Book: Eye Movement Desensitisation and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures

Book Title:

Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures

Author(s): Francine Shapiro.

Year: 2018.

Edition: Third (3rd).

Publisher: Guildford Press.

Type(s): Hardcover and Kindle.

Synopsis:

The authoritative presentation of Eye Movement Desensitisation and Reprocessing (EMDR) therapy, this ground-breaking book – now revised and expanded – has enhanced the clinical repertoires of more than 125,000 readers and has been translated into 10 languages. Originally developed for treatment of posttraumatic stress disorder (PTSD), this evidence-based approach is now also used to treat adults and children with complex trauma, anxiety disorders, depression, addictive behaviour problems, and other clinical problems. EMDR originator Francine Shapiro reviews the therapy’s theoretical and empirical underpinnings, details the eight phases of treatment, and provides training materials and resources. Vivid vignettes, transcripts, and reproducible forms are included.

New to This Edition

  • Over 15 years of important advances in therapy and research, including findings from clinical and neurophysiological studies.
  • New and revised protocols and procedures.
  • Discusses additional applications, including the treatment of complex trauma, addictions, pain, depression, and moral injury, as well as post-disaster response.
  • Appendices with session transcripts, clinical aids, and tools for assessing treatment fidelity and outcomes.

EMDR therapy is recognised as a best practice for the treatment of PTSD by the US Departments of Veterans Affairs and Defence, the International Society for Traumatic Stress Studies, the World Health Organisation, the UK National Institute for Health and Care Excellence (NICE), the Australian National Health and Medical Research Council, the Association of the Scientific Medical Societies in Germany, and other health care associations/institutes around the world.

Book: Complex PTSD: From Surviving to Thriving

Book Title:

Complex PTSD: From Surviving to Thriving: A Guide and Map for Recovering from Childhood Trauma.

Author(s): Pete Walker.

Year: 2013.

Edition: First (1st).

Publisher: CreateSpace Independent Publishing Platform.

Type(s): Paperback, Audiobook, and Kindle.

Synopsis:

I have Complex PTSD (CPTSD) and wrote this book from the perspective of someone who has experienced a great reduction of symptoms over the years. I also wrote it from the viewpoint of someone who has discovered many silver linings in the long, windy, bumpy road of recovering from CPTSD. I felt encouraged to write this book because of thousands of e-mail responses to the articles on my website that repeatedly expressed gratitude for the helpfulness of my work. An often echoed comment sounded like this: At last someone gets it. I can see now that I am not bad, defective or crazy…or alone!

The causes of CPTSD range from severe neglect to monstrous abuse. Many survivors grow up in houses that are not homes – in families that are as loveless as orphanages and sometimes as dangerous. If you felt unwanted, unliked, rejected, hated and/or despised for a lengthy portion of your childhood, trauma may be deeply engrained in your mind, soul and body. This book is a practical, user-friendly self-help guide to recovering from the lingering effects of childhood trauma, and to achieving a rich and fulfilling life. It is copiously illustrated with examples of my own and my clients’ journeys of recovering.

This book is also for those who do not have CPTSD but want to understand and help a loved one who does. This book also contains an overview of the tasks of recovering and a great many practical tools and techniques for recovering from childhood trauma. It extensively elaborates on all the recovery concepts explained on my website, and many more. However, unlike the articles on my website, it is oriented toward the layperson. As such, much of the psychological jargon and dense concentration of concepts in the website articles has been replaced with expanded and easier to follow explanations. Moreover, many principles that were only sketched out in the articles are explained in much greater detail.

A great deal of new material is also explored. Key concepts of the book include managing emotional flashbacks, understanding the four different types of trauma survivors, differentiating the outer critic from the inner critic, healing the abandonment depression that come from emotional abandonment and self-abandonment, self-reparenting and reparenting by committee, and deconstructing the hierarchy of self-injuring responses that childhood trauma forces survivors to adopt.

