)

Participants with a lifetime history of posttraumatic stress disorder (PTSD) and trauma-exposed controls with no PTSD history completed an emotional working memory capacity (eWMC) task. The task required them to remember lists of neutral words over short intervals while simultaneously processing sentences describing dysfunctional trauma-related thoughts (relative to neutral control sentences). The task was designed to operationalise an everyday cognitive challenge for those with mental health problems such as PTSD; namely, the ability to carry out simple, routine tasks with emotionally benign material, while at the same time tackling emotional laden intrusive thoughts and feelings. eWMC performance, indexed as the ability to remember the word lists in the context of trauma sentences, relative to neutral sentences, was poorer overall in the PTSD group compared with controls, suggestive of a particular difficulty employing working memory in emotion-related contexts in those with a history of PTSD. The possible implications for developing affective working memory training as an adjunctive treatment for PTSD are explored.     

Changing rational-emotive therapy (RET) to rational emotive behavior therapy (REBT)

Reasons are given for changing the name of Rational-Emotive Therapy (RET) to Rational Emotive Behavior Therapy (REBT) and for bringing its behavioral aspects into more prominence. Excerpted from “Changing Rational-Emotive Therapy (RET) to Rational Emotive Behavior Therapy (REBT).Behavior Therapist, 1994,16(10), 1–2, and fromReason and Emotion in Psychotherapy, Rev ed. updated. New York Carol Publishing, 1994. Reprinted with permission.     

Counselling in Action: A multimodal assessment and rational emotive behavioural approach to stress counselling: a case study

This paper demonstrates how the multimodal approach, developed by Arnold Lazarus (1989 Lazarus A.A. 1989 The practice of multimodal therapy: systematic, comprehensive and effective psychotherapy Baltimore John Hopkins University Press  [Google Scholar]), can be used to aid assessment of a client suffering from the effects of chronic, work-related stress. A rationale is provided for integrating the multimodal approach with rational emotive behaviour therapy theory, techniques and strategies (Kwee & Ellis, 1997 Kwee M. Ellis A. 1997 Can multimodal and rational emotive therapy be reconciled? Journal of Rational-Emotive & Cognitive-Behaviour Therapy 15 2 95 132 [Crossref] [Google Scholar]). A modality profile and a second order BASIC I.D. profile were developed and used as the link between assessment and the stress counselling programme (Palmer, 1992 Palmer, S. 1992. Multimodal assessment and therapy; a systematic, technically eclectic approach to counselling, psychotherapy and stress management. Counselling, 3(4): 220–224.  [Google Scholar]). A range of assessment tools were used to assess progress and a session by session report is provided.     

A thematic analysis of practitioners' understanding of domestic abuse in terms of post‐traumatic stress disorder (PTSD) and complex‐PTSD (C‐PTSD)

There is a growing body of evidence suggesting that domestic abuse (DA) should be conceptualised within the complex post‐traumatic stress disorder (C‐PTSD) model. Recently, in the draft of the International Classification of Diseases, Eleventh Revision, produced by the World Health Organization (WHO), C‐PTSD was included as a separate criterion in which DA is incorporated (ICD‐11, WHO, 2018). In this study, a thematic analysis was used to explore to what extent practitioners working with DA survivors are familiar with PTSD and C‐PTSD. Research into such a prevalent and detrimental problem as DA is important to understand whether the development of theoretical knowledge about DA and C‐PTSD is addressed in practice. In a Women's Centre in South London, six semi‐structured interviews with middle‐aged female practitioners were conducted to investigate each counsellor's experiences, knowledge and reflections. Six final themes were constructed to summarise the main results. The findings demonstrate limited practitioner understanding of DA in terms of C‐PTSD, which seems to impact not only the effectiveness of treatment plans with DA survivors, but also counsellors’ own psychological and physical states. It is also indicated that DA can be conceptualised within the C‐PTSD model that corresponds with previous literature indicating the complex nature of DA. The overall results of the current research acknowledge that DA sectors should not be neglected and better funding and effective psychoeducation in this field are needed.     

