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Lecture 4

PSYC 3F20 Lecture Notes - Lecture 4: Automatic Negative Thoughts, Dissociative Identity Disorder, Eye Movement Desensitization And Reprocessing

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Andrew Dane

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PSYC 3F20 January 25th, 2016
CBT Treatment for PTSD
Psychoeducation about PTSD
Client vividly imagines trauma for prolonged periods
Therapist guides construction of narrative about experience (e.g., tell the story).
May also be in vivo exposure to trauma-related stimuli
Anxiety management
Teach coping skills including relaxation skills and self-talk
Cognitive restructuring
Identify and evaluate evidence for negative automatic thoughts associated with trauma; replace with
coping thoughts
Automatic, Negative Thought Evidence? Coping Thought
I am weak and vulnerable It takes strength and courage to
confront trauma and I’ve been doing
I am a survivor
I am damaged beyond repair by this
Not true I can control my reaction
to the trauma in therapy
I’m getting stronger every day
Effectiveness of CBT
Compared to waitlist and usual care
Reductions in clinician and self-reported PTSD severity
Compared to supportive counseling and psychodynamic therapy at 3-month follow-up
Reductions in clinician and self-reported PTSD severity
Reduced amygdala activity, increased prefrontal cortex activity on fMRI following treatment, in
response to visual or verbal symptom provocation stimuli
Focus on disturbing image or memory as well as the emotions and thoughts that go along with it
Desensitization: use of bilateral stimulation
Client reports on associated thoughts, feelings, sensations, images that occurred during procedure;
these become the focus of next phase of bilateral stimulation.
Desensitization continues until subjective level of disturbance is reduced to 0.
Installation: traumatic image integrated with positive cognition (e.g., I am now in control).
Effectiveness of EMDR
Several studies indicate that relative to waitlist or usual care conditions
EMDR groups showed reduced self-report and clinician-rated severity of PTSD symptoms
48% of EMDR groups in six studies maintained diagnosis of PTSD after treatment compared to 95% of
WL/UC groups.
No difference from Trauma Focused CBT on clinician-rated and self-reported severity of PTSD symptoms at
post-test and 5-month follow-up.
Why Bilateral Stimulation?
Rationale for this procedure not well articulated by developers of EMDR
Some research suggests that eye movements use up working memory capacity (dual attention) and reduce
vividness of traumatic memories due to divided attention
However, EMDR without eye movement component as effective as those including this aspect, so the role of
bilateral stimulation has been debated
Medication and PTSD
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