The book also functions as a map to help you understand the somewhat linear progression of recovery, to help you identify what you have already accomplished, and to help you figure out what is best to work on and prioritise now. This in turn also serves to help you identify the signs of your recovery and to develop reasonable expectations about the rate of your recovery. I hope this map will guide you to heal in a way that helps you to become an unflinching source of kindness and self-compassion for yourself, and that out of that journey you will find at least one other human being who will reciprocally love you well enough in that way.

Book: The Complex PTSD Workbook

Book Title:

The Complex PTSD Workbook: A Mind-Body Approach to Regaining Emotional Control and Becoming Whole.

Author(s): Arielle Schwartz.

Year: 2020.

Edition: First (1st).

Publisher: Sheldon Press.

Type(s): Paperback, Audiobook, and Kindle.

Synopsis:

Those affected by complex PTSD commonly feel as though there is something fundamentally wrong with them – that somewhere inside there is a part of them that needs to be fixed. Though untrue, such beliefs can feel extremely real and frightening. Difficult as it may be, facing one’s PTSD from unresolved childhood trauma is a brave, courageous act – and with the right guidance, healing from PTSD is possible.

Clinical psychologist Dr Arielle Schwartz has spent years helping those with C-PTSD find their way to wholeness. She also knows the territory of the healing firsthand, having walked it herself. This book provides a map to the complicated, and often overwhelming, terrain of C-PTSD with Dr. Schwartz’s knowledgeable guidance helping you find your way.

In The Complex PTSD Workbook, you’ll learn all about C-PTSD and gain valuable insight into the types of symptoms associated with unresolved childhood trauma, while applying a strength-based perspective to integrate positive beliefs and behaviours.

Examples and exercises through which you’ll discover your own instances of trauma through relating to PTSD experiences other than your own, such as the following:

  • Information about common PTSD misdiagnoses such as bipolar disorder, ADHD, anxiety disorders, major depressive disorder, and substance abuse, among others.
  • Explorations of common methods of PTSD therapy including somatic therapy, EMDR, CBT, DBT, and mind-body perspectives.
  • Chapter takeaways that encourage thoughtful consideration and writing to explore how you feel as you review the material presented in relation to your PTSD symptoms.

The Complex PTSD Workbook aims to empower you with a thorough understanding of the psychology and physiology of C-PTSD so you can make informed choices about the path to healing that is right for you and discover a life of wellness, free of C-PTSD, that used to seem just out of reach.

Book: PTSD F*cking Hurts (Write That Sh*t Down)

Book Title:

PTSD Fcking Hurts (Write That Sht Down): A Guided Journal for Depression, PTSD, Mental Recovery, With Prompts to Help you through Emotional Healing, With Prompts and Activities.

Author(s): Sami’s Mental Health Journals.

Year: 2020.

Edition: First (1st).

Publisher: Independently Published.

Type(s): Paperback.

Synopsis:

A great Guided & Prompted Journal workbook for people suffering from PTSD or Complex PTSD (CPTSD). It is a perfect Journal for yourself if you are seeking a great book to help write down your thoughts. It will guide you throughout activities, Prompts, and questions you need to answer honestly in the journey of recovery, With space for notes.

It will also be a gift for someone who suffers from PTSD, or with having a hard psychologic experience.

Book: The PTSD Workbook

Book Title:

The PTSD Workbook: Simple, Effective Techniques for Overcoming Traumatic Stress Symptoms.

Author(s): Mary Beth Williams and Soili Poijula.

Year: 2016.

Edition: Third (3rd).

Publisher: New Harbinger.

Type(s): Paperback and Kindle.

Synopsis:

Post-traumatic stress disorder (PTSD) is an extremely debilitating condition that can occur after exposure to a terrifying event. But whether you are a veteran of war, a victim of domestic violence or sexual violence, or have been involved in a natural disaster, crime, car accident, or accident in the workplace, your symptoms may be getting in the way of you living your life.

PTSD can often cause you to relive your traumatic experience in the form of flashbacks, memories, nightmares, and frightening thoughts. This is especially true when you are exposed to events or objects that remind you of your trauma. Left untreated, PTSD can lead to emotional numbness, insomnia, addiction, anxiety, depression, and even suicide. So, how can you start to heal and get your life back?

