What is PTSD: Post-traumatic stress disorder may develop after an individual either witnesses or experiences a traumatic event, such as serious injury, death, sexual or physical violence. More recent research shows that PTSD can also develop following “traumatic invalidation.”

What is traumatic invalidation: is when an environment (often people important to the individual) rejects the person’s character, emotions, and behaviors. The person feels judged, dismissed, and disregarded and develops extreme negative beliefs about oneself, others, emotions, and the world overall.

What does invalidation do to a person: PTSD can develop when an individual persistently experiences invalidation. The symptoms of PTSD can be just the same as when PTSD develops after a witnessed or experienced life threatening event.

How to recover from traumatic invalidation: DBT-PE is the most widely used and researched treatment to heal from persistent invalidation. It helps people overcome patterns of invalidating beliefs and behaviors.

What are the signs of PTSD: Many people who experience a trauma do not go on to develop PTSD. When PTSD is diagnosed, there are four main areas of symptoms that people experience for at least two months following the trauma. These areas of symptoms include: re-experiencing the trauma, avoidance of trauma reminders, changes in thinking and mood, and hyper-arousal.

What triggers PTSD: When trauma is left untreated, many external or internal cues can be triggers. Examples of external cues can be sights, smells, sounds, pictures, music, words. Internal cues may include an image or memory.

Who does PTSD affect: Around 70% of people have a trauma in their lifetime, and roughly 5% will develop PTSD. It affects 7.7 million adults or 3.6% of the population. Multiple traumatic events increase the risk of developing PTSD. Women are 5x more likely to develop PTSD than men. Rape is the most common cause of PTSD, and 65% of men and 45% of women who are raped will develop PTSD. Childhood sexual abuse makes it more likely to develop PTSD in a lifetime.

What is the best therapy for trauma?

1. A type of cognitive behavior therapy (CBT) called Prolonged Exposure (PE) is the most evidence based to treat PTSD alone.
2. DBT-PE is for those experiencing additional symptoms along with PTSD, including high risk or life threatening behaviors, severe therapy interfering problems, and multiple diagnoses.
   • Two-thirds of people with PTSD experience two or more co-morbid conditions (such as personality disorders, substance abuse, eating disorders, psychosis, and mood disorders), and standard PE has historically excluded these symptoms from the treatment.
   • DBT-PE may be just as effective as PE for PTSD alone, but it has not been researched to treat PTSD as a single diagnosis.
3. Behavior Activation is another type of CBT that can be useful in helping people return to a life they have been avoiding due to trauma. This therapy is recommended depending on the level of severity of symptoms following the painful event.
4. Cognitive processing therapy is another leading trauma treatment. This is not offered at Wise Mind Counseling.

What is prolonged exposure (PE): PE is an exposure based treatment to reduce PTSD symptoms that both develop and are maintained by avoidance (cognitive and behavioral avoidance).

• In-vivo exposure is used to address behavioral avoidance and reduce distress. An individual is safely and gradually exposed to the trauma reminders that they are avoiding and that they want to stop avoiding. Avoidances are typically interferring in quality of life and can include people, places, objects, and situations.
• Imaginal exposure is used to address cognitive avoidance. An individual recalls the traumatic memory with support from the therapist and learns how to organize and process the memory.

What is DBT-PE: An exposure based treatment with the same mechanisms of change as PE. DBT-PE was developed to provide trauma treatment to individuals who were also in DBT. A difference of DBT-PE from PE is that DBT-PE adds an emotional focus to exposures and targets situations that are avoided due to depression, anxiety, and unjustified shame. DBT-PE also emphasizes identifying, processing, and structuring exposures to challenge trauma beliefs that maintain PTSD. The treatment is delivered in stages.

• Stage 1 uses DBT to target life-threatening and therapy interfering behaviors before treating trauma. It also includes teaching DBT skills to regulate emotions, tolerate stress, improve relationships, and build mindfulness.
• Stage 2 treats PTSD using in-vivo, imaginal, and processing.
• Stage 3 focuses on maintaining an exposure lifestyle and treating any remaining quality of life problems.

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