Mindfulness-Based Cognitive Therapy for Posttraumatic Stress Disorder (eBook)

Richard W. Sears, Kathleen M. Chard (Autoren)

eBook Download: EPUB

2016
John Wiley & Sons (Verlag)
9781118691434 (ISBN)

Infos

MBCT for PTSD provides solid principles, practical tools, and numerous case examples for integrating mindfulness into PTSD treatment. Based on the authors' experience in the first randomized controlled clinical trial, this pioneering book expands the range of potential treatment options.

• MBCT has been growing in popularity, and has solid research support, but this is the first text to apply it to trauma survivors
• This pioneering text is based on the authors' experience in using MBCT for PTSD in the first randomized controlled clinical trial
• Containing numerous case examples, it expands the range of potential treatment options and lends new hope for trauma survivors to lead more fulfilling lives

• The authors combined have a unique set of expert skills; Dr Chard is a well-known expert on PTSD, and Dr Sears is an expert on mindfulness and MBCT

Autor

Richard W. Sears is a clinical psychologist with a private psychology and consulting practice in Cincinnati, Ohio. He is clinical/research faculty at UC Integrative Medicine and a contract psychologist at the Cincinnati VA. His publications include Mindfulness in Clinical Practice (with R. B. Denton and D. Tirch, 2011), Perspectives on Spirituality and Religion in Psychotherapy (edited with A. Niblick) and Mindfulness: Living through Challenges and Enriching your Life in this Moment (Wiley-Blackwell, 2014). His website is www.psych-insights.com. Kathleen M. Chard is Associate Chief of Staff for Research and Director of the Trauma Recovery Center at the Cincinnati VA Medical Center and Professor of Psychiatry and Behavioral Neuroscience at the University of Cincinnati. She is the author of Cognitive Processing Therapy Therapist Manual, Department of Veterans Affairs (2008, 2014) and Cognitive Processing Therapy Group Treatment Manual, Department of Veterans Affairs, (2010, 2014). She has conducted numerous studies on the treatment of posttraumatic stress disorder in veteran and civilian populations.

Inhalt

Notes on Authors ix

Foreword xi

Acknowledgments xiii

Notes on Audio Resources xv

1 Introduction 1

2 Trauma, PTSD, and Current Treatments 7

Diagnostic Criteria for PTSD 7

Biology of PTSD 10

Who develops PTSD? 12

Current Evidence?]Based Treatments for PTSD 13

3 Mindfulness 22

Mindfulness Defined 22

Mechanisms of Action 34

How Mindfulness is Different 51

Treatments Utilizing Mindfulness 53

4 Overview of MBCT for PTSD 58

Outline of MBCT Sessions 59

Basic CBT Principles Used in MBCT 66

MBCT Mindfulness Exercises 75

Mindful Inquiry 92

5 Delivery of MBCT for PTSD 98

Which Delivery Format is Best to Use and When? 98

MBCT for PTSD Delivered in an Individual Format 99

MBCT for PTSD Delivered in a Group Format 124

Practicalities for Conducting MBCT Sessions for PTSD 131

Future Directions 135

6 Developing Personal and Professional Competence 140

The Importance of the Therapist's Own Practice 140

Mindfulness and Therapist Self?]Care 142

Developing Competence in MBCT for PTSD 143

Resources 148

References 156

Index 182

Textauszug

1
Introduction

Our world today is filled with violence. Even those who specialize in working with trauma victims can be stunned by the stories they hear of childhood abuse, family violence, sexual assaults, and the atrocities of war. Such events can leave lasting scars for those who experience them, whether or not the residual effects lead to full-blown clinical disorders like posttraumatic stress disorder (PTSD).

Inevitably, no matter what kind of clinical work one does, all therapists will encounter clients with some history of trauma. Therefore, we believe that all competent clinicians should have an understanding of PTSD, and at least some level of working knowledge of the principles involved in the treatment of individuals with trauma histories.

Clients are often reticent to seek out treatment, and even our best evidence-based practices for PTSD, such as Cognitive Processing Therapy (CPT; Chard, 2005; Resick et al., 2008) and Prolonged Exposure (PE; Foa et al., 1999), may not be effective at reducing symptoms to a sub-clinical level more than 70% of the time (Resick, Nishith, Weaver, Astin, & Feuer, 2002). Hence, tools to enhance current treatments, and to decrease residual symptoms, are continually being sought. This need resulted in the authors collaborating on a feasibility study to adapt mindfulness-based cognitive therapy (MBCT) for the treatment of individuals with PTSD.