In The PTSD Workbook, Third Edition, psychologists and trauma experts Mary Beth Williams and Soili Poijula outline techniques and interventions used by PTSD experts from around the world to conquer distressing trauma-related symptoms. In this fully revised and updated workbook, you’ll learn how to move past the trauma you’ve experienced and manage symptoms such as insomnia, anxiety, and flashbacks.

Based in cognitive behavioural therapy (CBT), this book is extremely accessible and easy-to-use, offering evidence-based therapy at a low cost. This new edition features chapters focusing on veterans with PTSD, the link between cortisol and adrenaline and its role in PTSD and overall mental health, and the mind-body component of PTSD. Clinicians will also find important updates reflecting the new DSM-V definition of PTSD.

This book is designed to give you the emotional resilience you need to get your life back together after a traumatic event.

Refugee Children & Adolescents and PTSD

Research Paper Title

Traumatic experiences of conditional refugee children and adolescents and predictors of post-traumatic stress disorder: data from Turkey.

Background

The researchers aimed to determine traumatic events, mental health problems and predictors of PTSD in a sample of conditional refugee children.

Methods

The sociodemographic features, chief complaints, traumatic experiences and psychiatric diagnoses according to DSM-5 were evaluated retrospectively.

Results

20.7% (n = 70) of children experienced the armed conflict or exposed to firefights at their country of origin. Most common diagnoses were anxiety disorders (n = 82, 24.3%), major depressive disorder (n = 52, 15.4%) and PTSD (n = 43, 12.7%). Age, number of traumatic experiences, explosion and sexual violence are the most important predictors for PTSD.

Conclusions

The results suggest that the number of traumas exposed as well as their nature predicted PTSD diagnosis. Refugee children have increased risk for psychiatric problems after migration and resettlement underlining the importance of an adequate follow-up for mental health and ensuring social support networks.

Reference

Yektas, C., Erman, H. & Tufan, A.E. (2021) Traumatic experiences of conditional refugee children and adolescents and predictors of post-traumatic stress disorder: data from Turkey. doi: 10.1080/08039488.2021.1880634. Online ahead of print.

Book: The Resilience Workbook

Book Title:

The Resilience Workbook – Essential Skills to Recover from Stress, Trauma, and Adversity.

Author(s): Glenn R. Schiraldi (PhD).

Year: 2017.

Edition: First (1st), Illustrated Edition.

Publisher: New Harbinger.

Type(s): Paperback and Kindle.

Synopsis:

What is resilience, and how can you build it? In The Resilience Workbook, Glenn Schiraldi-author of The Self-Esteem Workbook-offers invaluable insight and outlines essential skills to help you bounce back from setbacks and cultivate a growth mindset.

Why do some people sail through life’s storms, while others are knocked down? Resilience is the key. Resilience is the ability to recover from difficult experiences, such as death of loved one, job loss, serious illness, terrorist attacks, or even just daily stressors and challenges. Resilience is the strength of body, mind, and character that enables people to respond well to adversity. In short, resilience is the cornerstone of mental health.

Combining evidence-based approaches including positive psychology, cognitive behavioural therapy (CBT), acceptance and commitment therapy (ACT), mindfulness, and relaxation, The Resilience Workbook will show you how to bounce back and thrive in any difficult situation. You will learn how to harness the power of your brain’s natural neuroplasticity; manage strong, distressing emotions; and improve mood and overall well-being. You will also discover powerful skills to help you prevent and recover from stress-related conditions like post-traumatic stress disorder (PTSD), anxiety, depression, anger, and substance abuse disorders.

When the going gets tough, you need real, proven-effective skills to manage your stress and heal from setbacks. The comprehensive and practical exercises in this workbook will help you cultivate resilience, stay calm under pressure, and face all of life’s challenges.

Book: Emotion Efficacy Therapy

Book Title:

Emotion Efficacy Therapy: A Brief, Exposure-Based Treatment for Emotion Regulation Integrating ACT and DBT.

Author(s): Matthew McKay (PhD) and Aprilia West (PSyD, MT).

Year: 2016.

Edition: First (1st).

Publisher: New Harbinger.

