Assessment and Treatment of PTSD

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A comprehensive clinical assessment of PTSD should include administration of structured diagnostic interviews, self-report psychometrics, and an evaluation of trauma across the lifespan. Several structured interviews are available and the Clinician-Administered PTSD Scale for the DSM-IV and PTSD module of the Structured Clinical Interview for the DSM-IV have become standards in the field. Self-report instruments can also assist in diagnosis or provide efficient, low-cost assessment methods for research and screening purposes. Of these, several were constructed specifically for assessing PTSD (e.g., Mississippi Scale for Combat-related PTSD; PTSD Checklist; PTSD Diagnostic Scale). Others were derived from the existing items of major inventories such as the Minnesota Multiphasic Personality Inventory and the Symptom Checklist-90. Finally, instruments such as the Potential Stressful Events Interview and the Traumatic Stress Schedule are used to evaluate trauma across the lifespan.

Treatment for PTSD typically involves the use of psychotherapy, pharmacotherapy, or both. Of the psychotherapies, exposure-based approaches (e.g., systematic desensitiza-tion, flooding, prolonged exposure, imaginal and in vivo exposure, and implosive therapy) have received the most attention and empirical support to date. The common feature of each is the practice of gradually exposing the therapy client to trauma-related cues to desensitize and extinguish the accompanying conditioned emotional and physiological reactions. The therapeutic mechanism is generally conceptualized within the framework of classical conditioning; repeated exposure to trauma-related cues (e.g., trauma-related images evoked from memory) in the absence of the feared negative consequences (e.g., the trauma itself) re


duces the conditioned fear, anxiety, and avoidance characteristics of PTSD.

A second promising category of empirically validated treatments for PTSD is cognitive restructuring therapy. Based on cognitive therapy principles, this approach is designed to identify and modify dysfunctional trauma-related beliefs and to teach specific cognitive coping skills. The therapy process may also involve tasks that include an element of exposure, such as writing or describing the trauma to uncover trauma-related cognitions.

A third psychotherapy approach is anxiety management, variously referred to as relaxation training, stress inoculation, or biofeedback training. This approach does not focus on the trauma itself, but is instead geared toward teaching an individual the requisite skills for coping with stress, often via the use of relaxation. For this reason, anxiety management is often an adjunctive treatment to trauma-focused treatments.

Pharmacotherapy for PTSD generally targets symptoms of the disorder that it shares in common with the other anxiety disorders and major depression (i.e., hyperarousal, sleep disturbance, and anhedonia) and many medications developed for the treatment of these other disorders have been used to treat PTSD. Although clinical drug trials have shown fairly modest results overall, results suggest that some individuals with PTSD may benefit greatly from pharmacotherapy. The SSRIs (including sertraline, fluoxe-tine, and paroxetine) are currently the medications of choice for the treatment of PTSD.

Mark W. Miller Terence M. Keane VA Boston Healthcare System National Center for PTSD Boston University School of Medicine

See also: Trauma

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Do Not Panic

Do Not Panic

This guide Don't Panic has tips and additional information on what you should do when you are experiencing an anxiety or panic attack. With so much going on in the world today with taking care of your family, working full time, dealing with office politics and other things, you could experience a serious meltdown. All of these things could at one point cause you to stress out and snap.

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