Dr. Wil Horton's


(6 DVDs)

As some of you know, in the past I was the clinical director for an inpatient psychiatric unit at a state facility and in that capacity I have taken the Veterans Administration PTSD protocol training. You may also know veterans issues is close to my heart, so the training was great. I would like to share a little with you.

What is PTSD? When we hear the word we rapidly access our thoughts of combat personnel and their issues of coming home from wars. This is but one type of PTSD.

We are seeing a great flood of traumatic experiences in the form of natural disasters that people have to address and deal with. Tornadoes, fires, floods, just to name a few, have brought wide spread destruction to thousands of people. Then there are the "not so natural disasters"...the horrific man-made ones such as hit Boston this year.

Then add to this the economic problems of unemployment, or under employment bringing great pain to many, that is lingering and growing for parts of our population, and the "never-ending" loss of homes to mega-monster banks. Now we see cities and government brought to the brink of default...

All can cause PTSD.


Here is an overview of PTSD (from the VA Manual):

Post-Traumatic Stress:
Post-traumatic stress consists of a spectrum of traumatic stress disorders—hence, this Clinical Practice Guideline for the Management of Post-Traumatic Stress. These disorders can be arranged along a temporal axis, from Acute Stress Reaction, to Acute Stress Disorder, Acute PTSD, and Chronic PTSD. Each of these may be associated with serious mental and physical co-morbidities. Some survivors will experience only a part of this spectrum, while others will progress through the entire range.

Acute Stress Reaction (ASR) is not a DSM IV diagnosis and is used in this guideline to refer to a range of transient conditions that develop in response to a traumatic event. Onset of a least some signs and symptoms may be simultaneous with the trauma itself or within minutes of the traumatic event and may follow the trauma after an interval of hours or days. In most cases symptoms will disappear within days (even hours).

Acute Stress Disorder (ASD), a diagnosis defined by DSM IV, occurs when the individual has experienced trauma(s) as described above, has symptoms lasting more than two days, but less than one month after exposure to the trauma (may progress to PTSD if symptoms last >one month), and exhibits re-experiencing, avoidance, increased arousal, and at least three out of five dissociative symptoms.

Post-Traumatic Stress Disorder (PTSD) is a clinically significant condition with symptoms continuing more than 1 month after exposure to a trauma that has caused significant distress or impairment in social, occupational, or other important areas of functioning. Patients with PTSD may exhibit persistent re-experiencing of the traumatic event(s), persistent avoidance of stimuli associated with the trauma, numbing of general responsiveness (not present before the trauma), and persistent symptoms of increased arousal (not present before the trauma). PTSD can also have a delayed onset, which is described as a clinically significant presentation of symptoms (causing significant distress or impairment in social, occupational, or other important areas of functioning) at least 6 months after exposure to trauma.

PTSD is further sub-divided into Acute PTSD (symptoms lasting more than one month, but less than three months after exposure to trauma) and Chronic PTSD (symptoms lasting more than three months after exposure to trauma). PTSD can appear alone (presenting with common symptoms of PTSD) or more commonly with other co-occurring conditions (persistent difficulties in interpersonal relations, mood, chronic pain, sleep disturbances, somatization, and profound identity problems) or psychiatric disorders (meeting DSM criteria for another disorder, such as substance abuse, depression, and anxiety disorder).

The VA uses a special treatment model called Cognitive Processing Therapy.

Trauma often causes people to struggle with their memories and thoughts about the event. You may have a hard time making sense of what happened. You may find yourself getting "stuck" in your thoughts about the trauma and how it affects your life. This feeling of being unable to make sense of the trauma can make you want to avoid thinking about or dealing with your memories.

Cognitive Processing Therapy (CPT) helps you by giving you a new way to handle these distressing thoughts and to gain an understanding of these events. By using the skills learned in this therapy, you can learn why recovery from traumatic events has been hard for you. CPT helps you learn how going through a trauma changed the way you look at the world, yourself, and others. The way we think and look at things directly affects how we feel and act.

CPT has four main parts:

  1. Learning about your PTSD symptoms. CPT begins with education about your specific PTSD symptoms and how the treatment can help. The therapy plan will be reviewed and the reasons for each part of the therapy will be explained. You will be able to ask questions and to know exactly what you are going to be doing in this therapy. You will also learn why these skills may help.

  2. Becoming aware of thoughts and feelings. Next, CPT focuses on helping you become more aware of your thoughts and feelings. When bad things happen, we want to make sense of why they happened. An example would be a Veteran who thinks to himself or herself, "I should have known that this would happen." Sometimes we get stuck on these thoughts. In CPT you will learn how to pay attention to your thoughts about the trauma and how they make you feel. You'll then be asked to step back and think about how your trauma is affecting you now. This will help you think about your trauma in a different way than you did before. It can be done either by writing or by talking to your therapist about it.

  3. Learning skills. After you become more aware of your thoughts and feelings, you will learn skills to help you question or challenge your thoughts. You will do this with the help of worksheets. You will be able to use these skills to decide the way YOU want to think and feel about your trauma. These skills can also help you deal with other problems in your day-to-day life.

  4. Understanding changes in beliefs. Finally, you will learn about the common changes in beliefs that occur after going through trauma. Many people have problems understanding how to live in the world after trauma. Your beliefs about safety, trust, control, self-esteem, other people, and relationships can change after trauma. In CPT you will get to talk about your beliefs in these different areas. You will learn to find a better balance between the beliefs you had before and after your trauma.

Let's use what has been proven to work! All these victims of PTSD are out there and we can help them, so lets do it!



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