Type(s): Paperback and Kindle.

Synopsis:

If you treat clients with emotion regulation disorders – including depression, anxiety, post-traumatic stress disorder (PTSD), bipolar disorder, and borderline personality disorder (BPD) – you know how important it is for these clients to take control of their emotions and choose their actions in accordance with their values. To help, emotion efficacy therapy (EET) provides a new, theoretically-driven, contextually-based treatment that integrates components from acceptance and commitment therapy (ACT) and dialectical behaviour therapy (DBT) into an exposure-based protocol. In doing so, EET targets the transdiagnostic drivers of experiential avoidance and distress intolerance to increase emotional efficacy.

This step-by-step manual will show you how to help your clients confront and accept their pain, and learn to apply new adaptive responses to emotional triggers. Using a brief treatment that lasts as little as eight weeks, you will be able to help your clients understand and develop a new relationship with their emotions, learn how to have mastery over their emotional experience, practice values-based action in the midst of being emotionally triggered, and stop intense emotions from getting in the way of creating the life they want.

Using the transdiagnostic, exposure-based approach in this book, you can help your clients manage difficult emotions, curb negative reactions, and start living a better life. This book is a game changer for emotion exposure treatment!

What is Exposure Therapy?

Introduction

Exposure therapy is a technique in behaviour therapy to treat anxiety disorders. Exposure therapy involves exposing the target patient to the anxiety source or its context without the intention to cause any danger. Doing so is thought to help them overcome their anxiety or distress. Procedurally, it is similar to the fear extinction paradigm developed studying laboratory rodents. Numerous studies have demonstrated its effectiveness in the treatment of disorders such as generalised anxiety disorder (GAD), social anxiety disorder, obsessive-compulsive disorder (OCD), post traumatic stress disorder (PTSD), and specific phobias.

Brief History

The use of exposure as a mode of therapy began in the 1950s, at a time when psychodynamic views dominated Western clinical practice and behavioural therapy was first emerging. South African psychologists and psychiatrists first used exposure as a way to reduce pathological fears, such as phobias and anxiety-related problems, and they brought their methods to England in the Maudsley Hospital training programme.

Joseph Wolpe (1915-1997) was one of the first psychiatrists to spark interest in treating psychiatric problems as behavioural issues. He sought consultation with other behavioural psychologists, among them James G. Taylor (1897-1973), who worked in the psychology department of the University of Cape Town in South Africa. Although most of his work went unpublished, Taylor was the first psychologist known to use exposure therapy treatment for anxiety, including methods of situational exposure with response prevention – a common exposure therapy technique still being used. Since the 1950s several sorts of exposure therapy have been developed, including systematic desensitisation, flooding, implosive therapy, prolonged exposure therapy, in vivo exposure therapy, and imaginal exposure therapy.

Medical Uses

Generalised Anxiety Disorder

There is empirical evidence that exposure therapy can be an effective treatment for people with generalised anxiety disorder, citing specifically in vivo exposure therapy, which has greater effectiveness than imaginal exposure in regards to generalized anxiety disorder. The aim of in vivo exposure treatment is to promote emotional regulation using systematic and controlled therapeutic exposure to traumatic stimuli.

Phobia

Exposure therapy is the most successful known treatment for phobias. Several published meta-analyses included studies of one-to-three hour single-session treatments of phobias, using imaginal exposure. At a post-treatment follow-up four years later 90% of people retained a considerable reduction in fear, avoidance, and overall level of impairment, while 65% no longer experienced any symptoms of a specific phobia.

Agoraphobia and social anxiety disorder are examples of phobias that have been successfully treated by exposure therapy.

Post Traumatic Stress Disorder

Virtual reality exposure (VRE) therapy is a modern but effective treatment of post-traumatic stress disorder (PTSD). This method was tested on several active duty Army soldiers, using an immersive computer simulation of military settings over six sessions. Self-reported PTSD symptoms of these soldiers were greatly diminished following the treatment. Exposure therapy has shown promise in the treatment of co-morbid PTSD and substance abuse.

