Review of Advances in the Treatment of Posttraumatic Stress Disorder: Cognitive-behavioral Perspectives.

Abstract

STEVEN TAYLOR (Ed.) Advances in the Treatment of Posttraumatic Stress Disorder: Cognitive-behavioral Perspectives New York: Springer, 2004, 336 pages (ISBN 0-8261-2047-4, US$48.95 Hardcover) To paraphrase Steven Taylor, the editor, in his Preface, this collection of articles on PTSD intends to present reader-practitioners with a stand-alone source of descriptions of the state of the art in PTSD research and treatment. The text was expanded from a issue produced for the Journal of Cognitive Psychotherapy, entitled Current Directions in the Treatment of Posttraumatic Stress Disorder - which might have been a more apt title to retain, as this volume gives a very laudable overview of PTSD treatment from a cognitive-behavioural perspective, but, leaves many unanswered research questions regarding advances in treatment. In this regard, the text could be considered necessary but not sufficient, perhaps reflecting the state of affairs in PTSD research investigations as a whole. The list of noteworthy contributors (33 in total) includes many names well recognized in PTSD circles, with a definite American slant (e.g., the majority of the authors, approximately 82%, are American, along with two Canadians, two Australians and two from the United Kingdom to provide International representation). While this edited volume covers many state of the art CBT approaches in Part I and Part II, ranging from Exposure and EMDR to Cognitive Restructuring and Social Support, its unique and outstanding contribution is in Part III, which is dedicated to Special Populations with PTSD, specifically, Military Populations, those with predominant Anger, Chronic Pain, Dissociation, and Children and Adolescents. This may, in fact, be the first book to single out such special groups and begin to address their particular problems in PTSD treatment. New treatment approaches, such as Imagery Rehearsal Therapy (IRT) for posttraumatic nightmares, and Kubany's Cognitive for Trauma Related Guilt present intriguing possibilities. Again, the research literature is, as yet, limited. Treatment for anger amongst PTSD groups is a complex task, and the contributing authors in this section have rigorously compared Prolonged Exposure, Stress Inoculation Training, and combination interventions to determine the efficacy of CBT in anger reduction. Much of the data (in many of the chapters) are drawn from populations experiencing PTSD as a result of rape, domestic violence, abuse, and motor vehicle accidents. The generalizability of these positive CBT results and treatment applications to other special needs groups, such as survivors of large-scale natural catastrophes, is questionable and requires further investigation, beyond the scope of this volume. The chapter discussing PTSD and dissociation evolves as a theoretical and conceptual review of dissociation, with both encouragement and cautions for the use of Exposure with this particular population. For example, as the effectiveness of exposure therapy is thought to depend on the degree of emotional engagement with the previously avoided traumatic memories, the tendency for the client to dissociate in order to reduce anxiety when exposed to overwhelming stimuli may impede progress. The importance of a thorough clinical assessment of both capacity for dissociation and risk of self-harm prior to beginning exposure treatment is emphasized. Specific strategies are detailed, to help dissociative clients deal with flashbacks (grounding techniques; emphasis on safety and breathing), emotional numbing, and extreme anxiety or panic reactions during exposure treatment vital considerations for the scientist-practitioner. Perhaps the most-detailed treatment protocols are contained in the chapter on Treating PTSD in the Context of Chronic Pain. …