MBCT is an eight-session program, meeting once per week with regular home practice assignments, which teaches the skills of mindful awareness and the principles of cognitive-behavioral therapy. It was first developed in the 1990s by Zindel Segal, Mark Williams, and John Teasdale (Segal, Williams, & Teasdale, 2013), adapted from mindfulness-based stress reduction (MBSR), developed in the 1970s by Jon Kabat-Zinn, Saki Santorelli, Elana Rosenbaum, and their colleagues (Kabat-Zinn, 2013).

MBCT was originally designed to help individuals with a history of major depressive disorder prevent future recurrences. The more episodes a person experiences, the higher the risk for depression coming back again. After two major depressive episodes, the chance of having yet another recurrence rises to 70–80% (Keller, Lavori, Lewis, & Klerman, 1983; Kupfer, 1991).

A major focus of MBCT is teaching mindfulness skills, which fosters our capacity to pay attention to present moment experiences. Becoming aware of automatic reaction patterns opens up the possibility of making more adaptive choices. By noticing, rather than avoiding, unpleasant thoughts, emotions, and body sensations, clients can learn to relate to them differently. One of the techniques clients practice is known as “decentering” (Piaget, 1950; Piaget & Morf, 1958; Segal, Williams, & Teasdale, 2013), which involves recognizing thoughts as mental events, rather than getting overly caught up in them as if they were always perfect representations of reality. Learning to stay present with strong emotions and body sensations counteracts maladaptive avoidance patterns. By noticing the warning signals of rising levels of stress, depression, anxiety, or pain, clients can be proactive to take care of themselves, instead of ignoring those signals until they become overwhelming and more difficult to handle.

The evidence base for MBCT is strong, demonstrating significant reductions in depressive relapse rates, especially for those who have suffered three or more previous episodes (Chiesa & Serretti, 2011; Hofmann, Sawyer, Witt, & Oh, 2010; Kuyken, Crane, & Dalgleish, 2012; Ma & Teasdale, 2004; Piet & Hougaard, 2011; Segal, Teasdale, & Williams, 2004; Teasdale, Segal, & Williams, 1995; Teasdale, Segal, Williams, Ridgeway, Soulsby, & Lau, 2000; Williams & Kuyken, 2012). MBCT has also been shown to be as effective as maintenance antidepressant pharmacotherapy in preventing depression from returning (Kuyken, Byford, Byng, Dalgleish, Lewis, et al., 2010; Segal, Bieling, Young, McQueen, Cooke, et al., 2010).

Inspired by its success in preventing depressive relapse, clinicians and researchers have continued to study and adapt MBCT for a variety of populations and presenting issues, such as addictions (Bowen, Chalwa, & Marlatt, 2010), bipolar disorder (Deckersbach, Hölzel, Eisner, Lazar, & Nierenberg, 2014), cancer (Bartley, 2011), children and adolescents (Semple & Lee, 2011), eating disorders (Kristeller & Wolever, 2011), generalized anxiety disorder (Evans, Ferrando, Findler, Stowell, Smart, & Haglin, 2008; Roemer & Orsillo, 2002; Roemer, Orsillo, & Salters-Pedneault, 2008), health anxiety (Surawy, McManus, Muse, & Williams, 2014; Williams, McManus, Muse, & Williams, 2011), stress (Rimes & Wingrove, 2011; Sears, 2015), and tinnitus (Sadlier, Stephens, & Kennedy, 2008).

Given the frequent comorbidity of depression and PTSD, the usefulness of decentering from intense thoughts and emotions, and the importance of working with avoidance, investigating the potential benefits of using MBCT for PTSD holds much promise. Later in this book, we will discuss the preliminary results of studies like those done by the authors at the Cincinnati VA PTSD clinic, by Anthony King and colleagues at the Ann Arbor VA (King, Erickson, Giardino, Favorite, Rauch, Robinson, Kulkarni, & Liberzon, 2013), and Louanne Davis and Brandi Luedtke at the Indianapolis VA (Davis & Luedtke, 2013). We will also share clinical experiences from work we have done in private practice, medical agencies, and other settings.

