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Wednesday, December 28, 2016

7 Takeaways from “Prolonged Exposure Therapy for PTSD (Therapist Guide)”

7 Takeaways from “Prolonged Exposure Therapy for PTSD (Therapist Guide)”
Cliffsnotes from the Prolonged Exposure Therapy manual, in preparation for the VTSC Prolonged Exposure Therapy for Veterans (Basics & Advanced) workshops in early 2017.

I first learned about Prolonged Exposure (PE) not in graduate school, but in a two day seminar taught by Dr. Scott Michael last year. Dr. Michael is a psychologist with the Puget Sound VA & has been utilizing PE with veterans since 2003. His seminar got me very interested in the utility of PE in my work, as a DBT Therapist. With that being said, I also had a lot of room for growth in my knowledge base. I found the Foa, Hembree, & Rothbaum manual to meet my needs, and am excited to learn more about PE and practice it in my therapy work. Here’s the top 7 things I’ve learned from reading this manual:

  1. This text related a cognition commonly associated with PTSD (“The world is entirely dangerous.”) to feelings of incompetence to cope with the dangerous world. This makes sense when thinking about veterans; being incompetent is career ending in the military, a feeling of incompetence is horrendously difficult to overcome. I also got to thinking about my DBT clients; who tend to oscillate between apparent competence & active passivity. I can imagine the feelings of incompetence associated with PTSD are additional layers in DBT treatment that both client & therapist must navigate.
  2. The manual spoke a lot about habituation, but I enjoyed the description and explanation on page 15. The author(s) go on to say “clients also learn that they can tolerate their symptoms and that having them does not result in ‘going crazy’ or ‘losing control,’ fears commonly held by individuals with PTSD.” DBT clients go through at least six months of comprehensive treatment before doing a PTSD protocol; we teach them distress tolerance before they even start a program like prolonged exposure. That felt reassuring to my work. I also think that ‘going crazy’ or ‘losing control’ is a common misnomer due to the stigma in our society—especially in military culture. Sad, but I feel equipped to handle that conversation with a client.
  3. On page 19, the reader is informed that the client will receive a workbook that contains all necessary handouts and homework forms. I had no idea that PE included a client workbook! I like that aspect. Clients (& therapists) can photocopy the forms from the website.
  4. The manual was very clear that PE is a treatment for PTSD, not a treatment for trauma. I’d like to hear more about that and what that means; and how that looks in therapy.
  5. There’s an assessment called “Posttraumtic Stress Diagnostic Scale,” (PDS); which is available at a 50% discount for readers of the PE Manual. I have never heard of this particular scale, I’ve only used the Mississippi Scale for Combat-Related PTSD.
  6. Page 88 of the manual gives many examples of potential questions the therapist could ask to illicit additional details during the imaginal exposure. Until I am fluent with my PE skills, I think this would be very useful.
  7. Throughout the manual it occurred to me that the homework commitment is very time-intensive for PE. From my calculations, it seemed to take upwards of 5 hours a week. I imagine a client would have to really want the treatment for it to be successful.

Foa, E.B, Hembree, E.A, & Rothbaum, B.O. (2007). Prolonged Exposure Therapy for PTSD (Therapist Guide). New York: Oxford University Press.

Kimberly Hardy, LMHC