Obsessive Compulsive Disorder

Exposure and response prevention (also known as exposure and ritual prevention; ERP or EX/RP) is a variant of exposure therapy that is recommended by the American Academy of Child and Adolescent Psychiatry (AACAP), the American Psychiatric Association (APA), and the Mayo Clinic as first-line treatment of obsessive compulsive disorder (OCD) citing that it has the richest empirical support for both youth and adolescent outcomes.

ERP is predicated on the idea that a therapeutic effect is achieved as subjects confront their fears, but refrain from engaging in the escape response or ritual that delays or eliminates distress. In the case of individuals with OCD or an anxiety disorder, there is a thought or situation that causes distress. Individuals usually combat this distress through specific behaviours that include avoidance or rituals. However, ERP involves purposefully evoking fear, anxiety, and or distress in the individual by exposing him/her to the feared stimulus. The response prevention then involves having the individual refrain from the ritualistic or otherwise compulsive behaviour that functions to decrease distress. The patient is then taught to tolerate distress until it fades away on its own, thereby learning that rituals are not always necessary to decrease distress or anxiety. Over repeated practice of ERP, patients with OCD expect to find that they can have obsessive thoughts and images but not have the need to engage in compulsive rituals to decrease distress.

The AACAP’s practise parameters for OCD recommends cognitive behavioural therapy, and more specifically ERP, as first line treatment for youth with mild to moderate severity OCD and combination psychotherapy and pharmacotherapy for severe OCD. The Cochrane Review’s examinations of different randomised control trials echoes repeated findings of the superiority of ERP over waitlist control or pill-placebos, the superiority of combination ERP and pharmacotherapy, but similar effect sizes of efficacy between ERP or pharmacotherapy alone.

Techniques

Exposure therapy is based on the principle of respondent conditioning often termed Pavlovian extinction. The exposure therapist identifies the cognitions, emotions and physiological arousal that accompany a fear-inducing stimulus and then tries to break the pattern of escape that maintains the fear. This is done by exposing the patient to progressively stronger fear-inducing stimuli. Fear is minimised at each of a series of steadily escalating steps or challenges (a hierarchy), which can be explicit (“static”) or implicit (“dynamic” – refer to Method of Factors) until the fear is finally gone. The patient is able to terminate the procedure at any time.

There are three types of exposure procedures. The first is in vivo or “real life.” This type exposes the patient to actual fear-inducing situations. For example, if someone fears public speaking, the person may be asked to give a speech to a small group of people. The second type of exposure is imaginal, where patients are asked to imagine a situation that they are afraid of. This procedure is helpful for people who need to confront feared thoughts and memories. The third type of exposure is interoceptive, which may be used for more specific disorders such as panic or post-traumatic stress disorder. Patients confront feared bodily symptoms such as increased heart rate and shortness of breath. All types of exposure may be used together or separately.

While evidence clearly supports the effectiveness of exposure therapy, some clinicians are uncomfortable using imaginal exposure therapy, especially in cases of PTSD. They may not understand it, are not confident in their own ability to use it, or more commonly, they see significant contraindications for their client.

Flooding therapy also exposes the patient to feared stimuli, but it is quite distinct in that flooding starts at the most feared item in a fear hierarchy, while exposure starts at the least fear-inducing.

Exposure and Response Prevention

In the exposure and response prevention (ERP or EX/RP) variation of exposure therapy, the resolution to refrain from the escape response is to be maintained at all times and not just during specific practice sessions. Thus, not only does the subject experience habituation to the feared stimulus, but they also practice a fear-incompatible behavioural response to the stimulus. The distinctive feature is that individuals confront their fears and discontinue their escape response. The American Psychiatric Association recommends ERP for the treatment of OCD, citing that ERP has the richest empirical support.

While this type of therapy typically causes some short-term anxiety, this facilitates long-term reduction in obsessive and compulsive symptoms. Generally, ERP incorporates a relapse prevention plan toward the end of the course of therapy.