Interest in mindfulness among clinicians has quickly grown in popularity in the last decade, inspired by the personal benefits, the brain imaging studies, and the explosion of clinical research. However, as is all too common in clinical work, sometimes enthusiasm for an intervention precedes the evidence for how best to use it. A recent meta-analysis reviewed 18,753 mindfulness research citations, and found only 47 studies (with 3,515 subjects) that were randomized, clinical trials with active controls for placebo effects (Goyal, Singh, Sibinga, Gould, Rowland-Seymour, Sharma, Berger, et al., 2014).

The best empirical evidence to date comes from well-trained clinicians who utilize carefully developed interventions, such as MBSR, MBCT, dialectical behavior therapy (DBT; Linehan, 1993, 2014), and acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 2012).

Sometimes individuals with their own personal meditation backgrounds make assumptions about how mindfulness can be used clinically. While a personal practice provides an important foundation, mindfulness is simply a tool, and as such, must be used wisely, with an understanding of the populations and the presenting issues for which it is being used. Mindfulness should be used to enhance, and never to replace, good clinical training and competence.

By definition, people with PTSD have experienced something so terrible they do not want to continually remember it (APA, 2012). Yet, a part of their brain does not want them to forget, perhaps because it may be crucial to future survival. Much of the distress they experience comes from an ongoing battle with their own intrusive memories, thoughts, feelings, and body sensations. Hence, asking them to pay more attention to thoughts, emotions, and sensations will be uncomfortable at best, and if not done carefully, could even exacerbate their symptoms.

Our purpose is not to take away what we know works well for PTSD. It is important to be trained in best practices for the treatment of trauma. Rather, our purpose is to provide more tools and perspectives. After all, mindfulness is simply awareness. Given how complicated posttraumatic stress can be, paying more attention to the dynamics of what is going on is very important for both clients and clinicians.

Sometimes knowing what not to do is as important as knowing what to do, as lack of awareness can actually harm clients, despite the therapist’s best intentions. At one extreme, we as clinicians may be so uncomfortable or fearful of upsetting clients that we become shaped by them to avoid processing anything related to the trauma. A participant in an MBCT workshop at a national convention once asked, “Did you say you were doing research on mindfulness for PTSD? Wouldn’t paying more attention make clients with PTSD feel worse?”

“It certainly can, so it must be done very carefully,” I replied.

“Well, I have a client with PTSD,” he informed me. “And whenever anything comes up that reminds her of the trauma, she starts to get upset, so we talk about something else.” Not surprisingly, he went on to say that they had not made any progress in their work together.

At the other extreme, we can cause harm if we attempt to treat individuals with trauma histories without proper training. A Vietnam veteran once reported that he had been asked to participate in a psychodrama in which everyone acted out an experience from his tour in Vietnam. The veteran flashed back, reliving his Vietnam experience as if he were there again, and ended up attacking and choking the perhaps well-meaning but ill-equipped therapist.

Segal, Williams, and Teasdale (2013) were depression researchers looking for ways to prevent relapse, which led to the development of MBCT. They did not begin with an agenda for how they could promote mindfulness. Once developed, they were concerned about finding clinicians to support its implementation, since it requires both solid CBT clinical skills and experience, as well...

Produkt-Details

• Erscheint lt. Verlag: 2.3.2016
• Vorwort: Zindel V. Segal
• Sprache: englisch
• Themenwelt: Geisteswissenschaften ► Psychologie ► Klinische Psychologie
• Themenwelt: Medizin / Pharmazie ► Gesundheitsfachberufe
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Psychiatrie / Psychotherapie
• Schlagworte: attentional control • biological factors of PTSD • Clinical psychology • Cognitive behavioral therapy (CBT) • Cognitive Behavioural Therapy • cognitive diffusion • compassion based exercises • cortical thickening • CPT • depressive relapse • DSM-IV • DSM-V • emotional memory processing • emotional schemas • Emotion Regulation • family environment • Genetics • hypnosis • ICD-10 • insula • Klinische Psychologie • Kognitive Verhaltenstherapie • MBCT • Meditation • Metacognition • Mindfulness • Mindfulness based Cognitive Therapy • mindfulness-based interventions • mindfulness-based treatment • Psychologie • Psychology • Psychopharmacology • psychotherapy • psychotherapy: EMDR • PTSD • relaxation techniques • self control • social support • systematic insight training • Trauma • traumatic event • veterans • vicarious trauma • visualization exercises • Willingness
• ISBN-13: 9781118691434 / 9781118691434