Effects of trazodone on sleep in patients diagnosed with post-traumatic stress disorder (PTSD)

Trauma victims frequently report nightmares with experiences of reliving the stressful event in catastrophic dreams. The following day there are exaggerated startle responses and psychic numbing, followed that evening by a reluctance to go to sleep and insomnia. This study found trazodone to be effective in veteran patients with a diagnosis or symptoms of PTSD including sleep disturbance. Among this group of veterans, 20 of the 21 under 60 and 24 out of 27 over 60 had positive responses to bedtime trazodone doses, in that they slept better, including going to sleep more quickly, having fewer nightmares,and had less anger the next day. These benefits may be due to deepened non-REM sleep early in the night as well as delayed REM-sleep onset.     

Psychological management intervention guidelines for rape survivors with post-traumatic stress disorder (PTSD): A brief exploratory systematic literature review

This exploratory systematic literature review aimed to characterise the current evidence on psychological management intervention guidelines for use with rape survivors with post-traumatic stress disorder (PTSD) symptoms. For the data searches we accessed the following electronic databases: Google Scholar, Science Direct, EBSCOhost, and PsychInfo. We utilised search terms with variations of the following key words: psychological management guidelines of PTSD*, rape survivors*. Inclusion criteria were guidelines for rape survivors with PTSD that consider referral, treatment, and preventive and health promotion in an international setting. We excluded guidelines that did not address PTSD resulting from rape in an international setting. We employed a narrative synthesis data analysis approach to integrate the evidence from across studies. Findings suggest prevalent guidelines for rape survivors with PTSD focus on cognitive behavioural therapy and other psychological management interventions in highly specialised areas and Primary Health Care (PHC) settings in international countries, but not in other countries such as South Africa. Emerging guidelines are needed for PTSD psychological management interventions in rape care clinics situated in South Africa.     

Screening for trauma histories,posttraumatic stress disorder (PTSD), and subthreshold PTSD in psychiatric outpatients

The ability of the Structured Clinical Interview for DSM-IV (SCID) posttraumatic stress disorder (PTSD) module's screening question to identify individuals with PTSD or subthreshold PTSD was examined. First, the screen's sensitivity for detecting a trauma history was determined. Second, the incremental validity of a more thorough trauma assessment was examined by determining how many individuals responded negatively to the screen but then were diagnosed with PTSD or subthreshold PTSD. Last, the optimal SCID termination point for assessing subthreshold PTSD was determined. Using a trauma list increased the number of participants reporting a trauma; however, the SCID screen captured almost all individuals who had PTSD or subthreshold PTSD. When one screens for subthreshold PTSD, the SCID can be terminated on failure to meet Criterion B.     

Post-traumatic stress disorder,Vietnam veterans and the law: A challenge to effective representation

The legal system's increasing awareness of and understanding regarding post-traumatic stress disorders is presented. PTSD is discussed primarily in the context of litigation involving both violent criminal and nonviolent offenses. Other potential applications of PTSD at trial are reviewed. Post-conviction strategies involving PTSD are also discussed. A comprehensive review of case law involving PTSD is summarized.     

A test of the ABC model underlying rational emotive behavior therapy

The ABC model underlying Ellis's Rational Emotive Behavior Therapy predicts that people who think more irrationally should respond to daily stressors or hassles differently than do people who think less irrationally. This study tested this aspect of the ABC model. 192 college students were administered the Survey of Personal Beliefs and the Hassles Scale to measure irrational thinking and daily hassles, respectively. Students who scored higher on overall irrational thinking reported a significantly higher frequency of hassles than did those who scored lower on overall irrational thinking, while students who scored higher on awfulizing and low frustration tolerance reported a significantly greater intensity of hassles than did those who scored lower on awfulizing and low frustration tolerance. This indicates support for the ABC model, especially Ellis's construct of irrational beliefs central to this model.     