Mindfulness

A 2015 review pointed out parallels between exposure therapy and mindfulness, stating that mindful meditation “resembles an exposure situation because [mindfulness] practitioners ‘turn towards their emotional experience’, bring acceptance to bodily and affective responses, and refrain from engaging in internal reactivity towards it.” Imaging studies have shown that the ventromedial prefrontal cortex, hippocampus, and the amygdala are all affected by exposure therapy; imaging studies have shown similar activity in these regions with mindfulness training.

Research

Exposure therapy can be investigated in the laboratory using Pavlovian extinction paradigms. Using rodents such as rats or mice to study extinction allows for the investigation of underlying neurobiological mechanisms involved, as well as testing of pharmacological adjuncts to improve extinction learning.

What is Psychological First Aid?

Introduction

Psychological first aid (PFA) is a technique designed to reduce the occurrence of post-traumatic stress disorder. It was developed by the National Centre for Post Traumatic Stress Disorder (NC-PTSD), a section of the United States Department of Veterans Affairs, in 2006. It has been spread by the International Federation of Red Cross and Red Crescent Societies, Community Emergency Response Team (CERT), the American Psychological Association (APA) and many others. It was developed in a two-day intensive collaboration, involving more than 25 disaster mental health researchers, an online survey of the first cohort that used PFA and repeated reviews of the draft.

Refer to Crisis Intervention and Mental health First Aid.

Definition

According to the NC-PTSD, psychological first aid is an evidence-informed modular approach for assisting people in the immediate aftermath of disaster and terrorism to reduce initial distress and to foster short and long-term adaptive functioning. It was used by non-mental health experts, such as responders and volunteers. Other characteristics include non-intrusive pragmatic care and assessing needs. PFA does not necessarily involve discussion of the traumatic event. Just like physical first aid, psychological first aid focuses on providing effective initial support to individuals in distress.

Components

  • Protecting from further harm.
  • Opportunity to talk without pressure.
  • Active listening.
  • Compassion.
  • Addressing and acknowledging concerns.
  • Discussing coping strategies.
  • Social support.
  • Offer to return to talk.
  • Referral.

Steps

  • Contact and engagement.
  • Safety and comfort.
  • Stabilization.
  • Information gathering.
  • Practical assistance.
  • Connection with social supports.
  • Coping information.
  • Linkage with services.

Brief History

Before PFA, there was a procedure known as debriefing. It was intended to reduce the incidences of post traumatic stress disorder (PTSD) after a major disaster. PTSD is now widely known to be debilitating; sufferers experience avoidance, flashbacks, hyper-vigilance, and numbness. Debriefing procedures were made a requirement after a disaster, with a desire to prevent people from developing PTSD. The idea behind it was to promote emotional processing by encouraging recollection of the event. Debriefing has origins with the military, where sessions were intended to boost morale and reduce distress after a mission. Debriefing was done in a single session with seven stages: introduction, facts, thoughts and impressions, emotional reactions, normalisation, planning for future, and disengagement.

Debriefing was found to be at best, ineffective, and at worst, harmful. There are several theories as to why debriefing increased incidents of PTSD. First, those who were likely to develop PTSD were not helped by a single session. Second, being re-exposed too soon to the trauma could lead to retraumatisation. Exposure therapy in cognitive behavioural therapy (CBT) allows the person to adjust to the stimuli before slowly increasing severity. Debriefing did not allow for this. Also, normal distress was seen to be pathological after a debriefing and those who had been through a trauma thought they had a mental disorder because they were upset. Debriefing assumes that everyone reacts the same way to a trauma, and anyone who deviates from that path, is pathological. But there are many ways to cope with a trauma, especially so soon after it happens.

PFA seems to address many of the issues in debriefing. It is not compulsory and can be done in multiple sessions and links those who need more help to services. It deals with practical issues which are often more pressing and create stress. It also improves self efficacy by letting people cope their own way. PFA has attempted to be culturally sensitive, but whether it is or not has not been shown. However, a drawback is the lack of empirical evidence. While it is based on research, it is not proven by research. Like the debriefing method, it has become widely popular without testing.

Today, PFA has been widely used not just for crisis intervention for natural disasters, but also personal crises such as when individuals face traumatic losses of loved ones or pets, or when organisations go through critical incidents such as the suicide or death of a colleague.