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Complex PTSD requires emotional skills training + trauma focused therapy

by CHWatch on November 16, 2010

Short-term therapies like Rapid Resolution Therapy (RRT), EMDR, EFT, and somatic-experiencing all suggest we can resolve the negative impact of traumatic memories within a few therapy sessions. That has been super-exciting news.
However, for developmental trauma such as childhood abuse, many clients greatly benefit from additional training in managing stress and emotions. One of the first studies to actually illustrate this was just published by Cloitre, et al. in the American Journal of Psychiatry’s August 2010 edition.
Cloitre and colleagues took a group of women who were diagnosed with PTSD related to childhood abuse. The experimental group received training in emotional regulation and interpersonal skills for 8 weeks prior to receiving trauma focused cognitive-behavioral therapy.
The study also included two control groups. One control group received only supportive therapy prior to receiving CBT targeting the trauma, and did not get the emotional skills training. The other control group received emotional skills training, but did not receive specific trauma focused therapy during the subsequent 8 weeks of treatment.
The study found that 27% of the women who received both emotional skills training and trauma focused therapy had sustained remission of symptoms at the 6 month follow-up. This suggests that emotional skills training and specific trauma focused therapy together are needed for optimal treatment responses.
Teaching emotional regulation skills seems especially relevant for people who have suffered multiple traumas. If they grew up in a chaotic environment, chances are they never had the opportunity to learn how to naturally regulate emotions. Instead they may have turned substances, self-injury, sex, shopping, or other compulsive behaviors to feel better. So, even after they’ve cleared a specific trauma, they may still benefit from guidance on how to self-nurture and cope with other life stressors.
Even people who haven’t been traumatized may need help understanding and managing emotional reactions. So, I always spend some sessions teaching people healthy ways of doing this. I adapt the skills training to my client’s personality and value system. Some of my clients respond well to meditation practice. More restless clients do better with yoga, tai chi, or some other physical activity. My Christian clients prefer contemplative prayer. My creative clients love learning ways to use humor, metaphor, music, and art to redirect emotions. My technical clients like biofeedback.
Although it can be challenging to implement new behaviors, I tell my clients that we now know the brain is capable of neuroplasticity at any age. Therefore, it is never too late to learn new skills. Yet, as with any new skill learning, it requires practice and repetition to build those new neural networks.
These are really exciting times for the field of trauma therapy as we get closer to identifying what interventions really work for people. I’d love to hear about any interventions you’ve found that have helped your clients. Please leave your comments and ideas!
Courtney Armstrong is a Licensed Professional Counselor who specializes in trauma therapy. She has a private practice in Chattanooga, TN and also trains mental health professionals in creative ways to treat trauma. To contact Courtney, visit her website at www.courtneyarmstronglpc.com

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