Have you experienced an event or events in your life in which you were harmed or witnessed someone else being harmed? Do you re-experience the trauma, avoid reminders of the trauma and experience hyperarousal (hyperviligence, exaggerated startle response, irritability, insomnia and difficulty concentrating)? If you have the major symptoms above, you may meet criteria for Post-Traumatic Stress Disorder (PTSD).
To meet criteria for the DSM-V diagnosis of PTSD, an individual must have had exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).
In addition, the individual must experience the presence of intrusion symptoms (e.g., intrusive thoughts, nightmares, flashbacks), avoidance of stimuli associated with the event, and Negative alterations in cognitions and mood that are associated with the traumatic event.
PE is an evidence-based treatment developed by Edna B. Foa, PhD, the director of the Center for the Treatment and Study of Anxiety, for the treatment of PTSD and related depression, anger, and anxiety. PE is based on cognitive-behavioral principles and can be tailored to meet individual needs. PE is helps clients process traumatic events and reduce the symptoms associated with PTSD. About 80% of clients with PTSD have been demonstrated clinically significant improvement with PE. PE utilizes in vivo and imaginal exposure to re-experience the traumatic event through remembering it and engaging with, rather than avoiding, reminders of the trauma. In addition, client learn techniques, such as breathing retraining, to cope with symptoms.
DBT+PE is an adaptation of PE developed by Melanie Harned, Ph.D., for the treatment of individuals with co-occurring Borderline Personality Disorder (BPD) and PTSD who are receiving DBT. DBT+PE has specific guidelines for safely beginning PTSD treatment for individuals who have experienced life-threatening behaviors. Clients meet weekly for their regular DBT session, in addition to their DBT+PE session. Prolonged exposure is adapted to meet the specific needs of individuals with BPD. Clients use skills learned in DBT to cope with trauma related symptoms without avoidance of cues. In addition, clients continue to have access to DBT phone coaching.
Clients who complete PE or DBT+PE develop are relapse prevention plan with their therapist. Client will continue practicing exposure, approaching rather than avoiding difficult or feared situations and prepare for situations which are high risk for relapse. Client learn to manage potential relapses more effectively.