DiscoverCounselor Toolbox PodcastEvidence Based Practices for PTSD
Evidence Based Practices for PTSD

Evidence Based Practices for PTSD

Update: 2021-06-27
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Evidence Based Practices for PTSD

Dr. Dawn-Elise Snipes
AllCEUs Counselor Education

Objectives
- Explore physical, affective and cognitive evidence-based practices for PTSD
Physical
- Medications
- Use of benzodiazepines following trauma was not beneficial, and may increase the risk of developing PTSD
- Use of the beta-blocker propranolol have been conflicting but one RCT did show a significant decrease in the severity of PTSD symptoms and lower likelihood of developing subsequent PTSD
- SSRIs may be helpful for addressing anxiety and depressive symptoms related to PTSD

Physical
- Medications
- CBD may offer therapeutic benefits as an adjunct to psychological therapy for disorders related to inappropriate responses to traumatic memories and aversive memory processing
- Meds for Sleep Disorders in PTSD
- Prazosin, an alpha-1 blocker for HBP
- Eszopiclone (Lunesta)
- Risperidone and olanzapine (atypical antipsychotics)

Physical
- Nutrition
- Changes in diet with an emphasis on an anti-inflammatory protocol which contains Omega 3s, a full compliment of vitamins, minerals and amino acids may influence psychiatric disorders through direct effects on mood via the gut microbiome and nutrient availability
- Obesity is associated with changes in neurotransmitters, neuropeptides, and inflammatory factors that are present in both the gut and the brain and have effects on both mood and subsequent eating behaviors

Physical
- Hormones: Progesterone and estrogen appear to influence fear processing and extinction in PTSD with differing vulnerabilities at different stages of the menstrual cycle
- Exercise: Potential mechanisms by which aerobic exercise could exert a positive impact in PTSD include exposure and desensitization to internal arousal cues, enhanced cognitive function, exercise-induced neuroplasticity, normalization of hypothalamic pituitary axis (HPA) function, and reductions in inflammatory markers

Physical
- Mindfulness-Based Stretching and Deep Breathing Exercises reduce the prevalence of PTSD-like symptoms and normalize cortisol levels  in individuals exhibiting subclinical features of PTSD.
- HPA-Axis Re-regulation: Suppression of the HPA axis in PTSD has been reported, with less variability (fewer peaks and troughs) in the diurnal cortisol cycle in individuals with PTSD (Flat and the furious)

Physical
- Sleep: rapid-eye movement (REM) sleep, supports a process of affective brain homeostasis, optimally preparing the organism for next-day social and emotional functioning
- poor sleep is associated with increased anxiety, irritability, deficient coping, circadian rhythm disruption
-  investigators have found both hypo and hyperactivation of specific brain regions in individuals with PTSD during sleep
- People with PTSD are at higher risk of developing OSA

Affective/Cognitive
- Meta-analyses do not support the efficacy of wide spread use of psychological debriefing after trauma in preventing or reducing the intensity of PTSD
- meta-analyses have demonstrated the benefit of brief TF-CBT for prevention and multisession TF-CBT in patients with ASD or PTSD
- Exposure-based and other CBT protocols, as well as mindfulness-based cognitive therapy (MBCT)  psychological treatments in group and individual formats in patients PTSD
Affective/Cognitive
- CBT strategies
- Exposure
- Encourage patients to face fears
- Patients learn corrective information through experience
- Extinction of fear occurs through repeated exposure
- Successful coping enhances self-efficacy
- Safety response inhibition
- Patients restrict their usual anxiety-reducing behaviors (e.g., escape, need for reassurance)
- Decreases negative reinforcement
- Coping with anxiety without using anxiety-reducing behavior enhances self-efficacy
Affective/Cognitive
- CBT strategies cont…
- Cognitive strategies
- Education about the disorder and its treatment
- Cognitive restructuring, behavioral experiments targeting unhelpful thought patterns and beliefs
- Provides corrective information regarding the level of threat
- Can also target self-efficacy beliefs
- Arousal management/Emotion Regulation/Distress Tolerance skills can help patient control increased anxiety levels
- Surrender of safety cues (companion, lights)
- Development of adaptive self-efficacy beliefs
Affective/Cognitive
- EMDR
- Online EMDR has been demonstrated in early studies to be effective
- EMDR therapy reduced PTSD and other trauma-related symptoms, was more effective than other trauma treatments, and was shown to be an effective therapy when delivered with different cultures
- Neuroimaging data suggest a similar neurophysiological substrate for clinical improvement following EMDR and TF-CBT, involving changes affecting bilateral temporal pole connectivity
Affective/Cognitive
- Exposure Therapy and Systematic Desensitization
- ET has proven to be highly effective in reducing PTSD symptoms and comorbid symptoms associated with a variety of traumas
- Emotional Freedom Technique is being extensively used by the VA
Summary
- CBT, EMDR, Emotional Freedom and Exposure therapy are currently the most widely used approaches
- Sleep quality can bidirectionally impact PTSD symptoms.
References
- All references used in creating this presentation are linked throughout the powerpoint which is available in the related class at AllCEUs.com.
- Check the video notes for a link to the class.
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Evidence Based Practices for PTSD

Evidence Based Practices for PTSD

Dr. Dawn-Elise Snipes