PTSD+Treatment+Models

 __PTSD Treatment Models__ 

PTSD has commonly been found to be concurrent with substance use, but has not been proactively treated or evaluated in therapy. A study by Ford and Russo (2006) has discussed three different symptoms commonly treated for in therapy:
 * 1) intrusive re-experiencing (flashbacks, intrusive memories)
 * 2) hyperarousal (avoidance of reminders of past trauma, emotional numbing)
 * 3) hypervigilance

Neurologically, PTSD and substance use look similar. Both involve disregulations of key neurotransmitters such as dopamine, seratonin, and norepinephrine, as well as disregulations of neuropeptides in the autonomic nervous system, both which negatively affect how one regulates stress and reactivity (Ford & Russo, 2006).



Hyperarousal, which makes the individual react in a rapid, extreme manner for a prolonged period of time, can escalate into a negative preoccupation with mild and remote perceived risks, which then leads to increased stress and hypervigilance. To avoid these maladaptive feelings, the individual will avoid people, places, thoughts, activities, emotions, and this leads to social detachment and emotional numbing. This can lead to the inability to process memories and emotions correctly and the individual will experience the trauma over and over again (Ford & Russo, 2006).

__PTSD and Substance Use- The LINK:__  __Treatment__ The main goal of treatment is to work on coping skills and strategies, and replace impulsive reactions with reality, as well as working on behavioural patterns that sustain addiction (Ford & Russo, 2006).
 * to deal with hyperarousal, one would use substances to reduce anxiety
 * to deal with hyperactivity, some drugs are taken to maintain a high level of alertness
 * in the case of alcohol specifically, to deal with social distress, a form of avoidance, and to feel pleasure and a connection with others as well as decrease the arousal of the nervous system and limit the anxiety related symptoms associated with PTSD(Ford & Russo, 2006).

__Cognitive-Behavioural Therapy (CBT)__ Traditionally, CBT has not treated concurrent PTSD and substance use, however, newer forms of CBT have done so. These have been found to be effective in reducing anxiety, avoidance, and helping the client to feel empowered, hopeful, and work on social skills. Scientific trials do however have high drop-out rates. (Ford & Russo, 2006).

__Seeking Safety__ A women-only group therapy that is specific for concurrent PTSD and substance use. This focuses on 80 different coping skills, taught and mastered through presentation and exercises. This program does not discuss trauma. This has been very successful in decreasing PTSD and substance use, as well as helping deal with anxiety, hostility, interpersonal skills, and suicide risk (Ford & Russo, 2006).

__Trauma Recovery and Empowerment Model (TREM)__ Similar to Seeking Safety, for men. This has also treated concurrent mental illness, so it also deals with feelings of stigma and issues of poverty. Similar success to Seeking safety (Ford & Russo, 2006).

__Trauma Adaptive Recovery Group Education and Therapy (TARGET)__ One on one educational counselling. This program discusses biological and behavioural process of concurrent PTSD and substance use. Focuses on clients core values and hopes for personal identity. TARGET recognizes effective coping skills and helps the client to prepare and productively process current traumatic reminders of the event. This shifts the clients attention to creating meaningful, adaptive reactions, feelings, and thoughts to occur with both PTSD and substance use. Client and counsellor also work on goals, future planning and action plans. TARGET follows a three stage process that follows the acronym "Freedom" (Ford & Russo, 2006).

Stage One: (F) Focus: stabilize feelings and self regulate, slow down, orient, and self check. Stage Two: (R) Recognize triggers (E) Emotions (E) Evaluate (D) Define goals (O) Look at behavioural options and responses, manage stress. Stage Three: work on both stages again, repeat discussions and create a narrative of one's life.

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