Post-traumatic stress disorder in Vietnam veterans: Assessment in a forensic setting

The recognition and proper evaluation of Vietnam veterans' demonstrating Post-Traumatic Stress Disorder syndromes is reviewed. The special problems of accurate diagnosis and assessment of former Vietnam combatants is emphasized. The forensic evaluation of Vietnam veterans' raising the Post Traumatic Stress Disorder syndrome in either civil or criminal proceedings is comprehensively discussed. The question “What are the clinical techniques necessary to accomplish a competent forensic evaluation of the Vietnam veterans?” is specifically addressed with special emphasis on legal dispositions and treatment implications. The relationship between the criminal acts of combat veterans and their exposure to the psychological trauma of war is explored.     

Emotion-specific and emotion-non-specific components of posttraumatic stress disorder (PTSD): implications for a taxonomy of related psychopathology

Many cognitive theories of posttraumatic stress disorder (PTSD), including our own SPAARS model, propose that one basis of the disorder is the cognitive system's persistent failure to resolve discrepancies between trauma-related information and the content of pre-existing mental representations, such as schemas. This leads to the characteristic PTSD symptom pattern of re-experiencing and avoidance of trauma-related material. Furthermore, the nature of this unresolved discrepancy revolves around appraisals of threat and the corresponding emotion profile in PTSD is therefore predominantly intense fear and anxiety. This paper argues that this general framework can be extended to discrepancies around other appraisal dimensions such as loss, and consequently to other emotions such as sadness. A localized taxonomy is therefore proposed comprising emotional disorders that resemble PTSD in their basic patterns of re-experiencing and avoidance symptoms--what we call their 'emotion-non-specific component'--but that differ from PTSD in terms of the core emotions involved--what we call their 'emotion-specific component'. The clinical and nosological implications of this argument are discussed.     

A memory-based model of posttraumatic stress disorder: evaluating basic assumptions underlying the PTSD diagnosis

In the mnemonic model of posttraumatic stress disorder (PTSD), the current memory of a negative event, not the event itself, determines symptoms. The model is an alternative to the current event-based etiology of PTSD represented in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000). The model accounts for important and reliable findings that are often inconsistent with the current diagnostic view and that have been neglected by theoretical accounts of the disorder, including the following observations. The diagnosis needs objective information about the trauma and peritraumatic emotions but uses retrospective memory reports that can have substantial biases. Negative events and emotions that do not satisfy the current diagnostic criteria for a trauma can be followed by symptoms that would otherwise qualify for PTSD. Predisposing factors that affect the current memory have large effects on symptoms. The inability-to-recall-an-important-aspect-of-the-trauma symptom does not correlate with other symptoms. Loss or enhancement of the trauma memory affects PTSD symptoms in predictable ways. Special mechanisms that apply only to traumatic memories are not needed, increasing parsimony and the knowledge that can be applied to understanding PTSD.     

Towards case-specific applications of mindfulness-based cognitive-behavioural therapies: A mindfulness-based rational emotive behaviour therapy

Teasdale, Segal and Williams (2003 Teasdale, JD, Segal, ZV and Williams, JMG. 2003. Mindfulness training and problem formulation. Clinical Psychology: Science and Practice, 10: 157–160. [Crossref], [Web of Science ®] [Google Scholar]) present the combination of mindfulness and cognitive-behavioural therapy as “one of the most exciting and potentially productive avenues for future exploration.” (p. 160). In the same paper they also recommend moving beyond the current general-purpose, non-case-specific applications of mindfulness (p. 157). By integrating mindfulness interventions more closely with cognitive behavioural theories, clinicians should be in a better position to administer tailor-made mindfulness-based interventions in response to specific case formulations. This paper examines important similarities and differences between mindfulness and Rational-Emotive Behaviour Therapy (REBT), in view of integrating the two practices closely within a one-on-one counselling environment. The latter half of the paper then presents recommendations of how such integration might be achieved in practice. This is illustrated with examples of three new interventions that combine mindfulness with three specific types of cognitive dysfunction as per REBT.