Cognitive Behavioral Therapy (CBT)
Introduction to CBT
Cognitive behavioral therapy focuses on the relationship among thoughts, feelings, and behaviors, and notes how changes in any one domain can improve functioning in the other domains. For example, altering a person’s unhelpful thinking can lead to healthier behaviors and improved emotion regulation. CBT targets current problems and symptoms and is typically delivered over 12-16 sessions in either individual or group format.
This treatment is strongly recommended for the treatment of PTSD.
How CBT Can Help with PTSD
Using CBT to Treat PTSD
Therapists use a variety of techniques to aid patients in reducing symptoms and improving functioning. Therapists employing CBT may encourage patients to re-evaluate their thinking patterns and assumptions in order to identify unhelpful patterns (often termed “distortions”) in thoughts, such as overgeneralizing bad outcomes, negative thinking that diminishes positive thinking, and always expecting catastrophic outcomes, to more balanced and effective thinking patterns. These are intended to help the person reconceptualize their understanding of traumatic experiences, as well as their understanding of themselves and their ability to cope.
Exposure to the trauma narrative, as well as reminders of the trauma or emotions associated with the trauma, are often used to help the patient reduce avoidance and maladaptive associations with the trauma. Note, this exposure is done in a controlled way, and planned collaboratively by the provider and patient so the patient chooses what they do. The goal is to return a sense of control, self-confidence, and predictability to the patient, and reduce escape and avoidance behaviors.
Education about how trauma can affect the person is quite common as is instruction in various methods to facilitate relaxation. Managing stress and planning for potential crises can also be important components of CBT treatment. The provider, with the patient, has some latitude in selecting which elements of cognitive behavioral therapy are likely to be most effective with any particular individual.
Case Example
Jill, a 32-year-old Afghanistan War veteran
Jill had been experiencing PTSD symptoms for more than five years. She consistently avoided thoughts and images related to witnessing her fellow service members being hit by an improvised explosive device (IED). This case example explains how Jill's therapist used a cognitive worksheet as a starting point for engaging in Socratic dialogue.
For Patients & Families
What is Cognitive Behavioral Therapy?
References & Resources
Journal Article
Benight, C. C., & Bandura, A. (2004). Social cognitive theory of posttraumatic recovery: The role of perceived self-efficacy. Behaviour Research and Therapy, 42, 1129–1148
Book
Monson, C. M. & Shnaider, P. (2014). Treating PTSD with cognitive-behavioral therapies: Interventions that work. Washington, DC: American Psychological Association. doi: 10.1037/14372-000
Book
Ehlers, A. (2013). Trauma-focused cognitive behavior therapy for posttraumatic stress disorder and acute stress disorder. In Simos, G., & Hofmann, S. G. (eds). CBT for anxiety disorders: A practitioner book. New York: Wiley.
Journal Article
Rauch, S., & Foa, E. (2006). Emotional processing theory (EPT) and exposure therapy for PTSD. Journal of Contemporary Psychotherapy, 36(2), 61.
Book
Grey, N. (Ed.) (2009). A casebook of cognitive therapy for traumatic stress reactions. Hove, UK: Routledge.
Strongly Recommended
Cognitive Behavioral Therapy is strongly recommended by the APA Clinical Practice Guideline for the Treatment of PTSD (PDF, 1MB).