The Mental Health Provider's Role: Therapies

Mental health professionals have a variety of assessment tools available to them to appropriately diagnose PTSD. The Clinician Administered PTSD Scale (CAPS) is a structured clinical interview designed to assess adults for the seventeen symptoms of PTSD outlined in DSM-IV along with five associated features (guilt, dissociation, derealization, depersonalization, and reduction in awareness of surroundings). The CAPS has standardized prompts and follow-up questions, and a behaviorally-anchored 5-point rating scale corresponding to the frequency and intensity of each symptom listed.

Mental health professionals can offer expert education, counseling, and psychotherapeutic interventions that have been empirically shown to help recovery from PTSD. Many psychotherapeutic approaches have recognized merit in the treatment of PTSD. A survey of experts in the field of PTSD recognized cognitive therapy, exposure therapy, anxiety management training, and psychoeducation as the psychotherapeutic treatments of choice for adults.

"He came back [from the VA treatment program] and he said, Oh, I feel so good, you know... he talked about how the counselors helped him into getting a lot of this out and talking about all this stuff that was ugly to him, and he never even talked about it to anybody. And there was even a time that he said he missed 'em and that he wished that they could be there."

Below several types of therapy are described:

• Cognitive-behavioral therapy (CBT): Includes cognitive therapy and types of exposure therapy
• Anxiety management training (AMT)
• Psychoeducation

Cognitive-behavioral therapy (CBT)

Among psychotherapies, CBT treatments have received the most empirical study. CBT methods, together with psychoeducation, are the most recommended psychotherapy techniques. CBT includes methods such as:

• Cognitive therapy—modification of unrealistic assumptions, beliefs, and automatic thoughts that lead to disturbing emotions and impaired functioning.
• Imaginal exposure—the repeated verbal recounting of the traumatic memories until they no longer evoke high levels of distress.
• In vivo exposure—confrontation with situations that are now safe, but which the person avoids because they have become associated with the trauma and trigger strong fear. Repeated exposures facilitate habituation to the feared situation.

Anxiety management training (AMT)

AMT techniques may also be classified as CBT techniques. AMT teaches a set of tools to deal with stress and anxiety.

• Relaxation training—management of fear and anxiety through the systematic relaxation of the major muscle groups or the imagining of relaxing images.
• Breathing retraining—the use of slow abdominal breathing to help the patient relax and/or avoid hyperventilation with its unpleasant and often frightening physical symptoms.
• Assertiveness training—teaches expression of one's wishes, opinions, and emotions appropriately and without alienating others.

Psychoeducation

Psychoeducation provides patients (and often families) with information about the symptoms of and the various treatments for PTSD.

Psychotherapy conceptualized and implemented with sensitivity to the cultural context of American Indian and Alaska Native veterans can provide a powerful healing experience for the patient and a learning experience for the practitioner.